Comparative Evaluation and Correlation of Three Dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander as Against Niti Expander in Class Ii Cases With Maxillary Constriction - a Fem Study

Comparative Evaluation and Correlation of Three Dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander as Against Niti Expander in Class Ii Cases With Maxillary Constriction - a Fem Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Evaluation and Correlation of Three Dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander as Against Niti Expander in Class Ii Cases With Maxillary Constriction - a Fem Study Srushti Atole, Ranjit Kamble, Sumukh Nerurkar, Japneet Kaiser, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6579552/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Maxillary constriction, a common malocclusion characterized by reduced transverse maxillary width, is often associated with Class II skeletal patterns and posterior crossbite. It disrupts craniofacial balance and may contribute to functional issues like dental crowding and airway obstruction. While rapid maxillary expansion is widely used, slow maxillary expanders (SMEs) offer a more conservative, stable alternative. The Sawangi Flexiforce Expander (SFE), a novel stainless-steel SME, is designed to provide controlled skeletal and dentoalveolar expansion. This study evaluates the three-dimensional skeletal and dentoalveolar effects of SFE compared to the conventional NiTi expander using Finite Element Analysis (FEA). OBJECTIVE To compare and correlate the three-dimensional skeletal and dentoalveolar effects produced by the SFE and NiTi expander in Class II cases with maxillary constriction using the Finite Element Method. METHODS A high-resolution CT scan of a 13-year-old girl with Class II malocclusion was used to generate a 3D geometric skull model. The NiTi and SFE appliances were digitally modelled and positioned on the maxillary arch. Material properties and boundary conditions were assigned based on the literature. The model was meshed into 2,53,378 elements and analyzed using ANSYS software. Von Mises stress (MPa) and displacement (mm) were measured at various dental, dentoalveolar, and skeletal landmarks for both expanders. A statistical comparison was made using the students' unpaired t-test and Pearson’s correlation coefficient. RESULTS SFE showed significantly higher displacement than the NiTi expander across all planes—transverse (X), sagittal (Y), and vertical (Z)—with the greatest movement at the first permanent molar. Von Mises stress levels increased with activation, reaching effective expansion thresholds only at 3mm activation for SFE. Although SFE produced relatively higher stress values, differences were not statistically significant. Both appliances showed a strong, statistically significant positive correlation between stress and displacement, with SFE demonstrating greater skeletal effects and NiTi primarily inducing dentoalveolar changes. CONCLUSION The SFE appliance exhibited superior three-dimensional skeletal and dentoalveolar displacement compared to the NiTi expander. The positive correlation between stress and displacement confirms its biomechanical efficacy, making SFE a promising alternative for managing Class II malocclusions with maxillary constriction. Maxillary constriction Class II malocclusion NiTi expander Sawangi Flexiforce Expander (SFE) Three-dimensional displacement Von Mises stress Finite Element Analysis (FEA) Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 BACKGROUND Maxillary constriction, a common form of malocclusion, is characterized by a reduced transverse width of the maxilla and often presents with features such as a narrow arch and dental crowding ( 1 ). It frequently manifests as a posterior crossbite, with a reported prevalence of 0.99% among the Indian population ( 2 ). Early intervention is crucial to prevent progression and maintain both functional and aesthetic outcomes. Maxillary constriction can be associated with other malocclusions, such as Class II and III, particularly with a hypoplastic maxilla. Notably, Class II malocclusions tend to exhibit significantly narrower maxillary dimensions ( 3 ). Transverse maxillary deficiencies are typically corrected using orthodontic and orthopaedic methods that expand the palate ( 4 ). Emerson C. Angel, regarded as the pioneer of expansion therapy, introduced arch expansion to manage such conditions ( 5 ). Expansion techniques can be categorized based on the nature of applied forces: active or passive, and the target structure: orthopaedic (skeletal) or orthodontic (dentoalveolar). Active expansion applies direct force to the teeth or bones, while passive expansion depends on natural muscle forces. Rapid Maxillary Expansion (RME) is a widely used active technique for skeletal expansion that separates the mid-palatal suture, ideally in patients under 13–15 years of age ( 6 ). Although effective, RME can cause side effects such as discomfort, relapse, root resorption, and bone loss ( 7 ). RME can be achieved with both removable appliances (e.g., split acrylic plates) and fixed appliances like HYRAX, Hass, or Derichsweiler expanders. In contrast, Slow Maxillary Expansion (SME) uses light, continuous forces that are more physiologically compatible and cause fewer side effects ( 8 ). Devices such as quad helix, jackscrews, and NiTi expanders are commonly used for SME. The NiTi expander, developed from a thermally activated nickel-titanium alloy, offers consistent, superelastic forces over time but lacks customization options ( 9 ). The Sawangi Flexiforce Expander (SFE) is a slow palatal expander introduced by the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College. The appliance was filled for Patent (under the examination process, Application No. 20231076157). It is an innovative, stainless-steel appliance offering both anterior and posterior expansion through a central helix and loops. It delivers light, consistent forces, is cost-effective, and can be customized for individual cases—advantages over standard NiTi expanders. To evaluate the biomechanical performance of these expanders, the Finite Element Method (FEM) is employed. Originally developed in engineering, FEM enables accurate simulation of stress and strain within biological tissues and has become a vital tool in orthodontic research. However, limited FEM-based studies exist comparing SFE and NiTi expanders. To address this gap, the present study compares the three-dimensional skeletal and dentoalveolar effects of SFE and NiTi expanders in Class II patients with maxillary constriction. The null hypothesis assumes no significant difference between them, while the alternate hypothesis suggests a significant difference exists. MATERIALS AND METHOD The study was carried out in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College, located in Sawangi (M), Wardha, in partnership with DICUL AM Private Limited, Nagpur. The study commenced following approval from the Institutional Research Ethics Committee of Datta Meghe Institute of Higher Education and Research (Deemed to be University). Ethical clearance was granted on 06/02/2023, with reference number {DMIHER(DU)/IEC/2023/574}. The patient selection criteria were as follows. Inclusion criteria: Class II malocclusion with functional retrusion of the mandible. Patients with a constricted maxilla with or without a posterior crossbite. Pubertal age patients. Exclusion criteria: Patients with severe vertical growth pattern. Patients with a wide mandibular arch width. Patients with Class III malocclusion Patients with craniofacial deformities. Patients with a history of previous orthodontic treatment. Patients with a history of any trauma or surgery Sample Selection: A single patient was selected randomly from the patients attending the Outpatient Department (OPD) of the Orthodontics and Dentofacial Orthopaedics Department, Wardha. A 13-year-old female patient with skeletal Class II malocclusion was chosen for a CT scan of the skull. Selection was made in accordance with the predefined inclusion and exclusion criteria. The research aims and objectives were thoroughly explained to the patient’s parents, and their informed consent for the CT scan was obtained. METHODOLOGY I] Preparation of Model: To prepare the model, high-resolution CT scan images of a 13-year-old girl’s skull were obtained using a SIEMENS SOMATOM SCOPE 32-slice scanner, capturing 581 sequential axial images at 1 mm intervals for enhanced anatomical detail. These images were processed using GEOMAGIC FREEFORM software to create a precise 3D geometric model of the skull. Both the NiTi and Sawangi Flexiforce Expander (SFE) were also digitally modelled in the same software based on their clinical specifications and accurately positioned on the maxillary arch to simulate real-life application. The geometric skull model was then converted into a finite element model through meshing, a process in which the anatomy was divided into interconnected triangular (polygonal) elements using the Delaunay triangulation method. This meshing produced a highly detailed finite element model comprising 2,53,378 elements and 4,09,701 nodes, enabling a realistic simulation of mechanical behaviour under expansion forces. II] Defining Mechanical properties to the model: The mechanical properties (Young’s modulus and Poisson’s ratio) of the tooth, cortical bone, cancellous bone, suture, periodontal ligament, stainless steel and nickel-titanium in the model were defined according to the experimental data in previous studies, as shown in Table 1 Table 1: Material properties used in the Model Materials Young’s Modulus Poisson’s Ratio N/mm 2 Mpa Teeth(10) 20×10 3 20000 0.3 Compact Bone (10,11) 9.04×10 3 9042 0.3 Cancellous Bone(10) 7.9×10 2 7900 0.3 Nickel Titanium(12) 110×10 3 110000 0.35 Stainless steel(13) 190×10 3 -210×10 3 190000-210000 0.3 III] Laying boundary conditions: After assigning mechanical properties to the model, boundary conditions were established by restraining all cranial nodes except those at anatomical landmarks intended for stress and deformation analysis. The coordinate system defines displacements along the transverse (X), sagittal (Y), and vertical (Z) planes, with positive values indicating outward, backwards, and upward movement, respectively. The NiTi expander was activated using a standard 3-mm expansion, producing a force of 350 g (14), while the SFE was activated with 1-, 2-, and 3-mm increments. These activations induced stress and displacement across various skull regions. The complete finite element model, including skull, teeth, and periodontal ligament (PDL), was imported into ANSYS software for simulation. ANSYS was used to calculate the stress and displacement patterns, and in the final post-processing stage, contour plots were generated to represent the resulting forces and deformations visually. Von Mises stress distribution in MPa and displacement in millimetres (mm) was studied at the following landmarks of the skull model using FEM. Dental landmarks: a. Contact point between central incisors b. Cusp tip of canines c. Central pit of first permanent molars d. CEJ of central incisors, canines, and first permanent molars Dentoalveolar landmarks: a. Apical region of central incisors b. Apical region of canines c. Apical region of first permanent molars Skeletal landmarks: a. Mid-palatine suture- anterior tip and posterior tip b. Anterior nasal spine c. Nasal septum d. Internasal suture e. Nasomaxillary suture f. Frontonasal suture g. Frontomaxillary suture h. Zygomaticomaxillary suture i. Zygomaticofrontal suture j. Zygomaticotemporal suture k. Pterygomaxillary suture STATISTICAL ANALYSIS Statistical analysis was conducted to compare and assess the three-dimensional effects of both expanders on the nasomaxillary complex. Descriptive and inferential statistics were employed, utilizing the student’s unpaired t-test and Pearson’s