Search Results (84)

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. Full article

The objective of the present study was to evaluate and compare the accuracy of the computer-aided static navigation technique (NAV), augmented reality (AR) and freehand placement technique (FHT) for the bicortical orthodontic self-drilling mini-implants for maxillary skeletal expansion (MSE) appliances placed in palate. Material and Methods: A total of 120 bicortical orthodontic self-drilling mini-implants were placed in the palate of ten 3D printed anatomically based polyurethane models of a completely edentulous upper maxilla. The orthodontic mini-implants were randomly assigned to the following placement techniques: (A) computer-aided static navigation technique (n = 40) (NAV), (B) augmented reality device (n = 40) (AR) and (C) conventional freehand technique (n = 40) (FHT). Moreover, two implants were placed in each side of the midpalatal suture in every model according to the digital planification of the expander device. Subsequently, the orthodontic mini-implants were placed and postoperative CBCT scans were performed. Finally, coronal entry-point (mm), apical end-point (mm) and angular deviations (°) were calculated using a t-test. Results: Statistically significant differences were shown at coronal entry-point (p < 0.001), apical end-point (p < 0.001) and angular deviations (p < 0.001) between the three placement techniques of bicortical orthodontic mini-implants. Additionally, statistically significant differences were also shown between the orthodontic mini-implant positions concerning the entry point (p = 0.004) and angular deviation (p = 0.004). Conclusions: The augmented reality placement technique results are more accurate, followed by the computer-aided static navigation technique and the freehand technique for MSE appliances placed in palate. Full article

The purpose of this systematic review is to analyze the dentoalveolar changes resulting from the use of clear aligners in the treatment of transverse maxillary deficiency among growing children in the mixed dentition stage. An electronic literature search was carried out using the following databases: PubMed, Scopus, Cochrane Library, Embase, and Web of Science. The review protocol was prospectively registered in the PROSPERO database. Eligible studies included children aged 6 to 12 years in the mixed dentition period, presenting with erupted maxillary first molars and a transverse deficiency of the maxilla, and undergoing treatment with Invisalign^® First aligners. The review encompassed various study types including retrospective and prospective designs, randomized controlled trials, preliminary studies, and case series. Two independent reviewers conducted the data extraction process. The quality of evidence was assessed using the GRADE approach. Except for studies by Bruni et al., the risk of bias in selected articles was visually summarized in a traffic light plot using the robvis tool, following the ROBINS-I methodology. For the studies by Bruni et al., a separate visual representation was created using robvis with the RoB2 evaluation framework, prepared by the authors S.E.I. and C.A. In total, 14 studies were included in the final synthesis, selected from 265 records retrieved through electronic searches and an additional 36 identified via manual screening. Several parameters were considered in order to assess dentoalveolar expansion: intercanine width, intercanine transpalatal width, intercanine dentoalveolar width, first and second interdeciduous molar width, first and second interpremolar width, first and second interdeciduous molar transpalatal width, first intermolar width, first intermolar mesial, distal, and transpalatal width, molar inclination, arch depth, and arch perimeter, and intermolar dentoalveolar width. An improvement was recorded in all parameters. The studies comparing treatment with Invisalign^® First clear aligners and rapid maxillary expander highlighted that these both determined statistically significant differences compared to the natural growth group. Treatment with Invisalign^® First in mixed dentition proved to be very effective for dentoalveolar expansion of the maxillary arch, with good control of the crown angulation of the upper first molar and an increase in the palatal area similar to RME, compared to pre-treatment or to the natural growth group. It could represent an effective and comfortable alternative to the traditional rapid maxillary expander treatment. However, further high-quality studies are required to support our current observations and verifying the stability of treatment outcomes on a long-term basis. Full article

