ORIGINAL ARTICLE

In-silico evaluation of orthodontic

miniscrew-assisted rapid palatal
expanders for patients with various
stages of skeletal maturation
Abdelhak Ouldyerou,a Egon Mamboleo,b Lauren Gilchrist,b Khaled Alsharif,a Peter Ngan,a Ali Merdji,c
and Osama Mukdadib
Morgantown, WVa, and Mascara, Algeria

Introduction: This study aimed to use a finite element method to assess the stress on the miniscrews, skeletal
and dental changes resulting from maxillary expansion using either a tooth-bone-borne (TBB) or a bone-borne
(BB) device on patients with various skeletal maturation. Methods: Two types of expanders were modeled using
SolidWorks. The design of the 2 expanders was similar, with the exception that the BB appliance lacked support
for teeth (rods and bands). Both were placed on the palatal bones with the help of 4 miniscrews as bony
anchorage. Five skeletal maturation stages were examined using suture maturation classification by Angelieri.
A lateral displacement of 0.2 mm was applied to simulate 1 turn of jackscrew per day. The dental and skeletal
changes from the treatment were quantified. Results: Stage A sutural maturation exhibited the greatest skeletal
movement (0.13 mm/d) with a V-shaped displacement pattern. Stages B and C exhibited a more parallel expan-
sion pattern. Stages D and E exhibited the least amount of skeletal movement with either device. Compared with
the BB device, TBB demonstrated greater dental displacement. On average, the BB device exhibited a skeletal-
to-dental expansion ratio of 70% from stage A to C compared with 49% with the TBB device. Conclusions: BB
device showed more skeletal displacement than TBB, and the latter showed more dental side effects, particularly
during stages B and C. The miniscrew-assisted rapid palatal expansion appliance was effective with sutural
maturation stages A to C using the classification by Angelieri with a more parallel separation of the midpalatal
sutures in stages B and C. (Am J Orthod Dentofacial Orthop 2024;166:561-71)

I
n the domain of orthodontic care, it is common for Traditional treatment for posterior crossbites has
adolescent patients to present with maxillary trans- typically relied on tooth-borne palatal expanders. These
verse deficiencies, which is a notable concern. This appliances were used in the mixed dentition and early
deficiency often presents with the presence or absence permanent dentition.3 However, this approach has
of a posterior crossbite, dental crowding, and maxillary been associated with several side effects, including
incisor protrusion.1,2 buccal tilting of posterior teeth, reduction in buccal
bone thickness and crestal bone level, buccal root
resorption, and postretention relapse.3,4
For patients in early permanent dentition or more
a
Department of Orthodontics, School of Dentistry, West Virginia University, Mor-
advanced skeletal maturity, the use of miniscrew-
gantown, WVa.
b
Department of Mechanical, Materials and Aerospace Engineering, West Virginia assisted rapid palatal expansion (MARPE) appliances has
University, Morgantown, WVa. emerged as a preferred treatment modality with fewer
c
Department of Mechanical Engineering, Faculty of Science and Technology,
side effects.5,6 This orthodontic device uses 2 or 4 minis-
University of Mascara, Mascara, Algeria.
All authors have completed and submitted the ICMJE Form for Disclosure of Po- crews that are attached to the palatal bone as bony
tential Conflicts of Interest, and none were reported. anchorage.2 These MARPE appliances can be used as a
Address correspondence to: Osama Mukdadi, Department of Mechanical and
tooth-bone-borne (TBB) appliance with the jackscrew
Aerospace Engineering, West Virginia University, Morgantown, WV26506;
e-mail, [email protected]. connected to both the skeletal and dental units or a
Submitted, April 2024; revised and accepted, July 2024. bone-borne (BB) appliance with the jackscrew connected
0889-5406/$36.00
only to the palatal bone. Both of these designs have re-
Ó 2024 by the American Association of Orthodontists. All rights are reserved,
including those for text and data mining, AI training, and similar technologies. sulted in a high success rate in terms of anchorage.7,8
https://doi.org/10.1016/j.ajodo.2024.07.018

