Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy.

Eugen Silviu Bud,Petru Vaida,Mariana Păcurar,Cristina Ioana Bică,Anamaria Bud,Krisztina Martha,Alexandru Vlasa

doi:10.3390/biology10030187

Abstract

Simple SummaryIn this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.The use of maxillary expanders has the effect of distancing the maxillary bones at the level of the median palatal suture. During maxillary expansion, the main resistance forces occur at the zygomatico-maxillary sutures, and not in the median palatal suture, which is the basic principle on which this method is based. In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. The mid-palatal suture was separated in 88.88% of cases, buccal bone height of the alveolar crest had decreased at first molar both at oral and palatal level by approximately 2.07 mm in 40.7% of cases whilst the remaining 59.3% showed insignificant bone loss, with canines exhibiting buccal tipping of 4.10° in 62.5% of cases. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.

Highlights

The miniscrew-assisted rapid palatal expansion (MARPE) was first introduced in clinical practice in 2010 [1]
Clinicians have recently introduced several minimal invasive surgical techniques associated with MARPE, called corticopunctures or micro-osteoperforations, [7,8,9,10,11] to improve or facilitate the rate of tooth movement (RTM) and to reduce iatrogenic damage caused by the long-term wear of fixed appliances [12,13]
The software used for doingrapid the statistical analysis(MARPE)

Summary

Introduction

The miniscrew-assisted rapid palatal expansion (MARPE) was first introduced in clinical practice in 2010 [1]. The use of orthodontic micro-implants as auxiliary anchorage devices to optimize the application of mechanical forces to circum-maxillary sutures, makes it possible to avoid the otherwise indispensable osteotomies. This system, called MARPE, applies forces to the micro-implants, and not to the teeth or periodontium. Clinicians have recently introduced several minimal invasive surgical techniques associated with MARPE, called corticopunctures or micro-osteoperforations, [7,8,9,10,11] to improve or facilitate the rate of tooth movement (RTM) and to reduce iatrogenic damage caused by the long-term wear of fixed appliances [12,13]

Methods

Results

Conclusion