Long-term effects of conventional and miniscrew-assisted rapid palatal expansion on root resorption

Effect of customized 3D-printed MARPE appliance on hard tissues, soft tissues, and airway: A prospective CBCT study

BACKGROUND

The advances in technology have enabled the customization of appliances including mini-screw-assisted rapid palatal expansion (MARPE) appliances for skeletal expansion in young adult patients. The study assessed the short-term effects of customized MARPE appliances on the hard tissues, soft tissues, and airway volume over a period of 6 months.

METHODS

A total of 15 patients in the age range of 15 to 25 years were treated for transverse maxillary deficiency using a three-dimensional (3D) printed customized MARPE appliance. The changes in hard tissues, soft tissues, and airway volume were evaluated using cone beam computed tomography before expansion (T0) and at 6 months post-expansion (T1). The Digital Imaging and Communications in Medicine files were analyzed for post-expansion changes using the NemoCeph 3D and 3D Slicer 5.6.1 software.

RESULTS

An effective skeletal expansion was observed with significant changes in intercanine, interpremolar, and intermolar width; and decreased mid-palatal suture density in the anterior region (P < .05). The changes in tooth inclination and alveolar bone thickness were mostly non-significant apart from a significant decrease in buccal bone thickness in the coronal third region (P < .05). There was no significant root resorption or change in airway volumes (P > .05). The philtrum height increased significantly by 1.17 mm (P = .019) with no significant change on right and left sides.

CONCLUSIONS

Rapid palatal expansion with 3D-printed customized MARPE enables effective and symmetrical expansion with a significant increase in philtrum height and no significant adverse effects in terms of alveolar bone thickness, dental inclination, root resorption, and airway volumes.

Long-term assessment of skeletal and dental asymmetry after conventional and mini-implant-assisted rapid palatal expansion

INTRODUCTION

This study aimed to evaluate the short-term and long-term skeletal and dental asymmetry with miniscrew-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and control group using cone-beam computed tomography (CBCT) analysis.

METHODS

A total of 180 CBCT scans were analyzed for 60 patients divided into 3 groups: MARPE (mean age 13.7 ± 1.74 years), RPE (mean age 13.9 ± 1.14 years), and control (mean age 13.3 ± 1.49 years). CBCT scans were recorded at 3 points: pretreatment (T1), postexpansion (T2), and posttreatment (T3). The anterior nasal spine, posterior nasal spine, zygomaticomaxillary point, anterior nasal cavity width, posterior nasal cavity width (PNCW), external maxillary width, palatal width, and molar inclination were measured on the left and right sides in all CBCT scans. In addition, maxillary molar width (MMW) and maxillary canine width were also evaluated on the left and right sides. Statistical analysis was performed, and the parameters were tested within the groups from T1 to T2 and T1 to T3 using a paired t test. The mean changes were then compared among the 3 groups by a mixed analysis of variance test.

RESULTS

The RPE group showed significantly greater MMW on the left and right sides at T2 (P <0.05). MARPE and RPE led to a significant increase in the anterior nasal spine (right and left), zygomaticomaxillary point (right and left), anterior nasal cavity width (right and left), PNCW (right and left), external maxillary width (right and left), palatal width (right and left), MMW (right and left), maxillary canine width (right and left), and posterior nasal spine (left) at T2 compared with control (P <0.05). RPE led to a significant increase in the molar inclination (right and left) compared with MARPE and controls at T2. In the long term, the PNCW (right and left) was greater in MARPE compared with RPE and controls (P <0.05).

CONCLUSIONS

Within-group comparisons showed that there was no significant asymmetry in the MARPE and control group in the short and long term. The asymmetry for the RPE group was isolated to the MMW in the short term but not observed in the long term, and the magnitude of the asymmetry was clinically not significant.

Short- and long-term effects of conventional and miniscrew-assisted rapid palatal expansion on hard tissues using voxel-based superimposition of serial cone-beam computed tomography scans

INTRODUCTION

The objective of this study was to evaluate the short-term and long-term hard-tissue changes with miniscrew-assisted rapid palatal expansion (MARPE) and rapid palatal expansion (RPE) compared with a matched control group with voxel-based superimposition using 3-dimensional cone-beam computed tomography (CBCT) scans.

METHODS

A total of 180 CBCT scans were analyzed for 60 patients with a mean age of 13.9 years at 3 time points: pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were divided into 3 groups: MARPE, RPE, and controls. Voxel-based superimposition was performed for CBCTs from T1 to T2 and T1 to T3 using the anterior cranial base as a reference. The hard-tissue surfaces were extracted after the superimposition procedure. Nine landmarks were analyzed: nasion, A-point, pogonion, left and right alar bases, zygoma, and gonion. Within-group changes were analyzed using linear mixed-effects models, including a random intercept per subject and the mixed effect of time (T1, T2, or T3) with test P values adjusted for multiple testing using Tukey's method. Between-group changes were analyzed using linear mixed-effects models, including a random intercept per subject and the mixed effects of time, group, and group × time interaction with P values adjusted for multiple testing using the Benjamin-Hochberg false discovery rate method.

RESULTS

In the short term, both MARPE and RPE led to a significant downward movement of the right gonion and lateral movement of the right alar base compared with controls at T2 (P <0.05). In addition, MARPE led to a significant downward movement of pogonion and left gonion. RPE led to a significant downward movement of the A-point and lateral movement of the left alar base compared with controls at T2 (P <0.05). However, in the long-term, no changes were observed between the groups at T3.