561
562 Ouldyerou et al

The success in opening the midpalatal suture with Meshmixer, San Rafael, Calif). This process involved merg-
MARPE appliances ranges from 70%-90%, depending ing the individual bones to form a single volume. Subse-
on the design of the appliance, bone density, and quently, a 1.6 mm shell was applied to the merged
skeletal maturation.9-11 However, predicting the structure to establish the cortical bone layer. The internal
success of separating the 2 palatal bones has been architecture was filled to accurately represent the cancel-
uncertain. Clinicians commonly rely on dental and lous bone (Fig 1, A).
skeletal age assessments, including cervical vertebral The teeth (first and second premolars and molars)
and suture maturation, to predict the success of were constructed through the same process. The peri-
suture separation.12-14 odontal ligament (PDL) with a thickness of 0.20 mm
Few investigations have been reported on the perfor- was modeled using the offset command.
mance of MARPE appliances with various designs.15-23 In this study, 2 different palatal expander appliances,
Gupta et al15 conducted a comprehensive analysis namely BB and TBB, were designed using SolidWorks
comparing 4 distinct MARPE designs. Notably, their find- 2023 (Dassault Syst
eme SolidWorks Corp, Waltham,
ings highlight the superior skeletal expansion achieved by Mass). Both devices share almost identical components,
MARPE with bicortical anchorage. Cozzani et al16 exam- with the main distinction being that the BB appliance
ined both BB and TBB expanders, observing higher stress lacks support for teeth (rods and bands). Four
levels in all sutures with BB expanders and noting a ten- miniscrews were created with a length of 12 mm and a
dency for tipping of anchor teeth with TBB expanders. diameter of 1.5 mm, and device bases were designed
Their study recommended TBB expanders for patients with a length of 17 mm. The diameter of the rods was
with low-quality bone. In addition, another study17 set to 1.5 mm, whereas the bands were considerably
demonstrated the effectiveness of both BB and TBB thinner, with a thickness of 0.5 mm. All main dimensions
expanders in achieving maxillary expansion while high- of the expanders are depicted in Figure 1, B. In the TBB
lighting the potential for parallel maxillary expansion and appliance, 2 bands were affixed to the first molars.
reduced stress in craniofacial structures with surgically- Figure 1, C illustrates different views of both devices.
assisted rapid palatal expansion involving pterygomaxillary The miniscrews were anchored bicortically, penetrating
disjunction. Furthermore, maxillary expansion and ortho- through both the cortical bone layers of the palatal
dontic movements have been explored using computa- (Fig 1, A) vault and nasal floor to ensure primary stability
tional models.18-23 and facilitate effective skeletal expansion.
To the best of our knowledge, this study represents the Figure 2, A illustrates the skull sutures. A total of 16 su-
first work to compare the skeletal and dental changes of 2 tures, including lambdoid, parietomastoid, squamosal,
MARPE designs (BB and TBB) across 5 stages of suture sagittal, occipitomastoid, coronal, internasal, nasomaxil-
maturation using a finite element method. The first null lary, frontonasal, zygomaticofrontal, zygomaticotemporal,
hypothesis posits that there is no significant difference zygomaticomaxillary, midpalatal, transverse palatine,
between the 2 MARPE designs regarding the skeletal sphenoparietal, and sphenosquamosal suture, were gener-
changes across the 5 stages of sutural maturation. The ated using SolidWorks. The slicer tool was used to achieve a
second null hypothesis posits that there is no significant thickness of 0.2 mm, representing the suture width.
difference between the 2 MARPE designs on the dental The midpalatal suture refers to the soft tissue connect-
changes with the 5 stages of sutural maturation. The third ing the 2 maxillary bones. Figure 2, B displays the matura-
null hypothesis posits that there is no significant differ- tion shape of the midpalatal suture, classified according to
ence between the 2 MARPE designs on the periodontal Angelieri et al.12 Stage A is represented by a straight sutural
changes with the 5 stages of sutural maturation. line without interdigitation, stage B exhibits a scalloped su-
tural line, stage C features 2 parallel lines, stage D displays 2
parallel lines with complete fusion in the palatine bone,
MATERIAL AND METHODS
and stage E represents total fusion with no visible suture
The 3-dimensional skull model of an adult male was appearance. The midpalatal suture width can range from
sourced from a life science database archive.24 This 0.2-0.6 mm at the first molar level.25 For stages A and B,
repository is dedicated to preserving and organizing the sutures were modeled with a width of 0.2 mm and
datasets (including organs scanned by magnetic Young’s modulus of 0.068 MPa and 1 MPa, respectively.
resonance imaging) generated by researchers in Japan. Modeling the interdigitation of the 2 scalloped lines with
All skull bones were acquired in stereolithography bone tissue presents significant complexity; therefore, a
format, representing mesh files. The integration of all skull suture width of 0.6 mm and Young’s modulus of 10 MPa
bones was performed using open-source computer-aided and 100 MPa for stages C and D were chosen respectively
design software Meshmixer (version 3.5; Autodesk to represent the increased resistance of these suture tissues.