correlation coefficient. The analysis was performed using SPSS software version 27.0, with a significance level set at p<0.05. RESULTS The three-dimensional skeletal and dentoalveolar effects observed in this study were evaluated under the following sections: · Von Mises stress distribution over the nasomaxillary complex after the activation of both expanders. · Displacements of various landmarks in all three planes produced after the activation of both expanders I. VON MISES STRESS DISTRIBUTION TABLE 2: Stress Distribution [Von Mises stress (Mpa)] at skeletal and dentoalveolar landmarks produced by different amounts of activation of SFE Regions Selected landmark Amount of Activation 1mm 2mm 3mm Dental Contact point between central incisors 0.000059 0.0008 0.045 Cusp tip of canines 0.00009 0.0012 0.026 Central pit of 1 st permanent molars 0.0075 0.0012 0.915 CEJ of central incisors 0.000002 0.00078 0.0048 CEJ of canines 0.000007 0.00001 0.0095 CEJ of 1 st permanent molars 0.000058 0.0086 0.0128 Dentoalveolar Apical region of central incisors 0.000009 0.00004 0.0014 Apical region of canines 0.000012 0.00089 0.0038 Apical region of 1 st permanent molars 0.00067 0.00015 0.0056 Skeletal Midpalatine suture- anterior tip 0.00086 0.0046 0.365 Midpalatine suture-posterior tip 0.00007 0.00029 0.055 Anterior nasal spine 0.00056 0.0024 0.0625 Nasal Septum 0.00028 0.0018 0.095 Internasal Suture 0.00087 0.0056 0.0785 Nasomaxillary suture 0.00004 0.00073 0.0032 Frontonasal suture 0.00006 0.0089 0.0279 Frontomaxillary suture 0.000001 0.000046 0.00095 Zygomaticomaxillary suture 0.00007 0.00037 0.0059 Zygomaticofrontal suture 0.00002 0.00068 0.0755 Zygomaticotemporal suture 0.00004 0.0009 0.0395 Pterygomaxillary suture 0.00009 0.00018 0.0218 TABLE 3: Mean Values of Stress distribution produced by different amounts of activation of SFE Amount of activation Region Mean (Mpa) Std. Deviation N 1mm Dental 0.001286 0.0027 6 Dentoalveolar 0.00023 0.0003 3 Skeletal 0.000247 0.0003 12 Total 0.000541 0.0015 21 2mm Dental 0.002098 0.0029 6 Dentoalveolar 0.00036 0.0003 3 Skeletal 0.0022 0.0026 12 Total 0.00191 0.0026 21 3mm Dental 0.16885 0.3339 6 Dentoalveolar 0.0036 0.0017 3 Skeletal 0.0692 0.094 12 Total 0.0883 0.2 21 Table 3 summarizes the mean Von Mises stress (in MPa) and standard deviation across dental, dentoalveolar, and skeletal regions for 1mm, 2mm, and 3mm activations of the Sawangi Flexiforce Expander (SFE). Stress levels increased progressively with activation. In the dental region, stress rose from 0.001286 MPa (1mm) to 0.16885 MPa (3mm), while skeletal stress increased from 0.000247 MPa to 0.0692 MPa over the same range. Total mean stress also followed this upward trend, from 0.000541 MPa (1mm) to 0.0883 MPa (3mm). Stress levels at 1mm and 2mm activations were below the threshold typically required for effective maxillary expansion. However, the 3mm activation of the SFE produced stress within the effective range, making it a suitable level for comparison with the NiTi expander, which was activated according to its standard protocol in this study. TABLE 4: Stress Distribution [Von Mises stress (Mpa)] at skeletal and dentoalveolar landmarks produced by activation of SFE and NiTi Expander (3mm) Regions Selected landmark Expander SFE NiTi Dental Contact point between central incisors 0.045 0.015 Cusp tip of canines 0.026 0.013 Central pit of 1 st permanent molars 0.915 0.756 CEJ of central incisors 0.0048 0.0036 CEJ of canines 0.0095 0.0083 CEJ of 1 st permanent molars 0.0128 0.0098 Dentoalveolar Apical region of central incisors 0.0014 0.0009 Apical region of canines 0.0038 0.0024 Apical region of 1 st permanent molars 0.0056 0.0035 Skeletal Midpalatine suture- anterior tip 0.365 0.322 Midpalatine suture-posterior tip 0.055 0.045 Anterior nasal spine 0.0625 0.0554 Nasal Septum 0.095 0.105 Internasal Suture 0.0785 0.0719 Nasomaxillary suture 0.0032 0.0024 Frontonasal suture 0.0279 0.0209 Frontomaxillary suture 0.00095 0.00071 Zygomaticomaxillary suture 0.0059 0.0052 Zygomaticofrontal suture 0.0755 0.0679 Zygomaticotemporal suture 0.0395 0.0384 Pterygomaxillary suture 0.0218 0.0185 TABLE 5: Comparison of Von Mises stress (in MPa) across different regions between the SFE and NiTi Expander Regions SFE NiTi t-value p-value Dental 0.16±0.36 0.13±0.30 0.17 0.86 Dentoalveolar 0.003±0.002 0.002±0.001 0.93 0.40 Skeletal 0.069±0.098 0.062±0.087 0.17 0.86 Overall 0.088±0.20 0.074±0.171 0.23 0.81 # P-value derived from student’s Unpaired t-test The mean Von Mises stress (MPa) was compared between the Sawangi Flexiforce Expander (SFE) and NiTi expander across dental, dentoalveolar, and skeletal regions. In the dental region, stress was slightly higher in the SFE group (0.16 ± 0.36 MPa) compared to the NiTi group (0.13 ± 0.30 MPa). Similarly, dentoalveolar and skeletal stress values were marginally greater in the SFE group (0.003 ± 0.002 MPa and 0.069 ± 0.098 MPa, respectively) than in the NiTi group (0.002 ± 0.001 MPa and 0.062 ± 0.087 MPa). Overall mean stress in the nasomaxillary complex was 0.088 ± 0.20 MPa for SFE and 0.074 ± 0.171 MPa for NiTi. However, statistical analysis using an unpaired t-test revealed no significant differences (p > 0.05) between the two groups in any region, indicating that while SFE produced slightly higher stress levels, the differences were not statistically significant. II. DISPLACEMENTS OF VARIOUS LANDMARKS TABLE 6: Displacement (mm) in X (Transverse), Y(Sagittal), And Z(Vertical) Axis produced by activation of SFE and NiTi expander at all the selected landmarks Regions Selected landmark SFE NiTi X Y Z X Y Z Dental Contact point between central incisors 0.914 0.082 -0.045 0.02 0.01 -0.002 Cusp tip of canines 0.593 0.03 -0.036 0.01 0.001 -0.05 Central pit of 1 st permanent molars 1.43 0.037 -0.038 0.4 0.014 -0.014 CEJ of central incisors 0.152 0.082 -0.043 0.01 0.001 -0.03 CEJ of canines 0.045 0.029 -0.041 0.01 0.002 -0.006 CEJ of 1 st permanent molars 1.137 0.086 -0.077 0.09 0.01 -0.045 Dentoalveolar Apical region of central incisors 0.092 0.039 -0.045 0.01 0.01 -0.01 Apical region of canines 0.037 0.017 -0.038 0.02 0.001 -0.015 Apical region of 1 st permanent molars 0.08 0.082 -0.053 0.03 0.002 -0.009 Skeletal Midpalatine suture- anterior tip 0.05 0.042 -0.045 0.02 0.001 -0.02 Midpalatine suture-posterior tip 0.009 0.0087 -0.0017 0.01 0.002 -0.003 Anterior nasal spine 0.089 0.034 -0.004 0.002 0.001 -0.04 Nasal Septum 0.051 0.036 -0.004 0.01 0.007 -0.001 Internasal Suture 0.005 0.0003 -0.003 0.0003 0.00006 -0.0005 Nasomaxillary suture 0.0038 0.007 -0.0009 0.0002 0.0003 -0.0002 Frontonasal suture 0.0011 0.0067 -0.004 0.0003 0.00001 -0.002 Frontomaxillary suture 0.00023 0.0008 -0.0031 0.0001 0.0002 -0.002 Zygomaticomaxillary suture 0.007 -0.006 -0.02 0.002 -0.0001 -0.02 Zygomaticofrontal suture 0.005 -0.009 0.005 0.003 -0.001 0.006 Zygomaticotemporal suture 0.008 -0.007 -0.06 0.001 -0.0001 -0.009 Pterygomaxillary suture 0.043 -0.0077 -0.045 0.002 -0.001 -0.007 TABLE 7: Comparison of Displacement(mm) score in SFE and NiTi expander for X-Axis Regions SFE NiTi t-value p-value Dental 0.71±0.54 0.09±0.15 2.66 0.024 Dentoalveolar 0.06±0.02 0.02±0.01 2.81 0.048 Skeletal 0.02±0.02 0.004±0.006 2.18 0.040 Overall 0.22±0.41 0.03±0.08 2.09 0.043 # P-value derived from student’s Unpaired t-test The study compared X-axis displacement (in mm) between the Sawangi Flexiforce Expander (SFE) and NiTi expander across dental, dentoalveolar, skeletal, and overall regions. The SFE group showed significantly greater displacement in all regions: dental (0.71 ± 0.54 mm vs. 0.09 ± 0.15 mm), dentoalveolar (0.06 ± 0.02 mm vs. 0.02 ± 0.01 mm), skeletal (0.02 ± 0.02 mm vs. 0.004 ± 0.006 mm), and overall nasomaxillary complex (0.22 ± 0.41 mm vs. 0.03 ± 0.08 mm), compared to the NiTi group. The differences in displacement were statistically significant (p < 0.05), indicating that the SFE expander produces greater transverse expansion than the NiTi expander. TABLE 8: Comparison of Displacement(mm) score in SFE and NiTi Expander for Y-Axis Regions SFE NiTi t-value p-value Dental 0.05±0.02 0.006±0.005 4.35 0.001 Dentoalveolar 0.046±0.033 0.004±0.004 2.25 0.047 Skeletal 0.008±0.01 0.001±0.001 1.44 0.16 Overall 0.028±0.032 0.003±0.004 3.54 0.001 # P-value derived from student’s Unpaired t-test The study compared Y-axis displacement (in mm) between the Sawangi Flexiforce Expander (SFE) and NiTi expander across dental, dentoalveolar, skeletal, and overall regions. The SFE group showed higher mean displacements in the dental (0.05 ± 0.02 mm vs. 0.006 ± 0.005 mm), dentoalveolar (0.046 ± 0.033 mm vs. 0.004 ± 0.004 mm), and overall nasomaxillary complex (0.028 ± 0.032 mm vs. 0.003 ± 0.004 mm) compared to the NiTi group, with statistically significant differences (p < 0.05). However, at the skeletal region, the difference (0.008 ± 0.01 mm vs. 0.001 ± 0.001 mm) was not statistically significant. Overall, the SFE expander produced significantly greater displacement along the Y-axis in most regions than the NiTi expander. TABLE 9: Comparison of Displacement(mm) score in SFE and NiTi Expander for Z-Axis Regions SFE NiTi t-value p-value Dental -0.04±0.015 -0.02±0.02 6.87 0.0001 Dentoalveolar -0.04±0.007 -0.01±0.003 12.02 0.0001 Skeletal -0.01±0.02 -0.009±0.01 3.43 0.002 Overall -0.02±0.023 -0.01±0.015 6.89 0.0001 # P-value derived from student’s Unpaired t-test The study compared Z-axis displacement (in mm), indicating downward movement, between the SFE and NiTi expanders across dental, dentoalveolar, skeletal, and overall regions. The SFE group showed greater downward displacement in the dental (-0.04 ± 0.015 mm vs. -0.02 ± 0.02 mm), dentoalveolar (-0.04 ± 0.007 mm vs. -0.01 ± 0.003 mm), skeletal (-0.01 ± 0.02 mm vs. -0.009 ± 0.01 mm), and overall regions (-0.02 ± 0.023 mm vs. -0.01 ± 0.015 mm) compared to the NiTi group. Statistically significant differences (p < 0.05) were observed across all regions, indicating that the SFE expander produced significantly greater downward displacement along the Z-axis than the NiTi expander. TABLE 10: Correlation between Von Mises Stress (MPa) and Displacement(mm) produced by SFE and NiTi Expander SFE NiTi Expander Variable N (Landmarks) Mean Std. Deviation r-value p-value Mean Std. Deviation r-value p-value Von Mises Stress (Mpa) 21 0.08 0.20 0.579 0.002 0.08 0.20 0.579 0.002 Displacement(mm) 21 0.22 0.41 0.22 0.41 A correlation analysis between Von Mises stress (MPa) and displacement (mm) revealed that both the SFE and NiTi expanders showed statistically significant relationships. For the SFE, the mean stress was 0.08 MPa (±0.20) and mean displacement was 0.22 mm (±0.41), while for the NiTi expander, the mean stress was 0.07 MPa (±0.17) and displacement was 0.03 mm (±0.08). Pearson’s correlation test confirmed a significant positive correlation in both groups, indicating that increased stress levels directly influenced the magnitude of displacement achieved. DISCUSSION Maxillary constriction, a transverse deficiency of the maxilla, disrupts craniofacial balance and often leads to functional and skeletal imbalances. It can cause posterior crossbites, dental crowding, and compromised airway function, affecting nasal breathing and sleep. Posterior crossbite prevalence ranges from 4.6% to 23% (15). Maxillary transverse deficiency is often associated with Class II Division 1 malocclusion, seen in 5% to 15% of the Indian population (16). Maxillary constriction in Class II malocclusion due to mandibular retrusion is more pronounced and affects both the anterior and posterior regions. Conversely, when the class II malocclusion is due to maxillary protrusion, the constriction is primarily observed in the posterior region (intermolar width). In class II malocclusion, Mandibular retrusion leads to lower tongue posture, decreasing lateral pressure on the maxilla and limiting transverse growth. Although this may not be clinically evident, when models are articulated into Class I canine relation, crossbites often become apparent 5. Reduced maxillary intermolar width may contribute to distal occlusion, as suggested by McNamara et al. (17), who noted spontaneous Class II correction after expansion in early mixed dentition. Sayin and Turkkahraman (18)advocated for slow maxillary expansion (SME) in managing Class II Division 1 cases. Rapid maxillary expansion (RME) is ideal for those conditions where orthopaedic changes are required, such as sutural loosening in Class III cases, posterior crossbites due to skeletal deficiencies, or pre-surgical interventions. However, for minor transverse discrepancies (around 5 mm), SME appliances like SFE and NiTi expanders may be suitable. SME is more conservative and allows gradual sutural adaptation with less trauma, potentially offering better long-term stability, as supported by various authors in the literature. Animal and histological studies conducted by Bell RA et al .