Abstract
BackgroundDespite the gradual increase in the use of rapid maxillary expansion (RME), specifically RME with the aid of skeletal anchorage in adults, there have been no reports comparing dentoskeletal and soft tissue changes between nonsurgical tooth-borne and tooth-bone-borne RMEs in adults. This study aimed to analyse differences in dentoskeletal and soft tissue changes between tooth-borne and tooth-bone-borne RMEs using a similar appliance design and the same expansion protocol in adult patients.MethodsTwenty-one patients with tooth-borne expansion (a conventional expansion screw with two premolars and two molar bands for dental anchorage [T-RME]) and the same number of patients with tooth-bone-borne hybrid expansion (a conventional expansion screw with two premolar and two molar bands for dental anchorage and four mini-implants in the palate for skeletal anchorage [H-RME]) were included. Dentoskeletal and soft tissue variables at pretreatment (T1) and after expansion (T2) were measured using posteroanterior and lateral cephalograms and frontal photographs. The sex distribution of the two groups was analysed using the chi-square test, and the change after RME in each group was evaluated using the Wilcoxon signed-rank test. Differences in pretreatment age, expansion duration, post-expansion duration, and dentoskeletal and soft tissue changes after RME between the two groups were determined using the Mann–Whitney U test.ResultsThere were no significant differences in the expansion protocol, pretreatment conditions, and sex distribution between the two groups. Despite similar degrees of dental expansion at the crown level between the two groups, H-RME induced increased skeletal and parallel expansion of the maxilla compared to T-RME. After expansion, H-RME demonstrated increased forward displacement of the maxilla without significant changes in the vertical dimension, while T-RME exhibited increased backward displacement of the mandible, increased vertical dimension, and decreased overbite. Both groups showed significant retroclination and extrusion of the maxillary incisors without significant intergroup differences. There were no significant soft tissue changes between the two groups.ConclusionThis study suggests that using skeletal anchorage in RME may induce increased skeletal and parallel expansion of the maxilla without significant effects on the vertical dimension.
Highlights
Despite the gradual increase in the use of rapid maxillary expansion (RME), RME with the aid of skeletal anchorage in adults, there have been no reports comparing dentoskeletal and soft tissue changes between nonsurgical tooth-borne and tooth-bone-borne RMEs in adults
Facial width was not significantly increased in either group, but the increase in nasal width, maxillary width, and intermolar root width was greater in the hybrid RME (H-RME) group than in the tooth-borne RME (T-RME) group
The mandible was positioned more posteriorly relative to the maxilla in both groups (A point-nasion-B point [ANB]), and there was no significant difference in the maxillomandibular relationship changes between the two groups (ANB)
Summary
Despite the gradual increase in the use of rapid maxillary expansion (RME), RME with the aid of skeletal anchorage in adults, there have been no reports comparing dentoskeletal and soft tissue changes between nonsurgical tooth-borne and tooth-bone-borne RMEs in adults. In adult patients, because the resistance to expansion increases as the suture matures with aging, there are concerns about the failure of the skeletal maxillary expansion using the conventional expander [4, 8] A procedure such as surgically assisted RME for surgical separation of the maxilla have been proposed [9], but this present a potential risk of infection and additional costs due to an invasive operation [8]. Successful and stable nonsurgical expansion of the maxilla can be achieved in adults using the hybrid expander [15]
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