1. Figure 9: Model of events in sutures in response to orthopedic transverse tensile forces. As an initial response to tensile forces, a robust and sustained inflammatory response (markers: IL1β, TNF-α, CCL-2, CCL-5) recruits osteoclasts precursors into the area of mid-palatal suture and adjacent bone. As a result of osteoclast activity (markers: RANK and RANKL, CtsK, TRAP) and bone resorption, there is a significant reduction in the bone density in the area and the suture width is visibly increased. After this initial stage of overt catabolism in both tensile and compressive sutures, there is a transition marked by stimulation of bone formation via coupling factors including diffusible factors, membrane bound molecules and factors embedded in bone matrix (markers: TGF-β, BMP6, WNT10b and SP1). During this period and only after the catabolic stage, does the palatal and dental widths significantly increase, and physical expansion finally occurs. This transition period results in osteoblast stimulation and is followed by a strong anabolic phase (markers: Coll I, ALP, OC, OP) that ensures that the resorbed bone is replaced with new bone, re-establishing the integrity of the suture in the framework of the new skeletal dimensions.
Alikhani M, Alansari S, Al Jearah MM, Gadhavi N, Hamidaddin MA, Shembesh FA, Sangsuwon C, Nervina JM, Teixeira CC. Innovation (4):e1. doi: /2018.2