ObjectiveTo evaluate skeletal outcomes of the Alt-RAMEC protocol with facemask therapy compared with conventional rapid maxillary expansion (RME) in patients with cleft lip and/or palate.DesignSystematic review and meta-analysis.SettingData from international databases (PubMed, Embase, Scopus, Web of Science, CENTRAL, clinical trials registers, and Google Scholar) were analyzed.Patients/ParticipantsFour studies involving approximately 136 patients with cleft lip and/or palate met inclusion criteria.InterventionsAlternate RME and Constriction (Alt-RAMEC) followed by facemask protraction versus conventional expansion protocols.Main Outcome Measure(s)Cephalometric skeletal parameters (SNA, SNB, and ANB) and maxillary advancement.ResultsAlt-RAMEC with facemask produced a greater increase in SNA compared with controls (SMD 1.04; 95% CI 0.60-1.49; I² = 0%), while SNB changes were non-significant. ANB changes were variable across studies (I² = 96%). Certainty of evidence was moderate for SNA and low for SNB.ConclusionsAlt-RAMEC combined with facemask therapy may yield greater anterior maxillary displacement in cleft lip and palate patients than conventional RME protocols, though evidence remains limited. Standardized multicenter studies with long-term follow-up are needed.

Facial soft tissue changes in patients following rapid maxillary expansion in children: A systematic review.

Effectiveness of varying alternating rapid maxillary expansions and constrictions (Alt-RAMEC) durations on maxillary protraction in noncleft Class III malocclusion: A systematic review and meta-analysis.

Aim: Comparison of dental and dentoalveolar changes in patients treated with rapid maxillary expansion (RME) and patients treated with fixed appliance without RME. Comparison of effects of resin (bonded) and band (banded) hyrax. Material and method: The sample included 63 patients divided into two experimental groupsɸ– treated with band or resin hyrax, and the control group of patients treated with fixed appliance without RME. Scans made with cone beam computer tomography (CBCT) prior to (T1) and after the active phase of therapy (T2) were analyzed. We evaluated inclination of maxillary first permanent molars, width of vestibular cortical bone in first molars, vestibular inclination of alveolar processes, and width of upper dental arch. Results: The mean width of upper dental arch increased by 6.1źmm; skeletal width of the maxilla increased by 3.2źmm on the average, i.e. almost 50% of the overall expansion. We recorded changes in alveolar processes and first molars inclination after therapy together with loss of cortical bone. RME, compared to fixed appliance, results in significantly larger dental and skeletal expansion, more significant vestibular inclination of upper molars, and reduced width of cortical bone in the region of first molars. No statistically significant differences were found between resin and band hyrax. Conclusion: RME significantly affects dentoalveolar structures of the maxilla, which is confirmed by the results of measurements of anatomical parameters prior to and after the therapy.

Objectives: This study aimed to evaluate maxillary arch width increase in juvenile patients requiring space gain, but without skeletal transverse discrepancies necessitating orthopedic expansion. The comparison focused on the effects of Rapid Maxillary Expansion (RME) using Hyrax expanders and dentoalveolar expansion via Invisalign First. Methods: This retrospective longitudinal study analyzed digital dental models of 38 patients (19 males and 19 females, aged 8 ± 2 years) undergoing maxillary expansion at the Department of Biomedical, Surgical, and Dental Science, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico (Milan, Italy). Patients were divided into two groups: one treated with Hyrax expanders (n = 19) and the other with Invisalign First (n = 19). Intraoral scans were taken before (T0) and after treatment (T1), and measurements were performed using Mimics Materialize 21.0 software. Statistical analysis included t-tests, ANOVA, and regression models to assess differences in maxillary expansion between groups. Results: Both groups showed statistically significant transverse arch increases (p < 0.01). Hyrax achieved greater expansion at the deciduous canine level, while Invisalign showed more at the deciduous molar level. First permanent molar expansion was similar. ICC for reliability was excellent (>0.97). No significant differences in sex or Angle class distribution were observed. Conclusions: Hyrax and Invisalign First both produce measurable maxillary expansion, but they serve distinct roles. While Hyrax expanders provide rapid skeletal expansion, Invisalign First offers a less invasive alternative for dentoalveolar widening with controlled force application. They should not be used interchangeably. Appliance selection must be tailored to the severity and nature of the transverse deficiency.

