Application options and results

Submucosal application

Incision and osteotomy of the hard palate parallel to the suture

Submucosal application of the distractor

Distraction procedure started, palatal mucosa is closed

Retention period after distraction

Epimucosal application

Epimucosal application of the distractor

Epimucosally placed device after distraction

(3 weeks post-op) and start of the orthodontic treatment

Results

Orthodontic treatment during retention period

(3,5 months post-op)

Final view after distractor removal (4,5 months post-op)

Ordering Details
The Magdeburg Palatal Distractor
51-545-10 Palatal Distractor, 10 mm
51-545-15 Palatal Distractor, 15 mm

Recommended Instruments
50-900-00 Right angled screwdriver ASD, complete
50-911-22 Angled screwdriver bit Centre-Drive 2.0 mm
50-924-16 Twist Drill for ASD 2.0 mm screws

25-486-13 Modelling pliers

(two recommended)

51-512-90 Patient screwdriver, straight

51-517-90 Patient screwdriver,

combination straight + angled

48-350-24 Palatal fin-edge osteotome

1

Recommended Screws
25-662-05
25-662-07
25-662-09
25-663-47

Centre-Drive Titanium Mini Screws 2.0 x 5 mm (5 each)

Centre-Drive Titanium Mini Screws 2.0 x 7 mm (5 each)
Centre-Drive Titanium Mini Screws 2.0 x 9 mm (5 each)
Centre-Drive Titanium Mini Emergency Screws 2.3 x 7 mm (5 each)

25-672-05
25-672-07
25-672-09
25-673-47

Cross-Drive Titanium Mini Screws 2.0 x 5 mm (5 each)

Cross-Drive Titanium Mini Screws 2.0 x 7 mm (5 each)
Cross-Drive Titanium Mini Screws 2.0 x 9 mm (5 each)
Cross-Drive Titanium Mini Emergency Screws 2.3 x 7 mm (5 each)

10

10

10

10

alternative:
25-669-05 Centre-Drive Titanium Mini Drill Free Screws 2.0 x 5 mm (5 each)
25-669-07 Centre-Drive Titanium Mini Drill Free Screws 2.0 x 7 mm (5 each)
25-679-05 Cross-Drive Titanium Mini Drill Free Screws 2.0 x 5 mm (5 each)
25-679-07 Cross-Drive Titanium Mini Drill Free Screws 2.0 x 7 mm (5 each)

International Partners
in Oral, Plastic and
Craniomaxillofacial Surgery
06.03 . 90-136-02 . Printed in Germany
Copyright by Gebrder Martin GmbH & Co. KG
Alle Rechte vorbehalten.
Technische nderungen vorbehalten.
We reserve the right to make alterations.
Cambios tcnicos reservados.
Sous rserve de modifications techniques.
Ci riserviamo il diritto di modifiche tecniche.

KLS
Gebrder Martin GmbH & Co. KG
Ludwigstaler Strae 132 . D-78532 Tuttlingen
Postfach 60 . D-78501 Tuttlingen . Germany
Telefon +49 (0) 74 61 706-0
Telefax +49 (0) 74 61 706-193
info@martin-med.com
www.martin-med.com

Sales Organisation North America and Canada

KLS Martin L. P.
11239-1 St. Johns Industrial Parkway South
Jacksonville, Fl 32246
Office phone (904) 641-7746
Office fax
(904) 641-7378
WATS
(800) 625-1557

Distraction
Osteogenesis

The Magdeburg Palatal Distractor

for surgically assisted rapid maxillary expansion

www.martin-med.com

The Magdeburg Palatal Distractor

Introduction
In surgically assisted rapid palatal expansion, the transversal widening is achieved by using various expansion
devices fixated on the lateral teeth following bilateral
osteotomy of the lateral maxilla and, if needed, the median
palatine suture. Possible complications include tilting or
extrusion of supporting teeth, gingiva recession and alveolar process fenestration. Such unwelcome side effects are
not to be expected if a bone-supported palatal distractor is
used, due to the physical widening of the maxillary halves.