(19) and Storey et al. (20) stated that slow maxillary expansion enhances the preservation of the sutural structure and may result in better long-term stability compared to rapid maxillary expansion. Clinical studies performed by Mossaz-Joelson K et al. (21)also indicate that slow maxillary expansion provides better stability compared to rapid maxillary expansion. The SFE is a novel, custom appliance designed for parallel anterior-posterior expansion, overcoming the drawbacks of conventional appliances. Unlike many previous studies that examined expansion using various techniques, this study focused on the 3D effects of SFE and NiTi expanders in Class II maxillary constriction using FEA. A detailed skull model incorporating teeth, PDL, and circummaxillary sutures was analyzed in ANSYS software for stress and displacement patterns. INTERPRETATION OF RESULTS I. STRESS DISTRIBUTION EXERTED BY SFE APPLIANCE ON DIFFERENT AMOUNT OF ACTIVATION: In the present study, we found that the mean stress values for all regions increase significantly as the amount of activation increases from 1mm to 3mm: 1 mm (0.000247 MPa), 2 mm (0.00191 MPa), and 3 mm (0.0692 MPa). Studies on SME devices conducted by Mamboleo et al. (22)noted that 0.01–0.1 MPa stress is typically needed to stimulate sutural bone remodelling. The SFE met this threshold only at 3 mm activation, indicating that lower activations may not cause skeletal expansion and may induce only dental effects. Thus, 3 mm activation is more consistent with effective orthopedic force. II. COMPARISON BETWEEN STRESS DISTRIBUTION [VON MISES STRESS (MPA)] EXERTED BY SFE APPLIANCE AND NiTi EXPANDER: SFE showed higher stress levels than NiTi in the nasomaxillary complex, although differences were not statistically significant. Stress was concentrated at the first molar, consistent with Jafari et al. (23) and Kapadia et al. (24) , who noted similar stress peaks due to appliance anchorage. The anterior tip of the midpalatal suture showed the highest skeletal stress, diminishing posteriorly—a finding aligned with Kapadia et al. (24) Overall, both expanders exerted stress in similar patterns, supporting slow expansion efficacy as per Donohue et al. (25)and Kapadia et al. (24) III. DISPLACEMENT(MM) PRODUCED BY SFE AND NITI EXPANDER: SFE produced significantly higher displacement across all regions and planes (X, Y, and Z), indicating more effective expansion. This makes SFE suitable for broader dental and skeletal corrections compared to the NiTi expander, which exhibited more limited displacement. In the X-axis, SFE produced significantly higher mean displacement of 0.22 ± 0.41 mm, while NiTi only achieved 0.03 ± 0.08 mm. The SFE exhibited the most significant displacement in the dental region at the first permanent molar (1.43 mm), followed by the area between the central incisors (0.914 mm), both substantially higher than NiTi (0.4 mm and 0.02 mm, respectively). The SFE also produced relatively parallel anterior-posterior deformation than NiTi expander, while both expanders induced a characteristic "V"-shaped opening of the midpalatal suture, broader anteriorly and narrower posteriorly. This ‘V’ shaped deformation is supported by Jafari et al. (23) , Kapadia et.al. (24) , Corbridge JK. et al. (26) , Contrasting results were obtained by Sandikcioglu et al .(27), who, in their study, achieved more posterior expansion of the palate. In the Y-axis, SFE produced significantly more backwards displacement (0.028±0.032 mm) than NiTi (0.003±0.004 mm). Both appliances moved the maxilla posteriorly, consistent with findings from Wertz et al. (28) and Sandikcioglu et al. (27) , who reported that point A moved slightly backwards, and the ANB mostly showed high values. However, Jafari et al. (23) reported contrasting anterior displacement of the maxilla in their study. In the Z-axis, SFE induced greater downward displacement (-0.02±0.023 mm) compared to NiTi (-0.01±0.015 mm), affecting ANS and the dentition. Kapadia et al. (24) found similar downward displacement in expansion appliances. This vertical movement likely includes tooth tipping and extrusion, which was observed in this study and aligns with outcomes reported by Herold et al. (29) and Shetty et al. (30) IV. CORRELATION OF STRESS DISTRIBUTION AND DISPLACEMENT PRODUCED BY SFE AND NITI EXPANDER: A statistically significant positive correlation was observed between Von Mises stress and displacement, indicating that SFE effectively translates applied stress into movement. This supports its potential as a reliable alternative for maxillary expansion. NiTi expander also showed a strong positive correlation between stress and displacement, though overall displacement was less. This predictability makes NiTi suitable for cases needing mild to moderate dental expansion rather than substantial skeletal change. Notably, this study is among the first to explore the correlation between stress and displacement for both SFE and NiTi expanders, filling a significant gap in orthodontic literature. CONCLUSIONS The following conclusions were drawn from the study; The Sawangi Flexiforce Expander (SFE) produced significantly more three-dimensional displacement of skeletal and dentoalveolar landmarks than the NiTi expander in Class II cases with maxillary constriction. Stress patterns generated by the SFE were more evenly distributed compared to the NiTi expander, which showed localized stress concentrations. A positive correlation was observed between displacement and the stress patterns generated by the SFE, resulting in more significant skeletal displacement, whereas the NiTi expander primarily induced dentoalveolar changes. ABBREVIATIONS SFE Sawangi Flexiforce Expander NiTi Nickel Titanium FEA Finite Element Analysis FEM Finite Element Method Mpa Megapascal mm Millimeters RME Rapid maxillary Expansion SME Slow maxillary Expansion CT Computed Tomography HYRAX Hygenic Rapid Expander Declarations ETHICS APPROVAL AND CONSENT TO PARTICIPATE This study was performed in compliance with Good Clinical Practice (ICH-GCP), the Declaration of Helsinki and local legal and regulatory requirements. This research has been ethically approved by the Ethical Committee of DMIHER(DU)/IEC/2023/574. Before enrolment, the patient’s parent/ guardian signed an informed consent sheet. CONSENT FOR PUBLICATION: Not Applicable AVAILABILITY OF DATA AND MATERIALS: All data or materials generated or analyzed during this study are included in this article. COMPETING INTERESTS: Not applicable. FUNDING: No funds, grants, or other support were received during the preparation of this manuscript. AUTHORS' CONTRIBUTIONS: All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work. Concept and design: Dr Srushti Atole, Dr. Ranjit Kamble, Dr. Sumukh Nerurkar Acquisition, analysis, or interpretation of data: Dr Srushti Atole, Dr. Ranjit Kamble, Dr. Sumukh Nerurkar, Dr. Japneet Kaiser Drafting of the manuscript: Dr. Srushti Atole, Dr. Japneet Kaiser, Dr. Samiksha Tidke, Dr. Tejaswi Kamble Critical review of the manuscript for important intellectual content: Dr. Srushti Atole, Dr. Ranjit Kamble, Dr. Sumukh Nerurkar, Dr. Japneet Kaiser ACKNOWLEDGEMENTS: Not applicable. References Lee KJ, Choi SH, Choi TH, Shi KK, Keum BT. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes. Semin Orthod. 2018 Mar 1;24(1):52–65. Kaur H, Pavithra US, Abraham R. Prevalence of malocclusion among adolescents in South Indian population. J Int Soc Prev Community Dent. 2013 Jul;3(2):97–102. Marinelli A, Mariotti M, Defraia E. Transverse dimensions of dental arches in subjects with Class II malocclusion in the early mixed dentition. Prog Orthod. 2011;12(1):31–7. Marzban R, Nanda R. Slow maxillary expansion with nickel titanium. J Clin Orthod JCO. 1999 Aug;33(8):431–41. Relwani P, Kumar SP, Gowda NC, Swamy VN, Ramegowda S. Rapid Maxillary Expansion – A Review. IP Indian J Orthod Dentofac Res. 2(2):56–61. Fatima K, Chaudhari PK, Duggal R, Kharbanda OP, Thakar A. Effects of RME on Hearing in UCLP Patients: A Pilot Study. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc. 2023 Nov;60(11):1442–9. Rabah N, Al-Ibrahim HM, Hajeer MY, Ajaj MA. Evaluation of rapid versus slow maxillary expansion in early adolescent patients with skeletal maxillary constriction using cone-beam computed tomography: A short-term follow-up randomized controlled trial. Dent Med Probl. 2022;59(4):583–91. Venkateshwaran K, Kaur S, Shaon. Slow maxillary expansion: A review. Int J Health Sci. 2021 Dec 31;5(S2):303–14. Paul R, Kapoor TJ, Malhotra V, Nayak UK, Bhatt S. Efficacy of Nickel-Titanium Palatal Expanders. J Indian Orthod Soc. 2011 Oct 1;45(4_suppl1):243–50. Tanne K, Hiraga J, Kakiuchi K, Yamagata Y, Sakuda M. Biomechanical effect of anteriorly directed extraoral forces on the craniofacial complex: a study using the finite element method. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1989 Mar;95(3):200–7. Öhman C, Baleani M, Pani C, Taddei F, Alberghini M, Viceconti M, et al. Compressive behaviour of child and adult cortical bone. Bone. 2011 Oct;49(4):769–76. Stegaroiu R, Kusakari H, Nishiyama S, Miyakawa O. Influence of prosthesis material on stress distribution in bone and implant: a 3-dimensional finite element analysis. Int J Oral Maxillofac Implants. 1998;13(6):781–90. Araugio RM de S, Landre J, Silva D de LA, Pacheco W, Pithon MM, Oliveira DD. Influence of the expansion screw height on the dental effects of the hyrax expander: a study with finite elements. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2013 Feb;143(2):221–7. Corbett MC. Slow and continuous maxillary expansion, molar rotation, and molar distalization. J Clin Orthod JCO. 1997 Apr;31(4):253–63. Beltrami F, Kiliaridis S, Antonarakis GS. Long-term stability of posterior crossbite correction, treated in the mixed or permanent dentition of growing children: A systematic review and meta-analysis. Orthod Craniofac Res. 2024;27(1):1–14. Balachandran P, Janakiram C. Prevalence of malocclusion among 8–15 years old children, India – A systematic review and meta-analysis. J Oral Biol Craniofacial Res. 2021 Jan 23;11(2):192. McNamara JA, Brudon WL, Kokich VG. Orthodontics and Dentofacial Orthopedics. Needham Press; 2001. 576 p. Sayin MO, Turkkahraman H. Comparison of dental arch and alveolar widths of patients with Class II, division 1 malocclusion and subjects with Class I ideal occlusion. Angle Orthod. 2004 Jun;74(3):356–60. Bell RA, LeCompte EJ. The effects of maxillary expansion using a quad-helix appliance during the deciduous and mixed dentitions. Am J Orthod. 1981 Feb;79(2):152–61. Storey E. Tissue response to the movement of bones. Am J Orthod. 1973 Sep;64(3):229–47. Mossaz-Joëlson K, Mossaz CF. Slow maxillary expansion: a comparison between banded and bonded appliances. Eur J Orthod. 1989 Feb;11(1):67–76. Mamboleo E, Ouldyerou A, Alsharif K, Ngan P, Merdji A, Roy S, et al. Biomechanical Analysis of Orthodontic Miniscrew-Assisted Rapid Palatal Expansion on Dental and Bone Tissues: A Finite-Element Study. J Eng Sci Med Diagn Ther [Internet]. 