Dr. Gerard Altounian

Short CV

Docteur en chirurgie dentaire.

Former assistant at the University Paris VII

Former président of ESLO and SFOL

Instructor of the DUOL at the University Paris V 






AIMS: When we have to solve the crowding or a transversal discrepancy between the upper arch and the lower arch, we should ask ourselves these following questions.

METHODS: Is it large enough to receive all the teeth? Is there a lack of development of the base bone or is the transversal arch form development enough with an adapted volume to match with the lower arch?

If the answers are yes, we can align with our archwires the teeth by creating dento-alveolar modifications and expansion with or without stripping, but without surgery or extractions.


If these answers are no, orthodontists have only two choices: they decide  to extract teeth, specially when the crowding is severe or they ask their surgeon to expand surgically the maxilla, that means they ask them to create skeletal expansion as we routinely program for our young patients, in an orthopedic way.

When the surgeons are required to expand a maxilla they had also two choices until now!  To achieve the surgical correction of maxillary width they could select:

-Either a chirurgical disjunction made in one shot: Transverse expansion of the maxilla via Lefort 1 osteotomy with segments or also named Intermaxillary disjunction.

This procedure should be selected when the transversal discrepancy is under five 5 mm. As a complete Lefort 1 with repositioning is performed, other skeletal anomalies are treated in one stage surgery.  

-Either the chirurgical distraction named in English; SARME (surgically assisted rapid maxillary expansion) or in French EPRAC (Expansion palatine assistée chirurgicalement).

They have to select this procedure when the transversal discrepancy is over 5 mm.

But the surgical technic doesn’t allow maxillary protraction, impaction and mandibular advancement or retrusion. So patients can’t be treated in the same surgery and some of them give up.

Today, if we want to expand the maxilla more than 5 mm with or without other skeletal anomalies, we can select a third technique which is able to treat the patient in the same surgery.


Results and Conclusions: My goal is to help you choose between these different options and be able to discuss them with your surgeon.