The rapid maxillary expander is one of the most widely used devices in orthodontics, and this study analyzes the skeletal and dental effects of a two-band rapid maxillary expander (RME) and a splint resin palatal expander (SRPE) in growing children with skeletal maxillary contraction. Seventy-four subjects with palatal skeletal contraction and unilateral or bilateral posterior crossbite were treated using maxillary expander devices. The sample was made up of two different randomly assigned groups: RME (21 females, 17 males; mean age ± SD 7.7 ± 1.1 years) and SRPE (24 females, 15 males; mean age ± SD 7.6 ± 1.0 years). The effects of these two different devices were evaluated based on lateral cephalograms and measurements of digital models before and after treatment (7.0 ± 1.0 months). Longitudinal changes in the different groups were evaluated statistically using Student’s t-test (p < 0.05). No significant differences in treatment effects were found for any vertical or sagittal skeletal variables in the groups. However, there was a significantly increased maxillary intercanine distance in the SRPE group (36 patients; mean ± SD = 6.0 ± 4.8 mm) compared to the RME group (38 patients; mean ± SD = 3.1 ± 2.9 mm). The results of this study showed an increase in vertical skeletal dimensions in more patients treated using SRPE than RME. Moreover, the SRPE device was shown to be better at increasing the intercanine distance, and it could therefore be preferred in children with anterior dental crowding. An evaluation of long-term treatment stability would be useful to confirm the study results. Full article

Background/Objectives: Currently, clear aligners are preferred to conventional appliances, especially among adult patients. However, the use of aligners for treating maxillary constriction is still debated in the literature. Therefore, the purpose of this study was to assess maxillary dentoalveolar expansion following clear aligner therapy in adults using CBCT scans. Methods: The study sample encompassed 50 non-growing patients (27 females and 23 males) aged 20 to 42 undergoing clear aligner orthodontics without dental extractions or auxiliaries. Transverse linear distances were measured on initial and final CBCTs and, subsequently, analysed through paired t-test and ANOVA. We considered alveolar bone measurements and interdental widths measured at the buccal apices and cusps from canines to second molars. Results: The buccal alveolar ridge width showed the greatest expansion (1.01 ± 0.38 mm), followed by the palatal alveolar ridge and maxillary alveolar bone. Statistically significant improvements were observed for all interdental measurements. The most considerable changes occurred in the interpremolar cusp distances, while the least changes were seen in the intermolar apex distances. At the cusp level, the average interpremolar widths increased by 3.44 ± 0.22 mm for the first premolars and 3.14 ± 0.27 mm for the second ones. Conclusions: Clear aligner treatment can effectively manage a constricted maxillary arch. We found significant changes in the maxillary alveolar bone. Both inter-apex and inter-cusp widths increased in all teeth, with the highest values in the premolars. Moreover, the increases in interdental distances at both apex and cusp levels were related to tooth position. Full article

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities. Full article

Background: This study investigated the effects of preoperative maxillary plates on cleft width reduction in infants with unilateral cleft lip and palate and their control group. The study also aimed to compare the digital and manual methods in measurement of changes in maxillary segment positioning in sagittal and transverse dimensions using digital 3D models and conventional plaster casts. Methods: Twenty infants with unilateral cleft lip and palate and their control group of eleven infants with isolated cleft palate were enrolled in a prospective interventional study (2020 to 2024). Participants were treated with either active or passive maxillary plates. Sagittal, transversal and angular measurements were taken both manually as well as digitally at three time points: 24–48 h postnatal (T0), approximately at six months old (T1, immediately before surgery), and one year postoperatively (T2). Results: Significant reductions in cleft width were observed across all patients over the treatment period, regardless of the type of plate used (p < 0.001). The mean cleft width reduction was 5.050 mm. Infants treated with active plates had a larger reduction in cleft width than those with passive plates (p = 0.024), averaging 5.846 mm compared to 3.571 mm. Neither the side of the cleft nor the patient’s gender influenced the degree of cleft reduction (p = 0.884 and p = 0.245, respectively). The study found significant modifications in the maxilla’s transverse, sagittal, and angular dimensions (p < 0.001). When comparing sagittal growth, the study group differed from the control group (p = 0.004), with isolated cleft palate patients showing more substantial sagittal expansion. Additionally, the overall change in the ITT’ distance differed significantly between the study and control groups over time (p < 0.001). Cleft size at baseline did not affect the extent of changes within the cleft area. No significant discrepancies were found between digital and manual measurement methods, confirming the reliability of both. Conclusions: Active plates demonstrated greater efficacy in cleft reduction for wider and more divergent clefts, while passive plates were suitable for smaller clefts. Full article

