Conventional Rapid Maxillary Expansion Research Articles

TEMPORARY REMOVAL: Implications of maxillary expansion for the craniofacial phenotype in pediatric and adolescent obstructive sleep apnea

Obstructive Sleep Apnea (OSA) in growing children and adolescents is a multifaceted condition marked by recurrent episodes of breathing interruptions during sleep due to upper airway collapsibility. The pathophysiology of pediatric OSA includes neuromotor dysfunction, inflammation, and anatomical factors related to soft tissues and craniofacial morphology. The prevalence of OSA in children varies between 1-10%, and its impact can extend to behavioral, neurocognitive, cardiovascular, and metabolic issues. Adolescence poses unique diagnostic challenges due to significant physical and hormonal changes, necessitating age-appropriate criteria for OSA assessment.Maxillary transverse deficiency (MTD) is recognized as a critical craniofacial risk factor for pediatric OSA. Rapid Maxillary Expansion (RME) has garnered attention for its ability to open the midpalatal suture, expand the nasal and oropharyngeal airways, and reduce nasal resistance, thereby improving respiratory function. While RME is effective in many cases, microimplant-assisted RME is a promising alternative for severe cases or when conventional RME is insufficient. This technique offers enhanced skeletal expansion and airway improvement, though further research is needed to validate its functional benefits.Case reports highlight the successful application of RME and microimplant-assisted RME in treating pediatric OSA. These interventions resulted in significant improvements in airway dimensions, reduction in apnea-hypopnea index (AHI), and alleviation of symptoms such as snoring and daytime sleepiness.

Comparison of the effects on facial soft tissues produced by rapid and slow maxillary expansion using stereophotogrammetry: a randomized clinical trial

ObjectiveTo compare the effects on facial soft tissues produced by maxillary expansion generated by rapid maxillary expansion (RME) versus slow maxillary expansion (SME).Materials and methodsPatients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. A conventional RME screw was compared to a new expansion screw (Leaf expander) designed to produce SME. Both screws were incorporated in a fixed expander. The primary outcome was the difference of the facial tissue changes in the nasal area measured on facial 3D images captured immediately before application of the expander (T0) and after one year of retention, immediately after the expander removal (T1). Secondary outcomes were soft tissue changes of other facial regions (mouth, lips, and chin). Analysis of covariance was used for statistical analysis.ResultsFourteen patients were allocated to the RME group, and 14 patients were allocated to the SME group. There were no dropouts. Nasal width change showed a difference between the two groups (1.3 mm greater in the RME group, 95% CI from 0.4 to 2.2, P = 0.005). Also, intercanthal width showed a difference between treatments (0.7 mm greater in the RME group, 95% CI from 0.0 to 1.3, P = 0.044). Nasal columella width, mouth width, nasal tip angle, upper lip angle, and lower lip angle did not show any statistically significant differences. The Y-axis (anterior–posterior) components of the nasal landmark showed a statistically significant difference between the two groups (0.5 mm of forward displacement greater in the RME group, 95% CI from 0.0 to 1.2, P = 0.040). Also, Z-axis (superior-inferior) components of the lower lip landmark was statistically significant (0.9 mm of downward displacement in favor of the RME group, 95% CI from 0.1 to 1.7, P = 0.027). All the other comparisons of the three-dimensional assessments were not statistically significant.ConclusionsRME produced significant facial soft tissue changes when compared to SME. RME induced greater increases in both nasal and intercanthal widths (1.3 mm and 0.7 mm, respectively). These findings, though statistically significant, probably are not clinically relevant.Trial registration ISRCTN, ISRCTN18263886. Registered 8 November 2016, https://www.isrctn.com/ISRCTN18263886?q=Franchi&filters=&sort=&offset=2&totalResults=2&page=1&pageSize=10

Evidences From Systematic Reviews Regarding Miniscrew-Assisted Rapid Palatal Expansion (MARPE) Approach In Orthodontics

