Observation of orthopedic force distribution produced by maxillary orthodontic appliances.

A three-dimensional anatomic model was duplicated from a human skull, using different birefringent materials to simulate the various craniofacial structures. Individual bones of the midface were fabricated separately and then articulated in their correct sutural relation. One removable and four fixed maxillary appliances were used. The fixed appliances included the Haas, Minne-expander, Hyrax, and quad helix devices. The removable appliance incorporated an expansion screw in a full acrylic palate with appropriate retentive clasps. After the insertion of each appliance, intraoral forces were produced by incremental activation. The model was examined and photographed in the field of a transmission polariscope. Each appliance used produced a different range of load-activation characteristics. This was reflected by the differences in the stresses transmitted through the bones of the craniofacial complex and the effect on the various sutures. Stresses produced by the fixed appliances were concentrated in the anterior region of the palate, progressing posteriorly toward the palatine bone. The Haas, Minne-expander, and Hyrax appliances produced stresses that radiated superiorly along the perpendicular plates of the palatine bone to deeper anatomic structures, such as the lacrimal, nasal, and malar bones, as well as the pterygoid plates of the sphenoid. Similar stress characteristics were seen with the removable appliance. However, increased activation decreased retention of the appliance, thereby lessening the stress. The quad helix appliance proved to be the least effective orthopedic device. Although the effects of palate separation were seen with increased activation, this appliance primarily affected the posterior teeth.