Original Article

Study of Stress Distribution and Displacement of Various

Craniofacial Structures Following Application of Transverse

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

Orthopedic Forces—A Three-dimensional FEM Study
Alireza Jafari, MDS, M-Orthoa; K. Sadashiva Shetty, MDSb;
Mohan Kumar, BE (Mech), ME (Design), MISTE, PhDc

Abstract: The purpose of this study was to analyze the stress distribution patterns within the craniofacial
complex during rapid maxillary expansion. Therefore, a finite element model of a young human skull was
generated using data from computerized tomographic scans of a dried skull. The model was then strained
to a state of maxillary expansion simulating the clinical situation. The three-dimensional pattern of dis-
placement and stress distribution was then analyzed. Maximum lateral displacement was 5.313 mm at the
region of upper central incisors. The inferior parts of the pterygoid plates were also markedly displaced
laterally. But there was minimum displacement of the pterygoid plates approximating the cranial base.
Maximum forward displacement was 1.077 mm and was seen at the region of the anteroinferior border
of the nasal septum. In the vertical plane, the midline structures experienced a downward displacement.
Even the ANS and point A moved downward. The findings of this study provide some additional expla-
nation of the concept of correlation between the areas of increased cellular activity and the areas of
dissipation of heavy orthopedic forces. Therefore, the reason for the occurrence of sensation of pressure
at various craniofacial regions, reported by the patients undergoing maxillary expansion could be correlated
to areas of high concentration of stresses as seen in this study. Additionally, the expansive forces are not
restricted to the intermaxillary suture alone but are also distributed to the sphenoid and zygomatic bones
and other associated structures. (Angle Orthod 2003;73:12–20.)
Key Words: Rapid maxillary expansion (RME); Finite element model (FEM); Stress distribution; Dis-
placement; Maxilla

INTRODUCTION in the areas of articulation of maxilla (for example, under

the eyes and at the nasal area).9 Similar histological studies
Rapid maxillary expansion (RME) is indicated in the
on animals demonstrated a sign of increased cellular activ-
treatment of maxillary deficiency. During RME, high forces
ity at various craniofacial sutures.10–14 In relation to Wolff’s
are directed to the maxillary basal bone and perhaps to
law of bone transformation and stresses, this seems to point
other adjacent skeletal bones. Such heavy RME forces can
to the force concentration in these areas.
easily split the midpalatal suture in young individuals and
Where are the areas of maximum force concentration?
force the two maxillary halves laterally.1–8
How do these heavy forces get gradually dissipated? More-
Widening has been reported to be associated with sen-
sations of pressure at various craniofacial areas, especially over, is there the possibility of transmission of forces far
enough to the base of the skull with possibility of distortion
of sphenooccipital synchondrosis?10
a
Assistant Professor, Department of Orthodontics and Dentofacial It was difficult, if not impossible to answer the above
Orthopedics, Bapuji Dental College, Davangere, India.
b
Profesor and Head, Department of Orthodontics and Dentofacial questions by using conventional methods namely, strain
Orthopedics, Bapuji Dental College, Davangere, India. gauge, photoelastic, or laser holographic techniques. But in
c
Associate Professor, Department of Mechanical Engineering Ba- recent years, finite element (FE) analysis has been intro-
puji Institute of Engineering and Technology, Davangere, India. duced to orthodontics as a powerful research tool for solv-
Corresponding author: Alireza Jafari, Assistant Professor, Depart-
ment of Orthodontics and Dentofacial Orthopedics, Bapuji Dental
ing various structural mechanical problems. It is recognized
College, Davangere-577 004 Karnataka, India. as a general procedure for mechanical approximation to all
(e-mail: [email protected]) physical problems that can be modeled by deferential equa-
Revised and Accepted: June 2002. Submitted: November 2001. tion description.
q 2003 by The EH Angle Education and Research Foundation, Inc. FE analysis has been applied to the description of phys-

Angle Orthodontist, Vol 73, No 1, 2003 12

A THREE-DIMENSIONAL FEM STUDY 13

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

FIGURE 1. Dried young human skull used in this study.

ical form changes in biological structures, particularly in

the form of growth and development and restorative den-
tistry. There are broadly two types of application in bio-
mechanical studies. One is the analysis of stress and strain FIGURE 2. Scan image at the level of midorbital cavity.
with a given force system applied to the teeth or the cranial
complex. The other is the evaluation of the craniofacial
growth with the given skeletal displacement observed dur-
ing the growth changes.15
This study was planned to explore more in detail how
heavy transverse orthopedic forces generated by RME get
dissipated within the craniofacial complex. Therefore, the
aim of this study was to evaluate the pattern of stress ac-
cumulation, dissipation, and displacement of various cra-
niofacial structures after RME, using a three-dimensional
FE study.

