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Background:
Systematic Review

Comparison of Dentoalveolar Changes with Miniscrew-Assisted Versus Conventional Rapid Palatal Expansion in Growing Patients: A Systematic Review and Meta-Analysis

by
Hwang bin Lee
1,†,
Jong-Moon Chae
2,3,4,†,
Jae Hyun Park
4,5,
Na Jin Kim
6 and
Sung-Hoon Han
7,*
1
Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul 06591, Republic of Korea
2
Department of Orthodontics, School of Dentistry, University of Wonkwang, Iksan 54538, Republic of Korea
3
Wonkwang Dental Research Institute, University of Wonkwang, Iksan 54538, Republic of Korea
4
Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ 85206, USA
5
Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
6
Medical Library, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
7
Department of Orthodontics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Appl. Sci. 2025, 15(15), 8326; https://doi.org/10.3390/app15158326
Submission received: 19 June 2025 / Revised: 12 July 2025 / Accepted: 23 July 2025 / Published: 26 July 2025
(This article belongs to the Special Issue Trends and Prospects of Orthodontic Treatment, 2nd Edition)
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Abstract

Background: This meta-analysis aimed to evaluate the dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) compared with conventional rapid palatal expansion (CRPE) in growing patients (≤16 years). Methods: A systematic and comprehensive literature search was carried out independently by two reviewers using both MeSH terms and free-text keywords across PubMed, the Cochrane Library, and Embase, with studies published through February 2025 included. The risk of bias was assessed using the Cochrane ROB 2.0 tool. The GRADE system was employed to determine evidence quality. Results: Of the 462 initially screened articles, 6 met the inclusion criteria and were selected for quantitative synthesis. Most studies had a low risk of bias with some concerns in reporting. The pooled standardized mean difference (SMD) for tooth inclination changes in CRPE compared with MARPE was 0.98 (95% confidence interval (CI), 0.54 to 1.42; p < 0.01). The test for overall effect was significant (p < 0.01), but no significant differences were found between the subgroups. The pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.69 (95% CI, 0.37 to 1.00; p < 0.01). The test for overall effect was significant (p < 0.01), and there were substantial differences between the subgroups. The supporting evidence ranged in certainty from moderate to low. Conclusions: MARPE was more effective than CRPE in minimizing the buccal tipping and buccal bone loss of the maxillary first premolars and first molars. However, to further confirm these outcomes and guide evidence-based clinical practice, well-designed randomized controlled trials with long-term follow-up are necessary.

