THE EFFICIENCY OF TOOTH-ANCHORED VERSUS BONEANCHORED RAPID MAXILLARY EXPANSION IN YOUNG AND LATE ADOLESCENT PATIENTS

Abstract

Relevance of the problem. Incidence of posterior cross­bite has been reported to be 8–23% and it is a com­mon problem often seen in children and adolescents. An effective treatment of the skeletal transversal maxillary deficiency usually involves rapid maxillary expansion (RME). The expansion can be achieved using different types of expanders: bone anchored, tooth anchored or hybrid. The variety of clinical results comparing bone-borne and tooth-borne RME influence lack of unanimous treatment plan for adolescents. Aim. To compare the efficiency of tooth-borne expanders with bone-borne expanders by comparing dentoskeletal changes evaluated by CBCT. Material and methods. Electronic database search was carried out according to PRISMA principles. Five electro­nic research databases were searched including Medline (via PubMed), Cochrane Library, ProQuest, Wiley On­line Library and Web of Science. PICOS framework was used to form a focused question and the risk of bias was assessed using the Cochrane tool for randomized trials (RoB 2) by two individual researchers. Included studies were randomized clinical trials, published less than 10 years ago, with minimum follow-up period of 9 months with CBCT. Results. Two studies proved that bone borne RME produ­ced greater results in skeletal expansion, however other two studies failed to confirm these findings. Regarding alveolar bone loss, the results were also contradictory: two studies found no significant difference in both RME groups, however, other two studies found that bone borne RME exhibit less alveolar bone loss. As for den­tal tipping, the results were also different in all studies: In a study performed by Lagravere et al (2013), dental tipping occurred regardless of RME treatment for molar teeth, however in the premolar group, increased tipping was noticed in the tooth-anchored group. Another study by the same author concluded similar results: in the to­oth borne RME group no significant tipping in molars was seen, while in premolars, buccal crown tipping was observed, which was significant (p<0.003). In the bone borne RME group significant dental tipping was obser­ved in molars. Contrary to these findings, two studies concluded that dental tipping is experienced significantly less in the bone-borne RME group and one study per­formed by Davami et al found no significant difference in both groups. Conclusion. To conclude, current evidence suggests contradictory results in maxillary expansion using bone borne or tooth borne RME devices. Though the evidence is limited, both types of RME have similar outcomes. More studies with a higher number of patients are nee­ded to determine conclusive results.