Influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.

OBJECTIVES: To evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors. MATERIALS AND METHODS: Patients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record. RESULTS: Twenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02). CONCLUSIONS: One and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession. CLINICAL RELEVANCE: Clinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.

What is the impact of miniscrew-assisted rapid palatal expansion on the midfacial soft tissues? A prospective three-dimensional stereophotogrammetry study.

OBJECTIVES: To evaluate the midfacial soft tissue changes of the face in patients treated with miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS: 3D facial images and intra-oral scans (IOS) were obtained before expansion (T0), immediately after completion of expansion (T1), and 1 year after expansion (T2). The 3D images were superimposed and two 3D distance maps were generated to measure the midfacial soft tissue changes: immediate effects between timepoints T0 and T1 and overall effects between T0 and T2. Changes of the alar width were also measured and dental expansion was measured as the interpremolar width (IPW) on IOS. RESULTS: Twenty-nine patients (22 women, 7 men, mean age 25.9 years) were enrolled. The soft tissue in the regions of the nose, left of philtrum, right of philtrum, and upper lip tubercle demonstrated a statistically significant anterior movement of 0.30 mm, 0.93 mm, 0.74 mm, and 0.81 mm, respectively (p < 0.01) immediately after expansion (T0-T1). These changes persisted as an overall effect (T0-T2). The alar width initially increased by 1.59 mm, and then decreased by 0.08 mm after 1 year, but this effect was not significant. The IPW increased by 4.58 mm and remained stable 1 year later. There was no significant correlation between the increase in IPW and alar width (r = 0.35, p = 0.06). CONCLUSIONS: Our findings indicate that MARPE results in significant but small changes of the soft tissue in the peri-oral and nasal regions. However, the clinical importance of these findings is limited. CLINICAL RELEVANCE: MARPE is an effective treatment modality to expand the maxilla, incurring only minimal and clinically insignificant changes to the midfacial soft tissues.

What is the Oral Health-related Quality of Life following Miniscrew-Assisted Rapid Palatal Expansion (MARPE)? A prospective clinical cohort study.

BACKGROUND: Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical orthodontic treatment for transverse maxillary deficiency. This study aimed to investigate the Oral Health-related Quality of Life (OHRQoL) and pain perception of patients undergoing MARPE treatment. METHODS: 42 consecutive patients (9 men, 33 women) from the age of 16 onwards (mean: 27.4 ± 9.3 years; range 17.1-55.7 years) who received a MARPE treatment were included. OHRQoL was assessed with the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. Patients filled out the questionnaire at baseline (T0) and weekly during the expansion phase (P1) and in the post-expansion phase (P2). Pain intensity was assessed with a Visual Analogue Scale (VAS) questionnaire and filled out daily during expansion, along with a question on the intake of analgesics. The mean weekly and total OHIP-score and OHIP-score per domain were calculated at T0, P1 and P2, as well as mean weekly and total VAS-scores for average pain, maximum pain and analgesics intake during P1. Kruskal-Wallis tests were used to test for differences in OHIP between T0, P1 and P2. The level of significance was set at 0.05. RESULTS: The mean OHIP-score was 10.86 ± 9.71 at T0 and increased to 17.18 ± 10.43 during P1 (p < 0.001), after which it returned to pre-expansion levels, 9.27 ± 7.92 (p = 0.907) during P2. At the domain level, there was a statistically significant increase in OHIP-score at P1 for functional limitation, physical pain, psychological discomfort and social disability. The mean VAS-score for average pain during expansion was 16.00 ± 19.73 mm. Both OHIP-score (25.00 ± 10.25), average pain (33.72 ± 16.88 mm), maximum pain (44.47 ± 17.99 mm) and analgesics intake (59%) were highest at initiation of the expansion and decreased by the end of expansion. CONCLUSIONS: MARPE is a generally well-tolerated expansion treatment. A temporary decline in OHRQoL and moderate pain are present at the start of expansion, followed by a recovery of OHRQoL and very mild pain during the rest of treatment. Clinicians should be aware of the effects of MARPE on patients' quality of life and manage the expected discomfort and impediments with adequate communication and patient education.

Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults with the Dutch Maxillary Expansion Device: a prospective clinical cohort study.

OBJECTIVES: To provide a higher degree of evidence on the efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults, thereby applying the Dutch Maxillary Expansion Device (D-MED). MATERIALS AND METHODS: D-MED was developed as an individualized, 3D-designed, and fabricated MARPE appliance supported by 4 palatal miniscrews. Patients from the age of 16 onwards with transverse maxillary deficiency were enrolled consecutively. Pre-expansion and immediate post-expansion CBCTs and intra-oral scans were acquired and measurements of skeletal, alveolar, and dental expansion as well as dental and periodontal side-effects were performed. RESULTS: Thirty-four patients were enrolled (8 men, 26 women) with mean age 27.0 ± 9.4 years. A success rate of 94.1% was achieved (32/34 patients). The mean expansion duration, or mean observation time, was 31.7 ± 8.0 days. The mean expansion at the maxillary first molars (M1) and first premolars (P1) was 6.56 ± 1.70 mm and 4.19 ± 1.29 mm, respectively. The expansion was 60.4 ± 20.1% skeletal, 8.1 ± 27.6% alveolar, and 31.6 ± 20.1% dental at M1 and 92.2 ± 14.5% skeletal, 0.0 ± 18.6% alveolar, and 7.8 ± 17.7% dental at P1, which was both statistically (p < 0.001) and clinically significant. Buccal dental tipping (3.88 ± 3.92° M1; 2.29 ± 3.89° P1), clinical crown height increase (0.12 ± 0.31 mm M1; 0.04 ± 0.22 mm P1), and buccal bone thinning (- 0.31 ± 0.49 mm M1; - 0.01 ± 0.45 mm P1) were observed, while root resorption could not be evaluated. CONCLUSIONS: MARPE by application of D-MED manifested its efficacy in a prospective clinical setting, delivering a high amount of skeletal expansion with limited side-effects in late adolescents and adults. CLINICAL RELEVANCE: Higher quality evidence is supportive of MARPE as a safe and successful non-surgical treatment option for transverse maxillary deficiency.

Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis.

BACKGROUND: Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy. OBJECTIVES: This systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects. SEARCH METHODS: Seven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020. SELECTION CRITERIA: Randomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes. DATA COLLECTION AND ANALYSIS: Inclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality. RESULTS: Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%-96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm-3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm-7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days. LIMITATIONS: One of the main drawbacks was the lack of high-quality prospective studies in the literature. CONCLUSIONS AND IMPLICATIONS: MARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended. REGISTRATION: PROSPERO (CRD42020176618). FUNDING: No grants or any other support funding were received.

Orthodontic radiology: development of a clinical practice guideline.

OBJECTIVES: Radiographs are considered essential in orthodontics. However, their diagnostic value and indications for use are still uncertain, while exposure to radiation carries health risks. This study aimed to report on the development of a clinical practice guideline on orthodontic radiology. METHODS: A Guideline Development Taskforce was set up. The GRADE methodology was used for development and the RIGHT Statement for reporting of the guideline. We systematically reviewed articles to address the main clinical question: how different types of radiographs contribute to orthodontic diagnosis, treatment planning and post-treatment outcome evaluation. After a literature search and data extraction, we formulated conclusions and assessed the strength of the evidence according to the GRADE method. Both literature conclusions and the most important considerations, such as patient preferences, organizational matters and expert opinions were taken into account to finally issue recommendations. RESULTS: 7 clinical questions focused on orthopantomograms, lateral cephalograms, hand-wrist radiographs, peri-apical radiographs, bitewings, antero-occlusal radiographs, and cone-beam computer tomographic imaging. The literature search lead to 484 unique studies, of which 17 were included in the analysis. The strength of evidence of the conclusions was graded low or very low. We formulated considerations and took them into account when issuing the 13 clinical recommendations to address the clinical questions. CONCLUSIONS: There was a considerable lack of scientific evidence on this topic. Nonetheless, this guideline provides clinicians with a tool for decision-making regarding radiographic records while enhancing patient radiation protection. More research of higher quality is recommended for a future update.