2024 Jun 17 [cited 2025 Jan 30];7(041007). Available from: https://doi.org/10.1115/1.4065589 Jafari A, Shetty KS, Kumar M. Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces--a three-dimensional FEM study. Angle Orthod. 2003 Feb;73(1):12–20. Kapadia RM, Vaghani BR, Shah AM. Comparative evaluation of dental, dentoalveolar and skeletal effects of slow maxillary expansion using Jackscrew, Quadhelix and Niti palatal expander2 on a finite element model of a young skull. IP Indian J Orthod Dentofac Res. 3(3):154–62. Donohue VE, Marshman L a. G, Winchester LJ. A clinical comparison of the quadhelix appliance and the nickel titanium (tandem loop) palatal expander: a preliminary, prospective investigation. Eur J Orthod. 2004 Aug;26(4):411–20. Corbridge JK, Campbell PM, Taylor R, Ceen RF, Buschang PH. Transverse dentoalveolar changes after slow maxillary expansion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2011 Sep;140(3):317–25. Sandikçioğlu M, Hazar S. Skeletal and dental changes after maxillary expansion in the mixed dentition. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1997 Mar;111(3):321–7. Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod. 1970 Jul;58(1):41–66. Herold JS. Maxillary expansion: a retrospective study of three methods of expansion and their long-term sequelae. Br J Orthod. 1989 Aug;16(3):195–200. Shetty P, Hegde AM, Rai K. Study of stress distribution and displacement of the maxillary complex following application of forces using jackscrew and nitanium palatal expander 2--a finite element study. J Clin Pediatr Dent. 2009;34(1):87–93. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6579552","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469952483,"identity":"0d7b5148-1b6f-4599-8a74-2e38f473e407","order_by":0,"name":"Srushti Atole","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYJACZgYGCRDVwPABSLGxE6UlQYKBh4GxgXEGSAszcVoYwFqYeaCW4gXys88Yfy78YSFvz97Y+Njm1zZ5PmYGxg8fc3BrMTiXYyY9I0HCsIfnYLNxbt9twzZmBmbJmdvwaOHhMWPmSZBg7JFIbJPO7bnNCNTCxsyLR4t8D4/xZ6AWe6CW9t+WPbftCWphOMNjIA3UkgiyhZnhx+1EgloMzrCVSfOkSST3nDnYLNnbcDu5jZmxGa9f5HuYN3/msamzbW9vPvjhx5/btvNBjI/4HIYCGNvAZAOx6kHgDymKR8EoGAWjYKQAAOwlSD7NVnWQAAAAAElFTkSuQmCC","orcid":"","institution":"Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Srushti","middleName":"","lastName":"Atole","suffix":""},{"id":469952484,"identity":"3bd69e49-fd9c-4d5b-943d-6a1f88691414","order_by":1,"name":"Ranjit Kamble","email":"","orcid":"","institution":"Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and 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1","display":"","copyAsset":false,"role":"figure","size":263236,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e3D GEOMETRIC MODEL OF SKULL\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/0ed15b8b320eb2a089a815e9.png"},{"id":84776228,"identity":"fcd755c2-79f8-400f-bdbf-b3c4906afc30","added_by":"auto","created_at":"2025-06-17 09:00:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":213979,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMODEL OF SAWANGI FLEXIFORCE EXPANDER\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/fee53a32c9a0bfb3019c8cb9.png"},{"id":84776225,"identity":"aa6a91f4-9173-4f45-b4fa-4a4e6df664ae","added_by":"auto","created_at":"2025-06-17 09:00:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":209938,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMODEL OF NITI EXPANDER\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/665dcf4eb46afbd4a5f61de3.png"},{"id":84778344,"identity":"d4d04ff7-9822-4b18-a3e4-74b1d905790d","added_by":"auto","created_at":"2025-06-17 09:16:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":139919,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMESH MODEL OF SKULL\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/4891793ed3936b60204c6bdd.png"},{"id":84777055,"identity":"c3aa536e-e997-48b7-b89c-bb92656dd3c6","added_by":"auto","created_at":"2025-06-17 09:08:01","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":321238,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDISPLACEMENT PRODUCED BY SFE IN X- AXIS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/4aa74f547a5455351bda0958.png"},{"id":84776230,"identity":"ce8ee625-06fb-47e3-bbb1-562ee08798ca","added_by":"auto","created_at":"2025-06-17 09:00:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":343224,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDISPLACEMENT PRODUCED BY SFE IN Y- AXIS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/600ac5b14ba0053dc3224d4a.png"},{"id":84777061,"identity":"b8f545b2-da9a-4e18-a902-e10fee18af4e","added_by":"auto","created_at":"2025-06-17 09:08:02","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":335114,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDISPLACEMENT PRODUCED BY SFE IN Z- AXIS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/b6eac43fb0f18a0b452491b1.png"},{"id":96248652,"identity":"f217afcd-21b8-458d-a6c0-e112af16741e","added_by":"auto","created_at":"2025-11-19 07:28:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3980081,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6579552/v1/75b47c1f-9ce5-4d8e-afe5-7dcb02631deb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparative Evaluation and Correlation of Three Dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander as Against Niti Expander in Class Ii Cases With Maxillary Constriction - a Fem Study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eMaxillary constriction, a common form of malocclusion, is characterized by a reduced transverse width of the maxilla and often presents with features such as a narrow arch and dental crowding (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It frequently manifests as a posterior crossbite, with a reported prevalence of 0.99% among the Indian population (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Early intervention is crucial to prevent progression and maintain both functional and aesthetic outcomes. Maxillary constriction can be associated with other malocclusions, such as Class II and III, particularly with a hypoplastic maxilla. Notably, Class II malocclusions tend to exhibit significantly narrower maxillary dimensions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTransverse maxillary deficiencies are typically corrected using orthodontic and orthopaedic methods that expand the palate (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Emerson C. Angel, regarded as the pioneer of expansion therapy, introduced arch expansion to manage such conditions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Expansion techniques can be categorized based on the nature of applied forces: active or passive, and the target structure: orthopaedic (skeletal) or orthodontic (dentoalveolar). Active expansion applies direct force to the teeth or bones, while passive expansion depends on natural muscle forces.\u003c/p\u003e \u003cp\u003eRapid Maxillary Expansion (RME) is a widely used active technique for skeletal expansion that separates the mid-palatal suture, ideally in patients under 13\u0026ndash;15 years of age (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although effective, RME can cause side effects such as discomfort, relapse, root resorption, and bone loss (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). RME can be achieved with both removable appliances (e.g., split acrylic plates) and fixed appliances like HYRAX, Hass, or Derichsweiler expanders.\u003c/p\u003e \u003cp\u003eIn contrast, Slow Maxillary Expansion (SME) uses light, continuous forces that are more physiologically compatible and cause fewer side effects (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Devices such as quad helix, jackscrews, and NiTi expanders are commonly used for SME. The NiTi expander, developed from a thermally activated nickel-titanium alloy, offers consistent, superelastic forces over time but lacks customization options (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Sawangi Flexiforce Expander (SFE) is a slow palatal expander introduced by the Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College. The appliance was filled for Patent (under the examination process, Application No. 20231076157). It is an innovative, stainless-steel appliance offering both anterior and posterior expansion through a central helix and loops. It delivers light, consistent forces, is cost-effective, and can be customized for individual cases\u0026mdash;advantages over standard NiTi expanders.\u003c/p\u003e \u003cp\u003eTo evaluate the biomechanical performance of these expanders, the Finite Element Method (FEM) is employed. Originally developed in engineering, FEM enables accurate simulation of stress and strain within biological tissues and has become a vital tool in orthodontic research. However, limited FEM-based studies exist comparing SFE and NiTi expanders.\u003c/p\u003e \u003cp\u003eTo address this gap, the present study compares the three-dimensional skeletal and dentoalveolar effects of SFE and NiTi expanders in Class II patients with maxillary constriction. The null hypothesis assumes no significant difference between them, while the alternate hypothesis suggests a significant difference exists.\u003c/p\u003e"},{"header":"MATERIALS AND METHOD","content":"\u003cp\u003eThe study was carried out in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College, located in Sawangi (M), Wardha, in partnership with DICUL AM Private Limited, Nagpur.\u003c/p\u003e\n\u003cp\u003eThe study commenced following approval from the Institutional Research Ethics Committee of Datta Meghe Institute of Higher Education and Research (Deemed to be University). Ethical clearance was granted on 06/02/2023, with reference number {DMIHER(DU)/IEC/2023/574}.\u003c/p\u003e\n\u003cp\u003eThe patient selection criteria were as follows.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eClass II malocclusion with functional retrusion of the mandible.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatients with a constricted maxilla with or without a posterior crossbite.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePubertal age patients.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePatients with severe vertical growth pattern.\u003c/li\u003e\n \u003cli\u003ePatients with a wide mandibular arch width.\u003c/li\u003e\n \u003cli\u003ePatients with Class III malocclusion\u003c/li\u003e\n \u003cli\u003ePatients with craniofacial deformities.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatients with a history of previous orthodontic treatment.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatients with a history of any trauma or surgery\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSample Selection:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA single patient was selected randomly from the patients attending the Outpatient Department (OPD) of the Orthodontics and Dentofacial Orthopaedics Department, Wardha. A 13-year-old female patient with skeletal Class II malocclusion was chosen for a CT scan of the skull. Selection was made in accordance with the predefined inclusion and exclusion criteria. The research aims and objectives were thoroughly explained to the patient’s parents, and their informed consent for the CT scan was obtained.\u003c/p\u003e\n\u003ch3\u003eMETHODOLOGY\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eI] Preparation of Model:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo prepare the model, high-resolution CT scan images of a 13-year-old girl\u0026rsquo;s skull were obtained using a SIEMENS SOMATOM SCOPE 32-slice scanner, capturing 581 sequential axial images at 1 mm intervals for enhanced anatomical detail. These images were processed using GEOMAGIC FREEFORM software to create a precise 3D geometric model of the skull.\u003c/p\u003e\n\u003cp\u003eBoth the NiTi and Sawangi Flexiforce Expander (SFE) were also digitally modelled in the same software based on their clinical specifications and accurately positioned on the maxillary arch to simulate real-life application.