Background. Miniscrew-assisted rapid palatal expansion (MARPE) has been considered as relatively novel and effective method of orthodontic treatment, but the discussion is still ongoing regarding effectiveness of MARPE for different age population groups, while also in comparison with surgically assisted rapid palatal expansion or conventional rapid maxillary expansions, since evidences available for MARPE is mostly of insufficient quality.
 Objective. To collect and represent evidences of MARPE treatment outcomes in orthodontics based on the data available within systematic reviews.
 Materials and Methods. Search was provided via PubMed Central, Web of Science and Scopus databases, while also within Cochrane Library. Only systematic reviews written in English were considered for analysis. Primary outcomes such as success rate (percentage of cases, where required maxillary width was achieved) and maxillary expansion rate in means of midpalatal split, dental intermolar width, skeletal and dentoalveolar expansion, palatal suture opening, palatal width measured in millimeters or percentage were tabulated and analyzed. Secondary outcomes were presented in descriptive manner 
 Results. Overall 12 systematic reviews were enrolled into study group of targeted publications. Among these 12 systematic reviews primary outcomes were extracted from 8 of them, while rest 4 systematic reviews were used for analysis of secondary outcomes. Succes rate of MARPE varied in the range of 82.8-100%, while intermolar width increase after MARPE treatment – in the range of 4.79-6.55 mm. 
 Conclusion. Considering data available within systematic reviews MARPE approach seems to be reliable orthodontic treatment option, which help to gain significant increase for skeletal and dental intermolar width among patients with maxillary transverse deficiency. Such treatment strategy provides better results than conventional rapid maxillary expansion and lesser periodontal negative consequences compare to surgical-assisted rapid palatal expansion, even though quality of data supporting these statements are insufficient and debatable.

Buccal Alveolar Bone changes and upper first molar displacement after maxillary expansion with RME, Ni-Ti leaf springs expander and Tooth- Bone-borne Expander. A CBCT based analysis.

To evaluate the buccal alveolar bone changes and the upper first molar displacement in subjects treated with conventional rapid maxillary expansion (RME), Ni-Ti leaf springs expander (Leaf Expander) and Tooth-Bone-borne Expander (Hybrid Expander) using CBCT scans. The sample consisted of 52 children treated with RME (n=18), Leaf Expander (n= 17) and Hybrid Expander (n= 17). CBCTs were taken before and after maxillary expansion and the Horos software was used for the analysis. Descriptive statistics and paired t-test were used to assess changes between the pre-treatment and post-treatment measurements. ANOVA test and Tukey's post hoc test with Bonferroni correction was used for between groups comparison. The Hybrid Expander during preadolescence showed few advantages over the use of tooth-anchored expanders. An expansion approach with mini-screws is not preferable during early mixed dentition to a conventional approach. The differences in dental tipping values were clinically insignificant and the reduction in cortical bone thickness remained less than 1 mm. When possible, the use of second primary molars as anchorage should be preferred.

Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni–Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation

BackgroundThe aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni–Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars.MethodsPatients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy.Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3–6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes.ResultsThe Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group.ConclusionsAccording to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.

Evaluation of dental and skeletal effects of the asymmetric rapid maxillary expansion appliance: A three-dimensional finite element study.

Transverse maxillary deficiency is one of the most common skeletal anomalies. The incidence of posterior crossbite caused by maxillary deficiency is between 2.7% and 23.3%. Unilateral posterior crossbite is more common than bilateral crossbite. The most common treatment for skeletal posterior crossbite is rapid maxillary expansion (RME), in which the base of the maxillary bone is expanded by separating the midpalatal suture. This study compares the biomechanical effects of three different RME appliances, especially the effects on the midline, and evaluates the usability of the modified asymmetric RME (ARME) appliance for treating unilateral crossbites. Three scenarios were created with skull models using three different appliances: (1) conventional-bonded RME appliance; (2) full-cap splint RME appliance, with all teeth covered with acrylic; and (3) ARME, with all teeth on the right side and premolars and molars on the left side covered with acrylic. The finite element method was used to assess stress levels and displacements in all models after applying a 5-mm horizontal displacement to the RME screw. The lateral transverse movement of the first molars was greater with the conventional RME appliance than with the full-cap splint RME appliance. The lateral transverse movement of the first molar was greater on the left than on the right side with the ARME. The lateral transverse movement of the central incisors was greater with the full-cap splint RME appliance than with the conventional RME appliance. The lateral transverse movement of the central incisor was greater on the right than on the left side with the ARME. Asymmetrical RME appliance increases unilateral expansion compared to other appliances. Therefore, it should be used in cases of unilateral posterior crossbite. This appliance can also successfully treat posterior crossbite with upper midline deviation, since it corrects the shifted midline.