Background/Objectives: Rapid palatal expansion is commonly used to correct maxillary deficiencies. However, medications like Isotretinoin may influence bone remodeling during treatment. Isotretinoin, a drug used to treat acne, was the focus of this study, which aimed to evaluate its effect on bone repair after rapid palatal suture expansion in rats. Methods: The sample consisted of 40 Wistar rats, divided into two groups: the control group (CG), subjected only to orthodontic movement, and the experimental isotretinoin group (IG), where movement occurred after drug administration. Periods of 0, 7, and 14 days after the installation of the orthodontic device were analyzed, with a force of 30 g applied in all groups using a steel spring. After euthanasia, the maxillae were removed and analyzed via Micro-CT, histologically, and histomorphometrically. Results: The results showed that the expander was effective in promoting the expansion of the palatal suture. After 14 days, the total expansion was 381% (CG) and 299% (IG); the percentage of vessels in the connective tissue increased by 145% in CG and 84% in IG; and bone formation in both groups occupied 52% of the expanded palatal suture. No significant differences were observed between the groups regarding collagen fiber formation. Conclusions: It was concluded that the daily administration of Isotretinoin at the standard dose for the treatment of severe acne does not cause significant alterations in the bone repair process following the opening of the median palatine suture in rats. Full article

Background/Objectives: Miniscrew-assisted rapid palatal expansion (MARPE) has been increasingly used as a nonsurgical alternative for maxillary expansion in adults. However, reports of complications remain limited. This case describes a rare instance of maxillary bone fracture following MARPE and its clinical implications. Methods: A 32-year-old patient underwent MARPE as part of presurgical orthodontic treatment for maxillary constriction. Five days after activation, severe pain developed, followed by sensory disturbances in the infraorbital region. CT imaging revealed a maxillary fracture extending from the infraorbital foramen to the alveolar process. Symptoms gradually improved over two years, but psychological distress led to the abandonment of orthognathic surgery. Results: This case suggests that MARPE-induced maxillary fractures may be associated with stress concentration at the zygomatico-maxillary suture, particularly in individuals with increased midpalatal suture interdigitation and thin cortical bone. Finite element analysis and stress distribution studies indicate that the zygomatic buttress serves as a major resistance point, which may have contributed to the fracture. Conclusions: These findings highlight the importance of careful patient selection, preoperative CT assessments of bone thickness, and individualized expansion protocols. In high-risk cases, alternative approaches, such as surgically assisted expansion, may be considered. Further research on MARPE’s risk assessment and treatment protocols is needed to improve safety. Full article

Background/Objectives: The aim of this study is to investigate the side effects of two techniques of rapid maxillary expansion—Surgically Assisted Rapid Palatal Expansion (SARPE) and Miniscrew-Assisted Rapid Palatal Expansion (MARPE)—in adult patients, to guide the selection of the most cost-effective clinical treatment plan. Methods: The review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis—extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligibility criteria were defined based on the study objectives. The research team formulated a PICO question to identify relevant studies in the literature. Five databases were queried: MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science, and Embase. Additionally, a manual search was conducted. Results: The computer-assisted search identified 746 articles, of which only 26 fully met the inclusion criteria and were included in the scoping review. Among the included studies, 11 were retrospective, 12 were prospective, and 3 were randomized clinical trials. SARPE was evaluated in 21 studies, MARPE in 4 studies, and 1 article reported complications associated with both techniques. The side effects described in the studies were synthesized and categorized into five groups: expansion failure, asymmetric expansion, dentoalveolar issues, surgical complications, and appliance-related problems. Conclusions: The results indicate that both techniques involve risks. The most reported adverse effects were dentoalveolar and surgical in nature. Dentoalveolar side effects, such as dental tipping, were predominantly associated with the MARPE technique, while surgical complications were more commonly observed with the SARPE technique. Patient age is crucial for treatment choice as well as proper design and planning of the expansion device. Consequently, careful patient selection and treatment planning are essential to minimize the side effects of maxillary expansion in adult patients. Full article