CONCLUSIONS

There were significant differences in pogonion, alar base, and gonion between MARPE, RPE, and control groups in the short term. However, all the hard-tissue changes were transient, as there were no differences between the 3 groups in the long term.

Miniscrew-Assisted Rapid Palatal Expansion: A Scoping Review of Influencing Factors, Side Effects, and Soft Tissue Alterations

Background: Miniscrew-assisted rapid palatal expansion (MARPE) has gained attention as an effective alternative to traditional rapid palatal expansion, particularly in adult patients. This scoping review synthesizes recent evidence to assess the clinical efficacy and safety of MARPE, addressing a gap in comprehensive, up-to-date analyses in this area. Objective: To present the recent assessments concerning MARPE influencing factors, side effects, soft tissue alterations, and airway changes, focusing on comparisons with conventional devices. Methods: Using PRISMA guidelines, we conducted a search of the literature published in 2018-2023 using Medline, Scopus, and Embase databases. This review focused on randomized controlled trials, cohort studies, and other reviews that evaluated the outcomes of MARPE. Results: Our analysis included 75 studies and revealed that MARPE significantly improves suture expansion with fewer dental and skeletal side effects compared to traditional methods. The technique shows high efficacy in subjects up to 25 years of age, with reduced incidence of complications and improved stability of expansion. Conclusions: The results support MARPE as a viable and superior alternative for maxillary expansion in late adolescents and adults. Given its advantages over traditional methods, MARPE should be considered a standard procedure in orthodontic treatment plans. Future research should focus on long-term outcomes and optimization of patient-specific treatment protocols.

Effect of the Proximity of Roots to the Cortical Plate and Inclination of Incisors on External Apical Root Resorption

Background

External apical root resorption (EARR) is an unfavorable side effect of orthodontic treatment. Orthodontic treatment of patients with increased crowding could lead to the proclination of incisors and proximity of roots to the cortical plates.

Aims

The aim of this study was to evaluate the effects of the proximity of the labial and lingual cortical plates and the inclination of incisors on EARR.

Settings and Design

Twenty-six patients (age: 13.39 years) with nonextraction fixed orthodontic treatment were evaluated at pretreatment and posttreatment (52 cone-beam computed tomographies).

Materials and Methods

The maxillary and mandibular incisors (416 teeth) were evaluated for the pretreatment predictors such as the labial and palatal (lingual) cortical plate thickness, width of the mandibular symphysis/maxillary alveolus and cancellous bone, position of the root apex in cancellous/cortical bone, and treatment factors such as distance of root to the labial and palatal (lingual) outer and inner cortical plate and incisor inclination.

Statistical Analysis Used

Statistical analyses were performed with R software at a 0.05 significance level. Each parameter was compared between pretreatment and posttreatment by a paired t-test, and the association to root resorption was performed using a regression model.

Results

Clinically significant (>1 mm) root resorption was observed in 35% of all mandibular incisors and 52% of all maxillary incisors. Width of cancellous bone, position of the root apex in cortical bone, proximity of the root apex to the labial and palatal (lingual) outer cortical plate, lingual inner cortical plate, and proclination of incisors were significant factors associated with EARR.

Conclusions

Proximity to the cortical plates and proclination of incisors are associated with increased EARR.

Biomechanics of conventional and miniscrew-assisted rapid palatal expansion

Posterior Crossbite is a common condition resulting because of transverse maxillary deficiency. The growth of the craniofacial complex finishes first in the transverse dimension, followed by sagittal and vertical dimensions. Conventional rapid palatal expansion (RPE) appliances are commonly used to correct transverse maxillary deficiency. Although RPE is efficient in correcting posterior crossbite, it results in dental side effects such as buccal tipping of maxillary molars, root resorption, bone dehiscence, and relapse. Mini-implant-assisted RPE has been introduced to increase the skeletal effects of expansion especially in patients with increased maturation and greater interdigitation of midpalatal suture. This article will review the biomechanics of RPE and mini-implant-assisted RPE. Additionally, the different designs of MARPE and the long-term clinical effects of expansion appliances will also be discussed in detail.

Long-term efficacy and stability of miniscrew-assisted rapid palatal expansion in mid to late adolescents and adults: a systematic review and meta-analysis

BACKGROUND

The purpose of this study is to investigate the long-term efficacy and stability of Miniscrew-assisted Rapid Palatal Expansion (MARPE), including its primary outcomes, namely the nasomaxillary complex transverse skeletal and dental expansion, and related secondary outcomes.

METHODS

Electronic databases and manual literature searches, up to October 31, 2022, were performed. The eligibility criteria were the following: studies on patients with transverse maxillary deficiency treated with MARPE in adults and adolescents over 13.5 years of age.

RESULTS

Ultimately, twelve articles were included in the analysis, one prospective and eleven retrospective observational studies. Five studies showed a moderate risk of bias, while the remaining seven studies were at a serious risk of bias. The GRADE quality of evidence was very low. MARPE is an effective treatment modality for transverse maxillary deficiency (mean success rate: 93.87%). Patients showed increased mean in the skeletal and dental transverse expansion. The basal bone composition, mean alveolar bone and mean dental expansion accounted for 48.85, 7.52, and 43.63% of the total expansion, respectively. There was a certain degree of skeletal and dental relapse over time. MARPE could also cause dental, alveolar, and periodontal side effects, and have an impact on other craniofacial bones, upper airway, and facial soft tissue.

CONCLUSIONS

MARPE is an effective treatment for transverse maxillary deficiency, with a high success rate and a certain degree of skeletal and dental relapse over time.