Original Research Article

Stress Pattern and Deformation in Journal of Indian Orthodontic Society

55(3) 278­–284, 2021

Mid-palatal Suture and Posterior © 2020 Indian Orthodontic Society

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Dentoalveolar Area With Two Different DOI: 10.1177/0301574220961748
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Types of Rapid Maxillary Expansion
Appliances: A Finite Element Method Study

Nitya Shrivastava1 , Rakesh Thukral1, Ashish Garg1, Amit Tripathi1,

and Sunita Marothiya1

Abstract
Objective:The study was conducted to evaluate stress pattern and deformation in mid-palatal suture and posterior dentoalveolar
area during maxillary expansion therapy with two different types of rapid maxillary expansion by finite element method study.
Methods and Methodology: The finite element analysis was performed on a model of maxilla, with narrow maxillary base
and teeth digitally reconstructed, based on CBCT images, acquired by child (age 12.5 years) but not in permanent dentition
stage from available pool data.
Result: More amount of stress was observed in mid-palatal suture and posterior dental alveolar area by using the Hyrax
appliance as compared to the Haas appliance. Stress pattern evaluated in mid-palatal suture depicts maximum stress
concentration on the anterior region of mid-palatal suture at the position of incisive papilla. Deformation in maximum
quantity is observed in central incisors. Maximum stress generation and deformation are observed in lingual region of
premolar and molar areas. Minimum stress generation and deformation are observed in the posterior part of last molars.
Conclusion: Hyrax produces more stress and deformation in mid-palatal suture as well as in the posterior alveolar segment
in comparison to Haas appliance. Better results in the immediate skeletal response were obtained by the Hyrax-type expander
as compared to the Haas type.

Keywords
Hyrax, Haas, mid-palatal suture, FEM, RME

Received: 4 June 2020; Revised: 18 August 2020; Accepted: 28 August 2020

Abbreviations the posterior crossbite, to gain space, and to resolve maxillary

dental crowding.1-4 Rapid maxillary expansion treatment
FEM: finite element method most probably exerts forces of 15 to 50 N on the maxillary
RME: rapid maxillary expansion suture and para-maxillary structures, which prompt changes
in other skeletal structures adjacent to the maxilla as well.5
Introduction For proper diagnosis and assessment of the mid-palatal suture

In dentistry, if a constricted maxillary arch is diagnosed in 1

 epartment of Orthodontics and Dentofacial Orthopedics, Sri Aurobindo
D
an adolescent patient, the preferred treatment plan would be College of Dentistry, Indore, Madhya Pradesh, India
orthopedic expansion. Expansion appliances are commonly
Corresponding author:
used to correct the constriction present, involving separation Nitya Shrivastava, Department of Orthodontics and Dentofacial Orthopedics,
of the mid-palatal suture. Rapid maxillary expansion (RME) Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh 452001, India.
is usually performed to widen the maxilla in order to correct E-mail: [email protected]