MATERIALS AND METHODS

In this study the analytical model was developed from a
dry young human skull of a female with an approximate
age of 12 years. The skull excluding the mandible was
checked for the full complement of the permanent dentition
and gross defects or discontinuity in the craniofacial anat-
omy. The anatomical structures such as sutures become in-
distinguishable with computerized tomographic (CT) scan-
ning. Therefore, traces were placed in the form of barium
FIGURE 3. The digitized X,Y, and Z coordinates were fed into the
sulfate pellets in 0.25-mm circular pits, which were made computer to create grids and lines.
at three points along each of the craniofacial sutures (Figure
1). This was to transfer the precise location of the various
sutures onto the finite element model (FEM). tate paper, taking care so as not to distort the anatomy of
CT scan images of the skull excluding the mandible were the region. This was enlarged to 200 times and traced onto
taken in the axial direction, parallel to the Frankfort hori- the graph paper for digitization. Along the centerline of
zontal plane. Sequential CT images were taken at 5-mm bone, of each CT image, geometric points were defined and
intervals to reproduce finer and detailed aspects of the ge- assigned X, Y, and Z coordinates, which were fed into the
ometry (Figure 2). This methodology of model creation was preprocessor of the software for grid generation. The FE
aimed at improving over the previous methodologies, program used in this study was NISA-II Display-III and
where sections were taken at 10 mm intervals.16 was run on a Pentium-III computer. The grids created were
The individual CT scan sections were traced on an ace- then joined to form lines (Figure 3). The geometric lines

Angle Orthodontist, Vol 73, No 1, 2003

14 JAFARI, SHETTY, KUMAR

TABLE 1. Young’s modulus and Poisson’s ratio for various mate-

rials used in this study (Tanne et al)16
Young’s
Material Modulus kg/mm2 Poisson’s Ratio
Tooth 2.0 3 103 0.3
Compact bone 1.37 3 103 0.3
Cancellous bone 7.9 3 102 0.3

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

a FEM. The geometric entities created in the previous step
were replaced with finite elements and nodes at this stage.
The complete geometry is now defined as an assemblage
of discrete pieces called elements and are connected to-
FIGURE 4. The geometric points between two neighboring layers gether at a finite number of points called nodes. In this
were connected by straight lines forming flat triangular or quadrilat-
study a linear four nodal quadrilateral and triangular shell
eral surfaces between them.
elements were used, which were able to take membranes
into account, ie, in-plane deformation as well as bending
passing through these points described the measured bone deformations. The shell elements have six degrees of free-
geometry as close as possible. dom (DOF) at each of their unstrained nodes: three trans-
The next step was to generate geometric surfaces by join- lations (X, Y, and Z) and three rotations (around the X, Y,
ing lines together. Each layer created was stacked one and Z axes). In the present study the model consisted of
above the other in the axial direction and joined by straight 44142 DOF, which gives a more consistent result as com-
lines (Figure 4). Lines were joined to create patches. Only pared with previously published studies.16–18 The total num-
one half of the cranium with respect to the sagittal plane ber of elements and nodes created was 6951 and 7357, re-
was modeled and analyzed. Analysis of the complete skull spectively (Figure 5).
was not considered necessary because the analysis of one The mechanical properties of the compact and cancellous
half of the cranium will produce the same results as that of bones and teeth in the model were defined according to the
complete skull. experimental data in previous studies16,17 as shown in Table
The next step was to convert the geometric model into 1. All the craniofacial sutures that were integrated in the

FIGURE 5. (A) Frontal and (B) lateral views of the final three-dimensional finite element model.

Angle Orthodontist, Vol 73, No 1, 2003

A THREE-DIMENSIONAL FEM STUDY 15

model were assumed to have the same mechanical prop-

erties as the surrounding bone material.16–18
Restrains were established at all other nodes of the cra-
nium lying on the symmetrical plane, and appropriate
boundary conditions were imposed. In addition, a zero-dis-
placement and zero-rotation boundary condition was im-
posed on the nodes along the foramen magnum.