Objectives: This study aimed to compare the effects of surgically assisted rapid palatal expansion (SARPE) techniques and their combinations on the stresses (von Mises, maximum principal, and minimum principal) and displacements that occur in the maxilla, facial bones, and maxillary teeth using three-dimensional finite element analysis (FEA). Methods: SARPE was simulated using seven different osteotomy techniques. The FEA models were simulated with a combination of various osteotomies, including midpalatal and lateral osteotomies, lateral osteotomy with a step, and separation of the pterygomaxillary junction. For each osteotomy variant, the instantaneous displacements and stresses resulting from forces applied by a 1 mm expansion of a tooth-borne appliance were evaluated. Results: Midpalatal osteotomy increased lateral displacement in the alveolar bone margins and intermaxillary suture while significantly reducing stresses around the intermaxillary suture. The addition of a pterygomaxillary osteotomy to the midpalatal and lateral osteotomies effectively reduced stresses in the posterior maxilla and cranial structures while enhancing lateral displacement. Although lateral osteotomy significantly reduced stresses in the midface, its effect on maxillary expansion was limited. Stepped lateral osteotomy had minimal effects on transverse displacement and stress reduction. Conclusions: Increasing the number of osteotomies reduced stress levels in the maxilla while enhancing lateral displacement. These results highlight the importance of selecting the most appropriate osteotomy technique to achieve optimal outcomes. Full article

Background/Objectives: Obstructive sleep apnoea (OSA) is a sleep-related breathing condition that involves the presence of episodic disruptions to the sleeping pattern due to partial or complete airway obstruction. There are a range of treatment options that exist to alleviate the symptoms of this condition including CPAP, mandibular advancement, and maxillary expansion techniques. This systematic review and meta-analysis of published articles aims to determine if rapid maxillary expansion (“RME”) is an effective treatment option in the management of OSA, using quantitative parameters of AHI and SpO₂. Methods: An exhaustive review of the literature was conducted on EBSCO, PubMed, and Scopus databases. The PICO question for the systematic review was “Can rapid maxillary expansion be used as a viable treatment option using comparative AHI and SpO₂ parameters in the management of obstructive sleep apnoea?” A meta-analysis was also performed and the software used to carry out the meta-analysis was R 4.3.2 (R Core Team (2013)). Results: From the initial search, 62 articles were found and a further 4 articles were obtained from manual findings. Nine articles were included in the final systematic review and meta-analysis. Eight of the studies concluded that RME was successful to varying degrees in the management of OSA across both outcome variables assessed. The meta-analysis indicated that RME is an effective treatment option in the management of adult and paediatric OSA with the improvement of both parameters. The paediatric OSA sample with specific pre-treatment anatomical presentation (clear maxillary deficiency, narrow hard palate with crossbite) showed a noted resolution of OSA following RME at a pre-pubertal age, indicating that RME can be employed as a genuine treatment option for paediatric OSA as suggested by theory. Conclusions: The systematic review and meta-analysis provided sufficient significant data in favour of the alternative hypothesis to indicate that RME is an effective treatment option in the management of obstructive sleep apnoea, in terms of the AHI reduction and SpO₂ increase. Full article