1. Introduction

Rapid palatal expansion (RPE) is an orthodontic approach that addresses maxillary transverse deficiency by applying orthopedic forces to separate the midpalatal suture and open the circummaxillary sutures [1]. RPE has been reported to be effective in addressing transverse discrepancies in the dental arch [2,3], increasing nasal cavity volume [4], improving insufficient arch perimeter [5,6], and correcting posterior crossbites in the maxillary region [7,8].
A conventional tooth-borne rapid palatal expander directly transmits expansion forces to the dentoalveolar structures using teeth as anchorage. With increasing age, the midpalatal suture exhibits a more interdigitated pattern, resulting in greater suture resistance to expansion forces [9,10]. The application of tooth-borne expanders may lead to undesirable dental effects, including the buccal inclination of posterior teeth, reduction in the thickness of buccal alveolar bone, and root resorption on the buccal aspect, thereby potentially limiting the effectiveness of RPE [11,12,13]. Therefore, a thorough assessment of the patient’s skeletal maturity is crucial prior to RPE treatment, emphasizing that appropriate timing is a critical factor influencing treatment success.
In order to prevent such complications, surgically assisted RPE (SARPE) is commonly advocated as a suitable alternative method to CRPE for achieving maxillary expansion in late adolescent and adult patients [14]. SARPE is generally considered a simple and safe procedure with relatively low risks. However, various complications have been documented. Severe complications include potentially life-threatening vascular and neurological events [15]. Additionally, milder postoperative issues, such as pain, periodontal problems, asymmetry, incorrect expansion, sinusitis, and relapse, have also been reported [16]. These complications, along with surgical complexity and high costs, may restrict the clinical application of this technique [17].
Recently, miniscrew-assisted RPE (MARPE) has emerged as an effective non-surgical alternative for correcting transverse maxillary deficiencies in late adolescent and adult patients [18]. This approach typically employs either a tooth-bone-borne-anchored or exclusively bone-borne-anchored rigid appliance connected to miniscrews penetrating the palatal cortical bone, allowing for the direct transmission of orthopedic forces to the basal bone. Consequently, MARPE promotes parallel skeletal expansion along the midpalatal suture [19]. Compared to CRPE, MARPE offers reduced biological risks, lower financial costs, and fewer dentoalveolar side effects [20].
According to a finite element analysis performed in young adults, MARPE demonstrated a more uniform distribution of stress compared to CRPE, resulting in a reduction of undesirable dentoalveolar effects [21]. The success rate of midpalatal suture separation using MARPE has been reported to decrease with advancing age [12]. However, other studies have found that age does not significantly influence outcomes [22]. Histologic studies have led to consensus that CRPE is appropriate for palatal suture separation in patients younger than 15 years [9,10].
A recent meta-analysis involving late adolescents and adults demonstrated that MARPE led to a significant increase in dental tipping and a decrease in buccal bone thickness and alveolar bone height [23]. In comparison, a study in growing patients revealed that although MARPE caused less reduction in buccal bone thickness than CRPE, the difference was not clinically significant, and both modalities were considered safe for the alveolar bone morphology [24]. In contrast, Copello et al. reported that MARPE resulted in less buccal bone thickness reduction in the premolar region compared to CRPE. However, their meta-analysis did not stratify outcomes according to age group [25]. These findings collectively underscore the need for age-specific evaluation of dentoalveolar outcomes in MARPE application.
Therefore, the objective of this systematic review and meta-analysis is to assess the differences associated with the incorporation of miniscrews in palatal expansion by comparing the dentoalveolar change of MARPE and CRPE in growing patients. In contrast to previous studies, the present review is distinct in that it includes only randomized controlled trials utilizing CBCT analysis and limits the target population to skeletally immature individuals. The null hypothesis proposes that incorporating miniscrews into palatal expansion does not lead to a significant difference in dentoalveolar stability among growing patients.

2. Materials and Methods

2.1. Protocol and Eligibility Criteria

This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [26]. The review protocol has been registered on the PROSPERO platform under the registration number CRD420251048189. Comprehensive details regarding the protocol are available on the PROSPERO website.
  • Question: Does a difference exist in dentoalveolar change between MARPE and CRPE?
  • Participants: Growing patients (≤16 years) who underwent palatal expansion.
  • Interventions: Miniscrew-assisted rapid palatal expansion (MARPE).
  • Comparisons: Conventional rapid palatal expansion (CRPE).
  • Outcomes: Tooth inclination and buccal bone thickness.
  • Study design: Randomized controlled trials (RCTs).
Studies excluded from this review comprised animal experiments, laboratory (in vitro) investigations, case reports, case series, finite element analyses, review papers, editorials, and any other non-clinical research.

2.2. Information Sources and Search Strategy

Two reviewers (HBL and JMC) independently conducted a comprehensive literature search utilizing a combination of MeSH terms and non-indexed keywords to identify pertinent systematic reviews. The electronic search included Medline (accessed via PubMed), the Cochrane Library, and Embase, encompassing studies published up to 25 February 2025. The search was limited to studies published in English. To ensure completeness, reference lists of all eligible full-text articles were manually screened to detect any additional relevant studies not captured in the initial search. All search results were organized and deduplicated using EndNote software (version 21, Clarivate Analytics, Philadelphia, PA, USA). Search strategies were adapted to meet the indexing and formatting requirements of each individual database, with full search details available in Supplementary Table S1.

2.3. Study Selection and Data Extraction

The titles and abstracts of the selected papers were independently screened by two reviewers (HBL and JMC) to assess their eligibility. In cases of disagreement, consensus was reached through discussion with a third investigator (SHH). Following this, full-text screening of the eligible studies was performed independently by both reviewers before making final inclusion decisions. The inter-reviewer reliability was evaluated by computing Cohen’s Kappa coefficient. Data extraction from the included studies was performed independently based on the PICOS framework, collecting general details (author, publication year, and country), participant information (sample size, age, and gender), intervention or comparison (expander type), and measured outcomes (premolar inclination change, molar inclination change, and buccal bone thickness change).