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

It is a well known fact that the midpalatal suture sepa-
rates after initial application of heavy orthopedic forc-
es.1,3,8,10,13 Even though the midpalatal suture element was
created in this study, the nodes of this suture that were
placed on the symmetrical plane were left unconstrained.
This was done to investigate the stress distribution and de-
formation of the craniofacial complex after splitting of the
midpalatal suture.
Even though application of a known force is possible
with FE modeling, but for the purpose of comparison with
the previously published study,18 a known transversal (X)
displacement with a magnitude of 5 mm was applied on
the maxillary premolars and first permanent molar crown.
It was assumed that the two plates of transversal orthopedic
appliance moved apart by a total distance of 10 mm.
The displacements, von Mises stresses, and shear stress
in different planes were studied. The stress distribution pat-
terns were analyzed; the results were tabulated and graph-
ically represented. Because most of the stress was generated
along the maxillary bone, a detailed analysis of this region
was also carried out.

RESULTS
The biomechanical changes observed in this study were
evaluated under the headings
• Displacement of different bones of craniofacial complex
(Figure 6)
• Stress distribution among different bones and sutures
(Figure 7).
Table 2 shows the three-dimensional pattern of displace-
ments observed at 34 different anatomical structures located
in the craniofacial complex.

Displacement in the transverse plane

(X-displacement)
Maximum X-displacement (lateral displacement) was
5.313 mm at Node 12911, which corresponds to the incisal
edge of the upper central incisor. Pyramidal displacement
of maxilla away from the midline was evident from the
frontal view. The base of the pyramid was located on the
oral side and the apex faced the nasal bone. Viewed occlu-
sally, the two halves of the maxillary dentoalveolar com-
plex, basal maxilla, and lateral walls of the nasal cavity FIGURE 6. Pattern of deformation of the craniofacial complex with
separated more widely, anteriorly. The width of the nasal five mm of transverse expansion seen from (A) frontal view and (B)
cavity at the floor of the nose increased markedly, whereas cranial view of the cut section of the maxilla just above the palatal
the posterosuperior part of the nasal cavity had moved min- vault.

Angle Orthodontist, Vol 73, No 1, 2003

16 JAFARI, SHETTY, KUMAR

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

FIGURE 7. The pattern of computed Von-Mises stress distribution in the craniofacial complex with five mm of expansion.

imally in the lateral direction. No significant lateral dis- terior most portion of the nasal septum; this indicates a
placement was observed at the temporal, parietal, frontal, downward displacement of structures medial to the area of
sphenoid, and occipital bones. The inferior parts of the pter- force application. Maximum positive Z-displacement (up-
ygoid plates were markedly displaced or bent laterally. But ward displacement) was 1.758 mm at Node 241, which rep-
minimum displacement was observed in the region close to resents the body of the zygomatic bone. Considering both
the cranial base, where the plates were more rigid. these points, it is evident that the nasomaxillary complex
rotated in such a manner that the lateral structures had
Displacement in the anteroposterior plane moved upward and midline structures downward. The an-
(Y-displacement) terior part of the maxillary bone (ANS and point A) and
Maximum negative Y-displacement (backward displace- maxillary central incisors were displaced downward.
ment) was 1.159 mm at Node 2314, which corresponds to The magnitude and distribution of von Mises stresses
the posterior rim of the frontal process of the zygomatic produced at various sutures of the craniofacial complex by
bone, indicating that this portion of the craniofacial com- the activation of the RME device up to 5 mm on each side
plex has moved posteriorly. Maximum positive Y-displace- are shown in Table 3. Initial stress images of the three-
ment (forward displacement) was 1.077 mm at Node 6022, dimensional model of the skull are shown below (Figure
which represents the anteroinferior border of the nasal sep- 7). The areas of stress are shown with the help of different
tum. Maxillary bone, maxillary central incisors, and molars colors. The pellets of colors representing the tensile and
were slightly displaced forward. But the zygomatic bone compressive stresses are shown on the right-hand side of
showed a backward displacement. the diagram.
Using the computer-generated color diagrams the follow-
Displacement in the vertical plane ing results were obtained. In the maxillary region, a com-
(Z-displacement) pressive stress of 57.19 kg/mm2 was observed over the re-
Maximum negative Z-displacement (downward displace- gion of the crown of the first permanent molar. The rest of
ment) was 1.220 mm at Node 52, which represents the pos- the dentoalveolar regions from canine to molar also expe-