Background: Traditional methods for palatal expansion using fixed appliances often face limitations in comfort and aesthetics. In comparison, aligner therapy has limitations, particularly regarding maxillary expansion. The aim of this study is to examine the biomechanical properties regarding the wire diameter and bending of different stainless steel wires to evaluate their potential for incorporation into maxillary aligner therapy. Materials and Methods: Three rectangular stainless steel wires (0.016″ × 0.022″, 0.017″ × 0.025″, and 0.019″ × 0.025″) were tested for mechanical expansion forces in the intermolar region, comparing non-tooth-shaped bent wires (A groups) and tooth-shaped bent wires (B groups). Using a Z010 testing machine (ZwickRoell GmbH and Co. KG, Ulm, Germany), expansion forces were measured at 1 mm intervals over a 5 mm distance, with 15 samples analyzed per group. Statistical analyses included the Shapiro–Wilk test for normal distribution, the Mann–Whitney U test, which revealed significant results (U = 225, p < 0.001), and the Kruskal–Wallis test, which indicated significance (H = 39.130; df = 2; p < 0.001). Results: Tooth-shaped bent wires exhibited significantly lower expansion forces than non-tooth-shaped bent wires for all tested wire types. This difference was most notable in wires with larger transverse profiles (0.019″ × 0.025″), where the tooth-shaped bent wires displayed a marked reduction in mechanical load capacity. Specific force measurements for non-tooth-shaped wires ranged from 760.61 ± 79.51 mN at 1 mm of deformation to 2468.46 ± 66.27 mN at 5 mm of deformation, while tooth-shaped wires ranged from 116.80 ± 3.74 mN to 1979.49 ± 23.23 mN. Conclusions: These findings suggest that non-tooth-shaped bent wires offer a more efficient and uniform expansion potential for maxillary movements due to their stable elastic properties. Clinically, integrating non-tooth-shaped stainless steel wires into aligner therapy may provide a viable method for maxillary expansion, supporting both first- and second-order movements in orthodontic treatment. Further research is needed to explore the integration of such wires for effective maxillary expansion in aligner therapy. Full article

Microimplant-assisted rapid palatal expansion (MARPE) is a technique widely used to treat transverse discrepancies in adult patients. The present study aims to examine how age, sex, maxillary width, and suture bone density might influence MARPE efficacy. It also analyzes bone density variations across the midpalatal suture regions. Materials and Methods: This retrospective study included 30 adult patients who underwent MARPE treatment. Pre- and post-treatment CT scans were analyzed to quantify the maxillary width and bone density measured in Hounsfield units (HUs) in the anterior, middle, and posterior nasal spine regions. Statistical analyses were carried out and included descriptive statistics, t-tests, and effect size calculations. Results: Younger patients (age 22.13 ± 4.58) had significantly higher success rates compared to older patients (aged 25.66 ± 4.67). No significant differences were found regarding sex or the initial maxillary width. Lower bone density in the middle and posterior nasal spine regions was correlated with higher success rates. Data showed that the anterior nasal spine exhibited higher bone density, but this finding did not affect treatment outcomes significantly. Conclusions: Age seems to be a crucial factor in MARPE success, with younger patients showing better outcomes. Regarding bone density, results showed that its values in the middle and posterior nasal spine regions could be a determinant of treatment success. On the contrary, sex and the initial maxillary width did not appear to affect outcomes. These findings emphasize the importance of preoperative assessments and the consideration of individual anatomical variations for optimal MARPE treatment planning. Full article

Background: This case report describes the clinical management of a traumatic palatal ulcer, a complication associated with mini-implant-assisted rapid maxillary expansion (MARPE). Case Report: A 13-year-old female patient with maxillary constriction underwent MARPE treatment using a custom acrylic expander anchored by four mini-implants. Despite proper planning and device design, the patient missed her first follow-up appointment and continued activations, resulting in tissue inflammation and embedding of the device. Upon examination, swelling and displacement of the cement were observed, necessitating device removal. The traumatic ulcer was treated with chlorhexidine gel, paracetamol, and a soft diet. Complete recovery was achieved within one month. A second expander was then designed and installed, with more frequent monitoring and improved hygiene protocols. This approach led to successful expansion without complications. This case highlights the importance of precise treatment planning, proper mini-implant selection, and regular follow-ups in MARPE therapy. It also emphasizes the need for patient compliance and effective hygiene measures to prevent complications. Conclusions: The successful management of the traumatic ulcer demonstrates that prompt action and consideration of cost-effective treatment options can lead to positive outcomes in addressing MARPE-related complications. Full article