Surgically assisted rapid maxillary expansion: a systematic review of complications.

A systematic review of the literature on the complications of surgically assisted maxillary expansion (SARME) was performed. The search strategy was based on the PRISMA guidelines. The PubMed, SCOPUS, and Cochrane Library databases were searched. Data were extracted from the full texts after screening of the abstracts and titles. Human clinical studies encompassing 'maxillary expansion', 'palatal expansion', 'SARME', or 'SARPE' and that reported sufficient data for 'complication' were included. In vitro studies, case reports, meta-analyses, reviews, book chapters, animal studies, and studies with missing or insufficient data were excluded. The final selection included 12 articles for data extraction. A total of 851 patients underwent SARME, with 187 reported complications (21.97%). Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%. Minor complications were equally distributed between surgical (49.30%) and orthodontic complications (50.70%). The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%), and the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion. In conclusion, SARME procedures mostly present minor complications. Although several types of complication are described in the literature, occurrence rates are low, and technical issues such as pterygomaxillary disjunction and the pattern of distraction can be predictors of the complication risk.

Titanium mesh associated with rhBMP-2 in alveolar ridge reconstruction.

A systematic review of the literature was performed regarding the use of titanium mesh in association with recombinant human bone morphogenetic protein (rhBMP) for alveolar ridge reconstruction. The PubMed, Scopus, and Cochrane databases were searched for articles in English published up until June 2017. The inclusion criteria encompassed studies in humans - randomized clinical trials, prospective and retrospective studies, and case series. The screening and selection process was performed by three independent reviewers, with verification by a senior researcher in the case of disagreement. The initial search identified 92 studies. After removal of duplicates, 70 remained for title and abstract reading. Fifty-four articles were considered non-relevant, resulting in a total of 16 studies. Following application of the inclusion criteria, 10 studies were selected. An additional study was added after the hand search, giving a total of 11 articles. These reported on 106 patients who had undergone alveolar ridge augmentation with rhBMP and titanium mesh. There were 74 maxillary grafts and 22 mandibular grafts, and the success rate of rehabilitation was 93.4% to 100%. The most frequently reported complications were suture dehiscence and mesh exposure, but without graft loss. rhBMP associated with titanium mesh is a viable method for alveolar reconstruction with high success rates and low rates of local complications.