Principals for placement and expansion protocol for the bone-first Quadexpander in adolescents and adults

Abstract

Transverse maxillary deficiency is a common malocclusion in orthodontics, particularly challenging to treat in adults due to increased resistance from the midpalatal suture and circummaxillary sutures. Traditional tooth-borne expansion methods are effective in children but cause significant dental side effects in older patients. Surgically assisted rapid maxillary expansion (SARME) is invasive, leading to the development of minimally invasive, miniscrew-supported devices like the Quadexpander. The Quadexpander is a purely bone-borne appliance anchored by four miniscrews, designed using the "Bone First" principle, which prioritizes optimal bone quality for screw placement. This custom-designed appliance avoids the negative side effects on teeth associated with hybrid devices and allows for effective skeletal expansion in adults. The article discusses the TAD insertion sites, design, placement, and activation protocols of the Quadexpander, emphasizing its advantages in achieving non-surgical maxillary expansion with minimal complications.