ORIGINAL ARTICLE

The biomechanics of rapid maxillary sutural expansion

Stanley Braun, DDS, MME,a J. Alexandre Bottrel, DDS,b Kong-Geun Lee, DDS, MSD, PhD,c José J. Lunazzi,
PhD,d and Harry L. Legan, DDSe
Indianapolis, Ind, Rio de Janeiro and Campinas, Brazil, and Kwangju, South Korea

Micro-displacements (fringe patterns) in the bones of the craniofacial complex as seen through laser holography
during midpalatal sutural expansion with the Hyrax appliance are used to define the centers of rotation of the
maxillary halves in both the frontal and occlusal views. Biomechanical analyses of the maxillary expansion force
system are concomitant with the holographic findings and strongly suggest that the stainless steel wires joining
the teeth to any expansion device be of the largest diameter possible. In addition, in the case of the Hyrax
expansion device, it is recommended that the manufacturer increase the diameter of the activating screw as well
as those of the 2 adjacent wire guides. And, importantly, the use of acrylic as a structural member to join the
teeth to a sutural expansion device should be avoided if tipping of the maxillary halves is to be minimized, as
the acrylic lacks sufficient rigidity. (Am J Orthod Dentofacial Orthop 2000;118:257-61)

apid expansion of the midpalatal suture is an
R important part of the clinician’s armamentarium in
the correction of malocclusions.1-15 In this process,
investigators have reported a small degree of dental tip-
ping attributable to the initial mechanical response of
the periodontal tissues.16-21 And as Bell22 has reported,
“If the applied transverse forces are of sufficient magni-
tude to overcome the bioelastic strength of the sutural
elements, orthopedic separation of the maxillary seg-
ments can occur.” Earlier investigators have described a
lateral rotation or tipping of the palatal halves22-27 in the
frontal view, while in the occlusal view greater separa-
tion of the midpalatal suture is seen anteriorly with pro-
portionally less separation posteriorly.4,5,11,28-31
It is the purpose of this investigation to examine the
biomechanics involved in the motion of the palatal
halves, and to suggest improvements in the design of
the appliances commonly used in rapid maxillary
sutural expansion.
MATERIAL AND METHODS
Laser holography has been shown to be a valuable
method in which the initial micro-stresses or fringe pat-
terns resulting from various applied forces to the
human skull can be seen and recorded.32-36 The pat-
aClinical
Professor of Orthodontics, Vanderbilt University Medical Center.
bIn Private Practice, Rio de Janeiro, Brazil.
cAssistant Professor of Orthodontics, Chosun University, Kwangju, South
Korea.
dLaboratório de Óptica, UNICAMP – Inst. De Fisica, Campinas, Brazil.
eProfessor and Chairman, Orthodontics, Vanderbilt University Medical Center.
Reprint requests to: Stanley Braun, DDS, MME, 7940 Dean Road, Indianapo-
lis, IN 46240; e-mail, ortho.braun@juno.com.
Submitted October 1999; Revised and accepted January 2000.
Copyright © 2000 by the American Association of Orthodontists.
0889-5406/2000/$12.00 + 0 8/1/108254
terns provide a 3-dimensional view of skeletal and den-
tal micro-movements (micro-movement varies directly
with micro-stress). Micro-stresses result from the
application of force systems emanating from activation
of orthodontic appliances. Accordingly, a fresh, macer-
ated human skull was fixed in a supporting apparatus
similar to that used by Lee et al32 in a recent study (Fig
1). A schematic of the experimental holographic appa-
ratus in relation to the skull is shown in Fig 2. A highly
coherent monochromatic laser light was divided into 2
beams with a beam splitter. One of the beams was
directed via mirrors, expanded with a spatial filter, and
subsequently used to illuminate the skull. This beam,
the object beam, impinges on the holographic plate and
provides information about the instantaneous condition
of the skull surface being viewed. The second beam,
referred to as the reference beam, was not modulated
by any intervening object. When both of these beams
impinge on the plate, a hologram is registered. When
the hologram is made in a double exposure of a
mechanically stressed surface, a fringe pattern is pro-
duced, resulting from mechanical interference of each
registered wave. The fringe pattern yields information
concerning bone deformation. In this study, initial bone
micro-deformations or displacements were studied.
A 20 mW, helium-neon laser was used. The relative
magnification intensity of the reference and object
beams was 4:1. The helium-neon laser was directed
onto a holographic plate or film (Agfa Geraert, 8E75,
Ridgefield Park, NJ). A direct exposure technique was
used. First, the laser was exposed on the skull surface
being examined for 25 seconds. Then a midpalatal
suture expansion force was applied by activating the
Hyrax expander, and after 5 minutes, the laser was
257
258 Braun et al
Fig 1. Skull in supporting apparatus.