Angle Orthodontist, Vol 73, No 1, 2003

A THREE-DIMENSIONAL FEM STUDY 17

TABLE 2. Computational result of the transversal (X), sagittal (Y), TABLE 3. Computational result of the Von–Mises stress distribu-
and vertical (Z) displacement of the various skeletal structures of the tion on the various sutures of the craniofacial complex following 5
craniofacial complex following 5 mm of transverse expansion mm of transverse expansion
Selected von Mises Stress Values, kg/mm2
Region Nodes On X, mm Y, mma Z, mma
Suturesa Maximum Minimum Average
Dentoalveolar Incisal edge of 1 5.31 0.85 0.45
Internasal 55.4 7.22 19.18
Cusp tip of 3 5.09 0.71 0.33
Nasofrontal 32.7 8.13 15.82

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

Cusp tip of 6 5.13 0.74 0.26
Nasomaxillary 25.6 12.8 19.46
Apical region of 1 4.34 0.85 20.59
Frontomaxillary 9.38 8.11 8.67
Apical region of 3 3.94 0.50 0.26
Zygomaticomaxillary 8.95 2.85 5.71
Apical region of 6 4.08 0.49 0.29
Zygomaticofrontal 33.0 4.11 14.42
Maxilla Point ‘‘a’’ 4.08 0.97 20.84 Zygomaticotemporal 9.27 1.99 5.24
ANS 3.87 1.02 20.86
Tuberosity 3.65 0.42 0.22
a
Selected groups of nodes were chosen on the model to repre-
Zygomatic buttress 2.89 0.02 0.79 sent each suture, based on the barium sulphate marker used on the
Inferior orbital rim 1.85 20.12 0.72 dry skull.
Frontal process 0.97 0.09 20.15
Palate Anterior 3.22 1.03 20.61
of the frontal process of the zygomatic bone received 32.68
Posterior 2.06 1.05 21.02
kg/mm2 of forces. Similarly, the zygomatic arch and the
Nasal cavity wall Anteroinferior 3.25 0.52 0.00
Anterosuperior 1.26 0.16 20.02 area of the zygomaticotemporal suture had experienced
Posteroinferior 2.17 0.51 20.26 high levels of stress. An interesting finding of this study
Posterosuperior 0.65 0.02 20.02 was the presence of high stress all along the nasal septum,
Nasal bone Body 0.23 20.50 20.59 radiating upward to deeper anatomic structures such as the
Body 0.00 0.00 0.00 body of sphenoid bone. In the frontal, parietal, temporal,
Sphenoid bone Medial pterygoid— and occipital bones, RME produced stress levels ranging
inferior 1.86 20.49 20.37
from 0.0 to 4.085 kg/mm2.
Medial pterygoid—
superior 0.21 20.06 0.15 A comparison was made between the computational results
Lateral pterygoid— of this study and a similar previously published study;18 both
inferior 2.07 0.59 20.44 the studies were carried out independent of each other. A com-
Lateral pterygoid— parison of displacement of various craniofacial skeletal units
superior 0.44 0.08 0.13
of the two studies has been summarized in Table 4 and ac-
Greater wing 0.49 20.32 0.66
companying graphs. However, as stress distribution at various
Zygomatic bone Body 0.21 20.75 1.59
Frontal process 2.07 20.98 1.42 craniofacial sutures was not tabulated in the previous study,18
Zygomatic arch— we did not establish any comparison of von Mises stress dis-
anterior 0.44 20.93 1.67 tributions.
Zygomatic arch— Note that any variation in the values between the two
posterior 0.04 20.38 0.06
studies could be attributed to the sample used for the gen-
Frontal bone Supraorbital 0.01 20.02 0.10
eration of FEM or the model generated on the computer
Forehead 0.01 20.02 0.09
(or both) or selection of the nodes and elements on the FEM
Temporal Squamous 0.60 20.25 0.59
(or both).
Parietal Tuberosity 0.16 20.25 0.35
We presume the selection of the nodes and elements on
Occipital Squamous 0.01 20.05 0.05
the FEM is the single most important element in showing
a
Positive value (1) indicates an anterior movement in a sagittal variance; however the overall results are comparable except
(Y) plane and an upward movement in the vertical (Z) plane. Neg-
ative value (2) indicates a posterior movement in a sagittal (Y) plane for a few differences, which are mentioned in the discus-
and a downward movement in the vertical (Z) plane. sion.