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Fig 1. Three-dimensional computer-aided design modeling: A, Main expanders dimension; B, Con-

struction of 3-dimensional skull model and teeth; C, Two different expansion appliances of BB and TBB.

In this study, Young’s modulus of the suture was assumed employed, it was observed that stress increased within the
to follow a logarithmic scale from stage A to stage E, indi- miniscrews as the suture matured, progressing from stage
cating a transition from very soft tissue (stage A) to very A to stage E. Notably, all peak stresses were concentrated
hard tissue (stage E with complete fusion). at the neck of the miniscrews, in which they have contact
To simulate the expansion activation, a lateral with the cortical bone layer.
displacement of 0.2 mm was applied to the appliance, The highest von Mises stress was observed at stage E,
representing 1 turn per jackscrew, with 0.1 mm displace- reaching a magnitude of 1306 MPa with the BB device
ment on each side, as depicted in Figure 3. The foramen and 1277 MPa with the TBB device. Conversely, the lowest
magnum of the skull was fixed in all directions. Tetrahe- stress values were recorded at stage A, measuring 173 MPa
dral elements were selected for all components, with for the TBB device and 175 MPa for the BB device.
mesh refinement focused on the maxillary area. To At stage B, the BB device exhibited a stress of 409
ensure that the bones, expander device, teeth, and PDL MPa, whereas the TBB device showed 441 MPa. During
move as a single unit, bonded contact was assigned to stage C, the BB device displayed a stress of 628 MPa,
prevent any sliding or separation between them. slightly lower than the TBB device at 631 MPa. Moving
For computational efficiency, the cancellous bone, to stage D, both devices showcased similar stress levels,
cortical bone, PDL, sutures, teeth, and expanding appli- with the BB device at 978 MPa and the TBB device at 979
ances were assumed to be linearly elastic, isotropic, and MPa. Therefore, when comparing the stress distribution
homogeneous. All material properties used for the finite in the miniscrews of the 2 devices, BB and TBB, a slight
element investigation are summarized in Table I. difference was observed.
Figure 5 shows the von Mises stress distribution within
RESULTS BB and TBB devices. The maximum stress was observed in
Figure 4 illustrates the von Mises stress distribution the TBB device at stage E, with a value of 1108 MPa,
within the miniscrews. Regardless of the appliance device whereas the lowest value was 161 MPa at stage A.

