Objective: In orthodontics, non-surgical correction of a skeletal transversal discrepancy in adult patients is a challenge. The purpose of this study is to present a case report of an adult patient showing a maxillary transversal deficiency treated with a miniscrew assisted rapid palatal expansion (MARPE) and cortipuncture.
Case: A 35 year-old patient presenting a skeletal Class I relation with mandibular deviation to the right side, Class I malocclusion with transversal maxillary deficiency and unilateral crossbite. Treatment plan consisted on MARPE followed by fixed appliance. Due to the difficult in activating the jackscrew and aiming to obtain suture opening, cortipunctures using a 1.6mm x 7mm miniscrew were performed throughout the midpalatal suture in order to weaken bone resistance. After expansion, cone beam computed tomography images showed midpalatal suture opening, increase in maxillary intermolar width and minimal dental tipping.
Discussion and Summary: Although several methods to achieve skeletal expansion using miniscrew assisted palatal expanders have been proposed; in some cases opening the midpalatal suture may still be a hard task. This case report demonstrated that the combination of MARPE and cortipunctures might be a good alternative to facilitate suture opening and increase skeletal effect during expansion of adult patients.