Fig 2. Schematic of holographic arrangement: a, laser source;
b, beam splitter; c, beam expander; d, holographic plate, e,
spatial filter; ob, object beam; rb, reference beam.
exposed on a second holographic plate or film for 25
seconds. Frontal and occlusal exposures were made in
this fashion. The skull was allowed to come to a state of
equilibrium before any expansion forces were applied
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
Fig 3. Occlusal view of the Hyrax expansion appliance.
for each exposure. After development and fixation, the
plates were dried. The fringes present on the plates by
the double exposure holographic technique were subse-
quently reconstructed with the reference beam, and pho-
tographs were taken with a 35-mm auto-exposure cam-
era, using Kodak Technical Pan film (Rochester, NY).
The Hyrax appliance, seen in Fig 3, was attached by
soldered wires to the first premolar and first molar
bands. The cross-palatal wire, an integral part of the
appliance, was fabricated of 0.055-inch diameter stain-
less steel. The same diameter stainless steel wire seg-
ments were soldered horizontally, joining the first pre-
molar and first molar bands. In addition, the buccal
surfaces of all of the teeth, with the exception of the
second and third molars, were fitted with .022 edgewise
brackets. The assembly was then cemented into place,
using Ultra Band-Lok (Reliance Orthodontic Products,
Itasca, Ill). Then 0.017 × 0.025 stainless steel segments
were contoured to passively engage the brackets and
were subsequently tied in place with steel ligature wire.
RESULTS
In the frontal view, complex fringe patterns were
seen throughout the dentomaxillary complex, including
all of the adjoining osseous structures and sutures. The
teeth also exhibited some fringe patterns. The general-
ized fringe pattern converged at a discreet area approx-
imating the frontonasal suture (Fig 4, note arrow). This
is the locus of the center of rotation during the initial
displacement of the dentomaxillary complex.
In the occlusal view, a complex fringe pattern was
also noted, with convergence toward the posterior por-
tion of the midpalatal suture, approximating the posi-
tion of the third molars (Fig 5, note arrow). This is the
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 118, Number 3
Fig 4. Frontal view of micro-displacements (fringe pat-
terns) associated with midpalatal sutural appliance acti-
vation. The arrow indicates the center of rotation of
each maxillary half.
Fig 5. Occlusal view of micro-displacements (fringe pat-
terns) associated with midpalatal sutural appliance acti-
vation. The arrow indicates the center of rotation of each
maxillary half.
locus of the center of rotation of the dentomaxillary
complex in the occlusal view.
DISCUSSION AND CONCLUSION
Nanda37 has shown that facial sutures and peri-
odontal tissues behave in a similar manner in response
to applied force systems. The teeth and craniofacial
bones are essentially constrained bodies; one by the
periodontium, and the other by sutures. Consequently,
the biomechanical principles involved in tooth move-
ment may be applied to craniofacial bones. In addition,
Christiansen and Burstone38 and others39-41 have
repeatedly shown that in order to forecast the move-
Braun et al 259
B
Fig 6. A, Location of the center of resistance of the
dentomaxillary complex in the sagittal view. B, Loca-
tion of the center of resistance of the dentomaxillary
complex in the frontal view.
ment of a constrained body (describing its center of
rotation), the equivalent force system at its center of
resistance must be known.
Because Lee et al32 have identified the locations of
the centers of resistance of the dentomaxillary complex
in the sagittal and frontal views (Fig 6), one can relate
the force systems of midpalatal sutural expansion to
the centers of resistance of the attendant osseous struc-
tures. When an expansion force F is applied, as seen in
the frontal view (Fig 7) through activation of the Hyrax
appliance, an equivalent moment and force result at the
centers of resistance of each maxillary half. The mag-
nitude of the moment is equal to the perpendicular dis-
260 Braun et al
Fig 7. Force systems related to midpalatal sutural
expansion in the frontal view.
Fig 8. Force systems related to midpalatal sutural
expansion in the occlusal view.
tance Y from each respective center of resistance to the
line of action of the expansion force, multiplied by the
expansion force F. The moment equivalent (FY) tends
to cause the maxillary halves to rotate about their
respective centers of resistance, while the expansion
force F equivalent at the center of resistance tends to
translate the maxillary halves. The net result is to pro-
vide centers of rotation in line with and superior to
each center of resistance. However, each maxillary half
is constrained to rotate about the point shown in Fig 4,
because the osseous structures at the frontonasal suture
would have to rapidly resorb to permit rotation of the
maxillary halves about a point superior to the center of
resistance other than at the frontonasal suture. The cen-
ter of rotation is thus constrained to be at the fron-
American Journal of Orthodontics and Dentofacial Orthopedics
September 2000
tonasal suture since the resorption and reorganization
at this suture would be a relatively lengthy process ver-
sus expansion at the midpalatal suture. The fringe
(micro-stress) patterns on the zygoma are fundamen-
tally translatory, implying a primary shearing stress in
the zygomaticotemporal sutures, and primary compres-
sion and shearing stresses in the zygomaticomaxillary
and zygomaticofrontal sutures.