Effects of rapid maxillary expansion on anchorage alveolar bone meta-analysis

Purpose Rapid maxillary expansion (RME) is a routine method for correcting transverse maxillary deficiency. This paper investigated the effect of RME on anchorage alveolar bone and examined the differences between micro-implant-assisted RME and conventional RME. Methods Relevant articles were selected from the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases. Review Manager software (v.5.3) was used for the pooled analysis and Cochran Q and I 2 statistic tests were used to assess the heterogeneity. Results Following conventional RME, the distal buccal alveolar bone thickness and the mesiobuccal alveolar thickness of the maxillary first molars were significantly reduced. Hyrax (standard mean difference [SMD]: −0.93, 95% confidence interval [CI]: −1.20–0.66) and Haas procedures (SMD: −0.88, 95% CI: −1.40–0.36) significantly reduced the buccal vertical alveolar height of the maxillary first molars. Similar results were obtained for the maxillary first premolars following RME. The thickness of the buccal alveolar bone decreased with conventional RME compared to when using the method assisted by micro-implants. Conclusions Conventional RME can reduce the thickness and vertical height of maxillary alveolar bone, and there is less loss of alveolar bone when using micro-implant-assisted RME. Further research is needed to validate the findings.

Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study

AimTo compare the effects of three different maxillary expansion appliances with five different types of expansion modalities on stress distribution and displacement on the maxilla and its adjacent craniofacial structures using the finite element method (FEM).Materials and methodsCone-beam computed tomography data of a patient with maxillary transverse deficiency were rendered into a three-dimensional model of craniomaxillary structures. The expansion appliances included tooth-borne, hybrid, and bone-borne expanders. Five different expansion modalities were applied to each expander [conventional Rapid Maxillary Expansion (RME) (type 1), midpalatal suture cortico-puncture-assisted RME (type 2), LeFort l cortico-puncture-assisted RME (type 3), surgically assisted RME (SARME) without pterygomaxillary junction (PMJ) separation (type 4), and SARME with bilateral PMJ separation (type 5)]. The numerical and visual data were analyzed.ResultsThe highest amount of stress accumulation on teeth was found in the tooth-borne and hybrid groups. On the other hand, more stress concentration on the maxilla was observed in the bone-borne group. SARME cuts with PMJ separation increased total movement by reducing the stress on the midpalatal suture in all groups. While types 1, 2, and 3 were similar in terms of the amounts of displacement, types 4 and 5 increased the total amount of displacement in all groups. The total amounts of displacements from the highest value to the lowest value for the anterior and posterior maxilla were in the bone-borne, tooth-borne, and hybrid groups.ConclusionsSARME cuts were effective in reducing stress on the teeth, but the cortico-puncture application affected neither the stress values on the teeth nor the transverse displacement in the tooth-borne expanders. Surgical procedures such as SARME and corticotomy should be used with bone-borne devices to improve the outcomes of maxillary expansion procedures.

Comparative Evaluation of Skeletal and Dental Effects of Mini-Implant Assisted and Corticopuncture-Facilitated Rapid Palatal Expansion in Adults: A Randomized Clinical Study