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe geometric skull model was then converted into a finite element model through meshing, a process in which the anatomy was divided into interconnected triangular (polygonal) elements using the Delaunay triangulation method.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis meshing produced a highly detailed finite element model comprising 2,53,378 elements and 4,09,701 nodes, enabling a realistic simulation of mechanical behaviour under expansion forces.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eII] Defining Mechanical properties to the model:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mechanical properties (Young\u0026rsquo;s modulus and Poisson\u0026rsquo;s ratio) of the tooth, cortical bone, cancellous bone, suture, periodontal ligament, stainless steel and nickel-titanium in the model were defined according to the experimental data in previous studies, as shown in Table 1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 1: Material properties used in the Model\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"501\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaterials\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYoung\u0026rsquo;s Modulus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoisson\u0026rsquo;s Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN/mm\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMpa\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eTeeth(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e20\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eCompact Bone (10,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e9.04\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e9042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eCancellous Bone(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e7.9\u0026times;10\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e7900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNickel Titanium(12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e110\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e110000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eStainless steel(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e190\u0026times;10\u003csup\u003e3\u003c/sup\u003e-210\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e190000-210000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eIII] Laying boundary conditions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter assigning mechanical properties to the model, boundary conditions were established by restraining all cranial nodes except those at anatomical landmarks intended for stress and deformation analysis. The coordinate system defines displacements along the transverse (X), sagittal (Y), and vertical (Z) planes, with positive values indicating outward, backwards, and upward movement, respectively. The NiTi expander was activated using a standard 3-mm expansion, producing a force of 350 g (14), while the SFE was activated with 1-, 2-, and 3-mm increments. These activations induced stress and displacement across various skull regions. The complete finite element model, including skull, teeth, and periodontal ligament (PDL), was imported into ANSYS software for simulation. ANSYS was used to calculate the stress and displacement patterns, and in the final post-processing stage, contour plots were generated to represent the resulting forces and deformations visually.\u003c/p\u003e\n\u003cp\u003eVon Mises stress distribution in MPa and displacement in millimetres (mm) was studied at the following landmarks of the skull model using FEM.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDental landmarks:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea. \u0026nbsp;Contact point between central incisors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb. \u0026nbsp;Cusp tip of canines\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ec. \u0026nbsp;Central pit of first permanent molars\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ed. \u0026nbsp;CEJ of central incisors, canines, and first permanent molars\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDentoalveolar landmarks:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea. \u0026nbsp; \u0026nbsp;Apical region of central incisors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb. \u0026nbsp; \u0026nbsp;Apical region of canines\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ec. \u0026nbsp; \u0026nbsp;Apical region of first permanent molars\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eSkeletal landmarks:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea. \u0026nbsp; Mid-palatine suture- anterior tip and posterior tip\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb. \u0026nbsp; Anterior nasal spine\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ec. \u0026nbsp; Nasal septum\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ed. \u0026nbsp; Internasal suture\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ee. \u0026nbsp; Nasomaxillary suture\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ef. \u0026nbsp; \u0026nbsp;Frontonasal suture\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eg. \u0026nbsp; Frontomaxillary suture\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eh. \u0026nbsp; Zygomaticomaxillary suture\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ei. \u0026nbsp; \u0026nbsp;Zygomaticofrontal suture\u003c/p\u003e\n\u003cp\u003ej. \u0026nbsp; \u0026nbsp;Zygomaticotemporal suture\u003c/p\u003e\n\u003cp\u003ek. \u0026nbsp; Pterygomaxillary suture\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTATISTICAL ANALYSIS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was conducted to compare and assess the three-dimensional effects of both expanders on the nasomaxillary complex. Descriptive and inferential statistics were employed, utilizing the student\u0026rsquo;s unpaired t-test and Pearson\u0026rsquo;s correlation coefficient. The analysis was performed using SPSS software version 27.0, with a significance level set at p\u0026lt;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe three-dimensional skeletal and dentoalveolar effects observed in this study were evaluated under the following sections:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026middot; Von Mises stress distribution over the nasomaxillary complex after the activation of both expanders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026middot; Displacements of various landmarks in all three planes produced after the activation of both expanders\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eI. \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eVON MISES STRESS DISTRIBUTION\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 576px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 2: Stress Distribution [Von Mises stress (Mpa)] at skeletal and dentoalveolar landmarks produced by different amounts of activation of SFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 259px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelected landmark\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of Activation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 105px;\"\u003e\n \u003cp\u003eDental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eContact point between central incisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eCusp tip of canines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eCentral pit of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.0075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eCEJ of central incisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eCEJ of canines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eCEJ of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 105px;\"\u003e\n \u003cp\u003eDentoalveolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eApical region of central incisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eApical region of canines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eApical region of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" style=\"width: 105px;\"\u003e\n \u003cp\u003eSkeletal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eMidpalatine suture- anterior tip\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eMidpalatine suture-posterior tip\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eAnterior nasal spine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eNasal Septum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eInternasal Suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eNasomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eFrontonasal suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eFrontomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.000001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.000046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.00095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eZygomaticomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eZygomaticofrontal suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0755\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003eZygomaticotemporal suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 259px;\"\u003e\n \u003cp\u003ePterygomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.00018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.0218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"484\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 484px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 3: Mean Values of Stress distribution produced by different amounts of activation of SFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount of activation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (Mpa)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.001286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.00023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.000247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.000541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.002098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.00036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.00191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.16885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.3339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.0017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eTable 3 summarizes the mean Von Mises stress (in MPa) and standard deviation across dental, dentoalveolar, and skeletal regions for 1mm, 2mm, and 3mm activations of the Sawangi Flexiforce Expander (SFE). Stress levels increased progressively with activation. In the dental region, stress rose from 0.001286 MPa (1mm) to 0.16885 MPa (3mm), while skeletal stress increased from 0.000247 MPa to 0.0692 MPa over the same range. Total mean stress also followed this upward trend, from 0.000541 MPa (1mm) to 0.0883 MPa (3mm). Stress levels at 1mm and 2mm activations were below the threshold typically required for effective maxillary expansion. However, the 3mm activation of the SFE produced stress within the effective range, making it a suitable level for comparison with the NiTi expander, which was activated according to its standard protocol in this study.