Surgically assisted rapid maxillary expansion in lingual orthodontics – optimizing of coupling and timing

Martina Bräutigam, Benedict Wilmes, Nour Eldin Tarraf, Dieter Drescher

Surgically assisted rapid maxillary expansion (SARME) is primarily used in adult orthodontics. In many cases it is followed by further surgery to address further anteroposterior and/or vertical discrepancies. Treatment times in such cases are often long with adult patients usually requesting invisible appliances. Lingual appliances can provide the mechanical control required as well as fulfil the aesthetic demands in such cases. However lingual appliances are usually custom made and indirectly bonded. Due to tooth movement following surgery there is usually a long delay before impressions can be made for customized lingual appliances. This results in a long delay before alignement and leveling can be commenced post-surgery. Three cases are presented here demonstrating the simultaneous placement of bone anchored expansion devices for surgically assisted rapid maxillary expansion with customized lingual appliances. The combination of the two procedures allows the alignement and leveling to commence very soon after surgery significantly reducing treatment times. The design of the appliances and the clinical procedures are described and discussed.