2.4. Risk of Bias Assessment

The Cochrane Risk of Bias (ROB 2.0) tool was utilized to assess the methodological quality of the included randomized studies [27]. This assessment covered key areas, including the randomization process (selection bias), adherence to intended interventions (performance bias), completeness of outcome data (attrition bias), accuracy in outcome measurement (detection bias), selective reporting of results (reporting bias), and overall risk of bias. The risk of bias for each included study was classified into three levels: low risk, some concerns, or high risk. Two reviewers (HBL and JMC) independently evaluated the overall quality of the eligible studies.

2.5. Data Synthesis and Analysis

Meta-analyses were conducted using R software (version 3.5.0; R Project for Statistical Computing). The standardized mean difference (SMD), along with the 95% confidence interval (CI), was employed as the primary summary statistic. A random-effects model was applied to account for variability among the included studies. Statistical significance was defined at a threshold of 0.05. To assess heterogeneity, the I2 statistic and chi-square test were calculated. The analysis was conducted in line with Cochrane Handbook guidance to manage intra-patient correlation in cluster-structured data. A correlation coefficient of 0.07 was applied to inflate the standard error where clustering corrections were absent.

2.6. Assessment of Certainty of Evidence

The certainty of evidence for the primary outcomes was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach [28,29]. GRADE provides a structured framework for rating the quality of evidence across several domains, including study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias. In the present study, the certainty assessment for each outcome was planned to begin at a “high” level, as all included studies were randomized controlled trials. Downgrading decisions were subsequently applied as necessary, according to predefined criteria for each domain.

3. Results

3.1. Study Selection and Data Extraction

The initial search identified a total of 462 articles. After removing 315 duplicate records, the titles and abstracts of the remaining studies were screened, resulting in the exclusion of 290 articles that did not meet the predefined inclusion criteria. The full texts of the remaining 25 articles were then reviewed, and 19 additional studies were excluded based on the same criteria. Ultimately, a total of six studies met the eligibility criteria and were included in the final meta-analysis. The inter-reviewer reliability based on Cohen’s Kappa coefficient was 0.91. An overview of the study selection procedure is provided in Figure 1. Supplementary Table S2 outlines the excluded articles with corresponding reasons for exclusion, and Table 1 summarizes the key features of the included studies.

3.2. Risk of Bias Assessment

Figure 2 provides a visual summary of the risk of bias assessments across all included studies. In particular, Figure 2A presents domain-specific evaluations for each article, where green indicates a low risk of bias, yellow denotes an unclear level of risk, and red reflects a high risk of bias. This assessment reveals that most studies exhibit a low risk of bias across most domains. Most of the studies were rated as low risk for randomization, while one trial was categorized as having some concerns for randomization. None of the included studies showed concerns regarding deviations from the intended interventions, incomplete outcome data, or outcome measurement—all were judged to be at low risk in these domains. In the overall assessment and selection domain, only one trial was noted as low risk, while all other studies were ranked as having some concerns. The primary sources of bias concerns were related to unclear reporting of outcome measures and ambiguity in the selection of reported results, as detailed in Supplementary Table S3. Figure 2B illustrates the overall risk of bias distribution across domains, where the size of each green bar reflects the number of studies rated as low risk. A substantial portion of the included studies (83.3%) showed some level of concern regarding bias. Notably, issues such as the randomization process and selective outcome reporting were identified as domains requiring particular attention.

3.3. Meta-Analysis

Six articles (Pasqua et al. 2024 [30], Altieri and Cassetta 2022 [31], Bazargani et al. 2021 [32], Jia et al. 2021 [33], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences of tooth inclination and buccal bone thickness changes between MARPE and CRPE.