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 586px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 4: Stress Distribution [Von Mises stress (Mpa)] at skeletal and dentoalveolar landmarks produced by activation of SFE and NiTi Expander (3mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 248px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelected landmark\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpander\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eContact point between central incisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eCusp tip of canines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eCentral pit of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eCEJ of central incisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eCEJ of canines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eCEJ of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eApical region of central incisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eApical region of canines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eApical region of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eMidpalatine suture- anterior tip\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eMidpalatine suture-posterior tip\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eAnterior nasal spine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eNasal Septum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eInternasal Suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eNasomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eFrontonasal suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eFrontomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.00095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.00071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eZygomaticomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eZygomaticofrontal suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003eZygomaticotemporal suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 248px;\"\u003e\n \u003cp\u003ePterygomaxillary suture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"454\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 454px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 5: Comparison of Von Mises stress (in MPa) across different regions between the SFE and NiTi Expander\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.16\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.13\u0026plusmn;0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.003\u0026plusmn;0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.002\u0026plusmn;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.069\u0026plusmn;0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.062\u0026plusmn;0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.088\u0026plusmn;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.074\u0026plusmn;0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eP-value derived from student\u0026rsquo;s Unpaired t-test\u003c/p\u003e\n\u003cp\u003eThe mean Von Mises stress (MPa) was compared between the Sawangi Flexiforce Expander (SFE) and NiTi expander across dental, dentoalveolar, and skeletal regions. In the dental region, stress was slightly higher in the SFE group (0.16 \u0026plusmn; 0.36 MPa) compared to the NiTi group (0.13 \u0026plusmn; 0.30 MPa). Similarly, dentoalveolar and skeletal stress values were marginally greater in the SFE group (0.003 \u0026plusmn; 0.002 MPa and 0.069 \u0026plusmn; 0.098 MPa, respectively) than in the NiTi group (0.002 \u0026plusmn; 0.001 MPa and 0.062 \u0026plusmn; 0.087 MPa). Overall mean stress in the nasomaxillary complex was 0.088 \u0026plusmn; 0.20 MPa for SFE and 0.074 \u0026plusmn; 0.171 MPa for NiTi. However, statistical analysis using an unpaired t-test revealed no significant differences (p \u0026gt; 0.05) between the two groups in any region, indicating that while SFE produced slightly higher stress levels, the differences were not statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eII. \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eDISPLACEMENTS OF VARIOUS LANDMARKS\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"622\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 622px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 6: Displacement (mm) in X (Transverse), Y(Sagittal), And Z(Vertical) Axis produced by activation of SFE and NiTi expander at all the selected landmarks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelected landmark\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 98px;\"\u003e\n \u003cp\u003eDental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eContact point between central incisors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCusp tip of canines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCentral pit of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCEJ of central incisors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCEJ of canines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCEJ of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e1.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 98px;\"\u003e\n \u003cp\u003eDentoalveolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eApical region of central incisors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eApical region of canines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eApical region of 1\u003csup\u003est\u003c/sup\u003e permanent molars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" style=\"width: 98px;\"\u003e\n \u003cp\u003eSkeletal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMidpalatine suture- anterior tip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMidpalatine suture-posterior tip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.0017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAnterior nasal spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNasal Septum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eInternasal Suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.00006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNasomaxillary suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.0038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFrontonasal suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.0011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFrontomaxillary suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.00023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.0031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eZygomaticomaxillary suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e-0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eZygomaticofrontal suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eZygomaticotemporal suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e-0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePterygomaxillary suture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.0077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"472\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 472px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 7: Comparison of Displacement(mm) score in SFE and NiTi expander for X-Axis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.71\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0.09\u0026plusmn;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.06\u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0.02\u0026plusmn;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.02\u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0.004\u0026plusmn;0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.22\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e0.03\u0026plusmn;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e#\u003c/sup\u003eP-value derived from student\u0026rsquo;s Unpaired t-test\u003c/p\u003e\n\u003cp\u003eThe study compared X-axis displacement (in mm) between the Sawangi Flexiforce Expander (SFE) and NiTi expander across dental, dentoalveolar, skeletal, and overall regions. The SFE group showed significantly greater displacement in all regions: dental (0.71 \u0026plusmn; 0.54 mm vs. 0.09 \u0026plusmn; 0.15 mm), dentoalveolar (0.06 \u0026plusmn; 0.02 mm vs. 0.02 \u0026plusmn; 0.01 mm), skeletal (0.02 \u0026plusmn; 0.02 mm vs. 0.004 \u0026plusmn; 0.006 mm), and overall nasomaxillary complex (0.22 \u0026plusmn; 0.41 mm vs. 0.03 \u0026plusmn; 0.08 mm), compared to the NiTi group. The differences in displacement were statistically significant (p \u0026lt; 0.05), indicating that the SFE expander produces greater transverse expansion than the NiTi expander.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"481\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 481px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 8: Comparison of Displacement(mm) score in SFE and NiTi Expander for Y-Axis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e0.05\u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.006\u0026plusmn;0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e0.046\u0026plusmn;0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.004\u0026plusmn;0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e0.008\u0026plusmn;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.001\u0026plusmn;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e0.028\u0026plusmn;0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0.003\u0026plusmn;0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp; #\u003c/sup\u003eP-value derived from student\u0026rsquo;s Unpaired t-test\u003c/p\u003e\n\u003cp\u003eThe study compared Y-axis displacement (in mm) between the Sawangi Flexiforce Expander (SFE) and NiTi expander across dental, dentoalveolar, skeletal, and overall regions. The SFE group showed higher mean displacements in the dental (0.05 \u0026plusmn; 0.02 mm vs. 0.006 \u0026plusmn; 0.005 mm), dentoalveolar (0.046 \u0026plusmn; 0.033 mm vs. 0.004 \u0026plusmn; 0.004 mm), and overall nasomaxillary complex (0.028 \u0026plusmn; 0.032 mm vs. 0.003 \u0026plusmn; 0.004 mm) compared to the NiTi group, with statistically significant differences (p \u0026lt; 0.05). However, at the skeletal region, the difference (0.008 \u0026plusmn; 0.01 mm vs. 0.001 \u0026plusmn; 0.001 mm) was not statistically significant. Overall, the SFE expander produced significantly greater displacement along the Y-axis in most regions than the NiTi expander.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"497\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 497px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 9: Comparison of Displacement(mm) score in SFE and NiTi Expander for Z-Axis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.04\u0026plusmn;0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.02\u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e6.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDentoalveolar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.04\u0026plusmn;0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.01\u0026plusmn;0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e12.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.01\u0026plusmn;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.009\u0026plusmn;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.02\u0026plusmn;0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e-0.01\u0026plusmn;0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003csup\u003e#\u003c/sup\u003eP-value derived from student\u0026rsquo;s Unpaired t-test\u003c/p\u003e\n\u003cp\u003eThe study compared Z-axis displacement (in mm), indicating downward movement, between the SFE and NiTi expanders across dental, dentoalveolar, skeletal, and overall regions. The SFE group showed greater downward displacement in the dental (-0.04 \u0026plusmn; 0.015 mm vs. -0.02 \u0026plusmn; 0.02 mm), dentoalveolar (-0.04 \u0026plusmn; 0.007 mm vs. -0.01 \u0026plusmn; 0.003 mm), skeletal (-0.01 \u0026plusmn; 0.02 mm vs. -0.009 \u0026plusmn; 0.01 mm), and overall regions (-0.02 \u0026plusmn; 0.023 mm vs. -0.01 \u0026plusmn; 0.015 mm) compared to the NiTi group. Statistically significant differences (p \u0026lt; 0.05) were observed across all regions, indicating that the SFE expander produced significantly greater downward displacement along the Z-axis than the NiTi expander.