Are there benefits from using bone-borne maxillary expansion instead of tooth-borne maxillary expansion? A systematic review with meta-analysis

Abstract

Background The aim of the current systematic review was to compare the clinical effects of bone-borne or hybrid tooth-bone-borne rapid maxillary expansion (RME) with conventional tooth-borne RME in the treatment of maxillary deficiency. Methods Nine databases were searched up to September 2018 for randomized clinical trials comparing bone-borne or hybrid tooth-bone-borne RME to conventional tooth-borne RME in patients of any age or sex. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. Results A total of 12 papers on 6 unique trials with 264 patients (42.4% male; average age 12.3 years) were finally included. Limited evidence indicated that bone-borne RME was associated with greater suture opening at the first molar post-retention (1 trial; MD 2.0 mm; 95% CI 1.4 to 2.6 mm; moderate evidence quality) compared to tooth-borne RME, while no significant differences could be found regarding tooth inclination, nasal cavity width, and root resorption (very low to low evidence quality). Hybrid tooth-bone-borne RME was associated with less buccal tipping of the first premolar (2 trials; MD − 4.0°; 95% CI − 0.9 to − 7.1°; moderate evidence quality) and lower nasal airway resistance post-retention (1 trial; MD − 0.2 Pa s/cm 3 ; 95% CI − 0.4 to 0 Pa s/cm 3 ; moderate evidence quality) compared to tooth-borne RME, while no significant difference could be found regarding skeletal maxillary width, molar inclination, and analgesic use (low to moderate evidence quality). The main limitations affecting the validity of the present findings were (a) imprecision due to the inclusion of few trials with limited sample sizes that precluded robust detection of existing differences and (b) methodological issues of the included trials that could lead to bias. Conclusions Limited evidence from randomized trials indicates that bone-borne or hybrid tooth-bone-borne RME might present advantages in terms of increased sutural opening, reduced tooth tipping, and lower nasal airway resistance compared to conventional tooth-borne RME. However, the limited number of existing studies and issues in their conduct or reporting preclude the drawing of definite conclusions. Review registration PROSPERO ( CRD42017079107 ). Electronic supplementary material The online version of this article (10.1186/s40510-019-0261-5) contains supplementary material, which is available to authorized users.

Asymmetric nasomaxillary expansion induced by tooth‐bone‐borne expander producing differential craniofacial changes

“…Various types of tooth‐bone‐borne rapid palatal expanders (TBB‐RPEs) supported by skeletal anchorage devices have been developed to maximize the skeletal effect of maxillary basal expansion, particularly in young adults with transverse discrepancy . Although TBB‐RPE may have dentoalveolar and periodontal side effects around the supported teeth when compared to a pure bone‐borne rapid palatal expander (BB‐RPE), it has the advantages of better rigidity to overcome the sutural tissue resistance with less palatal tissue impingement than BB‐RPE . Non‐surgical TBB‐RPE is currently regarded as superior to both conventional tooth‐borne rapid palatal expansion (TB‐RPE) and surgically assisted rapid palatal expansion (SARPE) during early adulthood …”

Does rapid maxillary expansion change natural head position in children with maxillary constriction? A systematic review and meta-analysis

“…18 Despite there are a lot of studies about RME including metanalyses about the maxillary dentoalveolar transversal dimensions in Boluyt et al 2008 and about the airway after the treatment, few studies evaluated the NHP, which is an important data. [19][20][21] It was suggested that the improvement in the breathing mode from oral to nasal as a result of RME cause alterations in head posture, thereby contributing to a change in craniofacial development, supporting and adding to the soft tissue…”

Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander

“…In this respect, miniscrew-assisted rapid palatal expansion (MARPE) has been proposed as an effective method to obtain the skeletal opening of the midpalatal suture in late adolescents and Nevertheless, the morphology of the palate is not uniform, varying from individual to individual [11][12][13][14][15][16][17], and quantitative and qualitative evaluation of bone availability is essential to guarantee good primary stability and reliable anchorage, in particular in terms of parallelism and depth of miniscrew insertion [18][19][20][21][22]. In this respect, cone-beam computed tomography (CBCT) provides threedimensional quantitative and qualitative assessment of bone structures; furthermore, a digital workflow based on superimposition of 3D maxillary model on DICOM files has been proposed in order to: (1) virtually insert miniscrews in the palate choosing the most suitable position and angulation and (2) create tailored surgical guides that facilitate the precise directional positioning of palatal miniscrews [22].…”

“…Concerning the usage of MSE, this appliance is generally planned by using conventional dental stone models and 2D headfilms. However, these diagnostic tools do not allow to accurately define the location of the appliance relatively to midfaceskeletal structures and to assess the the potential risk of affecting critical anatomical areas [15][16][17]. Thus, a digital work-flow would be beneficial to: (1) accurately place the MSE relative to the bizygomatic line, in order to enhance the biomechanics of the expansion, i.e., overcome the resistances of zygomatic buttress bone, (2) maximize the bone thickness at micro-implant insertion sites, (3) define the minimum micro-implant length to penetrate the Maxillary Skeletal Expander (MSE, BioMaterials Korea Inc, Seoul, Korea) presents a unique design integrating two molar bands and a body that includes an expansion screw with four slots.…”

“…Each slot facilitates the placement of the four miniscrews (1.8 mm in diameter and 11 or 13 mm in length). The expander screw is placed between the maxillary first molars, barely anterior to the soft palate ( Figure 1b) [15][16][17]. Besides the different locations of miniscrews in the palate, the main difference between the two skeletal anchorage systems is that the MSE expander acts as a rigid insertion guide for the miniscrews placement while in the conventional method the expander is constructed after the placement of the miniscrews.…”