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Shrivastava et al. 279

prior to RME, occlusal radiographs have been introduced developed from the pool data of CBCT of a child (age 12.5
by Revelo and Fishman.6 With increased skeletal growth years) but not in permanent dentition stage. Modeling of the
and development, progressive ossification in the circum- maxillary body was carried out, which included mid-palatal
maxillary sutures occurs along with increased thickness suture, teeth, cortical and cancellous bone along with RME
of the bony structures, decrease in their versatility, and appliances, that is, Hyrax and Haas on maxillary body. In
expanded interdigitation of the mid-palatal suture. Each of terms of bone, two different types—cancellous and cortical
these variables add to opposition in opening of the mid-palatal bones—were considered. The alveolar crest edge was thought
suture and stable expansion of the maxilla. Various studies to be 1.08 mm occlusal to the cementoenamel junction (CEJ)
have been conducted to assess widening of the nasal cavity, of the tooth and its property were appointed.13-16
reformation of the maxillary sinus, and changes in circum- Mid-palatal suture properties were allocated to the gap
maxillary sutures and even the sphenoid bone of the cranial junction between two palatal shelves. The geometry of the
base possible after RME treatment. maxilla and teeth were digitally reconstructed. Solid model
The finite element method (FEM) was developed in of teeth was constructed. A 3D model of conventional Hyrax
1943 by Richard Courant,7 which concentrates on statically expansion screw (Leone, Italy) was laser scanned using a
uncertain frameworks with relative precision. The finite white light 3D scanner (Figures 1 and 2). This expansion
element analysis (FEA) is a computer simulation technique screw was activated to perform 0.25 mm widening per turn,
used in orthodontics to analyze stress distribution in biologic and twice-a-day activation protocol was pursued. Then, a
systems such as periodontal ligament and alveolar bone, as
custom-fabricated Haas model was constructed, which was
well as to find the center of resistance of a tooth or group
laser scanned like the previous model to create a 3D image.
of teeth. Because of its consistency, precision, and cost
The material properties of the elements, which closely
adequacy with no unsafe experimentation, this technique
resembled tooth structures, alveolar bone, sutures, and
will be utilized in the present study. Rapid palatal expansion
stainless steel, were assumed to be isotropic, homogeneous,
(RPE) has been used as an effective treatment for growing
and linearly elastic. Specific Young’s modulus and Poisson’s
patients since its first introduction by Angell8 in 1860. Graber
ratios were assigned to different structures as given and
and Swain9 also upheld RME for the treatment of cleft lip and
palate. From that point of time, clinicians have progressively assessed by past investigations (Table 1).13-18
included RME in the treatment of their patients.
Rapid palatal expansion is mostly indicated in patients
having lateral discrepancies involving unilateral or bilateral
posterior crossbite or patients having severely constricted
arch.10,11 Bell12 stated in his studies that positive skeletal
treatment by RME results in correction of posterior teeth
discrepancy and asymmetric condylar position.
The thought process of this investigation is to evaluate the
stress magnitudes and directions along the mid-palatal suture
and to compare stresses generated in transverse axis by two
different kinds of RME appliances. Results of this study will
be helpful in predicting the prognosis of RME and will also Figure 1. Model of Hyrax Appliance
help orthodontists to clinically select one among two of the
commonly used RME appliances, namely Hyrax or Haas
appliance.

Materials and Methods

To pursue the motive of this study, it was required to
generate quality 3D mesh. This necessitated the utilization
of finite element software with good generation and meshing
facility for accurate stress analysis. Hence, it was decided
to use SolidWorks 2016 (Dassault Systèmes SolidWorks
Corporation, Waltham, MA), Pro Engineering (PTC) and
ANSYS 16.0 (Ansys, Inc., Canonsburg, PA) for the study.
The FEA was performed on a model of maxilla, with
narrow maxillary base, and teeth digitally reconstructed based
on CBCT images acquired by the patient. These images were Figure 2. Model of Haas Appliance
280 Journal of Indian Orthodontic Society 55(3)

Table 1. Mechanical Properties of Structures Stress Pattern and Deformation on Mid-palatal Suture by Hyrax
Appliance
Young’s Modulus
Materials (MPa) Poisson’s Ratio According to the stress pattern observed in mid-palatal
Dentin 18,600 0.30 suture, maximum stress has been observed in posterior most
Alveolar bone 490 0.30 part of the mid-palatal suture (Figures 4 and 5), and also the
Cortical bone 14,700 0.30 stress concentration was found higher on the anterior region
of mid-palatal suture at the position of incisive papilla (13.20
Stainless steel 200,000 0.30
MPa). So, overall maximum stress was concentrated on the
Suture 0.68 0.47
location of incisive papilla below the junction of two central
Source: Ownman-Moll, et al. (1996); Halazoneticz (1996). incisors and on the posterior most part of maxilla.
Deformation in maximum quantity is observed in central
incisors (0.0024 mm) (Figures 6 and 7), which degrades as we
move posteriorly. Maximum deflection can be seen in central
incisors, as they move apart during maxillary expansion.