Abstract Introduction: Conventional rapid maxillary expansion (RME) in adults is difficult due to increased skeletal maturity of the midpalatal suture. Surgically assisted rapid palatal expansion (SARPE) treatment is recommended for adults with strongly consolidated sutures but has lesser acceptance due to its invasive nature. Mini-implant-assisted rapid palatal expansion (MARPE) produced dentoalveolar side effects along with some skeletal effects in adults while being highly successful in adolescents and young adults. A lesser invasive technique combined with a purely bone-borne-rapid-maxillary-expansion appliance (BBRME) is suggested in this study to achieve maximum skeletal effects and minimize the dentoalveolar side effects of expansion in adults with completely fused midpalatal sutures as an alternative to SARPE. Aim: This study aims to evaluate and compare skeletal and dental effects of mini-implant assisted, and corticopuncture-facilitated rapid palatal expansion in adults. Material and Methods: A randomized clinical study was performed on 18 patients (mean age 20.77 years) who were randomly divided into two groups: Group A (Corticopuncture-facilitated BBRME) and Group B (conventional MARPE). Pretreatment (T0) and postexpansion (T1) skeletal and dental effects of both the groups were analyzed using cone-beam computed tomography imaging. Results: A student’s paired t-test was used to evaluate the difference in expansion achieved between the two groups (T1-T0). Group A (BBRME with corticopunctures) showed increased transverse widths at the basal bone, nasal base, and jugal processes. Group B (conventional MARPE) showed increased inclination of the posterior teeth indicating dental tipping. Both groups were successfully treated with their respective protocols but dentoalveolar side effects were significantly less in group A (BBRME) suggesting a better prognosis in BBRME group. Conclusions: Greater skeletal changes were seen in group A (BBRME) (P < 0.05*) than in group B. Group B (MARPE) showed more dental side effects like dental tipping and lesser skeletal expansion. Corticopuncture-facilitated bone-borne RME (BBRME) is a viable and efficient method of maximizing skeletal expansion in adults with fully obliterated midpalatal sutures.

Hızlı ve Yarı Hızlı Maksiller Genişletme Etkinliğinin İskeletsel Maturasyon Aşamalarına Göre Karşılaştırılması: Retrospektif Bir Çalışma

Objective: This study aimed to compare the skeletal and dentoalveolar effects of the expansion force created by the semi-rapid and rapid activation protocols. Material and Methods: The study comprised 54 patients (26 female and 28 male) with transverse maxillary insufficiency. Of these patients, 22 were treated with semi-rapid maxillary expansion (SRME) and 32 with rapid maxillary expansion (RME). The SRME group consisted of 6 prepubertal, 8 pubertal, and 8 postpubertal patients, and the RME group consisted of 11 prepubertal, 11 pubertal, and 10 postpubertal patients. Treatment effects with both protocols were evaluated with 11 different measurements on posteroanterior cephalograms and plaster models taken before treatment and after a retention period of 3 months. Kruskal-Wallis analysis was used for comparisons between different maturation periods. Independent sample t-test and Mann-Whitney U test with Bonferroni correction were used for pairwise comparisons between two different activation protocols. Results: The increases in nasal and dental widths in the SRME group were found to be higher than in the RME group in the prepubertal patient group (p0.05). No statistically significant difference was found among prepubertal, pubertal, and postpubertal groups for all skeletal and dental measurements (p>0.05). Conclusion: The current study represented some evidence that the SRME activation protocol might cause less tissue resistance than the conventional RME. The efficiency of maxillary expansion therapy is similar in prepubertal, pubertal, and postpubertal patients in whom sutural resistance is resolved.

Interest of miniscrew-assisted rapid palatal expansion on the upper airway in growing patients: A systematic review

This systematic review aimed to identify, evaluate, and provide an overview of the available literature regarding the use of miniscrews in the rapid maxillary expansion (RME) on the upper airway. The eligibility criteria were prospective trials that compared RME and miniscrew-assisted rapid maxillary expansion (MARPE) regarding airways. A search of studies in Medline (via PubMed), the Cochrane Library, Scopus and Scielo that measured the effects on the upper airway was conducted until May 8, 2022. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias for systematic reviews thanks to the Cochrane Risk of Bias tool. Reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of 160 potentially eligible studies, 7 were considered for systematic review. The measurement of MARPE on airway was done with CBCT, rhinometry, and acoustic rhinomanometry. In total, 344 patients were assessed. Two included studies showed high risk of bias and the rest showed low to moderate risks of bias. Tooth-bone-borne RME significantly improved nasal airflow [(Mean difference (MD) 52.7cm3/s, 95% confidence interval (95% CI) (9.0-96.4), P=0.020)], reduced nasal resistance (MD 0.20Pa/cm3, 95% (0.38-0.02), P=0.028), Skeletal expansion at the level of the nasal cavity was significantly greater in the MARPE group. The magnitude of the expansion at the posterior level of the nasal cavity was almost two times higher in the tooth-bone-borne group [(MD) 1.75mm, 95% (1.16-2.35) and (MD) 0.78mm, 95% (0.11-1.45), P<0.001] CONCLUSIONS: The short-term airflow changes after MARPE seems promising. Additionally, MARPE is associated with greater skeletal maxillary expansion after retention, at various levels of the nasal cavity, compared to conventional RME.

