Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis

Abstract

Summary Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy. Objectives This systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects. Search methods Seven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020. Selection criteria Randomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes. Data collection and analysis Inclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality. Results Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days. Limitations One of the main drawbacks was the lack of high-quality prospective studies in the literature. Conclusions and implications MARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended. Registration PROSPERO (CRD42020176618). Funding No grants or any other support funding were received.

Comparison of dentoskeletal and soft tissue changes between tooth-borne and tooth-bone-borne hybrid nonsurgical rapid maxillary expansions in adults: a retrospective observational study

“…Although several studies have reported successful maxillary expansion in adult patients through nonsurgical expansion using a conventional expander [ 10 – 12 , 19 ], there have been concerns about potential side effects, such as buccal tipping and root resorption of anchor teeth, periodontal problems, low success rate, and low stability [ 8 , 10 , 20 ]. Our study showed that in both T-RME and H-RME groups, the maxillary arch was successfully expanded, and the opening of the midpalatal suture was verified through the PA cephalogram at T2, as well as the presence of midline diastema after expansion.…”

“…This differs from the findings of a study on adolescent patients in which the tooth-bone-borne hybrid expander provided greater expansion than the tooth-borne expander, but showed significant orbital level expansion with both expanders [ 23 ]. This difference is presumed to be due to the increased resistance to expansion in adults, as the circummaxillary sutures gradually mature with aging [ 8 ].…”

“…In growing patients, the opening of the midpalatal suture is successfully achieved by RME with a conventional tooth-borne expander, such as the widely used Hyrax-type expander [ 7 ]. However, in adult patients, because the resistance to expansion increases as the suture matures with aging, there are concerns about the failure of the skeletal maxillary expansion using the conventional expander [ 4 , 8 ]. Accordingly, a procedure such as surgically assisted RME for surgical separation of the maxilla have been proposed [ 9 ], but this present a potential risk of infection and additional costs due to an invasive operation [ 8 ].…”

“…Although several studies have reported successful nonsurgical maxillary expansion using a conventional expander in adults, the proportion of skeletal expansions out of dental expansions is lower than that in growing patients, and there are concerns about periodontal problems [ 8 , 10 – 12 ]. Recently, with the development of skeletal anchorage, bone-borne or tooth-bone-borne hybrid expanders have been introduced, which can more directly apply orthopaedic force to the bone by fixing the expanders to the palatal bone [ 13 , 14 ].…”

“…Recently, with the development of skeletal anchorage, bone-borne or tooth-bone-borne hybrid expanders have been introduced, which can more directly apply orthopaedic force to the bone by fixing the expanders to the palatal bone [ 13 , 14 ]. In particular, the tooth-bone-borne hybrid expander using mini-implants to reinforce the anchorage of the conventional Hyrax-type expander has received widespread attention because it obviates the need for complex surgery [ 8 ]. Successful and stable nonsurgical expansion of the maxilla can be achieved in adults using the hybrid expander [ 15 ].…”