Stress Pattern and Deformation in Posterior Dentoalveolar Area

According to the result obtained while applying the transverse
force along the mid-palatal suture, posterior teeth also
experienced the force and stress. Maximum stress generation
(1.4494 MPa) (Figure 8) and deformation (0.0021 mm)
Figure 3. Boundary and Loading Conditions in Maxillary Model (Figure 9) were observed in the lingual region of premolar
and molar areas. Minimum stress generation and deformation
The validation of the model was processed. After proper were observed in the posterior part of last molars.
validation, loading, and boundary conditions (Figure 3) were
assigned to the model. Boundary conditions were defined at all
peripheral nodes of the bone with zero degree of movement in
all directions so as to ascertain stress pattern and deformation
in mid-palatal suture and posterior dentoalveolar area.19
After all these conditions were checked, a tensile reciprocal
force of 15 pounds was applied along the X-axis of the last three
posterior teeth where Hyrax and Haas appliances were attached.
This computerized model was transferred to ANSYS software
(ANSYS WB 18.1). Stress distribution in the mid-palatal suture
was analyzed using ANSYS (version 12.1, ANSYSn Inc.,
Canonsburg, PA). Figure 4. von Mises Stress on Mid-palatal Suture After Applying
The numerical data in FEM produces colorful maps of Von HYRAX appliance
Mises stress and various principal stresses, named maximum
principal stress (MaxPS), middle principal stress (MidPS), and
minimum principal stress (MinPS), which were calculated for
whole study. Stress pattern and deformation value were measured
along the mid-palatal suture and posterior dentoalveolar area.

Results
Stress and Deformation Results From Hyrax Appliance
Initial analysis was carried out by placing Hyrax appliance
for applying transverse force. The boundary conditions and Figure 5. von Mises Stress Only Shown at Mid-palatal Suture After
force applied remained same for all the models. Applying HYRAX appliance
Shrivastava et al. 281

Stress and Deformation Results From Haas Appliance

Stress Pattern and Deformation on Mid-palatal Suture by Haas
Appliance
According to stress pattern observed in the mid-palatal suture,
maximum stress has been observed in the anterior region of
mid-palatal suture at the position of incisive papilla (10.33
MPa) (Figures 10 and 11), and also the stress concentration
was found to be higher on the posterior most part of mid-palatal
suture. So, overall maximum stress was concentrated on the
Figure 6. Deformation Pattern Calculated at Mid-palatal Suture
After Applying Hyrax Appliance
location of incisive papilla below the junction of two central
incisors and on the posterior most part of maxilla.
Deformation in maximum quantity was observed in central
incisors (0.0821 mm) (Figure 12), which degrades as we
move posteriorly. Maximum deflection can be seen in central
incisors as they move apart during the maxillary expansion.

Figure 7. Deformation Pattern Calculated at Mid-palatal Suture

After Applying Hyrax Appliance
Figure 10. von Mises Stress Only Shown at Mid-palatal Suture by
Haas Appliance

Figure 8. Deformation Pattern Calculated on Right Posterior by

Applying Hyrax Appliance Figure 11. Deformation Pattern Calculated at Mid-palatal Suture
by Haas Appliance

Figure 9. von Mises Stress on Mid-palatal Suture After Applying Figure 12. von Mises Stress Calculated on Posterior Tooth After
Haas Appliance Applying Haas Appliance for Maxillary Expansion
282 Journal of Indian Orthodontic Society 55(3)