3.3.1. Tooth Inclination Changes

Due to heterogeneity in study populations, methodological approaches, and follow-up durations, a random-effects model was applied. The substantial I2 value (70%; p < 0.01) further supported the presence of considerable variability across studies. To address this heterogeneity, a subgroup analysis was conducted, categorizing the studies into two subgroups: first molar and first premolar. Given this substantial heterogeneity, the assumption of equal between-study variance was not applied in the meta-ANOVA.
A total of five articles (Altieri and Cassetta 2022 [31], Bazargani et al. 2021 [32], Jia et al. 2021 [33], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences in tooth inclination changes between MARPE and CRPE. Figure 3 presents the pooled results in the form of forest plots. The results of the meta-analysis demonstrated that the pooled standardized mean difference (SMD) for tooth inclination changes in CRPE compared with MARPE was 0.98 (95% CI, 0.54 to 1.42; p < 0.01), indicating a significant increase in tooth inclination with CRPE. The overall test for effect was statistically significant (p < 0.01). However, there were no significant differences between the subgroups (p = 0.21).
The Maxillary First Molars (Mx6)
Five articles (Altieri and Cassetta 2022 [31], Bazargani et al. 2021 [32], Jia et al. 2021 [33], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences in tooth inclination changes between MARPE and CRPE in the Mx6. The results of the meta-analysis indicated that the pooled SMD for tooth inclination changes in CRPE compared with MARPE was 0.77 (95% CI, 0.26 to 1.29; p < 0.01), indicating a significant increase in tooth inclination with CRPE. A high level of heterogeneity (I2 = 64%; p = 0.02) was observed among the studies (Figure 3).
The Maxillary First Premolars (Mx4)
Three articles (Jia et al. 2021 [33], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences in tooth inclination changes between MARPE and CRPE in the Mx4. The results of the meta-analysis indicated that the pooled SMD for tooth inclination changes in CRPE compared with MARPE was 1.33 (95% CI, 0.63 to 2.04; p < 0.01), indicating a greater tooth inclination with CRPE, although this finding was not statistically significant. A high level of heterogeneity (I2 = 64%; p = 0.06) was observed among the studies (Figure 3).

3.3.2. Buccal Bone Thickness Changes

Due to heterogeneity in study populations, methodological approaches, and follow-up durations, a random-effects model was applied. While the I2 value (41%) indicated moderate heterogeneity, the p-value (p = 0.10) suggests that this heterogeneity is not statistically significant. Although the heterogeneity was not statistically significant, a subgroup analysis was performed, categorizing the studies into the Mx6 and Mx4 subgroups. Given this substantial heterogeneity, the assumption of equal between-study variance was not applied in the meta-ANOVA.
A total of five articles (Pasqua et al. 2024 [30], Altieri and Cassetta 2022 [31], Bazargani et al. 2021 [32], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences in buccal bone thickness changes between MARPE and CRPE. Figure 4 presents the pooled results in the form of forest plots. The results of the meta-analysis indicated that the pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.69 (95% CI, 0.37 to 1.00; p < 0.01), indicating a significant decrease in buccal bone thickness with CRPE. The pooled effect was statistically significant (p < 0.01), with a notable difference observed between subgroups (p = 0.04).
The Maxillary First Molars (Mx6)
Five articles (Pasqua et al. 2024 [30], Altieri and Cassetta 2022 [31], Bazargani et al. 2021 [32], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences in buccal bone thickness changes between MARPE and CRPE in the Mx6. The results of the meta-analysis indicated that the pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.48 (95% CI, 0.10 to 0.85; p = 0.01), indicating a significant decrease in buccal bone thickness with CRPE. A moderate level of heterogeneity (I2 = 37%; p = 0.17) was observed among the studies (Figure 4).
The Maxillary First Premolars (Mx4)
Three articles (Pasqua et al. 2024 [30], Celenk-Koca et al. 2018 [13], and Toklu et al. 2015 [34]) assessed the differences in buccal bone thickness changes between MARPE and CRPE in the Mx4. The results of the meta-analysis indicated that the pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 1.07 (95% CI, 0.66 to 1.47; p < 0.01), indicating a significant decrease in buccal bone thickness with CRPE. A low level of heterogeneity (I2 = 0%; p = 0.82) was observed among the studies (Figure 4).

3.3.3. Publication Bias Analysis

The funnel plots showed an asymmetrical pattern (Figure 5). However, the trim-and-fill analysis did not identify any studies requiring imputation, and the revised pooled effect size remained unchanged from the original estimate. Moreover, Egger’s regression test yielded non-significant p-values across all analyses, as detailed in Supplementary Table S4.

3.4. Certainty of Evidence

Based on the GRADE assessment, the certainty of evidence regarding tooth inclination changes was downgraded by two levels to “low certainty,” due to concerns related to potential risk of bias stemming from incomplete reporting of the randomization process and selective outcome reporting in some studies, as well as substantial heterogeneity among the included trials. In contrast, the certainty of evidence for buccal bone thickness changes was downgraded by one level to “moderate certainty,” reflecting minor concerns about risk of bias while demonstrating acceptable consistency and precision across studies.