Differences in dentoskeletal and soft tissue changes due to rapid maxillary expansion using a tooth-borne expander between adolescents and adults: A retrospective observational study.

ObjectiveThe purpose of this study was to compare the differences in dentoskeletal and soft tissue changes following conventional tooth-borne rapid maxillary expansion (RME) between adolescents and adults.MethodsDentoskeletal and soft tissue variables of 17 adolescents and 17 adults were analyzed on posteroanterior and lateral cephalograms and frontal photographs at pretreatment (T1) and after conventional RME using tooth-borne expanders (T2). Changes in variables within each group between T1 and T2 were analyzed using Wilcoxon signed-rank test. Mann–Whitney U test was used to determine the differences in the pretreatment age, expansion and post-expansion durations, and dentoskeletal and soft tissue changes after RME between the groups. Spearman’s correlation between pretreatment age and transverse dentoskeletal changes in the adolescent group was calculated.ResultsDespite similar amounts of expansion at the crown level in both groups, the adult group underwent less skeletal expansion with less intermolar root expansion after RME than the adolescent group. The skeletal vertical dimension increased significantly in both groups without significant intergroup difference. The anteroposterior position of the maxilla was maintained in both groups, while a greater backward displacement of the mandible was evident in the adult group than that in the adolescent group after RME. The soft tissue alar width increased in both groups without a significant intergroup difference. In the adolescent group, pretreatment age was not significantly correlated with transverse dentoskeletal changes.ConclusionsConventional RME may induce similar soft tissue changes but different dentoskeletal changes between adolescents and adults.

Comparison of the short-term effects of facemask therapy preceded by conventional rapid maxillary expansion or by an alternate rapid maxillary expansions and constrictions protocol : Aretrospective study.

We aimed to compare the short-term effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) with conventional rapid maxillary expansion (RME) followed by facemask (FM) therapy. A total of 30patients who had received facemask therapy after RME or Alt-RAMEC protocols were included in the study. The Alt-RAMEC/FM and RME/FM groups were created to be well-matched regarding cervical vertebral maturation stage and sex. In the Alt-RAMEC group (10males and 5females, 10.99 ± 1.80years), expansion screws were activated for aweek (two turns/day), then deactivated in the following week (two turns/day). The activation-deactivation protocol continued for 6 or 7weeks. In the RME/FM group (10males and 5females, 11.61 ± 1.20years), screw activation was performed according to the patients' requirements. Lateral cephalograms which had been taken at the beginning of treatment and at the end of the facemask therapy were analyzed. Intragroup and intergroup differences were statistically analyzed. Both groups showed asignificant sagittal advancement of the maxilla. However, the Alt-RAMEC/FM group showed statistically greater improvements than the RME/FM group for SNA (3.11 ± 1.79 vs. 1.45 ± 1.34, p = 0.008), ANB (4.29 ± 1.80 vs. 2.95 ± 1.19, p = 0.023), convexity (8.91 ± 4.29 vs. 5.61 ± 2.51, p = 0.016), and overjet (5.86 ± 2.29 vs. 4.61 ± 2.10, p < 0.001). The sagittal mandibular, vertical skeletal, dental, and soft tissue changes were similar between the groups (p > 0.05). The Alt-RAMEC protocol was found to be more effective in the correction of skeletal classIII malocclusion in the short term.

Does Maxillary Expansion Lead to Root Resorption?-A Comprehensive Review

The objective of this review article is to assess root resorption of conventional rapid maxillary expansion (RME) and mini screw assisted rapid palatal expansion (MARPE) with 2D and 3D radiographic imaging method. For this review article, the current literature was searched on the studies conducted on the effects of such expansion appliances on root resorption. Orthodontic patients with transverse maxillary defieiceny undergo maxillary expansion therapy for the correction of posterior crossbite. The evalution of root resorption in such patients can be done with either 2D radiographs such as perioapical radiograph, panoramic radiograph or 3D radiographs such as cone beam computed tomography. This review article will discuss the studies showing that conventional RME appliances can result in root resorption of molar teeth after the expansion procedure. In contrast, MARPE appliances have not shown significant root resorption after expansion procedures.

Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis.