Effects of maxillary protraction with an orthopedic facemask on fricatives.

Two-phase orthodontic treatment of transverse maxillary deficiency and hyperdivergent skeletal Class Ⅱ Division 2 malocclusion using rapid maxillary expander and clear aligners in a growing patient

Comparative biomechanical analysis of three rapid maxillary expanders in BCLP patients: A three-dimensional finite element study.

Background/Objectives: The nasomaxillary complex is a compound anatomical structure in which the correlation between changes in palatal width and height has been poorly investigated. Methods: A three-year prospective study with 28 patients treated with printed expanders was conducted. Measurements on CBCT images were performed before and after treatment; the width and height parameters were measured on a coronal slice of a CBCT image at the level of the first molars and upper first molar inclination relative to the palatal plane. Results: A significant difference was found between the values measured before and after treatment, including an increase in the measured width parameters and a statistically significant decrease in palatal height (0.75 ± 0.97). The mean change in the upper molar inclination was not significant (tooth 16: 0.60 ± 6.42; tooth 26: 2.19 ± 4.51). The regression analysis did not establish a significant correlation between the expansion of the maxillary occlusal width and palatal height change or a significant correlation between the increase in the upper molar inclination and palatal height change. Conclusions: The use of a printed tooth-borne expander causes predictable and reproducible skeletal changes. It is a feasible treatment option, allowing for precise screw positioning to achieve bodily movement of the teeth and decrease the change in molar inclination.

BackgroundThis study aimed to analyze the effects of tooth, tooth-bone, and bone-supported RME (rapid maxillary expansion) appliances on the nasomaxillary complex and nasopharyngeal area among individuals with maxillary transverse stenosis using CBCT (cone-beam computed tomography) and rhinomanometry. It also comparatively assessed the effects of these expansion methods.MethodsThe study used the CBCT images and rhinomanometry records of 45 patients with maxillary transversal stenosis, aged between 10 and 17 years, who underwent RME with Hyrax, hybrid, and mini-screw appliances. It also collected records from these patients at three stages: at the beginning of treatment, after active expansion, and after a 3-month retention. The study used CBCT images for dentoalveolar, skeletal, nasal, and pharyngeal measurements and evaluated rhinomanometry records for nasal airway resistance.ResultsCBCT recordings showed no significant within-group differences in measures of changes in pharyngeal and nasal volumes, whereas there were significant increases for these measures between recording periods in all RME groups. Furthermore, these increases remained mostly stable at the end of the retention period. Assessments of rhinomanometry recordings showed no significant within-group differences, whereas nasal resistance decreased during the inspiratory and expiratory phases in all RME groups, with some significant differences between periods. However, after retention, nasal resistance generally tended to return to baseline values.ConclusionsThe study revealed that the tooth, tooth-bone, and bone-supported RME appliances significantly increased the nasopharyngeal volume, and decreased nasal resistance.Trial registrationThe compliance of the study with the ethical rules was unanimously approved by the Atatürk University Faculty of Medicine Clinical Research Ethics Committee, with the decision dated September 30, 2021, and numbered B.30.2.ATA.0.01.00/378.

An 18-year-old female with incomplete unilateral cleft lip and palate presented with skeletal class I malocclusion, severe crowding, anterior crossbite, unilateral posterior crossbite, congenitally missing maxillary left lateral incisor, and root dilacerations. The aims of the treatment were to achieve good occlusion and improve psychological well-being. Orthodontic treatment with a preadjusted edgewise MBT 0.022 bracket system and asymmetric Hyrax-type expander achieved proper dental alignment and unilateral transverse expansion without affecting the non-crossbite side. The Rosenberg Self-Esteem Scale increased from 13 to 27, indicating enhanced psychological well-being. The asymmetric Hyrax-type expander was effective for correcting unilateral posterior crossbite.