4. Discussion

Rapid palatal expansion is slightly more effective in increasing the posterior transverse skeletal width of the maxilla, while slow palatal expansion induces less molar inclination [35]. On the other hand, patients who underwent slow palatal expansion reported significantly less pain than those treated with rapid palatal expansion during the first week of treatment, although no notable differences in pain levels were found between the two protocols thereafter [36]. Additionally, RPE may temporarily affect articulation of certain sounds during expansion, but these changes usually resolve after appliance removal [37].
According to a recent meta-analysis, MARPE is regarded as an effective modality for treating maxillary transverse deficiency, as it achieves considerable skeletal expansion in late adolescence. In contrast, it demonstrates fewer detrimental periodontal effects and certain clinical benefits compared to CRPE [38]. A recent review article suggests that the success rate of MARPE may decline in males beyond their mid-20s, while favorable outcomes can still be achieved in females into their mid-30s [39]. Similarly, the Delphi consensus reported that the likelihood of midpalatal suture opening decreases after the mid-20s, particularly in males. However, the panel did not reach a consensus on whether bone-anchored expanders produce greater skeletal expansion or lead to more stable medium- or long-term outcomes in growing patients [40].
Several studies in growing patients have reported that MARPE produces a skeletal-to-dental expansion ratio nearly twice as high as that of CRPE [13,33]. A CBCT-based study in growing patients reported that MARPE induced significant skeletal and dental expansion, with a more parallel midpalatal suture split compared to CRPE, consistent with previous findings [41]. MARPE was associated with greater long-term dentoskeletal stability and less relapse in transverse width compared to RPE, particularly in the premolar region after 10 years [42].
Melsen reported that significant interdigitation of the midpalatal suture occurs after puberty, based on histologic findings [9]. In addition, Baccetti et al. established that the peak pubertal growth spurt generally occurs at CVM stage III, which typically corresponds to ages 11–14 [43]. Supporting this, Choi et al. reported higher midpalatal suture opening success rates with MARPE in adolescents compared to adults, reinforcing the importance of skeletal rather than chronological age in patient selection [20].
This meta-analysis compared the dentoalveolar changes of MARPE and CRPE in growing patients. Overall, CRPE resulted in greater dental tipping and more pronounced buccal bone loss compared to MARPE. Similar trends were observed in both molars and premolars, with premolars exhibiting more buccal bone reduction. This observation may be explained by anatomical differences, as the buccal cortical plate in the premolar region tends to be thinner, and the supporting root morphology is generally less robust, making this area more susceptible to resorption under lateral forces. Furthermore, variations in palatal vault depth and arch morphology may contribute to localized stress concentration, further amplifying bone remodeling in the premolar area. These outcomes are interpreted as consequences of the differences in anchorage. MARPE, utilizing skeletal anchorage, enables more central expansion while minimizing buccal cortical bone resorption. These findings are consistent with previous studies that reported significantly less buccal bone loss with MARPE than with CRPE [13,25,44].
Furthermore, dental tipping was substantially more severe in the CRPE groups across the studies, supporting the claim that tooth-borne expanders transfer lateral forces directly to anchor teeth, causing unwanted dental side effects. Lin et al. also found that MARPE produced a more parallel opening of the midpalatal suture compared to CRPE, which may help explain the reduced dentoalveolar side effects [44]. Although often emphasized in adults, the preservation of periodontal structures is equally crucial in growing patients, making these characteristics highly relevant in this population. These findings suggest that MARPE should be considered preferentially when periodontal stability is a primary treatment objective in growing patients. Nevertheless, a tailored approach that incorporates skeletal maturity assessment, appliance design, and activation protocol remains essential.
Heterogeneity (I2) was noted among the included studies, which could be attributed to variations in appliance design, miniscrew placement, patient age range, and timing of post-expansion assessment. Additionally, differences in activation rates (ranging from 0.4 mm to 0.8 mm per day), retention periods (from 3 to 8 months), and post-expansion evaluation time points likely contributed to the observed heterogeneity. Such procedural inconsistencies highlight the importance of developing consensus guidelines for MARPE protocols to reduce variability and improve comparability across future studies. Despite asymmetry observed in the funnel plot and potential publication bias suggested by Egger’s test, the trim-and-fill analysis indicated that these did not significantly impact the overall effect estimates. The moderate-to-high heterogeneity observed in this study may reflect the clinical variability inherent in MARPE research, where differences in appliance design and activation protocols are commonly present.
Differences in radiographic analysis methods and anatomical landmark definitions can contribute to variability in outcomes across studies. In the present meta-analysis, only studies based on CBCT analysis were selected to control for such variables. This approach aimed to enhance the consistency of the results and reduce interpretive discrepancies. Nevertheless, future studies should adopt standardized outcome measures and reporting protocols, such as the CONSORT extension for orthodontic trials, to improve study quality and reproducibility.
The current study has several limitations. The number of included trials was limited, with most being single-center studies. Additionally, follow-up durations were often short, and MARPE appliance designs and protocols varied across studies, limiting generalizability. While some studies have shown promising long-term stability for MARPE, most evidence remains confined to short-term outcomes. Future studies should pursue standardized protocols across diverse MARPE designs, with longer follow-up durations, to assess skeletal stability. Subgroup analyses based on age, sex, and skeletal maturity are warranted to refine clinical guidelines and improve patient care. Moreover, comprehensive randomized trials that consider secondary outcomes, such as airway changes, soft tissue adaptation, and miniscrew stability, are necessary to inform broader clinical applications. Finally, the null hypothesis of no significant differences between MARPE and CRPE was partially rejected, as several outcomes demonstrated statistically significant differences favoring MARPE. However, this partial rejection should be interpreted cautiously given the moderate-to-high heterogeneity and the relatively limited number of high-quality randomized trials included.