DISCUSSION
rienced high initial stresses of 16.34–24.51 kg/mm2. The
zygomatic buttress and maxillary tuberosity showed areas The three-dimensional FEM used in the present study
of high stress. High stresses also were found around the provides the freedom to simulate orthodontic force systems
frontal process of the maxilla, nasomaxillary suture, naso- applied clinically and allows analysis of the response of the
frontal suture, frontomaxillary suture, and zygomaticomax- craniofacial skeleton to the orthodontic loads in three-di-
illary suture. The nasal bone, nasomaxillary suture, and na- mensional space.
sofrontal suture experienced compressive forces of up to The FE analysis has the following advantages: it is a
32.68 kg/mm2. Areas around the frontozygomatic suture noninvasive technique; the actual amount of stress experi-
and almost the whole length of the frontal process of the enced at any given point can be theoretically measured; the
zygomatic bone were fields of high stress. The anterior rim tooth, alveolar bone, periodontal ligament, and craniofacial

Angle Orthodontist, Vol 73, No 1, 2003

18 JAFARI, SHETTY, KUMAR

TABLE 4. Comparison of the computational result of the transversal (X), sagittal (Y), and vertical (Z) displacement of the various skeletal
structures of the craniofacial complex
Region Selected Nodes On Xa, mm X, mm Ya, mmb Y, mmb Za, mmb Z, mmb
Dentoalveolar Incisal edge of 1 5.00 5.31 1.40 0.85 21.40 20.45
Cusp tip of 6 5.00 5.13 1.40 0.74 20.80 0.26
Apical region of 1 4.99 4.34 2.10 0.85 21.20 20.59
Apical region of 3 4.99 3.94 2.10 0.50 21.10 0.26
20.40

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

Apical region of 6 4.91 4.08 2.00 0.49 0.29
Maxilla Anterior part of plate 4.90 3.22 2.10 1.03 21.10 20.61
Posterior part of plate 4.80 2.06 2.10 1.05 20.20 21.02
Sphenoid bone Inferior part lateral pterygoid plates 4.90 2.07 1.80 0.59 20.04 20.44
Superior part lateral pterygoid plates 1.40 0.44 1.60 0.08 20.70 0.13
Zygomatic bone Frontal process 3.90 2.07 1.60 20.98 20.40 1.42
Anterior zygomatic arch 3.30 0.44 0.70 20.93 0.40 1.67
Posterior zygomatic arch 0.60 0.04 20.04 20.38 0.20 0.06
Nasal cavity Anteroinferior wall 4.80 3.25 2.10 0.52 21.10 0.00
Anterosuperior wall 4.80 1.26 2.10 0.16 20.02 20.02
Posterosuperior wall 20.30 0.65 0.20 0.02 21.10 20.02
Nasal bone Body 0.30 0.23 21.20 20.50 21.10 20.59
Frontal bone Supraorbital 0.03 0.01 20.20 20.02 20.50 0.10
Parietal Tuberosity 0.00 0.16 20.05 20.25 20.02 0.35
Temporal Squamous 0.10 0.60 0.08 20.25 0.40 0.59
Occipital Squamous 0.002 0.01 20.02 20.05 20.02 0.05
a
Values taken from Iseri et al.18
b
Positive value (1) indicates an anterior movement in a sagittal (Y) plane and an upward movement in the vertical (Z) plane. Negative value
(2) indicates a posterior movement in a sagittal (Y) plane and a downward movement in the vertical (Z) plane.

