Expansion on TADs: Limits and Possibilities

Over the past few years, TADs and skeletal anchorage have been changing profoundly many orthodontic protocols, characterizing itself as one of the most significant revolutions in orthodontics in the last 25 years. The possibilities of clinical use and the protocols proposed are the most varied. Among these, maxillary expansion certainly plays a leading role. Indeed, the possibility of using a palate expander with skeletal support instead of a dental one immediately fascinated orthodontists. These have in fact glimpsed the possibility of expanding the maxilla in subjects older than the usual one, minimizing or even completely eliminating possible undesirable effects related to the procedure. Indeed, the forces related to palatal expansion with the increasing of maxillary resistances could determine possible undesired dental effects, such as buccal tipping, decrease in buccal bone thickness and marginal bone levels, and volume loss and thinning of the anchor teeth. However, different and sometimes conflicting clinical protocols have been proposed for maxillary expansion on TADs during last years. Different perspectives and different point of view have sometimes claimed for different clinical approaches, suggesting different results. The aim of my lecture will be to deeply analyze the new clinical possibilities and advantages of maxillary expansion on TADs and relative scientific evidences or most innovative findings. Not less importantly, possible limits related to the protocol will be analyzed, comparing advantages and limits of different clinical protocols.