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Fig 2. Modeling the skull sutures: A, Skull sutures. 1, lambdoid; 2, parietomastoid; 3, squamosal; 4,
sagittal; 5, occipitomastoid; 6, coronal; 7, internasal; 8, nasomaxillary; 9, frontonasal; 10, zygomatico-
frontal; 11, zygomaticotemporal; 12, zygomaticomaxillary; 13, midpalatal; 14, transverse palatine; 15,
sphenoparietal; 16, sphenosquamosal; and 17, pterygomaxillary suture; B, Midpalatal suture matura-
tion. EMPS, Young’s modulus of midpalatal suture.

Significantly, the peak stresses were concentrated at the MPa. At stage D, both devices demonstrated comparable
sites of lateral displacement application, specifically stress levels of 849 MPa and 853 MPa for both BB and
within the holes of the jackscrews. TBB devices, respectively.
At stage B, the BB device exhibited a stress of 491 All models exhibited a lateral displacement, as depicted
MPa, whereas the TBB device showed 446 MPa. in Figure 6. The same legend scale for the lateral displace-
Progressing to stage C, the BB device displayed a stress ment was employed to facilitate the comparison of skeletal
of 613 MPa, slightly lower than the TBB device at 629 and dental movements across all models. Remarkably, a

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Ouldyerou et al 565

Fig 3. Finite element analysis setup illustrating lateral displacement, boundary conditions, mesh
configuration, and initial measurement at baseline (T0). The first molar angulation change is measured
by tracking 2 reference points (nodes) on the right and left first molars. The angular change is calculated
using the postprocessing formula, in which the x-axis displacement (Dx) and the y-coordinates of the
molar cusp tip (MRy) and root apex (M’Ry) are used. R, right; L, left; M, first molar cusp tip; M, first molar
root apex; PF, palatine foramen; Zyg, zygomatic; q, first molar angular change.

large displacement was observed within stage A, under (Fig 6). At stages B and C, a more parallel expansion was
both BB and TBB devices, whereas stage E experienced observed with both devices.
the least amount of movement. Specifically, at stage A, a As for dental displacement, both BB and TBB devices
skeletal V-shaped displacement pattern was evident within showed similar lateral displacement at stage A with
both BB and TBB devices, with a greater displacement of approximately 0.13 mm displacement. For stages B-D,
0.13 mm observed anteriorly and 0.07 mm posteriorly a displacement of 0.13 mm was observed at the first

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molars for the TBB device. However, the BB device

Table I. Mechanical properties of the investigated
18 exhibited lower dental displacements of 0.11 mm, 0.08
models
mm, and 0.05 mm for stages B, C, and D, respectively.
Young’s modulus Poisson’s For stage E, the left and right maxilla were totally fused;
Component (MPa) ratio therefore, no significant skeletal or dental movement
Expansion device and 110000 0.345 was observed.
miniscrews
Cortical bone 13700 0.3
Because of the highest stress observed in the minis-
Cancellous bone 1370 0.3 crews and devices, stages D and E were excluded from
PDL 0.068 0.45 the postprocessing analysis of dental and skeletal
Tooth 20700 0.3 changes. Table II summarizes the total displacement
Sutures 0.4 (20 turns) observed in different sutures, the maxilla
Stage A 0.068
Stage B 1
bone, molars, and the PDL. Notably, the midpalatal
Stage C 10 suture exhibited the largest amount of displacement
Stage D 100 compared with other circummaxillary sutures across all

Fig 4. von Mises stresses (MPa) in the posterior miniscrews (front view).

Fig 5. von Mises stresses (MPa) in the expander’s device.

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Fig 6. Lateral displacement (in millimeters) during various stages of midpalatal suture maturation in BB
and TBB appliances.