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" style=\"width: 709px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 10: Correlation between Von Mises Stress (MPa) and Displacement(mm) produced by SFE and NiTi Expander\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi Expander\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Landmarks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVon Mises Stress (Mpa)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisplacement(mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;A correlation analysis between Von Mises stress (MPa) and displacement (mm) revealed that both the SFE and NiTi expanders showed statistically significant relationships. For the SFE, the mean stress was 0.08 MPa (\u0026plusmn;0.20) and mean displacement was 0.22 mm (\u0026plusmn;0.41), while for the NiTi expander, the mean stress was 0.07 MPa (\u0026plusmn;0.17) and displacement was 0.03 mm (\u0026plusmn;0.08). Pearson\u0026rsquo;s correlation test confirmed a significant positive correlation in both groups, indicating that increased stress levels directly influenced the magnitude of displacement achieved.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMaxillary constriction, a transverse deficiency of the maxilla, disrupts craniofacial balance and often leads to functional and skeletal imbalances. It can cause posterior crossbites, dental crowding, and compromised airway function, affecting nasal breathing and sleep. Posterior crossbite prevalence ranges from 4.6% to 23% (15). Maxillary transverse deficiency is often associated with Class II Division 1 malocclusion, seen in 5% to 15% of the Indian population (16). Maxillary constriction in Class II malocclusion due to mandibular retrusion is more pronounced and affects both the anterior and posterior regions. Conversely, when the class II malocclusion is due to maxillary protrusion, the constriction is primarily observed in the posterior region (intermolar width).\u003c/p\u003e\n\u003cp\u003eIn class II malocclusion, Mandibular retrusion leads to lower tongue posture, decreasing lateral pressure on the maxilla and limiting transverse growth. Although this may not be clinically evident, when models are articulated into Class I canine relation, crossbites often become apparent 5. Reduced maxillary intermolar width may contribute to distal occlusion, as suggested by \u003cstrong\u003eMcNamara et al.\u003c/strong\u003e(17), who noted spontaneous Class II correction after expansion in early mixed dentition. \u003cstrong\u003eSayin and Turkkahraman\u003c/strong\u003e(18)advocated for slow maxillary expansion (SME) in managing Class II Division 1 cases.\u003c/p\u003e\n\u003cp\u003eRapid maxillary expansion (RME) is ideal for those conditions where orthopaedic changes are required, such as sutural loosening in Class III cases, posterior crossbites due to skeletal deficiencies, or pre-surgical interventions. However, for minor transverse discrepancies (around 5 mm), SME appliances like SFE and NiTi expanders may be suitable. SME is more conservative and allows gradual sutural adaptation with less trauma, potentially offering better long-term stability, as supported by various authors in the literature. Animal and histological studies conducted by \u003cstrong\u003eBell RA et al\u003c/strong\u003e.(19) and \u003cstrong\u003eStorey et al.\u003c/strong\u003e(20) stated that slow maxillary expansion enhances the preservation of the sutural structure and may result in better long-term stability compared to rapid maxillary expansion. Clinical studies performed by \u003cstrong\u003eMossaz-Joelson K et al.\u003c/strong\u003e(21)also indicate that slow maxillary expansion provides better stability compared to rapid maxillary expansion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe SFE is a novel, custom appliance designed for parallel anterior-posterior expansion, overcoming the drawbacks of conventional appliances. Unlike many previous studies that examined expansion using various techniques, this study focused on the 3D effects of SFE and NiTi expanders in Class II maxillary constriction using FEA. A detailed skull model incorporating teeth, PDL, and circummaxillary sutures was analyzed in ANSYS software for stress and displacement patterns.\u003c/p\u003e"},{"header":" INTERPRETATION OF RESULTS","content":"\u003cp\u003e\u003cstrong\u003eI.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eSTRESS DISTRIBUTION EXERTED BY SFE APPLIANCE ON DIFFERENT AMOUNT OF ACTIVATION:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the present study, we found that the mean stress values for all regions increase significantly as the amount of activation increases from 1mm to 3mm: 1 mm (0.000247 MPa), 2 mm (0.00191 MPa), and 3 mm (0.0692 MPa). Studies on SME devices conducted by \u003cstrong\u003eMamboleo et al.\u003c/strong\u003e(22)noted that 0.01–0.1 MPa stress is typically needed to stimulate sutural bone remodelling. The SFE met this threshold only at 3 mm activation, indicating that lower activations may not cause skeletal expansion and may induce only dental effects. Thus, 3 mm activation is more consistent with effective orthopedic force.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eII.\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003eCOMPARISON BETWEEN STRESS DISTRIBUTION [VON MISES STRESS (MPA)] EXERTED BY SFE APPLIANCE AND NiTi EXPANDER:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSFE showed higher stress levels than NiTi in the nasomaxillary complex, although differences were not statistically significant. Stress was concentrated at the first molar, consistent with \u003cstrong\u003eJafari et al.\u003c/strong\u003e(23) and \u003cstrong\u003eKapadia et al.\u003c/strong\u003e(24)\u003cstrong\u003e,\u003c/strong\u003e who noted similar stress peaks due to appliance anchorage. The anterior tip of the midpalatal suture showed the highest skeletal stress, diminishing posteriorly—a finding aligned with \u003cstrong\u003eKapadia et al.\u003c/strong\u003e(24)\u0026nbsp;Overall, both expanders exerted stress in similar patterns, supporting slow expansion efficacy as per \u003cstrong\u003eDonohue et al.\u003c/strong\u003e(25)and \u003cstrong\u003eKapadia et al.\u003c/strong\u003e(24)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIII. \u003cu\u003eDISPLACEMENT(MM) PRODUCED BY SFE AND NITI EXPANDER:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;SFE produced significantly higher displacement across all regions and planes (X, Y, and Z), indicating more effective expansion. This makes SFE suitable for broader dental and skeletal corrections compared to the NiTi expander, which exhibited more limited displacement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn the X-axis,\u0026nbsp;\u003c/strong\u003eSFE produced significantly higher mean displacement of 0.22 ± 0.41 mm, while NiTi only achieved 0.03 ± 0.08 mm. The SFE exhibited the most significant displacement in the dental region at the first permanent molar (1.43 mm), followed by the area between the central incisors (0.914 mm), both substantially higher than NiTi (0.4 mm and 0.02 mm, respectively). The SFE also produced relatively parallel anterior-posterior deformation than NiTi expander, while both expanders induced a characteristic \"V\"-shaped opening of the midpalatal suture, broader anteriorly and narrower posteriorly. This ‘V’ shaped deformation is supported by \u003cstrong\u003eJafari et al.\u003c/strong\u003e(23)\u003cstrong\u003e, Kapadia et.al.\u003c/strong\u003e(24)\u003cstrong\u003e, Corbridge JK. et al.\u003c/strong\u003e(26)\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eContrasting results were obtained by\u0026nbsp;\u003cstrong\u003eSandikcioglu et al\u003c/strong\u003e.(27), who, in their study, achieved more posterior expansion of the palate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn the Y-axis,\u003c/strong\u003e SFE produced significantly more backwards displacement (0.028±0.032 mm) than NiTi (0.003±0.004 mm). Both appliances moved the maxilla posteriorly, consistent with findings from \u003cstrong\u003eWertz et al.\u003c/strong\u003e(28) and \u003cstrong\u003eSandikcioglu et al.\u003c/strong\u003e(27)\u003cstrong\u003e\u0026nbsp;,\u003c/strong\u003e who reported that point A moved slightly backwards, and the ANB mostly showed high values.\u0026nbsp;However, \u003cstrong\u003eJafari et al.\u003c/strong\u003e(23)\u0026nbsp;reported contrasting anterior displacement\u0026nbsp;of the maxilla in their study. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn the Z-axis,\u003c/strong\u003e SFE induced greater downward displacement (-0.02±0.023 mm) compared to NiTi (-0.01±0.015 mm), affecting ANS and the dentition. \u003cstrong\u003eKapadia et al.\u003c/strong\u003e(24) found similar downward displacement in expansion appliances. This vertical movement likely includes tooth tipping and extrusion, which was observed in this study and aligns with outcomes reported by \u003cstrong\u003eHerold et al.\u003c/strong\u003e(29) and \u003cstrong\u003eShetty et al.\u003c/strong\u003e(30)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIV. \u003cu\u003eCORRELATION OF STRESS DISTRIBUTION AND DISPLACEMENT PRODUCED BY SFE AND NITI EXPANDER:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant positive correlation was observed between Von Mises stress and displacement, indicating that SFE effectively translates applied stress into movement. This supports its potential as a reliable alternative for maxillary expansion. NiTi expander also showed a strong positive correlation between stress and displacement, though overall displacement was less. This predictability makes NiTi suitable for cases needing mild to moderate dental expansion rather than substantial skeletal change.\u003c/p\u003e\n\u003cp\u003eNotably, this study is among the first to explore the correlation between stress and displacement for both SFE and NiTi expanders, filling a significant gap in orthodontic literature.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003e \u003cb\u003eThe following conclusions were drawn from the study;\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe Sawangi Flexiforce Expander (SFE) produced significantly more three-dimensional displacement of skeletal and dentoalveolar landmarks than the NiTi expander in Class II cases with maxillary constriction.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStress patterns generated by the SFE were more evenly distributed compared to the NiTi expander, which showed localized stress concentrations.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA positive correlation was observed between displacement and the stress patterns generated by the SFE, resulting in more significant skeletal displacement, whereas the NiTi expander primarily induced dentoalveolar changes.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"ABBREVIATIONS","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSawangi Flexiforce Expander\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiTi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNickel Titanium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFinite Element Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFinite Element Method\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMpa\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMegapascal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003emm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMillimeters\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRapid maxillary Expansion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSlow maxillary Expansion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComputed Tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHYRAX\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHygenic Rapid Expander\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in compliance with Good Clinical Practice (ICH-GCP), the Declaration of Helsinki and local legal and regulatory requirements. This research has been ethically approved by the Ethical Committee of DMIHER(DU)/IEC/2023/574. Before enrolment, the patient\u0026rsquo;s parent/ guardian signed an informed consent sheet.