In the occlusal view, the fringe patterns point to a
center of rotation at the distal aspect of the maxillary
midpalatal suture approximating the distal one third of
the third molars. This is concomitant with a moment-
to-force ratio equal to FZ/F = Z, which tends to posi-
tion the center of rotation in this view distal to the cen-
ters of resistance of the maxillary halves (Fig 8).
If less tipping were desired (in the frontal view)
and a more linear opening of the maxillary suture
anteroposteriorly (in the occlusal view), the fabricated
structure joining the sutural opening mechanism to the
teeth would have to be more rigid, as would the guides
and activating screw of the Hyrax appliance itself.
Lack of sufficient rigidity of the totality of the sutural
expansion appliance permits the observed centers of
rotation. By increasing the rigidity of both the sutural
expansion device and the wires joining it to the teeth,
the moment induced by the necessary offsets from the
dentomaxillary centers of resistance are reduced
or countervailed, resulting in reduced equivalent
moment-to-force ratios at the centers of resistance.
This causes the center of rotation to migrate superiorly
in the frontal view, reducing the degree of tipping, and
in the occlusal view, the center of rotation would
migrate further posteriorly, resulting in a more linear
separation of the midpalatal suture.
Increased rigidity can be obtained by using the
largest possible diameter stainless steel wires and a
larger diameter activating screw. (Appliance manufac-
turer, take note!) The stiffness of a wire varies directly
as the fourth power of its diameter. For example, if the
palatal wire diameters were increased from 0.055 to
0.070 inch, their stiffness would increase 262% (R2/R1
= [d2/d1]4 = [.070/.055]4 = 2.62).
In the occlusal view, a more linear opening may also
be achieved by locating the sutural opening mechanism
more posteriorly. This would reduce the offset Z (Fig 8)
and thus the moment-to-force ratio would be reduced,
driving the center of rotation further posteriorly. How-
ever, this may not be as practical as increasing the appli-
ance rigidity, since patient access for repeated activa-
tions of the appliance would be more difficult.
The sutural expansion designs that use an acrylic
interface with the teeth are far less stiff than those con-
structed solely of soldered stainless steel wire. These
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 118, Number 3
type expansion devices allow for a greater degree of
undesirable maxillary half tipping in the frontal and
occlusal planes during midpalatal sutural expansion.
We wish to express our gratitude to David L. F. da
Silva, who assisted in making the holograms.
REFERENCES
1. Barnes RE. The early expansion of deciduous arches and its
effect on the developing permanent dentition. Am J Orthod
1956;42:83-97.
2. Cheney EA. Indications and methods for the interception of
functional crossbites and interlockings. Dent Clin N Am 1959;
July:385-92.
3. Clifford FO. Crossbite correction in the deciduous dentition:
principles and procedures. Am J Orthod 1971;59:343-9.
4. Davis JM. Why early treatment of crossbites? Dent Digest
1969;75:449-52.
5. Harvold E. Some biological aspects of orthodontic treatment in
the transitional dentition. Am J Orthod 1963;49:1-14.
6. Moyers RE. Handbook of Orthodontics, 3rd ed. Chicago: Year
Book Medical Publications; 1974.
7. Ricketts RM. Early treatment. J Clin Orthod 1979;13:181-99.
8. Kutin G, Hawes RR. Posterior crossbites in the deciduous and
mixed dentition. Am J Orthod 1969;56:491-504.
9. Ficarelli JP. A brief review of maxillary expansion. J Ped
1978;93:29-32.
10. Myers DR. Condylar position in children with functional poste-
rior crossbites: before and after crossbite correction. Ped Dent
1980;2:190-4.
11. Haas AJ. Rapid expansion of the maxillary dental arch and nasal
cavity by opening of the mid-palatal suture. Angle Orthod
1961;31:73-90.
12. Bishara SE, Staley RN. Maxillary expansion: clinical implica-
tions. Am J Orthod Dentofacial Orthop 1987;91:13-4.
13. Graber TM. Orthodontics: principles and practice, 3rd ed.
Philadelphia: WB Saunders; 1972.
14. Sims JM. Minor tooth movement in children. St Louis: Mosby;
1972.
