Application options and resultsSubmucosal application

Epimucosal application

Results

Incision and osteotomy of the hard palate parallel to the suture Submucosal application of the distractor

Distraction procedure started, palatal mucosa is closed Retention period after distraction

Epimucosal application of the distractor Epimucosally placed device after distraction(3 weeks post-op) and start of the orthodontic treatment

Orthodontic treatment during retention period (3,5 months post-op)

Final view after distractor removal (4,5 months post-op)

Gebrüder Martin GmbH & Co. KG Ludwigstaler Straße 132 . D-78532 Tuttlingen Postfach 60 . D-78501 Tuttlingen . Germany Telefon +49 (0) 74 61 706-0Telefax +49 (0) 74 61 706-193info@martin-med.comwww.martin-med.com

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Ordering DetailsThe Magdeburg Palatal Distractor

51-545-10 Palatal Distractor, 10 mm51-545-15 Palatal Distractor, 15 mm

Recommended Instruments50-900-00 Right angled screwdriver ASD, complete50-911-22 Angled screwdriver bit Centre-Drive® 2.0 mm50-924-16 Twist Drill for ASD 2.0 mm screws

25-486-13 Modelling pliers (two recommended)

51-512-90 Patient screwdriver, straight

51-517-90 Patient screwdriver,combination straight + angled

48-350-24 Palatal fin-edge osteotome

Recommended Screws25-662-05 Centre-Drive® Titanium Mini Screws 2.0 x 5 mm (5 each)25-662-07 Centre-Drive® Titanium Mini Screws 2.0 x 7 mm (5 each)25-662-09 Centre-Drive® Titanium Mini Screws 2.0 x 9 mm (5 each)25-663-47 Centre-Drive® Titanium Mini Emergency Screws 2.3 x 7 mm (5 each)

25-672-05 Cross-Drive Titanium Mini Screws 2.0 x 5 mm (5 each)25-672-07 Cross-Drive Titanium Mini Screws 2.0 x 7 mm (5 each)25-672-09 Cross-Drive Titanium Mini Screws 2.0 x 9 mm (5 each)25-673-47 Cross-Drive Titanium Mini Emergency Screws 2.3 x 7 mm (5 each)

alternative:

25-669-05 Centre-Drive® Titanium Mini Drill Free Screws 2.0 x 5 mm (5 each)25-669-07 Centre-Drive® Titanium Mini Drill Free Screws 2.0 x 7 mm (5 each)

25-679-05 Cross-Drive Titanium Mini Drill Free Screws 2.0 x 5 mm (5 each)25-679-07 Cross-Drive Titanium Mini Drill Free Screws 2.0 x 7 mm (5 each)

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Osteogenesis

Distraction

The Magdeburg Palatal Distractor

for surgically assisted rapid maxillary expansion

www.martin-med.com

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51-545-10 Palatal Distractor, 10 mm51-545-15 Palatal Distractor, 15 mm

The Magdeburg Palatal DistractorIntroductionIn surgically assisted rapid palatal expansion, the trans-versal widening is achieved by using various expansiondevices fixated on the lateral teeth following bilateral osteotomy of the lateral maxilla and, if needed, the medianpalatine suture. Possible complications include tilting orextrusion of supporting teeth, gingiva recession and alveo-lar process fenestration. Such unwelcome side effects arenot to be expected if a bone-supported palatal distractor isused, due to the physical widening of the maxillary halves.

Design of the distractorThe functional component of this bidirectional enoraldistractor (ref. no. 51-545-10/-15) consists of a cylind-rical body with two longitudinal slide bearings.The cylinder incorporates an angular drive with a central spindle featuring two counteracting threads (a right-handed and a left-handed one).At the beginning of each thread, an offset bar with aninternal thread is located. Each of these bars connects to a 4-hole miniplate located at a right angle to the cylinder body.

The distractor is activated transorally, using a special distraction screwdriver (ref. no. 51-512-90 resp. 51-517-90).

One full turn is equivalent to a distraction length of 0.2 mm. A daily distraction distance of 0.4 mm is recommended.

Developed in cooperation withProf. Dr. Dr. K.-L. Gerlach, Dr. Chr. ZahlDept. of Oral & Maxillofacial SurgeryO-v-G-University Magdeburg, Germany

Benefits• Safe and symmetrical physical movement of the

two maxillary halves

• High retention stability, no relapses

• Since the distractor is directly fixed to the palatal bones, root resorption, buccal fenestration and tooth tilting is prevented. Missing lateral teeth are no contraindication.

• Allows simultaneous orthodontic multi-band treatment to form the dental arches; this means a significant further reduction of overall treatment times.

• Easy handling by the patient and great comfort in wearing the device

• High degree of patient safety thanks to non-dividible device design (no loose components)

Indications• Narrow maxilla (severe cases)

• Disproportion between tooth size and size of maxilla

• Angle class II and III patients

• Cleft patients

• Stenosis of the nasal meati

Contra-indications• Insufficient bone volume or quality so that a secure

planning of the distraction is not possible.

• A general contraindication is a bad health condition:immune deficiency – irradiated patients.

Surgical approach• Bilateral vestibular mucosal incision

• Exposure of the facial maxillary sinus walls

• Osteotomy from the priform aperture to the maxillary tuber

• Weakening the connection between the tuber and the pterygoid process is recommended

• Bilateral osteotomy parallel to the palatal suture(alternatively after elevating the nasal floor mucosa using the fin-edge osteotome ref. no.48-350-24)

• Either from a nasal approach beyond the piriform aperture or transorally by a direct palatal approach

• Distractor is adapted to the anatomical conditions of the palate.

