Distraction Osteogenesis for Maxillary Expansion (DOME) Therapy
Distraction Osteogenesis for Maxillary Expansion, which is also referred to as DOME was created at Stanford University. Dome is used to expand the upper jaw in adults.
In the past, maxillary expansion procedures have had unpredictable results. DOME, however, has consistently demonstrated positive results in improving nasal breathing and providing space for the tongue. These are both important factors for improving the breathing while sleeping.
Through the latest advances in orthodontics and minimally invasive facial surgery, a narrow, high arched palate can be transformed into a dome-shape palate.
A narrow maxilla is associated with various issues such as nasal obstruction, crowded teeth, and hindered facial development. This feature is also common amount patients who have obstructive sleep apnea (OSA). For children and young adults, a narrow maxilla can be expanded using a customized expander without the need for surgery. Before adulthood, the facial bone are fairly soft and pliable. For older patients, however, non-surgical treatments are not an option. Fortunately, with the DOME procedure, the operation is minimally invasive and can be performed in less than 30 minutes.
According to recent research published in 2017 by the American Academy of Otolaryngology, DOME was a promising treatment option for adults with obstructive sleep apnea who had high arched palates and were not successful with a CPAP treatment. Similar procedures have been found to be highly successful in the treatment of pediatric patients with OSA and high arched palates. It was only recently attempted in adult patients.
A joint study was recently conducted at Stanford University. The study was performed by the Division of Sleep Surgery, Department of Otolaryngology – Head & Neck Surgery, Stanford University School of Medicine; the Stanford University Sleep Medicine Division; the Department of Otolaryngology—Head & Neck Surgery, Cathay General Hospital, Taipei, Taiwan; the School of Medicine, Fu Jen Catholic University, Taipei, Taiwan and the Section of Pediatric Dentistry, Division of Growth and Development, UCLA School of Dentistry. The study included 20 adult patients who were on average 31.7 years-old and had obstructive sleep apnea with high arched palates. One of the selection criteria for the patients was based on their inability to tolerate continuous positive airway pressure (CPAP) treatment or traditional oral appliance treatment. They also had nasal floor width measurements which will be discussed in more detail later on.
Step 1: The Placement of the Maxillary Expander with Mini-implants. This procedure is performed by an Orthodontist. The maxillary expander is custom-fabricated to fit the narrow palatal vault using 4-6 mini-implants along the mid-palatal suture and in some cases, the ridge of the posterior teeth. The first step is typically completed by an orthodontist in their office under a local anesthesia. In this step, a customized maxillary expander and four to six mini-implants are installed in the roof of the mouth.
Step 2: The Maxillary osteotomy which is performed by a surgeon. Cuts are made in the upper jaw bone to allow for the desired expansion. Everyone ends up with a jaw anatomy similar to that of a child. Patients are typically observed overnight to ensure that pain is manageable. A liquid or soft diet is recommended for the first week. Once approved, the patient can return to a normal diet. The second step of the DOME is completed by an oral surgeon. This is often performed at an outpatient clinic under general anesthesia. In this portion of the procedure, the surgeon makes the natural ‘suture’ of bone in the palate deeper and wider. This causes a tiny gap between the two sides of the upper jaw.
Step 3: The expansion which is performed by the patient at home. After approximately five days, the patient will use a “key” to turn the expander daily. This part of the process is usually completed for about a month. Once complete, the new nasal floor is created and often results in a “gap” between the front teeth. The goal of the third step is to achieve a total expansion of about 8-10mm in a month.
Step 4: The re-establishment of normal occlusion which is performed by the orthodontist. During step four of the process, the orthodontist will apply braces as their office. The braces typically remain for about a year. They are used to close the gap, adjust the teeth and help to achieve a stable bite.
Possible Side Effects
It is common and expected for patients to experience a slight tingling or prickling sensation in the roof of their mouth. This can be especially prominent in the early weeks of treatment. This sensation is caused by the nerves in the roof of your mouth being stretched. The pain does go away as new tissue grow and the tension on the cells subsides.
Three people who were included in the earlier mentioned study experienced a small amount of bleeding inside their palates. Their front teeth were also temporarily darkened as they healed from the surgical portion of the procedure.
Overall, there were no cases of nasal infection, fistulas or malunion (of the bone ‘suture’) reported in the 20 patients included in the study. None of the patients lost any of teeth. While this is rare, it has happened in previous studies.
Improvements with DOME
The set of indices which were used in the study conducted at Stanford compare various measurements before and after DOME treatment. The comparisons used the demographic, subjective and objective parameters of Body Mass Index, Epworth Sleepiness Scale, Nose Obstruction Symptom Evaluation, Apnea-Hypopnea Index, Oxygen Desaturation Index, Effective Resistance Inspiration of each lung, and Nasal Floor Width both at the front of the mouth and at the back to determine improvements.
Easier breathing, improved oxygen saturation (ODI) and improved sleep quality and an improved smile paired with minimal risks or side effects makes DOME an appealing treatment option for adults who suffer from OSA and high arched palates.
Contact us today to discuss if you could benefit from distraction osteogenesis maxillary expansion (DOME) treatment.
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