Can Changing the Transverse Dimension Improve the Quality of Orthodontic Treatment in Children? Dr. Roberta Lione AAO June 2021. Episode 101

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Farooq Ahmed

Can Changing the Transverse Dimension Improve the Quality of Orthodontic Treatment in Children? Dr. Roberta Lione


Malocclusion is not a disease, but rather a set of dental deviations which in some cases can influence quality of life


·      Quality of life

o   RME can improve the QOL McNamara 2015



Presentation of narrow maxilla:

·      Facial presentation

o   Underdeveloped midface

o   Narrow pharangeal airway

o   Increased nasal resistance

o   Mouth breathing

o   Altered tongue position



AOB presentation

·      Maxillary narrow in AOB cases compared to normal growing patients

o   Mechanical blockage of the incisors and anterior maxilla

o   Poor upper tooth to lip

o   Reduced gingival show on smiling

·      Palatal morphology of AOB Vs control Lagena 2018

o   Difference in AP and vertical morphology of palate

o   AOB palates higher and narrower than control

o   AOB cases narrow maxilla and mandible Balanti 2009

o   Narrow nose, narrow alar base, narrow zygomatic and mandible

·      Functional imbalance

o   Excessive vertical growth in the maxilla

o   Clockwise rotation of growth



Treatment modalities

1.     Orthodontic therapy – dentoalveolar openbites

a.     Quadhelix with spurs – eliminate digit sucking habit. Jones 1989, Henry 1993

2.     Orthopaedic approach

a.     RME – skeletal origin of AOB (hyperdivergent cases)

b.     Lower removable bite blocks

                                               i.     5mm lower bite block


RME and lower removable bite block treatment for AOB

·      Expansion allows spontaneous eruption of the upper incisors (narrow arch resulting in mechanical obstruction in vertical eruption)

·      Expansion can increase the vertical dimension, to control the vertical dimension bite blocks in the lower arch can be used


Evidence Lione 2017 AJODO

1 year of RME and bite block

·      Significant rotation of mandibular rotation

·      Improve AOB by 2mm

·      LAFH decrease by 1.5mm


Stability long term Mucedero 2018

·      Maintained reduced extrusion of molars, when compared to untreated AOB cases

·      Overbite 1.8mm greater in treated group Vs control


 Effects of RME on facial pattern in AOB cases Lione 2019

·      Changes of patients cephalogram analysis

·      Effect of RME

o   Increase in ramu height / posterior face height

o   Counter clockwise rotation of the mandible

o   Reduced steepness of occlusal plane

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