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS:\u0026nbsp;\u003c/strong\u003eAll data or materials generated or analyzed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING:\u0026nbsp;\u003c/strong\u003eNo funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS\u0026apos; CONTRIBUTIONS:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConcept and design: Dr Srushti Atole, Dr. Ranjit Kamble, Dr. Sumukh Nerurkar\u003c/p\u003e\n\u003cp\u003eAcquisition, analysis, or interpretation of data: Dr Srushti Atole, Dr. Ranjit Kamble, Dr. Sumukh Nerurkar, Dr. Japneet Kaiser\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: Dr. Srushti Atole, Dr. Japneet Kaiser, Dr. Samiksha Tidke, Dr. Tejaswi Kamble\u003c/p\u003e\n\u003cp\u003eCritical review of the manuscript for important intellectual content: Dr. Srushti Atole, Dr. Ranjit Kamble, Dr. Sumukh Nerurkar, Dr. Japneet Kaiser\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLee KJ, Choi SH, Choi TH, Shi KK, Keum BT. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes. Semin Orthod. 2018 Mar 1;24(1):52\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eKaur H, Pavithra US, Abraham R. Prevalence of malocclusion among adolescents in South Indian population. J Int Soc Prev Community Dent. 2013 Jul;3(2):97\u0026ndash;102. \u003c/li\u003e\n\u003cli\u003eMarinelli A, Mariotti M, Defraia E. Transverse dimensions of dental arches in subjects with Class II malocclusion in the early mixed dentition. Prog Orthod. 2011;12(1):31\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMarzban R, Nanda R. Slow maxillary expansion with nickel titanium. J Clin Orthod JCO. 1999 Aug;33(8):431\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eRelwani P, Kumar SP, Gowda NC, Swamy VN, Ramegowda S. Rapid Maxillary Expansion \u0026ndash; A Review. IP Indian J Orthod Dentofac Res. 2(2):56\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eFatima K, Chaudhari PK, Duggal R, Kharbanda OP, Thakar A. Effects of RME on Hearing in UCLP Patients: A Pilot Study. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc. 2023 Nov;60(11):1442\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eRabah N, Al-Ibrahim HM, Hajeer MY, Ajaj MA. Evaluation of rapid versus slow maxillary expansion in early adolescent patients with skeletal maxillary constriction using cone-beam computed tomography: A short-term follow-up randomized controlled trial. Dent Med Probl. 2022;59(4):583\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eVenkateshwaran K, Kaur S, Shaon. Slow maxillary expansion: A review. Int J Health Sci. 2021 Dec 31;5(S2):303\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003ePaul R, Kapoor TJ, Malhotra V, Nayak UK, Bhatt S. Efficacy of Nickel-Titanium Palatal Expanders. J Indian Orthod Soc. 2011 Oct 1;45(4_suppl1):243\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eTanne K, Hiraga J, Kakiuchi K, Yamagata Y, Sakuda M. Biomechanical effect of anteriorly directed extraoral forces on the craniofacial complex: a study using the finite element method. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1989 Mar;95(3):200\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003e\u0026Ouml;hman C, Baleani M, Pani C, Taddei F, Alberghini M, Viceconti M, et al. Compressive behaviour of child and adult cortical bone. Bone. 2011 Oct;49(4):769\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eStegaroiu R, Kusakari H, Nishiyama S, Miyakawa O. Influence of prosthesis material on stress distribution in bone and implant: a 3-dimensional finite element analysis. Int J Oral Maxillofac Implants. 1998;13(6):781\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eAraugio RM de S, Landre J, Silva D de LA, Pacheco W, Pithon MM, Oliveira DD. Influence of the expansion screw height on the dental effects of the hyrax expander: a study with finite elements. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2013 Feb;143(2):221\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eCorbett MC. Slow and continuous maxillary expansion, molar rotation, and molar distalization. J Clin Orthod JCO. 1997 Apr;31(4):253\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eBeltrami F, Kiliaridis S, Antonarakis GS. Long-term stability of posterior crossbite correction, treated in the mixed or permanent dentition of growing children: A systematic review and meta-analysis. Orthod Craniofac Res. 2024;27(1):1\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eBalachandran P, Janakiram C. Prevalence of malocclusion among 8\u0026ndash;15 years old children, India \u0026ndash; A systematic review and meta-analysis. J Oral Biol Craniofacial Res. 2021 Jan 23;11(2):192. \u003c/li\u003e\n\u003cli\u003eMcNamara JA, Brudon WL, Kokich VG. Orthodontics and Dentofacial Orthopedics. Needham Press; 2001. 576 p. \u003c/li\u003e\n\u003cli\u003eSayin MO, Turkkahraman H. Comparison of dental arch and alveolar widths of patients with Class II, division 1 malocclusion and subjects with Class I ideal occlusion. Angle Orthod. 2004 Jun;74(3):356\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eBell RA, LeCompte EJ. The effects of maxillary expansion using a quad-helix appliance during the deciduous and mixed dentitions. Am J Orthod. 1981 Feb;79(2):152\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eStorey E. Tissue response to the movement of bones. Am J Orthod. 1973 Sep;64(3):229\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eMossaz-Jo\u0026euml;lson K, Mossaz CF. Slow maxillary expansion: a comparison between banded and bonded appliances. Eur J Orthod. 1989 Feb;11(1):67\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eMamboleo E, Ouldyerou A, Alsharif K, Ngan P, Merdji A, Roy S, et al. Biomechanical Analysis of Orthodontic Miniscrew-Assisted Rapid Palatal Expansion on Dental and Bone Tissues: A Finite-Element Study. J Eng Sci Med Diagn Ther [Internet]. 2024 Jun 17 [cited 2025 Jan 30];7(041007). Available from: https://doi.org/10.1115/1.4065589\u003c/li\u003e\n\u003cli\u003eJafari A, Shetty KS, Kumar M. Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces--a three-dimensional FEM study. Angle Orthod. 2003 Feb;73(1):12\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eKapadia RM, Vaghani BR, Shah AM. Comparative evaluation of dental, dentoalveolar and skeletal effects of slow maxillary expansion using Jackscrew, Quadhelix and Niti palatal expander2 on a finite element model of a young skull. IP Indian J Orthod Dentofac Res. 3(3):154\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eDonohue VE, Marshman L a. G, Winchester LJ. A clinical comparison of the quadhelix appliance and the nickel titanium (tandem loop) palatal expander: a preliminary, prospective investigation. Eur J Orthod. 2004 Aug;26(4):411\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eCorbridge JK, Campbell PM, Taylor R, Ceen RF, Buschang PH. Transverse dentoalveolar changes after slow maxillary expansion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2011 Sep;140(3):317\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eSandik\u0026ccedil;ioğlu M, Hazar S. Skeletal and dental changes after maxillary expansion in the mixed dentition. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1997 Mar;111(3):321\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eWertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod. 1970 Jul;58(1):41\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eHerold JS. Maxillary expansion: a retrospective study of three methods of expansion and their long-term sequelae. Br J Orthod. 1989 Aug;16(3):195\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eShetty P, Hegde AM, Rai K. Study of stress distribution and displacement of the maxillary complex following application of forces using jackscrew and nitanium palatal expander 2--a finite element study. J Clin Pediatr Dent. 2009;34(1):87\u0026ndash;93. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maxillary constriction, Class II malocclusion, NiTi expander, Sawangi Flexiforce Expander (SFE), Three-dimensional displacement, Von Mises stress, Finite Element Analysis (FEA)","lastPublishedDoi":"10.21203/rs.3.rs-6579552/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6579552/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND\u003cbr\u003e\n \u003c/strong\u003eMaxillary constriction, a common malocclusion characterized by reduced transverse maxillary width, is often associated with Class II skeletal patterns and posterior crossbite. It disrupts craniofacial balance and may contribute to functional issues like dental crowding and airway obstruction. While rapid maxillary expansion is widely used, slow maxillary expanders (SMEs) offer a more conservative, stable alternative. The Sawangi Flexiforce Expander (SFE), a novel stainless-steel SME, is designed to provide controlled skeletal and dentoalveolar expansion. This study evaluates the three-dimensional skeletal and dentoalveolar effects of SFE compared to the conventional NiTi expander using Finite Element Analysis (FEA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE\u003cbr\u003e\n \u003c/strong\u003eTo compare and correlate the three-dimensional skeletal and dentoalveolar effects produced by the SFE and NiTi expander in Class II cases with maxillary constriction using the Finite Element Method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003cbr\u003e\n \u003c/strong\u003eA high-resolution CT scan of a 13-year-old girl with Class II malocclusion was used to generate a 3D geometric skull model. The NiTi and SFE appliances were digitally modelled and positioned on the maxillary arch. Material properties and boundary conditions were assigned based on the literature. The model was meshed into 2,53,378 elements and analyzed using ANSYS software. Von Mises stress (MPa) and displacement (mm) were measured at various dental, dentoalveolar, and skeletal landmarks for both expanders. A statistical comparison was made using the students' unpaired t-test and Pearson’s correlation coefficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003cbr\u003e\n \u003c/strong\u003eSFE showed significantly higher displacement than the NiTi expander across all planes—transverse (X), sagittal (Y), and vertical (Z)—with the greatest movement at the first permanent molar. Von Mises stress levels increased with activation, reaching effective expansion thresholds only at 3mm activation for SFE. Although SFE produced relatively higher stress values, differences were not statistically significant. Both appliances showed a strong, statistically significant positive correlation between stress and displacement, with SFE demonstrating greater skeletal effects and NiTi primarily inducing dentoalveolar changes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION\u003cbr\u003e\n \u003c/strong\u003eThe SFE appliance exhibited superior three-dimensional skeletal and dentoalveolar displacement compared to the NiTi expander. The positive correlation between stress and displacement confirms its biomechanical efficacy, making SFE a promising alternative for managing Class II malocclusions with maxillary constriction.\u003c/p\u003e","manuscriptTitle":"Comparative Evaluation and Correlation of Three Dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander as Against Niti Expander in Class Ii Cases With Maxillary Constriction - a Fem Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 08:59:57","doi":"10.21203/rs.3.rs-6579552/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9069aa3-7ca8-4a48-b108-65330b38081c","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T18:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 08:59:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6579552","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6579552","identity":"rs-6579552","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}