maturation stages (A-C). At stage C, it displayed a total During stage B, the angular change within the right
displacement of 2.92 mm posteriorly, followed by the molar was 3.32 for TBB and 1.95 for BB. Similarly,
zygomaticomaxillary and pterygomaxillary sutures with during stage C, the angular change was 3.62 for TBB
1.79 mm each. Furthermore, at stages B and C, the mid- and 1.39 for BB. This indicates that the TBB appliance
palatal suture demonstrated a total displacement of 1.80 exhibited a significantly higher angular change than in
mm with both devices. the BB appliance in both stages.
Comparing both devices, TBB showed larger displace- Figure 7 illustrates the ratio of skeletal-to-dental
ment for the first molars at stages A-C. In contrast, BB changes observed within BB and TBB appliances. In
exhibited less displacement, particularly at stage B and stage A, BB appliances exhibited a ratio of 64%, whereas
stage C. Specifically, TBB demonstrated a displacement TBB appliances showed a slightly lower ratio of 61%.
of approximately 2.4 mm for the first molars. In contrast, Moving to stage B, the ratio for BB appliances increased
BB showed a displacement of approximately 1.5 mm at to 73%, whereas for TBB appliances, it decreased to
stage B and 1 mm at stage C for the first right molar. 50%. Interestingly, in stage C, the disparity became
Similar notes were observed regarding the periodontal more pronounced, with BB appliances demonstrating a
displacement in both the right and left PDL. Stage A indi- significantly higher ratio of 79%, compared with only
cated comparable periodontal displacements with both 35% for TBB appliances.
TBB and BB devices. However, it is noteworthy that as
the suture matures, the displacements in the right and
DISCUSSION
left PDL are larger with the TBB device.
Table III provides the measurement of skeletal and Tooth-borne expanders, which rely solely on support
dental changes observed throughout midpalatal suture from the dental units such as the posterior premolars and
maturation (stages A-C) with both BB and TBB appli- molars teeth, have conventionally been used for midpa-
ances after treatment of 20 turns. No significant differ- latal suture opening in the mixed to early perma-
ence was found between BB and TBB. The measured nent.26,27 The forces transmitted from the teeth
difference in distances between the right and left zygo- through the rods of these expanders result in undesirable
matic were 2.52 mm and 2.56 mm for BB and TBB, side effects such as buccal tipping of the anchored teeth
respectively. Similarly, for the palatine foramen right and loss of buccal bone width.28 In response to these
and left, the variances were 2.85 mm and 2.86 mm for limitations, both BB and TBB expanders have been
BB and TBB, respectively. When assessing the distance developed to achieve greater skeletal expansion with
between the right molar and left molar cusp tip, the assistance of miniscrews as bony anchorage.27 In
measurements revealed 4.41 mm and 4.71 mm in BB this study, these 2 expanders were computer-
and TBB, respectively. However, the angular changes simulated, and finite element analysis was used to deter-
of the right molars were 2.51 and 2.69 for BB and mine the amount of lateral displacement in 5 suture
TBB, respectively. maturation stages.