• Transmucosal fixation of the 2.0 mm titanium screws, either self-cutting with pre-drilling (ref. no. 25-662-05) or self-drilling without pre-drilling (ref. no. 25-669-05)

• Alternatively epimucosal application with 2.0 x 7 or 9 mm titanium screws is possible (ref. nos. 25-662-07/-09 or 25-669-07).

• Following fixation, functional test by activating 2 mm and reset to starting position

Distraction protocol• Latency period: 6 days

• Distraction of 0.4 mm per day with patient screwdriver (ref. no. 51-520-90), two full 360° turns per day

• Retention period after distraction: 3 months

• Orthodontic multi-band treatment can already be started or continued during retention period.

NOTE: In clinical use, no mucousal pressure necroses have been observed below the base of the plate in any of the cases where the distractor was applied epimucosally.

Application optionsThis distractor offers three different application options, to be used according to the indication (age of patient, maxillary anomaly, operatingspace).

1. Submucosal application after stripping the palatine mucousa

2. Epimucosal application

3. Transmucosal application following a short sagittal incision of the palatine mucosal just below the supporting miniplates.

Procedures for children and adolescentsBasically, the distractor can also be used for accelerated palatine suture expansion in children.In this case, however, it is usually preferable toemploy the smaller device, which must be appliedtransmucosally.

The surgically supported widening of the maxilla as described above is a procedure that should onlybe used after the transitional dentition phase hasbeen completed, as otherwise tooth buds might be damaged. Osteotomies of the pterygomaxillarysutures are usually unnecessary. If palatine sutureosteotomy is required, it can always be performedin these cases starting from the nasal aperture after elevating the nasal floor mucosa.

Bending procedureTo avoid distractor plate damage during the bending procedure, please use always two bending pliers ref. no. 25-486-13.

7. Langford SR, Sims MR:Root surface resorption, repair, and periodontal attachment following rapid maxillary expansion in man.Am J Orthod 1982; 81: 108-115

8. Lehman JA, Haas AJ:Surgical-orthodontic correction of transverse maxillary deficiency.Dental Clin North Am 1990; 2: 385-395

9. Mommaerts MY:Transpalatal distraction as a method of maxillary expansion.Br J Oral Maxillofac Surg 1999; 37: 268-272

10. Moss JP:Rapid expansion of the maxillary arch.I:.J Pract Orthod 1968; 2: 165-165

11. Moss JP:Rapid expansion of the maxillary arch. II: Indications for rapid expansions.J Pract Orthod 1968; 2: 215-223

12. Neubert J, Somsiri S, Howaldt H-P, Bitter K:Die operative Gaumennahterweiterung durch eine modifizierte Le-Fort-I-Osteotomie.Dtsch Z Mund Kiefer GesichtsChir 1989; 13: 57-64

13. Neyt NMF, Mommaerts MY, Abeloos JVS,De Clercq CAS, Neyt LF:Problems, obstacles and complications with transpalatal distraction in non-congenital deformities.J Cranio Maxillofac Surg 2002; 30: 139-143

14. Pinto PX, Mommaerts MY, Wreakes G, Jacobs W:Immediate postexpansion changes following the use of the transplatal distractor.J Oral Maxillofac Surg 2001; 59: 994-1000

15. Strömberg C, Holm J:Surgically assisted, rapid maxillary expansion in adults.A retrospective long-term follow-up study.J Cranio Maxillofac Surg 1995; 23: 222-227

16. Timms DJ, Moss JP:An histological investigation into the effects of rapid maxillaryexpansion on the teeth and their supporting tissues.Trans Eur Orthod Soc 1971: 263-271

17. Timms DJ:The relationship of rapid maxillary expansion to surgery,with special reference to midpalatal synostosis.Br J Oral Surg 1981; 19: 180-196

18. Treutlein C, Swennen G, Berten JL, Schwestka-Polly R:Transpalatinale Distraktion - eine alternative Methode der transversalen Expansion des Oberkiefers.Dtsch Zahnärztl Z 2002; 57S: 19

19. Zahl Chr, Gerlach KL:Der Palatinaldistraktor - ein innovativer Ansatz für dieGaumennahterweiterung.Mund Kiefer GesichtsChir 2002; 6: 446-449

Bibliography

1. Bays RA, Greco JM:Surgically assisted rapid palatal expansion:An outpatient technique with long-term stability.J Oral Maxillofac Surg 1992; 50: 110-113

2. Bell WH, Epker BN:Surgical-orthodontic expansion of the maxilla.Am J Orthod 1976; 50: 517-528

3. Derichsweiler H.:Die Gaumennahterweiterung. Methode, Indikation und klinische Bedeutung.München, Carl Hanser, 1956

4. Feller K-U, Herzmann K, Schimming R, Eckelt U:Gaumennahtsprengung nach Glassman. Erfahrungen bei mono- und bimaxillaren Dysgnathieoperationen.Mund Kiefer GesichtsChir 1998; 2: 26-29

5. Glassman AS, Nahigian SJ, Medway JM, Aronowitz HI:Conservative surgical orthodontic adult rapid palatal expansion: Sixteen cases.Am J Orthod Dentofacial Orthop 1984; 86: 207-213

6. Kraut RA:Surgically assisted rapid maxillary expansion by opening the midpalatal suture.J Oral Maxillofac Surg 1984; 42: 651-655