Modified Maxillary Skeletal Expander For Thin Palatal Bone

This case presents the use of a modified Maxillary Skeletal Expander (MSE) for a patient with maxillary transverse deficiency and inadequate palatal bone thickness. A 28-year-old male with deep overbite and bilateral posterior crossbite showed buccal tipping of posterior teeth and minimal occlusal contacts. CBCT confirmed maxillary transverse deficiency (maxillary basal width: 53.6 mm; mandibular: 56.3 mm). Traditional MSE was contraindicated due to insufficient palatal bone thickness (1.8–2.2 mm). A hybrid anchorage system was used: Four miniscrews (1.8 × 11 mm) were placed in thicker bone areas: anterior miniscrews between the first and second premolars (bone thickness 2.7–2.9 mm) and posterior miniscrews between the second premolars and first molars (bone thickness 3.4–3.6 mm). Tooth-borne anchorage was reinforced with bands on the first premolar and molars. After 2 weeks of activation, CBCT revealed a 5.2 mm maxillary expansion, a parallel midpalatal suture opening, and improved posterior occlusion. In patients with thin palatal bone (<2 mm), risks like miniscrew failure or cortical fracture exist. This approach ensured stability by: Parasagittal implantation targeting bone-rich areas (≥2.7 mm thickness). Hybrid anchorage combining bone-borne MSE and tooth-borne support for optimized force distribution. CBCT-guided MSE with hybrid anchorage effectively addressed maxillary transverse deficiency in a patient with low bone thickness (1.8–2.2 mm). Proper site selection and biomechanical load sharing are essential for non-surgical skeletal expansion.