bones can be simulated and the material properties of these craniofacial components on loading. Thus, the results of
structures can be assigned to the nearest one that possibly this study are valid only for a single specific human skull.
can simulate the oral environment in vitro; the displacement The wedge shape opening of the midline structure in this
of the tooth can be visualized graphically; the point of ap- study was evident both in the vertical and anteroposterior
plication, magnitude, and direction of a force may easily be plane. The results of the present study support those of the
varied to simulate the clinical situation; reproducibility does previous studies, which reported that the separations were
not affect the physical properties of the involved material; pyramidal in shape, with the base of the pyramid located
and the study can be repeated as many times as the operator at the oral side of the bone and the center of rotation located
wishes.15 near the frontonasal suture.1,2,3,6,8,18
FEM is a powerful contemporary research tool, and plen- Previous studies3,8,18 have shown that in the frontal plane,
ty of literature is available on the study of stress distribution the fulcrum of the rotation for each of the maxillae was
and deformation of nonliving as well as natural and restored approximately at the frontomaxillary suture. Using im-
craniofacial structures affected by three-dimensional stress plants,5 the maxillae were found to tip anywhere between
fields, which are difficult to assess otherwise.15–18 But ex- 21 to 18 degrees relative to each other. Thus the findings
perimental or clinical confirmation of the theoretical pre- of the previous studies regarding the transverse rotations of
diction should be the goal in any simulation study. In this the nasomaxillary complex with RME are confirmed by the
FE analysis, direct validation of the theoretical results was computational results of the present study.
not possible, therefore the results of the present study were Wertz8 and Isaacson22,23 suggest that the main resistance
compared with the results of the previously published hu- to midpalatal suture opening is probably not in the suture
man studies3,5,7,8,19,20 and were found to be in conformity. itself but in the surrounding structures of the sphenoid and
In previous studies on human8,21 or animal3,10,13 skulls, it zygomatic bones. Chaconas and Caputo24 also mentioned a
was possible only to determine the response of surrounding limiting factor for maxillary expansion, which may depend
bones to high-level forces, and the experiment could not be on the fusion or lack of fusion between the maxilla and
repeated. The experimental method employed in this study pterygoid plates of the sphenoid bone. Melsen and Melsen25
permitted the visualization of bone reactions, even with the have shown that the heavy interdigitation of the osseous
lowest loading degree. One should be aware that the struc- surfaces between the palatine bone and the maxilla and the
tural and spatial relationships of various craniofacial com- pterygoid process of sphenoid bone makes disarticulation
ponents vary among individuals. It is important to realize difficult in late juvenile and early adolescence periods.
that these factors may contribute to varied responses of the Timms7 concluded that RME will separate the maxilla and

Angle Orthodontist, Vol 73, No 1, 2003

A THREE-DIMENSIONAL FEM STUDY 19

palatine bones but would splay the pterygoid processes of those bones, which did not have a direct sutural articulation
the sphenoid bone outward because they are not bilaterally with the maxilla and palatine bones, showed comparatively
paired bones. little or no displacement at all. But many investigators have
Similarly, comparatively less or no displacement of the pointed out that RME is not only limited to the palatal
pterygoid plates was seen in this study, and transmission region but also causes dramatic changes in the craniofacial
of the expansion forces to the other parts of the sphenoid structures. Gardner and Kronman10 in a study of RME on
bone are suggestive of their role as a constraint on the trans- rhesus monkeys found that the lambdoid, parietal, and mid-