5. Conclusions

The present review and meta-analysis indicated that MARPE was more effective than CRPE in reducing undesirable dentoalveolar effects in growing patients. MARPE was associated with less buccal bone loss and reduced tooth inclination. These findings support considering MARPE as a preferable treatment option in this population. Further high-quality randomized controlled trials with long-term follow-up are recommended to confirm these results.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app15158326/s1. Table S1: Search strategy of the online databases. Table S2: Excluded studies from full-text reading. Table S3: Risk of bias. Table S4: Analyses for publication bias, Table S5: PRISMA 2020 for Abstracts Checklist. Table S6: PRISMA 2020 for Checklist. References [44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61] are cited in the Supplementary Materials.

Author Contributions

Conceptualization, H.b.L., J.-M.C., J.H.P. and S.-H.H.; formal analysis, H.b.L., J.-M.C., N.J.K. and S.-H.H.; writing—original draft preparation, H.b.L., J.-M.C., N.J.K. and S.-H.H.; writing—review and editing, H.b.L., J.-M.C., J.H.P., N.J.K. and S.-H.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Acknowledgments

This paper was supported by Wonkwang University in 2025. The authors acknowledge the assistance of ChatGPT (Version 4; OpenAI, San Francisco, CA, USA) in language editing and text refinement during the preparation of this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