Rapid maxillary expansion (RME) is widely recognized in the literature as a fundamental component of the orthopedic management of Class III malocclusion. Its primary objective is to facilitate maxillary protraction and establish a more favorable skeletal relationship between the maxilla and mandible. Various types of palatal expanders are available, and these devices can be effectively combined with other treatment modalities. This study aimed to conduct a literature review on the benefits of using palatal expanders in Class III patients, with a particular focus on comparing the most commonly adopted techniques. A structured literature search was performed in the PubMed and Virtual Health Library (VHL) databases using the descriptors “Palatal Expansion Technique,” “Class III,” and “Orthodontics,” combined with the Boolean operator “AND.” Only articles published in English were included. The reviewed studies indicate that palatal expansion remains a valuable therapeutic approach for Class III malocclusion, with its effectiveness enhanced when combined with complementary techniques such as facemasks or skeletal anchorage (e.g., mini-implants), particularly during early growth phases. Consistent improvements in skeletal structure and occlusion were reported. Palatal expansion corrects maxillary constriction and improves the maxillo-mandibular relationship. Additionally, it provides functional benefits for respiration, phonation, and mastication, as well as significant aesthetic and psychological advantages.

Maxillary transverse deficiency (MTD), a common malocclusion, is typically treated with maxillary expansion. However, adult MTD patients often present challenges for skeletal expansion due to matured mid-palatal sutures. To address this, the authors developed a minimally invasive surgical technique utilizing piezosurgery to separate the mid-palatal suture and buccal/lingual bone sutures in the anterior maxilla. Then, the Hyrax expander was used for rapid maxillary expansion (RME). This approach effectively achieves maxillary skeletal expansion with successful mid-palatal suture opening, offering a reliable solution for adult MTD.

Comparison of differential and conventional rapid maxillary expansion on upper airway dimensions in children with bilateral complete cleft lip and palate: A CBCT-based secondary analysis of a clinical trial.

To evaluate the role of orthodontic and craniofacial orthopaedic interventions in the prevention and management of otitis media with effusion (OME), focusing particularly on rapid maxillary expansion (RME) and its implications for Eustachian tube function. A comprehensive search was conducted in PubMed, Embase, and Web of Science using a structured combination of MeSH terms by two expert researchers from inception to December 2024. Randomised and non-randomised prospective studies involving pediatric patients (2-18 years) with chronic OME were included. The effectiveness of preventive measures was compared with alternative treatments or no interventions. Study quality was assessed using the ROBINS-I v2 tool. RME emerges as a promising preventive option for managing OME particularly in patients with orthodontic indications. By addressing structural contributors to Eustachian tube dysfunction, RME improves middle ear health and complements otolaryngological interventions. Integrating orthodontic and otolaryngological strategies represents an effective multidisciplinary approach to reducing OME incidence and recurrence. Further studies are needed to confirm the long-term stability and the generalisability of these observed benefits.

An objective method for assessing the maturation of bone sutures involved in the rapid maxillary expansion.

This study aimed to use finite element analysis to evaluate the effects of acrylic HYRAX and hybrid HYRAX devices in the treatment of rapid maxillary expansion (RME), particularly on the orbital compartments. In the present study, a craniofacial model was developed utilizing computed tomography data obtained from the visible human project. A total of four distinct models were generated by designating the sutures in the adult variation as closed and those in the non-adult variation as open while incorporating both expansion devices into the model. Both acrylic and hybrid device models were subjected to expansion forces of 0.25 mm and 5 mm, yielding eight distinct scenarios for comprehensive analysis. Significant stress and displacement were observed, particularly around the orbital compartments in all scenarios. Displacement decreased with increased sutural ossification and the resulting stresses demonstrated elevation. In adult models, the hybrid device generated reduced stress, especially around the orbital compartments. Based on these findings, it is proposed that the orbital compartments may serve as a clinically relevant site for measuring the increased intracranial pressure during RME treatment. To prevent possible side effects, RME should be performed at an early age, and if ossification is suspected to be increased, bone-supported expansion devices are recommended.