Benefits
Safe and symmetrical physical movement of the
two maxillary halves
High retention stability, no relapses
Since the distractor is directly fixed to the palatal
bones, root resorption, buccal fenestration and tooth
tilting is prevented. Missing lateral teeth are no
contraindication.
Allows simultaneous orthodontic multi-band treatment
to form the dental arches; this means a significant
further reduction of overall treatment times.
Easy handling by the patient and great comfort in
wearing the device

High degree of patient safety thanks to non-dividible

device design (no loose components)

51-545-10 Palatal Distractor, 10 mm

51-545-15 Palatal Distractor, 15 mm

Design of the distractor

Indications

The functional component of this bidirectional enoral

distractor (ref. no. 51-545-10/-15) consists of a cylindrical body with two longitudinal slide bearings.
The cylinder incorporates an angular drive with a
central spindle featuring two counteracting threads
(a right-handed and a left-handed one).
At the beginning of each thread, an offset bar with an
internal thread is located. Each of these bars connects
to a 4-hole miniplate located at a right angle to the
cylinder body.

Narrow maxilla (severe cases)

The distractor is activated transorally, using a

special distraction screwdriver (ref. no. 51-512-90
resp. 51-517-90).
One full turn is equivalent to a distraction length
of 0.2 mm. A daily distraction distance of 0.4 mm
is recommended.

Disproportion between tooth size and size of maxilla

Angle class II and III patients
Cleft patients
Stenosis of the nasal meati

Contra-indications
Insufficient bone volume or quality so that a secure
planning of the distraction is not possible.
A general contraindication is a bad health condition:
immune deficiency irradiated patients.

Developed in cooperation with

Prof. Dr. Dr. K.-L. Gerlach, Dr. Chr. Zahl
Dept. of Oral & Maxillofacial Surgery
O-v-G-University Magdeburg, Germany

Surgical approach
Bilateral vestibular mucosal incision
Exposure of the facial maxillary sinus walls
Osteotomy from the priform aperture to the
maxillary tuber
Weakening the connection between the tuber
and the pterygoid process is recommended
Bilateral osteotomy parallel to the palatal suture
(alternatively after elevating the nasal floor
mucosa using the fin-edge osteotome ref. no.
48-350-24)
Either from a nasal approach beyond the
piriform aperture or transorally by a direct
palatal approach
Distractor is adapted to the anatomical
conditions of the palate.
Transmucosal fixation of the 2.0 mm titanium
screws, either self-cutting with pre-drilling
(ref. no. 25-662-05) or self-drilling without
pre-drilling (ref. no. 25-669-05)

Application options
This distractor offers three different application
options, to be used according to the indication
(age of patient, maxillary anomaly, operating
space).
1. Submucosal application after stripping the
palatine mucousa

Alternatively epimucosal application with

2.0 x 7 or 9 mm titanium screws is possible
(ref. nos. 25-662-07/-09 or 25-669-07).
Following fixation, functional test by activating
2 mm and reset to starting position

Distraction protocol
Latency period: 6 days

2. Epimucosal application

Distraction of 0.4 mm per day with patient

screwdriver (ref. no. 51-520-90), two full
360 turns per day

3. Transmucosal application following a short

sagittal incision of the palatine mucosal just
below the supporting miniplates.

Retention period after distraction: 3 months

Orthodontic multi-band treatment can already
be started or continued during retention period.
NOTE: In clinical use, no mucousal pressure
necroses have been observed below the base
of the plate in any of the cases where the
distractor was applied epimucosally.

Procedures for children

and adolescents

7. Langford SR, Sims MR:

Root surface resorption, repair, and periodontal attachment
following rapid maxillary expansion in man.
Am J Orthod 1982; 81: 108-115

Basically, the distractor can also be used for

accelerated palatine suture expansion in children.
In this case, however, it is usually preferable to
employ the smaller device, which must be applied
transmucosally.

