[The use of bone distraction in the treatment of the transverse direction in adults]

Crowding and mal-positioning of teeth in the dental arch are problems frequently encountered with adult patients. These discrepancies are associated with a lack of development of basal bone, a shortcoming whose etiology is difficult to discern. Treating these problems with expansion assisted by surgery depends on osseous distraction, the separating of segments of bone to create new bone and the movement of whole groups of teeth and their periodontium, a technique that assures excellent stability. It is important to define precisely the indications for this technique as well as our therapeutic protocols, both in the maxilla and in the mandible. For an expander we use a single thread expansion screw welded to two molar bands. To be sure it works effectively; the surgeon first opens the maxillary suture to liberate the two portions of the maxilla. After a ten day wait, the expansion screw is opened daily for up to two weeks depending on how much expansion is required. When the desired point is attained, the expansion device is locked, and the patient returns for check-up visits every ten days. During this period the patient is outfitted with a false tooth to mask the large and unsightly diastema that has appeared between the central incisors. Three months after the original intervention the patient receives a full-banded strap-up. The orthodontist usually employs centripetal forces to level the teeth and to correct rotations in an effort to minimize the risk of periodontal complications. The results that we have obtained with this treatment have fulfilled our expectations with significant improvement in arch form, full respect for the periodontium, an improvement in facial balance, and the appearance of a generous and pleasing smile.