Success and complication rate of miniscrew assisted non-surgical palatal expansion in adults - a consecutive study using a novel force-controlled polycyclic activation protocol

Abstract

Introduction Bone-borne miniscrew assisted palatal expansion (MAPE) is a common technique to improve maxillary transverse deficiency in young adolescents. Adult patients usually present a challenge, as they often require additional surgical assisted maxillary expansion (SARPE). There is still no clear statement about non-surgical expansion in adult patients using this technique. The aim of this study was to evaluate the success and complication rate of non-surgical palatal expansion in adults utilizing MAPE with a novel force-controlled polycyclic expansion protocol (FCPC). Methods This consecutive study consisted of 33 adult patients with an average age of 29.1 ± 10.2 years (min. 18 years, max. 58 years), including one dropout patient. First, four miniscrews were inserted and after 12-weeks latency, the expander was placed and the FCPC protocol was applied (MAPE group). In case of missing expansion, a SARPE was performed (SARPE group). After maximum expansion, a cone beam CT was made and widening of the midpalatal suture was measured. The outcome variables were successful non-surgical expansion and, with sample size power above 80%, the odds of failed non-surgical expansion and associated complications were evaluated. The primary predictor variable was age. Statistical analysis was performed using R (Version 3.1) to calculate power, to construct various models for measuring the odds of requiring surgical intervention/complications, and others. Results Successful non-surgical expansion was achieved in 27 patients (84.4%), ranging from 18 to 49 years. Mean age differed significantly between both groups (26.8 ± 8.2 years vs. 41.3 ± 9.9 years; p < 0.001). Mean expansion at the anterior and posterior palate for the MAPE group was 5.4 ± 1.5 mm and 2.5 ± 1.1 mm, respectively. Among these subjects’ complications were observed in 18.5%. Age significantly increased the odds of complications (p = 0.019). Conclusions 1. The success rate of MAPE among individuals aged 18 to 49 years was 84.4%. 2. A V-shaped expansion pattern in the antero-posterior dimension was mostly observed. 3. Complications were significantly associated with age. 4. A careful expansion protocol seems to be beneficial to prevent unfavorable results in adult patients. Trial registration Consecutive cohort study, Review Board No. EK-2-2014/0016.

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

“…24 Also, it is essential to note that complications are significantly associated with increasing age. 29 Although MARPE offers an effective method for correcting the transverse skeletal deficiency, given the cost and increased risk of complications in older patients, it F I G U R E 4 Pre-and posttreatment treatment photos of a 16-year-old male patient treated with a hybrid MARPE appliance. Two miniscrews placed in the anterior palate were used to design a hybrid MARPE appliance.…”

“…Unfortunately, none of these reports were able to indicate a reliable parameter that can predict absolute success with MARPE other than a negative correlation with chronological age 24 . Also, it is essential to note that complications are significantly associated with increasing age 29 . Although MARPE offers an effective method for correcting the transverse skeletal deficiency, given the cost and increased risk of complications in older patients, it could present challenges for the patients and the practitioners in the practice setting.…”

The comparison of biomechanical effects of the conventional and bone-borne palatal expanders on late adolescence with unilateral cleft palate: a 3-dimensional finite element analysis

“…Those tooth effect of C-RPE wound be enhanced in late adolescence[ 3 ]. By contrast, the bone-borne palatal expander (B-RPE) has been proved to be effective for arch expansion in adolescent or adult patients without CLP, which produces more skeletal expansion and less buccal inclination of teeth[ 22 , 23 ]. Moreover, unlike the C-RPE, the alignment of dentition with brackets could be carried out synchronously using B-RPE[ 2 ].…”

“…In UCLP patients applied with B-RPE, the expanding force from anchoring miniscrews was dispersed posteriorly to disarticulate the maxilla from the neighboring pterygoid of sphenoid. Thus, miniscrew assisted non-surgical palatal expansion was effective in adults [ 22 ]. Sutures play a functional role in osteogenesis, including connection and cushion.…”

Non-surgical rapid maxillary expansion with mini-implants in adults: A Narrative Review

“…A careful design and expansion protocol (polycyclic and slow) seems to be beneficial to avoid unreliable results in older patients. 25 Particularly, immediately after expansion, undesirable effects include discomfort in the incisor or nasal suture regions and ulceration or necrosis of the palatal mucosa. There may be some swelling at the mid-palatal suture.…”