Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Eligibility Criteria
2.3. Inclusion and Exclusion Criteria
2.4. Data Sources and Search Strategy
2.5. Data Collection
3. Results
Study Selection and Characteristics
4. Case Report
4.1. Etiology and Diagnosis
4.2. Treatment Objectives
4.3. Treatment Strategy
4.4. Treatment Progress
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BB MARPE | Bone-born RME appliance |
CBCT | Cone-beam computed tomography |
MARPE | Miniscrew Anchored Rapid Palatal Expander |
M-MW | Molar-maxillary width |
MW | Maxillary-width |
OSAS | Obstructive sleep apnea syndrome |
PA | Posteroanterior |
P-MW | Premolar-maxillary width |
RME | Rapid maxillary expansion |
TAD | Temporary anchorage device |
TB RME | Tooth-borne RME appliance |
TBB MARPE | Tooth–bone-borne MARPE appliance |
TTB RME | Tooth-tissue-borne RME appliance |
U6 | Upper first molar |
L6 | Lower first molar |
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Author/ Year | Study Design | Sample Size | Data Collection | Average Age (Years Old) | Type of Appliance | Protocol of Expansion | Features of the Screw | Amout of Expansion Achieved (mm) | Outcomes | Retention Period |
---|---|---|---|---|---|---|---|---|---|---|
Gökçe, 2021 | Retrospective | 54 (25 M, 29 F) | Pretreatment (T0) and posttreatment (T1) Postero Anterior cephalometric radiographs | 13.28 ± 1.20 (TBB) 13.08 ± 1.06 (TTB) 12.05 ± 1.35 (TB) | -TBB -TTB -TB | First week 2 turns/day and then 1 turn/day 1 turn = 0.25 mm | 9 mm Hyrax expansion screw (G&H Orthodontics, Franklin, IN, USA) | Intermolar width: TB = 5.5 mm TTB = 4.47 mm BB = 6.71 mm | Skeletal changes are more evident in TTB and TBB groups | 3 months |
Yildirim, 2018 | Observational | 20 (11 F, 9 M) | Micro CT device on premolar teeth after expansion and extraction | 11–16 (mean age 14.31 ± 1.36) | BB and TTB in the same patient using modified device | N.D. | Hyrax screw | N.D. | Root resorptions are more frequent in the TTB group, mostly in the apical and middle thirds | 3 months |
Canan, 2017 | RCT | 47 (25 F, 22 M) | Superimposition of 3D digital maxillary dental models; OHIP-14 questionnaire to value quality of life | 12.63 ± 1.36 (TB) 12.92 ± 1.07 (BB) 13.41 ± 0.88 (HB) | -TB -BB -TBB | 2 turns/day 1 turn = 0.25 mm | 9 mm Hyrax; Lewa-Dental, Remchingen, Germany) | Mean turns = 26; Mean screw expansion = 6.5 mm | Dentoalveolar maxillary expansion with mild relapse in all groups; Lower expansion of the BB on the right side; Spontaneous interdental expansion in the mandibular dentitions | 6 months |
Silveira, 2021 | RCT | 34 | Digitally superimposed pre-treatment and post-retention 3D intraoral scans on the palatal rugae using the software 3DSlicer | 11–16 year | -Hyrax (TB) -Mini-hyrax (TB) | 2 turns/day 1 turn = 0.25 mm | −8 mm mini expander jackscrew (Dynaflex, Saint Ann, USA) −9 mm Hyrax jackscrew (Morelli, Sorocaba, Brazil) | Mean turns = 30; Mean screw expansion = 7.5 mm | No significant differences in dental effects, impact on quality of life and pain perception | 6 months |
Kavand, 2019 | Retrospective | 36 | CBCT at T0 before expansion and T1 post retention | 14.7 years (BB) 14.4 years (TB) | -BB -TB | 2 turns/day 1 turn = 0.25 mm | Jackscrew (Palex II Extra-Mini Expander, Su mmit Orthodontic Services, Munroe Falls, OH, USA) | Mean palatal width expansion TB = 1.5 ± 0.4 BB = 2.2 ± 0.3 mm | Increased volume of nasal cavity and nasopharynx; Increased maxillary dental and skeletal width in both groups; Buccal tipping of maxillary molars in TB. | 3 months |