To compare the effectiveness and side effects of miniscrew-assisted rapid maxillary expansion (MARME) with conventional rapid maxillary expansion (RME) in the treatment of transverse maxillary deficiency. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched in the MEDLINE, Embase, and Cochrane Central databases. The quality of included RCTs was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the extent of dentoskeletal expansion achieved. Secondary outcomes were the dental and periodontal side effects. We calculated summary weighted mean differences (MD) with 95% confidence intervals (CI) using random-effects meta-analysis. Six RCTs involving 287 participants met the inclusion criteria. Compared to conventional RME, MARME was associated with a greater palatal suture opening (mm) measured at the anterior nasal spine (MD = 1.21, 95% CI 0.75 to 1.66), first premolars (MD = 1.13, 95% CI 0.72 to 1.55), first molars (MD = 1.18, 95% CI 0.28 to 2.09), and posterior nasal spine (MD = 1.14, 95% CI 0.30 to 1.98), increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars (MD = - 6.06, 95% CI - 10.36 to - 1.76) and first molars (MD = - 3.17, 95% CI - 5.35 to - 0.99). MARME is associated with the following advantages over traditional tooth-borne RME: increased palatal suture opening, increased palatal width, and reduced buccal tooth inclination. This study is registered with PROSPERO, CRD42021256750. MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.

Comparison of the dento-skeletal effects produced by Leaf expander versus rapid maxillary expander in prepubertal patients: a two-center randomized controlled trial.

This study aimed to compare the skeletal and dentoalveolar effects produced by slow maxillary expansion (SME) with the Leaf expander versus the conventional rapid maxillary expansion (RME) on digital dental casts, lateral and postero-anterior cephalometric radiographs. This is a superiority, two-center, two arms parallel balanced randomization trial. Patients in the mixed dentition were included with a transverse interarch discrepancy of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group) was compared to a conventional RME screw (RME group). The primary response variable was the difference in maxillary intermolar width (U6-U6) measured at baseline (T0) and one-year follow-up (T1) on the digital dental casts. Other dento-skeletal variables were also measured on digital dental casts and cephalograms. Computer-generated block randomization was used with allocation concealed in sequentially numbered opaque sealed envelopes. The examiner was blinded on the type of expander used. Linear models were used for statistical analysis. Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. U6-U6 did not show a statistically significant difference between the two groups (-0.4 mm in favor of the RME group, 95% CI from -1.2 to 0.5, P = 0.365). As for the other secondary variables no statistically significant differences were found between the two groups except maxillary intercanine width (U3-U3, -0.9 mm in favor of the RME group, 95%CI from -1.5 to -0.3, P = 0.005) and maxillary skeletal width (Mx-Mx, -1.4 mm in favor of the RME group, 95%CI from -2.4 to -0.3, P = 0.013). No significant differences between the RME and Leaf groups were detected for any of the analyzed dento-skeletal variables except the T1-T0 differences in U3-U3 and Mx-Mx that were significantly greater in the RME group. The study was registered in the ISRCTN register on 08/11/2016 with the number ISRCTN18263886. No funding or conflict of interest to be declared.

MODERN PERSPECTIVES ON RAPID PALATAL EXPANSION

Maxillary deficiency in the transverse dimension is a common problem in children. The conventional management of such malocclusion is with conventional rapid maxillary expansion. The beneficial effects of such an orthodontic therapy are explained in detail in the literature. But there are also negative effects of conventional rapid maxillary expansion. Thus, the improvements in the methods of expansion has led to discovery of miniscrew assisted rapid palatal expansion. The miniscrew assisted rapid palatal expansion are supported by mini implants and thus enable better skeletal expansion of maxilla. This article will discuss the favourable effects, negative effects, and clinical uses of conventional and miniscrew assisted rapid palatal expansion.

Evaluation of the Relationship Between Midpalatal Suture Maturation Indicators as Predictors for Surgically-Assisted and Conventional Rapid Maxillary Expansion.