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

verse forces. Further indications of the deep anatomic ef- sagittal sutures of the vault of the cranium showed evidence
fects of the transverse orthopedic forces were observed by of distortion, and in one animal a split of 1.5 mm was
the stress in the areas of the zygomatic processes, namely reported.
the zygomaticomaxillary and zygomaticotemporal sutures. An increase in nasal width has been demonstrated as a
The deep anatomical effects of these orthopedic appliances response to RME.3,4,6,8,18 The numerical results of the pre-
was also observed by the high stress levels in the areas of sent study demonstrate that the width of the nasal cavity at
the maxillary bone, in the maxillary molar area, zygomatic the floor of the nose increased markedly compared with the
process, external walls of the orbit, frontozygomatic suture, superior part. This result is similar when compared with the
and frontal process of maxilla. Pavlin and Vukicevik study.21 Therefore a combination of
It has been reported previously that some of the patients increase in nasal width, lowering of palatal plane, and prob-
subjected to RME feel pressure in the vault of the palate, ably straightening of the nasal septum after RME can help
in the region of the alveolar process, in the frontonasal re- the patients with nasal stenosis. Wertz28 and Hershey et al29
gion, under the eyes, and generally throughout the face.9,24 have recorded reduction in nasal airway resistance after
Interestingly enough, these anatomical landmarks coincide rapid maxillary expansion.
with the area of high-stress distribution in the present FEM The results of the present study using the three-dimen-
study. sional FEM of a human skull provided some additional ex-
Hass3 and others2,6,8,10,18,26 found the maxilla to be more planation about the bony tissue mechanical reactions, which
frequently displaced downward and forward. The final po- are the first steps in the compound process of tissue re-
sition of the maxilla, after completion of expansion is un- sponse to jaw expansion. Acquaintance with these initial
predictable, and it has been reported to return, partially or mechanical reactions helps the orthodontist to understand
completely, to its original position. Wertz8 believed that the better the final therapeutic effects and the way the ortho-
disjunction of the maxillopalatine complex from pterygoid dontic appliance actually acts on the basal bones and su-
process could provide a possible answer to few rare instanc- tures of the craniofacial system.
es in which point A and the entire maxilla were moved
forward by a significant amount. But Gardner and Kron- CONCLUSIONS
man10 believed the fact that the maxilla moving forward
and downward during the expansion procedure was corre- The results of the present study using the three-dimen-
lated with the opening of the sphenooccipital synchondro- sional FEM of a human skull indicted that the transverse
sis. orthopedic forces not only produced an expansive force at
In this study, however, point A and ANS moved forward the intermaxillary suture but also high forces on various
by 1.074 mm. This is in agreement with the above studies. structures on the craniofacial complex, particularly the
But the opening of sphenooccipital synchondrosis could not sphenoid and zygomatic bones.
be seen as a factor and, therefore, the restraining effect of The confining effect of the pterygoid plates of the sphe-
the pterygoid plates of the sphenoid bone and the buttress- noid minimizes dramatically the ability of the palatine
ing effect of the zygomatic bone could be the possible ex- bones to separate at the midsagittal plane. Further posteri-
planation for forward movement of the nasomaxillary com- orly, the pterygoid plates can bend only to a limited extent
plex. because pressure is applied to them, and their resistance to
The literature published on the vertical skeletal displace- bending increases significantly in the parts closer to the
ment of the upper jaw after RME agrees that the maxilla cranial base where the plates are much more rigid. There-
descends either parallel or rotates anteriorly or posterior- fore, the clinician should realize that with activation of the
ly.3,4,8,20,27 But all authors do not agree on this point.2 The RME appliance he/she is producing not only an expansion
analytical result of the present study showed that the palate force at the intermaxillary suture but also forces on other
moved slightly downward, more in the posterior than an- structures within the craniofacial complex that may or may
terior, displaying a forward rotation in the palatal plane. not be beneficial for the patient.
How far from the dentoalveolar region do the expansion It should be noted that during surgically assisted RME,
forces affect the skeletal sutures? A number of authors re- release of the pterygoid plates is necessary because, unlike
ported that these forces can affect the other bones surround- the maxilla, which is the paired bone, the sphenoid is a
ing the maxillary complex.6,8,10,18 In this study, however, single bone with both pterygoid processes attached. There-

Angle Orthodontist, Vol 73, No 1, 2003

20 JAFARI, SHETTY, KUMAR

fore, the pterygoid processes must be separated from the dental changes resulting from rapid maxillary expansion. Angle
maxilla to allow posterior maxillary expansion. Orthod. 1966;36:152–164.
12. Starnbach HK, Cleall JF. The effects of spliting the midpalatal
Because of their relative rigidity, skeletal tissues offer suture on the surrounding structures. Am J Orthod. 1964;50:923–
immediate resistance to expansion force. But another equal- 924.
ly important factor is the soft tissue complex that invests 13. Storey E. Tissue response to the movement of bones. Am J Or-
these skeletal structures. The muscles of mastication, the thod. 1973;64:229–247.
14. Ten Cate AR, Freeman E, Dickinson JB. Sutural Development:
facial muscles, and the investing fascia are relatively elastic structure and its response to rapid expansion. Am J Orthod. 1977;

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/73/1/12/1374448/0003-3219(2003)073_0012_sosdad_2_0_co_2.pdf by Colombia user on 05 August 2024