15. Schuler RJ. Cephalometric diagnosis of the increase in mandibular
arch length by utilizing buccal expansion for the individual patient
[unpublished masters thesis]. Loma Linda University, 1975.
16. Cleall JF, Bayne DI, Posen JM, Subtelny JD. Expansion of the
mid-palatal suture in the monkey. Angle Orthod 1965;35:23-35.
17. Cotton LA. Slow maxillary expansion: skeletal vs dental
response to low magnitude force in Macaca Mulatta. Am J
Orthod 1978;73:1-23.
18. Hicks EP. Slow maxillary expansion: a clinical study of the
skeletal vs dental response in low magnitude force. Am J Orthod
1978;73:121-41.
19. Murray JM, Cleall JF. Early tissue response to rapid maxillary
expansion in the mid-palatal suture of the rhesus monkey. J Dent
Res 1971;50:1654-65.
20. Starnbach HK, Cleall JF. Effects of splitting the mid-palatal suture
on the surrounding structures. Am J Orthod 1963;50:923-32.
21. Starnbach HK, Bayne D, Cleall J, Subtelny JD. Facioskeletal
Braun et al 261
and dental changes resulting from rapid maxillary expansion.
Angle Orthod 1966;36:152-64.
22. Bell RA. A review of maxillary expansion in relation to rate of
expansion and patient’s age. Am J Orthod 1982;81:32-6.
23. Storey E. Bone changes associated with tooth movement: a his-
tologic study of the effect of force in the rabbit, guinea pig, and
rat. Aust Dent J 1955;59:147-58.
24. Storey E. Bone changes associated with tooth movement: a his-
tologic study of the effect of force for varying durations in the
rabbit, guinea pig, and rat. Aust Dent J 1955;59:209-20.
25. Brossman RE, Bennett CG, Merow WW. Facioskeletal remod-
eling resulting from rapid palatal expansion in the monkey. Arch
Oral Biol 1973;18:987-93.
26. Rune B, Sarnas KV, Selvik G, Jacobsson S. Movement of max-
illary segments after expansion and/or secondary bone grafting
in cleft lip and palate: a roentgen stereogrammetric study with
the aid of metallic implants. Am J Orthod 1980;77:643-53.
27. Timms DJ. A study of basal movement with rapid maxillary
expansion. Am J Orthod 1980;77:500-7.
28. Ekstrom C, Henrikson CO, Jensen R. Mineralization in the mid-
palatal suture after orthodontic expansion. Am J Orthod
1977;71:449-59.
29. Wertz RA. Skeletal and dental changes accompanying rapid
mid-palatal suture opening. Am J Orthod 1970;58:41-66.
30. Debbane EF. A cephalometric and histologic study of the effects
of orthodontic expansion of the mid-palatal suture of the cat. Am
J Orthod 1958;44:187-219.
31. Bell RA, LeCompte EJ. The effects of maxillary expansion
using a quad-helix appliance during the deciduous and mixed
dentitions. Am J Orthod 1981;79:152-61.
32. Lee KG, Ryu YK, Park YC, Rudolph DJ. A study of holographic
interferometry on the initial reaction of maxillofacial complex
during protraction. Am J Orthod Dentofacial Orthop 1997;
111:623-32.
33. Krag G, Duterloo HS, TenBosch JJ. The initial effect of the
orthopedic forces: a study of alterations in the craniofacial com-
plex of a macerated human skull. Am J Orthod 1982;81:57-64.
34. Ichikawa K, Nakagaw M, Kamogashira K, Hata S, Itoh T, Mat-
sumoto M. The effects of orthopedic forces on the craniofacial
complex utilizing maxillary protraction. J Jpn Orthod Soc
1984;43:325-36.
35. Dermaut LR, Beerden L. The effect of class elastic force on a
dry skull measured by holographic interferometry. Am J Orthod
1981;79:294-304.
36. Pavlin D, Vukicevic D. Mechanical reactions of facial skeleton
to maxillary expansion determined by laser holography. Am J
Orthod 1984;86:498-507.
37. Nanda R, Golden B. Biomechanical approaches to the study of the
alterations of facial morphology. Am J Orthod 1980;78:213-26.
38. Christiansen R, Burstone CJ. Centers of rotation within the peri-
odontal space. Am J Orthod 1969;55:353-69.
39. Marcotte MR. Biomechanics in orthodontics. Philadelphia: BC
Decker, Inc; 1990.
40. Nanda R. Protracting of the maxilla in rhesus monkeys by con-
trolled extraoral forces. Am J Orthod 1978;74:121-41.
41. Braun S, Winzler J, Johnson BE. An analysis of orthodontic
force systems applied to the dentition with diminished alveolar
support. Eur J Orthod 1993;15:73-7.