Following Surgically Assisted Rapid Palatal Expansion, Do Tooth-Borne or Bone-Borne Appliances Provide More Skeletal Expansion and Dental Expansion?

PURPOSE: The aim of this study was to compare outcome measurements of skeletal and dental expansion with bone-borne (BB) versus tooth-borne (TB) appliances after surgically assisted rapid palatal expansion (SARPE). This study was performed to provide quantitative measurements that will help the oral surgeon and orthodontist in selecting the appliance with, on average, the greatest amount of skeletal expansion and the least amount of dental expansion. MATERIALS AND METHODS: A computerized database search was performed using PubMed, EBSCO, Cochrane, Scopus, Web of Science, and Google Scholar on publications in reputable oral surgery and orthodontic journals. A systematic review and meta-analysis was completed with the predictor variable of expansion appliance (TB vs BB) and outcome measurement of expansion (in millimeters). RESULTS: Of 487 articles retrieved from the 6 databases, 5 articles were included, 4 with cone-beam computed tomographic (CBCT) data and 1 with non-CBCT 3-dimensional cast data. There was a significant difference in skeletal expansion (standardized mean difference [SMD], 0.92; 95% confidence interval [CI], 0.54-1.30; P < .001) in favor of BB rather than TB appliances. However, there was no significant difference in dental expansion (SMD, 0.05; 95% CI, -0.24 to 0.34; P = .03). CONCLUSION: According to the literature, to achieve more effective skeletal expansion and minimize dental expansion after SARPE, a BB appliance should be favored.

Surgically Assisted Rapid Palatomaxillary Expansion With or Without Pterygomaxillary Disjunction: A Systematic Review and Meta-Analysis.

PURPOSE: The purpose of this review was to evaluate the outcome measurements of anterior expansion, posterior expansion, and complications after surgically assisted rapid palatal expansion (SARPE) with or without pterygomaxillary disjunction (PMD). MATERIALS AND METHODS: A computerized database search was performed using PubMed, CINAHL, Cochrane, Scopus, and Web of Science. Then, a computerized search was conducted in Google Scholar and ProQuest to overcome publication bias. RESULTS: From the original 125 combined results, 3 met the inclusion criteria. The Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project assessed 2 articles as weak and 1 as moderate. The systematic review included a total of 48 patients (11 male and 37 female). For 25 patients, SARPE was performed with PMD and for 23 patients SARPE was performed without PMD. A tooth-borne fixed hyrax-type palatal expansion screw appliance was used for all cases, activated 1 to 2 mm intraoperatively, and, after a latency period of 3 to 7 days, activated 0.5 to 0.6 mm per day for 38 patients and 0.25 mm for the other 10 until adequate expansion. Postexpansion retention was performed using ligature wired hyrax in 18 patients for 4 months. Comparisons were based on cone-beam computed tomographic projections, study models only, or a combination of study models, anteroposterior cephalometric radiographs, and occlusal radiographs. The time to measure the changes ranged from before fixed orthodontic retention to 6 months after the completion of active expansion. A meta-analysis was possible only for anterior (intercanine) and posterior (inter-molar) dental expansions. CONCLUSION: The literature is inconclusive regarding the effect of PMD on the outcomes of SARPE. Further controlled trials are needed.