Long-term dental and skeletal changes in patients submitted to surgically assisted rapid maxillary expansion: A meta-analysis
PhD Student, Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidad Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Oral surgery, oral medicine, oral pathology and oral radiology
08/2012; 114(6). DOI: 10.1016/j.oooo.2012.01.040
This meta-analysis evaluated long-term dental and skeletal changes in patients submitted to surgically assisted rapid maxillary expansion.
A search was performed in electronic databases. Human clinical trials with patients submitted to surgically assisted rapid maxillary expansion with a follow-up of at least 1 year after expansion were selected. A methodological quality scoring process was used. A meta-analysis was performed to compare measurements of skeletal and dental structures.
Three hundred sixty-five titles and abstracts were read. Ultimately 10 studies met the inclusion criteria. The 3 articles ranked as presenting low methodological quality were excluded. Three measurements could be compared and 3 time periods were used to assess changes.
There is moderate evidence to conclude that maxillary alveolar width and intercanine and intermolar width have a long-term significant increase as a result of surgically assisted rapid maxillary expansion. A significant relapse is expected in the intercanine width after expansion.
Available from: Amirfarhang Miresmaeili
- "Practical clinical experience has shown that SARME is reliable and effective for the correction of transverse maxillary deficiency in skeletally mature patients. However, there is no consensus in the literature regarding the type of distractor (tooth-borne or boneborne ) that should be used in SARME to provide the best dental and skeletal results and stability (Suri and Taneja, 2008; Verstraaten et al., 2010; Vilani et al., 2012). Tooth-borne devices transmit the expansion force to the anchor teeth and may cause buccal tipping of the anchor teeth, maxillary dentoalveolar tipping and several complications including periodontal problems, root resorption, tooth extrusion, cortical bone resorption and fenestration, speech problems, and relapse. "
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To evaluate and compare the short-term (post-retention) skeletal and dental changes following bone-borne and tooth-borne surgically assisted rapid maxillary expansion (SARME) using cone beam computed tomography (CBCT).
and methods: In this randomized clinical study, 30 patients with transverse maxillary deficiency underwent either tooth-borne (n = 15) or bone-borne (n = 15) SARME. Before treatment and immediately after the consolidation period, CBCT was obtained and the nasal floor width, interdental root distance, palatal bone width and interdental cusp distance were measured at first premolar and first molar regions of maxilla. Results: Twenty eight patients completed the study protocol. In both tooth-borne (n=13) and bone-borne (n=15) groups the highest degree of expansion occurred in the dental arch, followed by palatal bone, and nasal floor (V-shaped widening in coronal dimension). The amount and pattern of expansion was comparable between anterior and posterior maxillary regions in each group (parallel posteroanterior expansion) and between the two groups.
Dental and skeletal effects of tooth-borne and bone-borne devices were comparable. The overall complication rate was negligible. Selection of an expansion device should be based on each individual patient's requirements. Future long-term clinical trial studies to evaluate the stability and relapse of these two techniques are recommended.
Available from: Sylvain Chamberland
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ABSTRACT: To the Editor:
I think article by Vilani et al1 in the December issue of your journal does not meet the level of research quality or methodological soundness that a meta-analysis should have. There are several significant problems:
The inclusion criterion of follow-up of at least 1 year after expansion should be interpreted with caution because it does not differentiate studies with patients who are still in orthodontic treatment from studies with patients whose orthodontic treatment is completed. So final dental changes (expansion and relapse) cannot be estimated with precision. Specifically, the studies of Koudstaal et al.,2 Byloff and Mossaz,3 and Berger et al.4 are 12-month studies, while the other studies have follow-up after the end of ortho treatment.5, 6, 7, 8
The short-term data were pooled with longer-term data that ranged from 2 to 6 years at follow-up. Moreover, the observation time points differ among the studies. Three studies report the maximum expansion point at the end of the distraction period being their T22, 3, 4 while other studies report an expansion point taken at the end of ortho treatment.5, 6, 7 The study of Kurt et al.5 recruited in the Surgically Assisted Rapid Palatal Expansion (SARPE) group 4 patients who underwent orthopedic expansion that had failed.
The meta-analysis would have benefited from an objective of differentiating short-term and long-term dental and skeletal changes. Our prospective study9 who include 38 consecutively treated patients with SARPE was an attempt to clarify these points.
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