Stress Pattern and Deformation on Posterior Dentoalveolar Area Discussion

According to the results obtained, while applying the
During the course of this study, a maxillary model consisting
transverse force along the mid-palatal suture, posterior teeth
of mid-palatal suture, teeth, palate, and alveolar bone was
also experienced the force with the generation of stress.
designed using CBCT model of a 12.5-year-old child.
Maximum stress generation (1.121 MPa) and deformation
Separately, Hyrax and Haas maxillary expansion appliances
(0.018 mm) were observed in the palatal region of premolar
were designed. With the help of this FEA study, we evaluated
and molar areas (Figure 13; Tables 2 and 3).
the magnitude of stress and deformation and their pattern
followed by comparing Hyrax and Haas.
According to Isacson et al,20 with a single turn of jackscrew
produces 3 to 10 pounds of force which will generate 20
pounds of force after multiplying all turn of a day. Separation
of central incisors occur between the 9th and 12th turns in all
the patients.
In our study, a force of 15 pounds2 was applied on the
palatal surface of premolar and molar areas in transverse
direction, applying the same boundary conditions on the
maxillary model for both the appliances, that is, Hyrax and
Figure 13. Deformation Pattern Calculated on Right Posterior Haas. Loading conditions were changed accordingly as
Tooth After Applying Haas Appliance each appliance clinically produces different load-activation
characteristics as per their designs.
The major difference between two types of appliances is
Table 2. Comparative Evaluation of von Mises Stress and Deformation the presence of band attachment in the Hyrax appliance and
Present in the Mid-palatal Suture and Posterior Dental Area by Hyrax acrylic pad in the Haas appliance. If we do consider the theory
and Haas Appliances given by Haas,21 better utilization of acrylic pad is to increase
the anchorage for better skeletal response during RME.
S. von Mises There are three types of stress simulated in this study: (a)
No. Location Stress (MPa) Deformation
maximum principal stress (MaxPS), (b) minimum principal
Mid-palatal 13.20 0.0024 mm stress (MinPS) and (c) Von Mises stress. All these values of
suture stress depict different properties and nature of stress. Von
1. Hyrax
Posterior 1.4494 0.0021 mm Mises stress is the most stable stress; it shows the equivalent
dental area stress that is used to determine whether a given material will
Mid palatal 10.33 0.0021 mm yield or fracture, which is mostly used for ductile materials.22
suture MaxPS shows the area undergoing the highest tension,
2. Haas
Posterior 1.121 0.0018 mm which is responsible for bone apposition, while MinPS shows
dental area the area undergoing the highest compression responsible for
bone resorption, thus play important role in bone remodeling.23
In the present study, maximum stress pattern has been
Table 3. Maximum and Minimum Stress Value Observed at the Mid- observed in the mid-palatal suture in the posterior most
palatal Suture by Hyrax and Haas Appliances part of mid palatal suture (Figure 9), and also the stress
concentration was found to be higher on the anterior region
Hyrax (Measured Haas (Measured of mid-palatal suture at the position of incisive papilla. So,
Stress in MPa) Stress in MPa) overall maximum stress was concentrated on the location of
Maximum principal stress incisive papilla below the junction of two central incisors
Max. 15.09 11.884 and on the posterior most part of maxilla. Deformation in
Min. −2.3908 −1.5982 maximum quantity is observed in central incisors (Figure
Middle principal stress 10), which degrades downward as we move posteriorly.
Maximum deflection can be seen in central incisors, as they
Max. 5.4678 4.109
Min. −3.34 −2.1685
move apart during the maxillary expansion.
According to results obtained from this research, the
Minimum principal stress Hyrax appliance produces more stress and deformation in
Max. 2.4526 1.7278 the mid-palatal suture as well as in the posterior alveolar
Min. −8.7427 −5.6302 segment (where the force is directly applied, ie, premolars
and molars) as compared to the Haas appliance. However,
Shrivastava et al. 283

