Comparison of skeletal and dentoalveolar changes between pure bone-borne and hybrid tooth-borne and bone-borne maxillary rapid palatal expanders using cone-beam computed tomography

Abstract

Objectives: The objectives of the study were to compare the skeletal, dentoalveolar, and periodontal changes between two types of microimplant-assisted rapid maxillary expansion appliances: The bone-anchored maxillary expanders (BAME) and the tooth-bone-anchored maxillary skeletal expander (MSE). Materials and Methods: Thirty-four patients with a transverse maxillary deficiency were divided into two groups; the first group (16 patients, average age 14.9 years) was treated with the MSE appliance, and the second group (18 patients, average age 13.8 years) was treated with the BAME appliance. Cone-beam computed tomography scans were taken at pre-treatment (T1) and immediately post-expansion (T2) to measure the changes in midpalatal suture opening, total expansion (TE), alveolar bone bending, dental tipping (DT), and buccal bone thickness. Data were analyzed using paired t-test and two-sample t-test. Results: Midpalatal suture separation was found in 100% of the patients in both groups. The TE at the first molar was 5.9 mm in the MSE group and 4.7 mm in the BAME group. The skeletal contributions were 56% and 83% of TE for the MSE and BAME groups, respectively. Significantly less dental buccal tipping and buccal bone loss were found with the BAME group. The midpalatal suture in both groups exhibited a parallel opening pattern in the axial plane. Conclusion: The use of BAME appliance resulted in greater skeletal effects, less dental tipping, and less buccal bone reduction compared to MSE appliance (immediately after maxillary expansion).

Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: a single-centre retrospective study

“…This is still in agreement with current literature, suggesting that pure bone-borne expansion eliminates the dental side effects of tipping due to the absence of direct force application to the teeth, and in fact exhibits uprighting of the posterior teeth instead [ 17 , 23 , 32 ]. As the maxilla expands, forces applied from the buccal musculature may impart force on the crowns of teeth preventing buccal tipping and promoting uprighting whilst reducing buccal bone thinning [ 10 , 17 , 18 ].…”

Clinical advances in maxillary skeletal expansion and introduction of a new MARPE concept

“…In a study where pure bone‐borne MARPE (supported with only four miniscrews) was compared to the tooth‐ and bone‐borne combination MARPE (four‐miniscrews and a palatal bar between the first molars) 100% success was achieved in midpalatal suture separation. However, the bone‐borne appliance caused a significantly more significant skeletal width increase, fewer dental side effects, and less buccal bone reduction than the combination MSE appliance 30 …”

“…However, the bone-borne appliance caused a significantly more significant skeletal width increase, fewer dental side effects, and less buccal bone reduction than the combination MSE appliance. 30 Depending on where and how the miniscrews are inserted, it is possible to use longer miniscrews and obtain bicortical anchorage, including the palate and the nasal floor. While it may be argued that obtaining bicortical anchorage is not associated with success, 24 bicortical anchorage could reduce the lateral drift of the miniscrews when subjected to heavy forces.…”

Effectiveness of miniscrew assisted rapid palatal expansion using cone beam computed tomography: A systematic review and meta-analysis

“… 7 The device is classified mainly as: 1) bone-anchored maxillary expansion (BAME), which is a bone-borne type having no tooth attachment and 2) hybrid design or tooth-bone-anchored maxillary expansion, which combines both bone and tooth support. 8 , 9 MARPE may consist of two to four miniscrews, and may also be mono-cortical or bi-cortical miniscrew anchorage. 10 , 11 Among the appliances used for MARPE, MSE is the type that promotes the bi-cortical engagement of the four miniscrews into the cortical bone of the palate and nasal floor.…”