Alcin, 2021 | RCT | 20 (12 F, 8 M) | Micro-CT of maxillary first premolars | 12–15 | -TBB -TB -Acrylic-bonded TB -Full-coverage TB | 1turn/day 1 turn = 0.25 mm | Hyrax screw | Mean turns = 34; | All expansion appliances cause root resorption, mostly on the buccal surface; TBB causes lesser root resorption than TB appliances. | 3 months |
Celenk-Koca, 2018 | RCT | 40 TB group: 12 F, 8 M; BB group 13 F, 7 M | CBCT evaluation of: -transverse skeletal widths; -buccal bone thickness; -tooth inclination -root length | 13.84 ± 1.36 (TB) 13.81 ± 1.23 (BB) | -TB -BB | 2 turns/day 1 turn = 0.25 mm | Hyrax screw | Molar width: TB = 4.2 + 1.7 BB = 4.5 + 1.3 | BB increased the maxillary suture opening more than 2.5 times than TB and did not result in any dental side effects | 6 months |
Annarumma, 2021 | Retrospective | 24 (12 M, 12 F) | CBCT evaluation of: -maxillary width; -inclination of the alveolar process; -tooth inclination; -vertical dental height; -periodontal tissues | 13.9 | -BB on 4 miniscrews | 2 turns/day | Hyrax screw on BB | mean expansion screw = 8.12 ± 2.98 mm | BB expansion was effective with negligible dental effects | 12 months |
Aljawad, 2021 | Case-control retrospective study | 33 17 TB 16 control group | Upper airway dimensions (CBCT) | mean age 12.6 ± 1.8 | -TB | 2 turns/day 1 turn = 0.25 mm | Hyrax screw (Dentaurum, Ispringen, Germany) | N.D. | RME causes an increase in upper airway dimensions | 3 months |
Torun, 2017 | Retrospective study | 28 (10 M, 18 F) | Measurements of soft tissue with CBCT at T0, T1 | 13.91 ± 1.8 | TB | 2 turns/day 1 turn = 0.25 mm | Hyrax screw (Dentaurum, Ispringen, Germany) | Mean Screw expansion: 9–10 mm | significant changes in facial soft tissues P < 0.001 | 6 months |
Lotfi, 2018 | Retrospective study | 20 (8 M, 12 F) | Measurements of upper airway volume changes with CBCT at T0, T1 | 12. 3 ± 1.9 | -TB | 2 turns/day | Hyrax screw | N.D | Significant changes in nasal cavity volume | 6 months |
Chun, 2022 | Prospective RCT | 40 TB group: 20 (6 M, 14 F) MARPE group (8 M, 12 F) | CBCT evaluation of: -skeletal changes; -dentoalveolar changes; -periodontal changes | 14.0 ± 4.3 years | -TB -MARPE | 1 turn/day for 35 days 1 turn = 0.20 mm | Hyrax expander (Dentaurum, Ispringen, Germany) | 7 mm screw expansion | Greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) in the MARPE group compared to the TB group; Similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the TB group; Lesser buccal displacement of the anchor teeth in the MARPE group. | 3 months |
Jia, 2021 | Prospective RCT | 60 MARPE 30 TB 30 | CBCT and dental cast | 14.8 ± 1.5 (TB) 15.1 ± 1.6 (MARPE) | -MARPE -TB | 2 turns/day 1 turn = 0.25 | MARPE TTB: jackscrew (length: 12 mm; anatomic expander type: ‘‘s;’’ Forestadent, Pforzheim, Germany) TB HYRAX: jackscrew (anatomic expander type; Forestadent) | Mean expansion at maxillary basal bone TTB: 4.53 TB: 4.53 | MARPE enabled more predictable and greater skeletal expansion, less buccal tipping and alveolar height loss on anchorage teeth. | 3 months |