Rapid maxillary expansion (RME) is an effective orthopedic procedure to correct maxillary transversal deficiency in young patients. In cases of sutural closure, surgically assisted RME is used to reduce the resistance to sutural disjunction. Foundation of a diagnostic relationship between maturation indices and the expected skeletal response to expansion can enable clinicians to identify the need for surgically assisted RME prospectively. The primary aim of this study was to assess the correlation between the amount of achieved skeletal expansion with midpalatal suture density on computed tomography images, and the secondary aim was to assess the correlation between the amount of achieved skeletal expansion with the recently suggested midpalatal suture maturation indicators: cervical vertebral maturation (CVS), midpalatal suture maturation stage (MPSM) and midpalatal suture density ratio. Forty Digital Imaging and Communications in Medicine data from the archived computed tomography scans of 20 patients (mean age: 15.55 years) before RME (T1) and after 3-month retention period (T2) were analyzed. The tested maturity indicators did not show statistically significant correlation between the skeletal effect proportions. However, clinically and radiologically effective RME was seen in MPSMs A, B, and C and also cervical vertebra stages CVS5 and CVS6. More research is needed to determine a diagnostic predictor for the skeletal effects of maxillary expansion treatment modalities.

Microimplant Assisted Rapid Palatal Expansion: A Comprehensive Review

Maxillary transverse deficiency routinely requires expansion of the palate. In prepubertal patients, Rapid Maxillary Expansion (RME) is a reliable treatment modality. However, in skeletally mature patients due to progressively interdigitated mid palatal suture, decreased elasticity of bone and increased stiffness of the osseous articulations of the maxilla with the adjoining bones, palatal expansion becomes challenging. Patients are frequently suggested to opt for more invasive procedures, like the Surgically Assisted Rapid Palatal Expansion (SARPE). The quest for minimally invasive expansion appliances with pure orthopaedic movement led researchers to incorporate mini-implants with conventional RME. Microimplant Assisted Rapid Palatal Expansion (MARPE) maximises skeletal expansion and minimises dentoalveolar undesirable effects and obviates the need for orthognathic surgery. This comprehensive review aims to discuss MARPE as an effective, non surgical, minimally invasive treatment modality for skeletally mature patients with maxillary transverse insufficiency. Furthermore, various designs of MARPE with different placement sites, lengths, and numbers of miniscrews along with the latest technological advancements to improve diagnosis and treatment planning using CBCT and intraoral scan, as well as the use of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology to custom fabricate three dimensional (3D) miniscrew insertion surgical guide, 3D laser-printed metallic mini-implant to enhance implant placement accuracy and comfort were discussed along with the clinical significance and limitations of the MARPE. Maxillary Skeletal Expander (MSE) is a unique lineage of MARPE when combined with facemask results in distraction osteogenesis like movement of midface and forms a promising basis for non surgical orthopaedic treatment modality for skeletal class III mature patients. Bone-anchored maxillary expansion appliances provide better vertical control, especially beneficial for hyperdivergent skeletal pattern patients. MARPE significantly increases transverse widths of the nasal floor, nasopharyngeal volume and significantly lowers mean nasal airway resistance thereby facilitating nasal breathing. MARPE results in greater orthopaedic expansion and safety, with fewer undesirable effects and high success rates.

Digital Planning for Mini-Implant Supported Palatal Expander in Open-Bite Treatment

Open bite malocclusion, due to it’s multifactorial etiology, has always been considered a difficult problem to treat. Often associated with transverse maxillary deficiency, this is a real challenge in the field of orthodontics. The traditional approach, for this type of anomaly, in adult patients, is orthognathic surgery and RME (rapid maxillary expansion). There are several approaches to the treatment of adult patients using digital technology. Mini-implant supported palatal expander limits the side effects of the conventional RME and is less invasive compared to orthognathic surgery. Precise and predictable mini-implant insertion, using a customized surgical guide, provides a safe therapeutic approach. This case report combines Cone-beam computed tomography (CBCT), laser scan superimposition, computer-aided design (CAD) and 3D printing in order to design and print a customized surgical guide for orthodontic mini-implant insertion. A CBCT scan was performed to determine the optimal site for mini-implants’ placement. Using the 3Shape Trios Intraoral Scanner the maxilla and the mandible were laser-scanned. Blue Sky Plan 4 software was used to design the surgical guide, and RayWare software was used for printing it. 4 mini-implants were inserted using a safe and predictable technique. The 3D technology represents the future of orthodontics, reducing the risks, chair-side time while providing the best treatment plan for the patient.