Modulating craniofacial growth: The role of maxillary expansion appliances

• Author Details:   
• Raj Bhagwatkar ^*
• Harsha Kaurani
• Naina R Jambure
• Amruta N Mantri
• Priyanka Singh

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Background: Modulating craniofacial growth is fundamental in orthodontics, especially during childhood and adolescence, where skeletal structures remain adaptable. Transverse maxillary discrepancies, such as maxillary constriction, are common and can lead to functional and aesthetic complications if untreated.
Objectives: To review biomechanical principles, clinical indications, biological responses, and efficacy of various maxillary expansion techniques including rapid maxillary expansion (RME), slow maxillary expansion (SME), functional appliances, Quad Helix, NiTi expanders, and the Alt-RAMEC protocol.
Materials and Methods: This review followed key elements of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework to ensure transparency and rigor. A comprehensive literature review was conducted focusing on the clinical application and outcomes of different maxillary expansion modalities.
Results: RME effectively produces rapid skeletal expansion in growing patients, improving arch width and nasal airway dimensions. SME offers controlled expansion with reduced side effects, suitable for mild cases and compromised periodontal support. Functional appliances like the Frankel Functional Regulator facilitate transverse growth by modulating soft tissue forces. The Quad Helix appliance allows multidirectional force application and versatility. NiTi expanders utilize shape memory alloys to deliver light continuous forces ideal for non-compliant patients. The Alt-RAMEC protocol enhances circummaxillary suture disarticulation, improving maxillary protraction outcomes in Class III and cleft cases.
Conclusion: Maxillary expansion appliances are integral to orthodontic growth modulation. Treatment success depends on timely intervention, appliance selection, and patient compliance. Emerging technologies promise to refine these techniques further.