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Table II. Total displacement in different components Table III. Comparative of skeletal and dental changes
across midpalatal suture maturation (stages A-C) with
Variables Stage A Stage B Stage C
BB and TBB appliances
Midpalatal suture
BB 2.92 1.80 1.80 ZygR- PFR- MR- MR- ML- Ratio of
TBB 2.92 2.05 1.82 ZygL PFL ML M0 R M0 L skeletal vs
Nasomaxillary suture Appliances (mm) (mm) (mm) ( ) 
( ) dental changes
BB 1.35 0.38 0.13 Stage A
TBB 1.35 0.20 0.14 BB 2.529 2.854 4.417 2.69 2.34 64%
Frontomaxillary suture TBB 2.540 2.874 4.710 2.51 2.54 61%
BB 1.02 0.31 0.12 Stage A
TBB 1.02 0.19 0.11 BB 1.293 2.277 3.083 1.95 1.86 73%
Internasal suture TBB 1.325 2.440 4.867 3.32 3.59 50%
BB 1.30 0.37 0.10 Stage A
TBB 1.30 0.19 0.10 BB 0.697 1.637 2.071 1.39 1.39 79%
Frontonasal suture TBB 0.710 1.668 4.713 3.62 3.82 35%
BB 0.83 0.24 0.14
TBB 0.83 0.13 0.13 Zyg, zygomatic; PF, palatine foramen; M, first permanent molars
Zygomaticotemporal suture cusp tip; M0 , first permanent molars root apex; L, left; R, right.
BB 1.23 0.46 0.34
TBB 1.23 0.61 0.33
Frontozygomatic suture A similar observation was noted for the stress with the
BB 0.94 0.21 0.37 devices, with the highest stresses observed during stages
TBB 0.94 0.67 0.37 D and E. However, an in vitro study30 demonstrated
Zygomaticomaxillary suture
that plastic deformation could occur in miniscrews and
BB 1.79 1.05 0.65
TBB 1.79 1.30 0.72 jackscrews, consequently imposing limitations on the
Pterygomaxillary suture expansion process.
BB 1.79 0.69 0.51 Stages D and E can mimic sutural maturation typi-
TBB 0.85 0.75 0.52 cally observed in adults. Thus, the literature recommen-
Maxilla bone
ded the use of surgically-assisted rapid palatal expansion
BB 2.76 1.93 1.79
TBB 2.75 1.95 1.81 rather than conventional or MARPE appliances during
First right molar these stages to mitigate the risk of failure associated
BB 2.45 1.67 1.19 with the expansion.31
TBB 2.49 2.60 2.59 Even with just 1 turn of lateral displacement applied,
PDL - first right molar
both expanders exhibited a triangular (V-shaped)
BB 2.12 1.36 0.96
TBB 2.16 2.06 2.03 pattern of suture opening, which appeared wider anteri-
First left molar orly than posteriorly. This pattern was particularly
BB 2.39 1.55 1.07 pronounced during stage A, in which both devices
TBB 2.50 2.59 2.56 demonstrated similar outcomes. A V-shaped pattern of
PDL - first left molar
opening was also described in the clinical treatment of
BB 2.07 1.27 0.86
TBB 2.17 2.02 1.94 patients in the mixed to early permanent dentitions,
particularly with BB expanders.31,32 This can be
explained by the suture softness at stage A, characterized
Equivalent von Mises stress in the miniscrews was by its lowest stiffness (Young’s modulus). Furthermore,
analyzed for both expanders across the 5 stages of suture because of the location of the jackscrew, the region
maturation, focusing on a single turn with a lateral that experiences the most reaction forces from the high-
displacement of 0.2 mm. For both expanders, the minis- est stress distribution is posterior, which makes it more
crews exhibited stress levels below the yield strength of resistant and reduces skeletal movement at this level.
titanium (approximately 910 MPa29) during stages A The midpalatal suture demonstrated a significantly
and B. However, in stages D and E, characterized by greater total displacement compared with other sutures.
partial or complete fusion, stress levels in the miniscrews This can be attributed to the placement of anchorage
surpassed the yield strength, potentially resulting in miniscrews within the palate, which effectively facilitates
plastic deformation and eventual mechanical failure. soft tissue movement. Moreover, the midpalatal suture
Thus, the first null hypothesis posited that there is no inherently presents a region of resistance to maxillary
difference in skeletal response to various sutural matura- expansion, as corroborated by ex-vivo findings.33 The
tion stages was rejected. midpalatal suture was expanded during stages A, B,

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Fig 7. The ratio of skeletal-to-dental changes observed within BB and TBB appliances.

