Abstract
IntroductionBone-borne miniscrew assisted palatal expansion (MAPE) is a common technique to improve maxillary transverse deficiency in young adolescents. Adult patients usually present a challenge, as they often require additional surgical assisted maxillary expansion (SARPE). There is still no clear statement about non-surgical expansion in adult patients using this technique. The aim of this study was to evaluate the success and complication rate of non-surgical palatal expansion in adults utilizing MAPE with a novel force-controlled polycyclic expansion protocol (FCPC).MethodsThis consecutive study consisted of 33 adult patients with an average age of 29.1 ± 10.2 years (min. 18 years, max. 58 years), including one dropout patient. First, four miniscrews were inserted and after 12-weeks latency, the expander was placed and the FCPC protocol was applied (MAPE group). In case of missing expansion, a SARPE was performed (SARPE group). After maximum expansion, a cone beam CT was made and widening of the midpalatal suture was measured. The outcome variables were successful non-surgical expansion and, with sample size power above 80%, the odds of failed non-surgical expansion and associated complications were evaluated. The primary predictor variable was age. Statistical analysis was performed using R (Version 3.1) to calculate power, to construct various models for measuring the odds of requiring surgical intervention/complications, and others.ResultsSuccessful non-surgical expansion was achieved in 27 patients (84.4%), ranging from 18 to 49 years. Mean age differed significantly between both groups (26.8 ± 8.2 years vs. 41.3 ± 9.9 years; p < 0.001). Mean expansion at the anterior and posterior palate for the MAPE group was 5.4 ± 1.5 mm and 2.5 ± 1.1 mm, respectively. Among these subjects’ complications were observed in 18.5%. Age significantly increased the odds of complications (p = 0.019).Conclusions1. The success rate of MAPE among individuals aged 18 to 49 years was 84.4%.2. A V-shaped expansion pattern in the antero-posterior dimension was mostly observed.3. Complications were significantly associated with age.4. A careful expansion protocol seems to be beneficial to prevent unfavorable results in adult patients.Trial registrationConsecutive cohort study, Review Board No. EK-2-2014/0016.
Highlights
Bone-borne miniscrew assisted palatal expansion (MAPE) is a common technique to improve maxillary transverse deficiency in young adolescents
In order to reduce these side effects, the rigidity of the expander used in this current study was improved and a novel 2-stage protocol was applied for miniscrew assisted palatal expansion (MAPE) [17]
Using a multivariate binomial logistic stepwise regression of surgical intervention against age, gender, and duration of expansion the model showed significantly (p < 0.019 with power > 80%) high odds for the need of surgicallyassisted rapid palatal expansion (SARPE) that increases by 17.9% per year above the baseline age of 18 years
Summary
Bone-borne miniscrew assisted palatal expansion (MAPE) is a common technique to improve maxillary transverse deficiency in young adolescents. In order to reduce these side effects, the rigidity of the expander used in this current study was improved and a novel 2-stage protocol was applied for miniscrew assisted palatal expansion (without Rapid expander activation) (MAPE) [17]. With this protocol (force-controlled polycyclic protocol: FCPC), an activation period is followed by a slow forcecontrolled polycyclic expansion period to weaken the circummaxillary sutures and enable maxillary expansion. This protocol has similarities with the Alt-RAMEC protocol [18] but is continued throughout the whole expansion period and and combined with force control
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