and can be stretched as the expansion forces are applied. 71:622–636.
But the ability of the stretched muscles, ligaments, and fas- 15. Korioth TWP, Versluis A. Modeling the mechanical behaviour of
cia to permanently adapt to the new environment is a matter the jaws and their related structures by finite element (FE) anal-
ysis. Crit Rev Oral Biol Med. 1997;8:90–104.
that deserves further investigation.
16. Tanne K, Hiraga J, Kakiuchi K, Yamagata Y, Sakuda M. Bio-
mechanical effect of anteriorly directed extraoral forces on the
ACKNOWLEDGMENTS craniofacial complex: a study using the finite element method.
Am J Orthod Dentofac Orthop. 1989;95:200–207.
The authors would like to thank Drs. Benoy Mathew, A. V. Arun, 17. Hiraga MJ, Tanne K, Nakamura S. Finite element analysis for
Abdul Hakeem, Govardhan Rao, Krishnakant Reddy, T. Ramanjulu, stresses in the craniofacial sutures produced by maxillary pro-
K. Divakar, K. Vani, Chetana Chandra, Sunil Sunny, Ashutosh Shetty traction forces applied at the upper canines. Br J Orthod. 1994;
and faculty members and students of the Department of Orthodontics 21:343–348.
and Dentofacial Orthopedics, Bapuji Dental College, Davangere, In- 18. Iseri H, Tekkaya AE, Oztan O, Bilgic S. Biomechanical effect of
dia. rapid maxillary expansion on the craniofacial skeleton, studied by
the finite element method. Eur J Orthod. 1998;20:347–356.
19. Isaacson RJ, Murphy TD. Some effect of rapid maxillary expan-
REFERENCES sion in cleft lip and palate patients. Angle Orthod. 1964;34:143–
154.
1. Cleall JF, Bayne D, Posen J, Subtelny JD. Expansion of the mid- 20. Wertz R, Dreskin M. Midpalatal suture opening—a normative
palatal suture in the monkey. Angle Orthod. 1965;35:23–35. study. Am J Orthod. 1977;71:367–381.
2. Davis WM, Kronman JH. Anatomical changes induced by split- 21. Pavlin D, Vukicevic D. Mechanical reactions of facial skeleton
ting of the midpalatal suture. Angle Orthod. 1969;39:126–132. to maxillary expansion determined by laser holography. Am. J.
3. Hass AJ. Rapid expansion of the maxillary dental arch and nasal Orthod. 1984;85:498–507.
cavity by opening the midpalatal suture. Angle Orthod. 1961;31: 22. Isaacson RJ, Ingram AH. Forces produced by rapid maxillary
73–90. expansion. Part II. Forces present during treatment. Angle Orthod.
4. Hass AJ. The treatment of maxillary deficiency by opening the 1964;34:261–270.
midpalatal suture. Angle Orthod. 1965;35:200–217. 23. Isaacson RJ, Wood JL, Ingram AH. Forces produced by rapid
5. Hicks EP. Slow maxillary expansion a clinical study of the skel- maxillary expansion. Part I. Design of the force measuring sys-
etal versus dental response to low-magnitude force. Am J Orthod. tem. Angle Orthod. 1964;34:256–260.
1978;73:121–141. 24. Chaconas SJ, Caputo AA. Observation of orthopedic force dis-
tribution produced by maxillary orthodontic appliances. Am J Or-
6. Memikoglu TUT, Iseri H. Effects of a bonded rapid maxillary
thod. 1982;82:492–501.
expansion appliance during orthodontic treatment. Angle Orthod.
25. Melson B, Melsen Flemming. The postnatal development of the
1999;69:251–256.
palatomaxillary region studies on human autopsy material. Am J
7. Timms DJ. A study of basal movement with rapid maxillary ex- Orthod. 1982;82:329–342.
pansion. Am J Orthod. 1980;77:500–507. 26. Cotton LA. Slow maxillary expansion: skeletal versus dental re-
8. Wertz RA. Skeletal and dental changes accompanying rapid mid- sponse to low magnitude force in Macaca mulatta. Am J Orthod.
palatal suture opening. Am J Orthod. 1970;58:41–66. 1978;73:1–23.
9. Zimring JF, Isaacson RJ. Forces produced by rapid maxillary ex- 27. Fried KH. Palate—tongue relatively. Angle Orthod. 1971;61:308–
pansion. Part II. Forces present during retention. Angle Orthod. 323.
1965;35:178–186. 28. Wertz EA. Changes in nasal airflow incident to rapid maxillary
10. Gardner GE, Kronman JH. Cranioskeletal displacement caused by expansion. Angle Orthod. 1968;38:1–11.
rapid palatal expansion in the Rhesus monkey. Am J Orothod. 29. Hershey HG, Stewart BL, Warren DW. Changes in nasal airway
1971;59:146–155. resistance associated with rapid maxillary expansion. Am J Or-
11. Starbach H, Bayne D, Cleall J, Subtelny JD. Facioskeletal and thod. 1976;69:274–284.

Angle Orthodontist, Vol 73, No 1, 2003