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Applsci 15 08326 g001
Figure 1. Flow chart of included systematic reviews.
Figure 1. Flow chart of included systematic reviews.
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Figure 2. (A) Domain-wise risk of bias across all studies. (B) Overall domain-specific risk of bias evaluation [13,31,32,33,34].
Figure 2. (A) Domain-wise risk of bias across all studies. (B) Overall domain-specific risk of bias evaluation [13,31,32,33,34].
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Figure 3. Forest plot of the meta-analysis on tooth inclination changes. Mx6, maxillary first molar; Mx4, maxillary first premolar [13,31,32,33,34].
Figure 3. Forest plot of the meta-analysis on tooth inclination changes. Mx6, maxillary first molar; Mx4, maxillary first premolar [13,31,32,33,34].
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Figure 4. Forest plot of the meta-analysis on buccal bone thickness changes. Mx6, maxillary first molar; Mx4, maxillary first premolar [13,30,31,32,34].
Figure 4. Forest plot of the meta-analysis on buccal bone thickness changes. Mx6, maxillary first molar; Mx4, maxillary first premolar [13,30,31,32,34].
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Applsci 15 08326 g005aApplsci 15 08326 g005b
Figure 5. Funnel plot of publication bias analysis. (A) Tooth inclination changes and (B) buccal bone thickness changes.
Figure 5. Funnel plot of publication bias analysis. (A) Tooth inclination changes and (B) buccal bone thickness changes.
Applsci 15 08326 g005aApplsci 15 08326 g005b
Table 1. Main characteristics of the included studies.
Table 1. Main characteristics of the included studies.
Study Year/
Nationality		Sample Size
/Gender		AgeData
Collection		MARPE
Design		CRPE
Design		Expansion
Protocol		Duration
of
Expansion		RetentionOutcomesResults
Pasqua 2024
/Brazil [30]		42 patients: TBB (12 female and 9 male); TB (5 female and 16 male)TBB: 13.3 ± 1.3 y; TB: 13.2 ± 1.4 yCBCT and clinical exam (pre- and 3 months post-expansion)Hybrid hyrax: 2 miniscrews in anterior paramedian palate + molar bandsConventional hyrax with molar bands (tooth-borne)1 turn (0.8 mm) initially, then 2/4 turns per day (0.2 mm each)Until overcorrection; CBCT after 3 months3 months (expander removed before post-CBCT)CBCT: Buccal and palatal bone thickness, marginal crest level, clinical attachment level (CAL), and gingival recessionBuccal bone loss: TB 1.3 ± 0.4 mm vs. TBB 0.5 ± 0.2 mm; molar tipping: TB 6.5° ± 2.1°, TBB 1.3° ± 1.0°; Nasal width gain: TB 1.4 ± 0.6 mm vs. TBB 2.6 ± 0.8 mm
Altieri
2022
/Italy [31]		36 enrolled, 26 analyzed: TB (8 female and 10 male); TBB (7 female and 11 male)TBB: 12.3 ± 0.8 y; TB: 12.2 ± 0.3 yCBCT (pre-treatment and 6 months post-expansion)Computer-guided MARPE with 4 miniscrews in anterior/posterior paramedian regionsConventional hyrax with molar bands (tooth-borne)1st day: 4 quarter turns; then 3 quarter turns/day (0.6 mm/day)Screw opening until 8 mm; 6-month follow-up8 months (appliance left as retainer)CBCT: Changes in maxillary base, alveolar, and zygomatic width; nasal cavity width; molar inclination; periodontal supportMaxillary base width: TB 2.89 ± 2.27 mm vs. TBB 6.79 ± 3.65 mm; Alveolar width: TB 6.02 ± 0.98 mm vs. TBB 5.10 ± 2.93 mm; Zygomatic width: TB 4.80 ± 1.57 mm vs. TBB 8.15 ± 1.38 mm; Nasal width: TB 3.10 ± 0.74 mm vs. TBB 5.00 ± 0.95 mm; Molar tipping: TB 6.01° ± 10.80°, TBB 0.17° ± 3.54°
Bazargani 2021
/Sweden [32]		52 patients: TB (13 female and 13 male), TBB (13 female and 13 male)TB: 9.3 ± 1.3 y; TBB: 9.5 ± 1.2 yCBCT and plaster models at T0, T1, T2 (1-year follow-up)Tooth-bone-borne expander with 2 miniscrews (1.7 × 8 mm, Orthoeasy) placed in anterior palateHyrax expansion screw with bands on maxillary first molars and premolars (tooth-borne)2 quarter turns/day (0.5 mm/day) until overcorrectionVaried; analyzed T0–T2 (1 year)6 months post-expansion (device removed before T2)CBCT: Skeletal and dental expansion; midpalatal suture width; nasal cavity change; molar tipping; stability; plaster model widthsMidpalatal suture expansion (S1_inf): TB 2.3 ± 0.5 mm vs. TBB 3.4 ± 0.9 mm; Nasal width (N1): TB 1.8 mm vs. TBB 3.5 mm; Post-expansion relapse: TB −1.4 mm, TBB −1.7 mm (intermolar width); Molar tipping: no significant difference at 1 year
