Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis

Dentoalveolar, periodontal and skeletal effects of maxillary expansion techniques assisted by temporary anchorage devices compared with conventional protocols in growing patients with transverse maxillary deficiency: A systematic review and meta-analysis

OBJECTIVES

To synthesise the dentoalveolar, periodontal and skeletal changes that occur when using maxillary expansion techniques assisted by temporary anchorage devices compared to conventional protocols.

METHODS

Five databases and grey literature were consulted, up to December 2023, focusing on intervention designs and excluding other type of studies. The quality assessment was conducted by using the adaptation for orthodontics of the CONSORT statement, the guidelines for reporting non-randomised studies, the RoB-2 tool, and the ROBINS-I tool. A descriptive summary and meta-analysis using RevMan 5.4 were performed.

RESULTS

Nine clinical trials were included (n=377 patients, mean age 13.2±0.6) with a diagnosis of transverse maxillary deficiency. The analysed studies showed qualitative dentoalveolar and periodontal changes after expansion, which were greater on the maxillary first premolars in tooth-borne appliances. Meta-analyses for some effects were included from two studies (n=64); patients who used tooth-borne appliances had greater effects of buccal intercoronal width between the premolars with statistically significant differences (Std Mean difference 2.34; 95% CI: 0.04-4.65 p=0.05). Conversely, those patients who used bone-borne or hybrid appliances had greater effects of buccal intercoronal width between molars with statistically significant differences (Std Mean difference -0.64; 95% CI: -1.38-0.10; p=0.09).

CONCLUSIONS

According to the studies analysed, all measurements increased in the intervention groups after expansion. Quantitative analyses show different findings at dentoalveolar level when tooth-borne, bone-borne or hybrid appliances are considered. Nevertheless, the results should be taken with caution due to the heterogeneity of the studies. The protocol was registered at PROSPERO (CRD42021283170), with no funding to report.

Temporary anchorage devices in orthodontics: a bibliometric analysis of the 50 most-cited articles from 2012 to 2022

OBJECTIVES

To identify and analyze the 50 most cited articles on temporary anchorage devices (TADs) and investigate the achievement and development of scientific research about the topic through a bibliometric analysis.

MATERIALS AND METHODS

On August 22, 2022, a computerized database search was performed to detect papers published in the scientific literature about TADs from 2012 to 2022. Metrics data were identified using the Incites Journal Citation Reports (Clarivate Analytics) data set. The Scopus database was used to obtain information on the authors' affiliations, country of origin, and h-index. Key words were automatically harvested from the selected articles to implement the visualized analysis.

RESULTS

From a total of 1858 papers screened by searching the database, a list of the top 50 most cited articles was created. The total number of citations collected by the 50 most cited articles in TADs was 2380. Among the 50 most cited articles on TADs, 38 were original research papers (76.0%) and 12 were reviews (24.0%). As shown by the key word-network analysis, Orthodontic anchorage procedure was identified as the larger node.

CONCLUSIONS

Findings of this bibliometric study showed an increasing number of citations for papers on TADs, accompanied by a simultaneous rise in scientific interest in this topic in the past decade. The present work identifies the most influential articles, emphasizing the journals, the authors, and the topics addressed.

Maxillary expansion in nongrowing patients. Conventional, surgical, or miniscrew-assisted, an update

Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilateral or bilateral posterior crossbite, narrow, tapering, or high palatal arch. The development of temporary anchorage devices led to a new generation of tooth-bone-borne expansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion. This article reviews the age limitation and complication and soft tissue change of nonsurgical maxillary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.

Evaluation of palate-related factors of the effectiveness of microimplant-assisted rapid palatal expansion in late adolescents and adults

INTRODUCTION

This study investigated the factors of the effectiveness of microimplant-assisted rapid palatal expansion (MARPE) in late adolescents and adults, such as age, midpalatal suture maturation (MPSM) stage, palate length (PL), palatal index (PI), and midpalatal bone thickness (MBT), and at each microimplant position, the palate bone thickness (PBT), the nasal cortical bone thickness (CoTN), the cancellous bone thickness (CaT), and the palate cortical bone thickness (CoTP) were evaluated.

METHODS

Cone-beam computed tomography (CBCT) images of 50 patients (mean, 23.30 ± 7.03 years; range, 16-51 years) treated with MARPE were evaluated. Maxillary expansion ratio (MER) was used to assess the MARPE effectiveness and grouped patients into low and high MER groups according to the mean of MER. MER was the ratio of maxillary expansion width to MARPE screw expansion measured in CBCT images. The t-test was used to analyze the differences between the low and high MER groups. The Pearson correlation test was performed to investigate the correlation between MER and age, MPSM stage, PL, PI, MBT, PBT, CoTN, CaT, and CoTP.

RESULTS

Age, MPSM stage, and MBT in regions 18 mm and 21 mm behind the incisor foramen correlated negatively with MER ([Formula: see text], - 0.390, - 0.386, and - 0.335, respectively, all [Formula: see text]), whereas PBT and CoTN of anterior microimplant positions correlated positively with MER ([Formula: see text] and 0.418, respectively, all [Formula: see text]). No correlation was observed between other variables and MER.

CONCLUSIONS

MARPE effectiveness decreased as age and midpalatal suture maturation stage increased, respectively. Thinner midpalatal suture bone in regions 18 mm and 21 mm behind the incisor foramen, thicker palate bone, and nasal cortical bone of anterior microimplant positions were related to more effective MARPE.

CLINICAL RELEVANCE

In patients with older chronological age and later MPSM stages, MARPE effectiveness might be unsatisfactory. Clinicians should carefully evaluate the palate bone thickness before MARPE treatment.

Clinical Use of Aligners Associated with Nuvola® OP System for Transverse Maxillary Deficiency: A Retrospective Study on 100 Patients

Introduction: Aligners represent a common treatment for orthodontic patients thanks to their countless advantages including aesthetics, comfort, and oral hygiene maintenance; at the same time, they are associated with a reduced number of visits and a low incidence of complications. Although aligners have undergone considerable improvements over time, to date they have limitations in resolving the most serious malocclusions related to transverse maxillary deficiency. The aim of the present study was to retrospectively evaluate an orthodontic protocol (the Nuvola® OP System) which associates a morpho-functional corrector (to be used for 30 min/day) with the aligner, allowing for the treatment of cases that would be difficult or unpredictable with aligners alone. Methods: Linear measurements were taken on STL files of 100 patients. In 77 patients between 18 and 55 years (mean 28.6 ± 16.2 (standard deviation) years), 3D superimpositions of the maxilla obtained from intraoral scans before and after treatment were performed in order to evaluate the degree of maxillary expansion. The normality of the data distribution was tested. The pre- and post-treatment data were compared using a paired t-test with a 5% significance level. After treatment, a questionnaire was proposed to assess patients’ degree of satisfaction and compliance. Results: A statistically significant difference (p < 0.05) for each distance evaluated was found. The maximum expansion was obtained at the first molar level (2.35 ± 1.64 mm). Of the subjects who completed the questionnaire, 96% were satisfied and 90% were able to perform the protocol without difficulty for the required duration. Conclusions: A significant expansion of the maxillary arch as well as a high degree of patient satisfaction and compliance were observed with the Nuvola® OP System. Further studies are needed in order to clinically evaluate the relative contribution of the aligners and morpho-functional device to the obtained expansion.