8. Lehman JA, Haas AJ:

Surgical-orthodontic correction of transverse maxillary
deficiency.
Dental Clin North Am 1990; 2: 385-395

The surgically supported widening of the maxilla

as described above is a procedure that should only
be used after the transitional dentition phase has
been completed, as otherwise tooth buds might
be damaged. Osteotomies of the pterygomaxillary
sutures are usually unnecessary. If palatine suture
osteotomy is required, it can always be performed
in these cases starting from the nasal aperture
after elevating the nasal floor mucosa.

Bending procedure
To avoid distractor plate damage during the
bending procedure, please use always two
bending pliers ref. no. 25-486-13.

Bibliography
1. Bays RA, Greco JM:
Surgically assisted rapid palatal expansion:
An outpatient technique with long-term stability.
J Oral Maxillofac Surg 1992; 50: 110-113
2. Bell WH, Epker BN:
Surgical-orthodontic expansion of the maxilla.
Am J Orthod 1976; 50: 517-528
3. Derichsweiler H.:
Die Gaumennahterweiterung. Methode, Indikation
und klinische Bedeutung.
Mnchen, Carl Hanser, 1956
4. Feller K-U, Herzmann K, Schimming R, Eckelt U:
Gaumennahtsprengung nach Glassman. Erfahrungen bei
mono- und bimaxillaren Dysgnathieoperationen.
Mund Kiefer GesichtsChir 1998; 2: 26-29
5. Glassman AS, Nahigian SJ, Medway JM, Aronowitz HI:
Conservative surgical orthodontic adult rapid palatal
expansion: Sixteen cases.
Am J Orthod Dentofacial Orthop 1984; 86: 207-213
6. Kraut RA:
Surgically assisted rapid maxillary expansion by opening
the midpalatal suture.
J Oral Maxillofac Surg 1984; 42: 651-655

9. Mommaerts MY:
Transpalatal distraction as a method of maxillary expansion.
Br J Oral Maxillofac Surg 1999; 37: 268-272
10. Moss JP:
Rapid expansion of the maxillary arch.I:.
J Pract Orthod 1968; 2: 165-165
11. Moss JP:
Rapid expansion of the maxillary arch. II: Indications
for rapid expansions.
J Pract Orthod 1968; 2: 215-223
12. Neubert J, Somsiri S, Howaldt H-P, Bitter K:
Die operative Gaumennahterweiterung durch eine
modifizierte Le-Fort-I-Osteotomie.
Dtsch Z Mund Kiefer GesichtsChir 1989; 13: 57-64
13. Neyt NMF, Mommaerts MY, Abeloos JVS,
De Clercq CAS, Neyt LF:
Problems, obstacles and complications with transpalatal
distraction in non-congenital deformities.
J Cranio Maxillofac Surg 2002; 30: 139-143
14. Pinto PX, Mommaerts MY, Wreakes G, Jacobs W:
Immediate postexpansion changes following the use of the
transplatal distractor.
J Oral Maxillofac Surg 2001; 59: 994-1000
15. Strmberg C, Holm J:
Surgically assisted, rapid maxillary expansion in adults.
A retrospective long-term follow-up study.
J Cranio Maxillofac Surg 1995; 23: 222-227
16. Timms DJ, Moss JP:
An histological investigation into the effects of rapid maxillary
expansion on the teeth and their supporting tissues.
Trans Eur Orthod Soc 1971: 263-271
17. Timms DJ:
The relationship of rapid maxillary expansion to surgery,
with special reference to midpalatal synostosis.
Br J Oral Surg 1981; 19: 180-196
18. Treutlein C, Swennen G, Berten JL, Schwestka-Polly R:
Transpalatinale Distraktion - eine alternative Methode der
transversalen Expansion des Oberkiefers.
Dtsch Zahnrztl Z 2002; 57S: 19
19. Zahl Chr, Gerlach KL:
Der Palatinaldistraktor - ein innovativer Ansatz fr die
Gaumennahterweiterung.
Mund Kiefer GesichtsChir 2002; 6: 446-449