Jia 2021
/China [33]		60 patients: MARPE (n = 30), Hyrax (n = 30) (gender not reported) 12–16 y (mean age not reported)CBCT (pre-treatment and 3 months post-expansion)MARPE with 4 miniscrews in anterior paramedian palate + molar bandsConventional hyrax with molar bands (tooth-borne)2 turns/day (0.2 mm per turn); until desired expansionUntil desired expansion3 months (expander maintained)Buccal bone thickness, alveolar bone height, root length, and molar inclinationBuccal bone loss: Hyrax 0.75 mm vs. MARPE 0.34 mm; Alveolar height loss: Hyrax 1.76 mm vs. MARPE 0.60 mm; Molar tipping: Hyrax 5.67° vs. MARPE 1.78°
Celenk-Koka 2018
/Turkey [13]		40 patients (20 conventional
RME (12 female
and 8 male) and
20 miniscrew-supported
RME (13 female and 7 male))		Conventional
RME:
13.84 ± 1.36 y;
Miniscrew-supported
RME:
13.81 ± 1.23 y		CBCT (pre- and post-expansion, 6-month retention)Hyrax expansion screw individually
fitted and supported by 4 mini-implants
(1.8 mm × 9 mm, Orlus,
Ortholution Co, Seoul, Korea)
inserted into the palatal alveolar bone
between the roots of first and second
premolars, and between second
premolars and first molars (bone-borne
expansion)		Hyrax expansion
screw with occlusal
coverage of premolars
and first molar (and
extension for second
molar) (tooth-borne
expansion)		2 turns/day (activation period: ~20 days)~20 days6 months (passive retention with same appliance)Buccal alveolar bone width: measurement from
the outermost point of the bone to the roots at
the level of the bifurcation and trifurcation of
the maxillary first premolars and maxillary first molars, respectively.		Sutural expansion: TB 1.3 ± 0.7 mm vs. TBB 3.6 ± 1.2 mm; Nasal width gain: TB 1.2 ± 1.1 mm vs. TBB 2.9 ± 1.7 mm; Incisive foramen: TB 1.4 ± 0.8 mm vs. TBB 3.2 ± 0.9 mm; Molar tipping: TB 3.98° ± 3.4°, TBB 1.3° ± 2.1°
Toklu 2015
/Turkey [34]		25 patients: TB (8 female and 5 male), TBB (6 female and 6 male)TB: 14.3 ±2.3 y; TBB: 13.8 ±2.2 yCBCT (pre- and 3 months post-expansion)Hybrid hyrax: 2 miniscrews (1.8 × 9 mm) near 2nd/3rd palatal rugae + molar bandsTooth-borne hyrax expansion screw attached to first premolars and first molars2 turns/day; average activation ~19–20 days~20 days3 months with expander, followed by transpalatal archCBCT: Periodontal changes (buccal/palatal bone thickness), skeletal width, and dental inclination of canines, premolars, and molars1st premolar expansion: TB 7.5 ± 4.2 mm vs. TBB 3.2 ± 2.6 mm; 2nd premolar: TB 8.0 ± 3.3 mm vs. TBB 4.5 ± 3.8 mm; Molar tipping: TB 6.8° ± 5.4°, TBB 2.4° ± 5.5°; Palatal bone gain: TB +1.7 ± 0.7 mm, TBB +1.3 ± 0.6 mm; Nasal width: TB 2.46 ± 1.69 mm, TBB 2.54 ± 1.94 mm
CBCT, cone-beam computed tomography; MARPE, miniscrew-assisted rapid palatal expansion; CRPE, conventional rapid palatal expansion; RME, rapid maxillary expansion; TBB, tooth-bone-borne; CAL, clinical attachment level; y, years.
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Lee, H.b.; Chae, J.-M.; Park, J.H.; Kim, N.J.; Han, S.-H. Comparison of Dentoalveolar Changes with Miniscrew-Assisted Versus Conventional Rapid Palatal Expansion in Growing Patients: A Systematic Review and Meta-Analysis. Appl. Sci. 2025, 15, 8326. https://doi.org/10.3390/app15158326

AMA Style

Lee Hb, Chae J-M, Park JH, Kim NJ, Han S-H. Comparison of Dentoalveolar Changes with Miniscrew-Assisted Versus Conventional Rapid Palatal Expansion in Growing Patients: A Systematic Review and Meta-Analysis. Applied Sciences. 2025; 15(15):8326. https://doi.org/10.3390/app15158326

Chicago/Turabian Style

Lee, Hwang bin, Jong-Moon Chae, Jae Hyun Park, Na Jin Kim, and Sung-Hoon Han. 2025. "Comparison of Dentoalveolar Changes with Miniscrew-Assisted Versus Conventional Rapid Palatal Expansion in Growing Patients: A Systematic Review and Meta-Analysis" Applied Sciences 15, no. 15: 8326. https://doi.org/10.3390/app15158326

APA Style

Lee, H. b., Chae, J.-M., Park, J. H., Kim, N. J., & Han, S.-H. (2025). Comparison of Dentoalveolar Changes with Miniscrew-Assisted Versus Conventional Rapid Palatal Expansion in Growing Patients: A Systematic Review and Meta-Analysis. Applied Sciences, 15(15), 8326. https://doi.org/10.3390/app15158326

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