various studies have been conducted by different authors Conclusion

between RME appliances by computerized cast analysis,19
laser scanning technique, and computed tomography.20 All From the results of our study, we concluded that:
these studies confirm that the Haas appliance demonstrated
1. The stress pattern evaluated in the mid-palatal
greater orthopedic movement, and the Hyrax appliance
suture that depicts maximum stress was found to be
demonstrated greater dentoalveolar expansion. Also,
higher on the anterior region of mid-palatal suture
a study conducted on RME appliances using 3D FEM
at the position of incisive papilla. Also the same
supports the theory that larger sutural displacement occurs
stress value was observed in the posterior most
with the Haas appliance.
part of the maxilla. So, overall maximum stress
In contrast to all the above-mentioned studies, the
was concentrated on the location of incisive papilla
results of our research can be clarified by different
below the junction of two central incisors and on the
appliance design: all the major differences appear because
posterior most part of maxilla.
of difference in anchorage supporting system, that is,
2. Deformation in maximum quantity was observed
connection of jackscrew with molar teeth. In the Hyrax-
in the central incisors, which degrades downward
type appliance, the jackscrew is directly associated with
as we move posteriorly. Maximum deflection was
the band of a rigid stainless steel wire, not at all like the
seen in the central incisors as they move apart during
Haas-type appliance, where the acrylic pad is in charge of
maxillary expansion.
interfacing the stainless steel structure to the jackscrew. As
3. According to the results obtained while applying the
per a past report about the biomechanics of RME, appliances
transverse force along the mid-palatal suture, some
which utilize an acrylic interface with the teeth are far less
amount of stress is also generated in the posterior teeth.
hardened than those developed exclusively of stainless steel
Maximum stress generation and deformation were
wire.17 However, the acrylic cushion would be significant,
observed in the palatal region of premolar and molar
particularly during retention period, when it would prevent
areas. Minimum stress generation and deformation
the bone from moving the teeth, thus preventing orthopedic
were observed in the distal part of last molars.
relapse of maxillary expansion.
4. According to this study, whenever load is applied
As this study was not carried out for long-term use and
on premolars and molars from the palatal side,
retention periods, we have only evaluated and assessed
the Hyrax appliance produces more stress and
the immediate effect of RME appliances. So, for better
deformation in the mid-palatal suture as well as in
understanding of long-term effect of both appliances, that
the posterior alveolar segment in comparison to Haas
is, Hyrax and Haas, specially during retention and post-
appliance. Better results in the immediate skeletal
retention period, further research is required. In the same
response were obtained by the Hyrax-type expander
way as other FEM research studies, this investigation also
as compared to the Haas type.
had restrictions because of the scientific model, as premises
and presumptions were used to create the FEM from a
Acknowledgments
solitary patient, which may not be totally similar to all the
inclusive community with individual variability just as I would like to thank Dr Ashish Garg and Dr Rakesh Thukral for guid-
ing me in the course of completing this article. I am immensely thank-
different clinical circumstances.
ful to Dr Bhavna Virang, Ex-Reader, Department of Orthodontics
It may be possible, that long term result of RME expansion
and Dentofacial Orthopedics, who has helped in making this article
appliance did not support this investigation as it is based on complete. I am obliged to her for being a constant source of helpful
quick impacts of expansion. Thus, we can conclude, that guidance to me throughout this period of dissertation. I am at loss for
if we do not consider long-term treatment duration and words in thanking Dr Geet Chaddha and Dr Shobhit Bajaj as their
basically focus on treatment responses within few months, constant encouragement and guidance have been my strength and
Hyrax provides better results than Haas. FEM elements in helped me throughout the course of this article. Process of FEM was
our model representing biological tissues were considered not possible without the help I received from my FEM engineers Mr
isotropic and solved with linear-elastic properties. Because Manoj Bangre, Mr Tushar Dongre, and Mr Deepak Shinde.
only one palatal suture was included in the FEM model and
the rest of the sutures were not considered, the results were Availability of Data and Material
obtained only in transverse axis and not in sagittal or vertical All data generated or analyzed during this study are included in this
direction. published article (and its supplementary information files).
The results of the present investigation, however, offer
probably right clinical potential outcomes, which must be Statement of Informed Consent and Ethical
kept in acknowledgment with guarded positive thinking. Approval
Hence, further research is expected to think about the impact Necessary ethical clearances obtained from institution,RC/2018/
of rapid maxillary expansion appliance on mid-palatal suture PG/08 ; informed consent not applicable due to in-vitro nature of
and dentoalveolar area. study
284 Journal of Indian Orthodontic Society 55(3)

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