and C. For instance, with the TBB expander, the average that TBB expanders have rods that transmit more force
total displacement measured was 2.26 mm, similar to to the first molars. Consequently, the second null
previous study results.34 hypothesis was not supported and thus rejected.
Conversely, the zygomaticomaxillary and pterygo- Furthermore, any movement of the teeth will inher-
maxillary sutures exhibited comparatively fewer ently involve changes in the PDL because of their
displacements. This diminished displacement can be anatomic interconnection. It can be deduced that fully
attributed to reduced strain experienced by these sutures bonded contact between the first molars and PDL allows
during the expansion process.33 them to function as 1 unit. Stages B and C showed greater
Dental angular changes in degrees were assessed PDL displacements with the TBB than with the BB device,
within the first molars. Two reference points (nodes) and therefore, the third null hypothesis was rejected.
were selected during postprocessing to track their coor- Clinicians may benefit greatly from the use of FEM as
dinates: 1 at the cusp tip and 1 at the root apex of the a tool to accomplish and measure dental and skeletal
first molars. Using these coordinates, the angular changes during treatment. As many clinicians use
changes were calculated. This method allows for the landmark-based quantitative assessment.32,35 FEM
measurement of displacement and angular changes in involves obtaining the stereolithography file from cone-
3 dimensions. The average angular tipping within the beam computed tomography scans, offering a more
right first molar within BB and TBB was found to be comprehensive and detailed analysis of measurements.
2.00 and 3.15 , respectively, which aligns closely with As a finite element study, this study may have some
the results from a previous study,32 which reported limitations. First, the exclusion of the jackscrew was
values of approximately 1.7 in BB and 3.5 in TBB. due to computational constraints. Instead, a lateral
On average, in this study, the BB appliance exhibited displacement was applied to the expander bases to simu-
a skeletal-to-dental expansion ratio of 70%, ranging late the expansion. Secondly, the mechanical properties
64%-79% across suture maturation. Conversely, the of suture tissues were assumed to be linear and increase
TBB appliance displayed an average ratio of 49%, vary- logarithmically with maturation, as empirical data on
ing from 35% to 61%. It was concluded that a greater these properties are lacking. Currently, there are no
skeletal-to-dental expansion ratio was with BB viable in vivo methods to directly determine the mechan-
expanders. This difference can be attributed to the fact ical properties of skull sutures. Despite these limitations,

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consistent properties were maintained across all models Haas-type and hyrax-type expanders: a randomized clinical trial.
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AUTHOR CREDIT STATEMENT
12. Angelieri F, Cevidanes LHS, Franchi L, Gonçalves JR, Benavides E,
Ouldyerou Abdelhak contributed to conceptualiza- McNamara Jr JA. Midpalatal suture maturation: classification
tion, data curation, formal analysis, methodology, soft- method for individual assessment before rapid maxillary expan-
sion. Am J Orthod Dentofacial Orthop 2013;144:759-69.
ware, validation, original draft preparation, and
13. Nie X, Zhang X, Liu Y, Yan S, Men Y, Yu J, et al. Evaluation of
manuscript review and editing; Egon Mamboleo palate-related factors of the effectiveness of microimplant-
contributed to conceptualization, methodology, soft- assisted rapid palatal expansion in late adolescents and adults.
ware, validation, and manuscript review and editing; Clin Oral Investig 2023;27:3531-44.
Lauren Gilchrist contributed to methodology, software, 14. Salmoria I, de Souza EC, Furtado A, Franzini CM, Custodio W.
Dentoskeletal changes and their correlations after micro-implant-
validation, and manuscript review and editing; Khaled
assisted palatal expansion (MARPE) in adults with advanced midpa-
Alsharif contributed to supervision and manuscript latal suture ossification. Clin Oral Investig 2022;26:3021-31.
review and editing; Peter Ngan contributed to supervi- 15. Gupta V, Rai P, Tripathi T, Kanase A. Stress distribution and
sion, resources, and manuscript review and editing; Ali displacement with four different types of MARPE on craniofacial
Merdji contributed to manuscript review and editing; complex: a three-dimensional finite element analysis. Int Orthod
2023;21:100813.
and Osama Mukdadi contributed to conceptualization,
16. Cozzani M, Nucci L, Lupini D, Tripodi D, Noori N, Hasani M, et al.
supervision, and manuscript review and editing. Two different designs of mini-screw assisted maxillary expanders,
using FEM to analyse stress distribution in craniofacial structures
and anchor teeth. Int Orthod 2022;20:100607.
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American Journal of Orthodontics and Dentofacial Orthopedics December 2024
Vol 166
Issue 6