ABSTRACTObjectivesThis study aimed to establish a clustering‐based classification model for skeletal expansion outcomes after miniscrew‐assisted rapid maxillary expansion (MARPE) and evaluate its clinical implications.Material and MethodsThe study samples comprised 61 patients with transverse discrepancy who underwent maxillary skeletal expansion using MSE I. Cone‐beam computed tomography images before (T0) and after (T1) expansion were analysed with nine measurements assessing transverse changes in the maxilla, molars and appliance. Gaussian mixture model clustering, random forest models and decision trees identified expansion patterns and key classifiers, establishing a classification system. Two‐ and one‐way analyses of variance compared intergroup characteristics.ResultsThe clustering‐based classification model identified four distinct clusters of skeletal expansion patterns, establishing two key classifiers: expansion efficiency (good/poor) and parallelism (parallel/V‐shaped). Poor responders had an older age and showed significantly lower efficiency, more V‐shaped tendencies, greater activation loss and longer intervals until interincisal diastema than good responders (p < 0.001). V‐shaped responders exhibited less efficiency, reduced posterior expansion and increased miniscrew slippering (p < 0.001). Twenty days until interincisal diastema can be used to monitor expansion efficiency. Age is a useful predictor of efficiency, except during the ambiguous period of 16.81–20.14 years (17.91–19.88 for males, 16.95–18.94 for females) and for outliers.ConclusionThis study introduces a concrete classification system for MARPE outcomes, emphasising the role of expansion efficiency and parallelism in optimising clinical results. These four identified phenotypes provide a data‐driven validation of the existing concepts of expansion patterns and their implications for treatment.

To compare the effects of the face mask and Carrière Motion® III appliance in growing patients with Class III malocclusion associated with maxillary retrognathia. The null hypothesis was that both appliances, applied after rapid maxillary expansion, would have similar effects. Skeletal, dental, and soft tissue changes were evaluated using lateral cephalometric radiographs of 26 patients aged 6-9 years, taken before (T0) and after treatment (T1). Cephalometric analyses were performed using Nemoceph® software (NEMOTEC, Madrid, Spain). Statistical analyses were carried out with MedCalc version 12.7.7 (MedCalc Software bvba, Ostend, Belgium) with significance set at p<0.05. SNA°, A-NasionPerp, and Co-A increased significantly in both groups, with no significant intergroup difference. Co-Gn, Wits, ANB°, S-N, and the articular angle also increased significantly in both groups. SNB° decreased significantly only in the Carrière Motion® III group. Greater anterior maxillary rotation occurred with the face mask, while reduced rotation was observed with the Carrière Motion® III. Lower facial height decreased slightly but significantly in the Carrière Motion® III group, and increased in the face mask group. Overjet and molar relationship improved significantly in both groups. The UL-E line distance decreased in the face mask group, while the Carrière Motion® III showed no significant soft tissue changes. The null hypothesis was rejected. The two appliances had different effects; however, the Carrière Motion® III proved effective for early Class III treatment and may be considered an alternative, particularly for patients with social concerns about extraoral traction.

Objective: This study aims to evaluate the impact of mini-implant assisted rapid maxillary expansion (MARPE) on intrabony canals in the anterior maxilla. Methods: The cone beam computed tomography (CBCT) scans obtained before and after treatment from 24 patients who underwent mini-implant assisted rapid maxillary expansion (MARPE) were analyzed retrospectively. In the sagittal plane, three levels of the incisive foramen (lower, middle, and upper) were assessed. Mediolateral and buccolingual widths were measured on axial sections, and the widest diameter of the canalis sinuosus was measured in the coronal section. Pre-treatment and post-treatment measurements were statistically compared. Results: The mediolateral width of the incisive foramen showed a statistically significant increase at the lower and middle levels during the T1 stage compared with the T0 stage (p=.0001). In the buccolingual width of the incisive foramen, measurements at the lower level in the T1 stage also exhibited a statistically significant increase compared to the T0 stage (p=.0049). However, no statistically significant difference was found in the measurements at the middle level (p=.365) (Table 3). Additionally, the measurements on the right side of the canalis sinuosus demonstrated a statistically significant increase in the T1 stage compared to the T0 stage (p=.0004) (Table 4). Conclusion: MARPE causes expansion of the intrabony canals in the anterior maxilla. The expansion of these canals may be attributed to the need for increased vascularization and innervation accompanying the increased bone volume.