Akan, 2021 | RCT | 32 16 TB 16 TBB | Changes in soft tissues before RME (T0) and post-retention (T1) evaluated by stereophotogra mmetry | 13.4 ± 1.3 | -TB -TBB | First week 2 turns/day and then 1 turn /day 1 turn = 0.25 mm | TB:Hyrax screw (Dentaurum, Ispringen, Germany) MARPE TTB mini-screws 2 mm diameter and 9 mm length (Benefit mini-implants; PSM Medical Solutions) | Mean numbers of activations were 25.25 ± 4.42 turns in hyrax group and 24.88 ± 3.40 turns in hybrid hyrax group. | Both appliances had effects on soft tissue profile; Anterior face height and lower face height increased in both groups; Upper lip length increased by 0.36 mm in theTBB group and 0.10 mm in the TB group. | 3 months |
Lo Giudice, 2020 | Retrospective study | 33 | Linear and angular measurements in the coronal view to assess buccal inclinations and widths of mandibular posterior units. | 14.4 ± 1.3 (TB) 14.7 ± 1.4 (BB) | -TB -BB | 2 turns/day 1 turn = 0.25 mm | Hyrax miniscrew (Palex II ExtraMini Expander, Su mmit Orthodontic Services, Munroe Falls, OH, USA; Figure 1B) | 16–26 width TB = 4.20 ± 1.39 BB = 3.02 ± 1.48 | A clinically significant gain of space in the mandibular arch should not be expected after RME | 6 months |
Cheung, 2021 | RCT | 44 | Measurements of upper airway volume changes with CBCT at T0, T1 | ND | -TB -TBB | 2 turns/day 1 turn = 0.25 mm | Hyrax screw (Hyrax, Dentaurum, Ispringen, Germany) Keles keyless expander (Keles, Istanbul, Turkey) | N.D. | No statistically significant difference across the TB and TBB | 6 months |
Measurements | Norm | Pre-Treatment | Post-Treatment |
---|---|---|---|
Anterior Cranial Base(S-N) | 74.5 ± 3 | 66 | 66.5 |
Facial Axis (BaN-PTGn) | 90° ± 3 | 84.4° | 85.8° |
Mandibular Lenght (Goc-Me) | 74.5 ± 5 | 61.9 | 64 |
Posterior Cranial Base (S-Ar) | 34 ± 3 | 30.9 | 31.4 |
Height Mandibular Ramus (Ar-Goc) | 47.5 ± 5 | 33.9 | 38.3 |
Saddle angle: (N-S-Ar) | 123° ± 5 | 120.4° | 118.8° |
Articular angle (S-Ar-Goc) | 143° ± 7 | 150.1° | 149.6° |
Gonial angle (Ar-Goc-Me) | 130° ± 7 | 128.6° | 129.1° |
Upper gonial angle (Ar-Goc-N) | 52° ± 3 | 53° | 52.4° |
Lower gonial angle (Me-Goc-N) | 70° ± 2 | 75.6° | 76.7° |
Anterior facial height (N-Me) | 113 ± 7 | 105.2 | 108.9 |
Posterior facial height (S-Goc) | 77.5 ± 7.5 | 62.6 | 67.3 |
Jarabak Facial Proportion % | 61% ± 3 | 59.5% | 61.8% |
SNA | 82° ± 2 | 80.9° | 79.7° |
SNB | 80° ± 2 | 75.1° | 76° |
ANB | 2° ± 2 | 5.8° | 3.7° |
U1—palatal plane | 110° ± 2 | 112.7° | 111.2° |
IMPA | 90° ± 3 | 96.9° | 97.8° |
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Inchingolo, A.D.; Ferrara, I.; Viapiano, F.; Netti, A.; Campanelli, M.; Buongiorno, S.; Latini, G.; Carpentiere, V.; Ciocia, A.M.; Ceci, S.; et al. Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report. Children 2022, 9, 1046. https://doi.org/10.3390/children9071046
Inchingolo AD, Ferrara I, Viapiano F, Netti A, Campanelli M, Buongiorno S, Latini G, Carpentiere V, Ciocia AM, Ceci S, et al. Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report. Children. 2022; 9(7):1046. https://doi.org/10.3390/children9071046
Chicago/Turabian StyleInchingolo, Alessio Danilo, Irene Ferrara, Fabio Viapiano, Anna Netti, Merigrazia Campanelli, Silvio Buongiorno, Giulia Latini, Vincenzo Carpentiere, Anna Maria Ciocia, Sabino Ceci, and et al. 2022. "Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report" Children 9, no. 7: 1046. https://doi.org/10.3390/children9071046