Korean J Orthod.  2022 May;52(3):182-200. 10.4041/kjod21.256.

Effectiveness of miniscrew assisted rapid palatal expansion using cone beam computed tomography: A systematic review and meta-analysis

Affiliations
  • 1Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
  • 2Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand

Abstract


Objective
This study aims to examine the effectiveness of miniscrew assisted rapid palatal expansion (MARPE) treatment in late adolescents and adult patients using cone-beam computed tomography (CBCT).
Methods
Literature search was conducted in five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) based on the PICOS keyword design focusing on MARPE. Out of the 18 CBCT screened outcomes, only nine parameters were sufficient for the quantitative meta-analysis. The parameters were classified into three main groups: 1) skeletal changes, 2) alveolar change, and 3) dental changes. Heterogeneity test, estimation of pooled means, publication bias, sensitivity analysis and risk of bias assessment were also performed.
Results
Upon database searching, only 14 full-text articles were qualified from the 364 obtained results. Heterogeneity test indicated the use of the random-effects model. The pooled mean estimate were as follows: 1) Skeletal expansion: zygomatic width, 2.39 mm; nasal width, 2.68 mm; jugular width, 3.12 mm; and midpalatal suture at the posterior nasal spine and anterior nasal spine, 3.34 mm and 4.56 mm, respectively; 2) Alveolar molar width expansion, 4.80 mm; and 3) Dental expansion: intercanine width, 3.96 mm; inter-premolar width, 4.99 mm and inter-molar width, 5.99 mm. The percentage of expansion demonstrated a skeletal expansion (PNS) of 55.76%, alveolar molar width expansion of 24.37% and dental expansion of 19.87%.
Conclusions
In the coronal view, the skeletal and dental expansion created by MARPE was of the pyramidal pattern. MARPE could successfully expand the constricted maxilla in late adolescents and adult patients.

Keyword

Evidence-based orthodontics; Microimplant assisted rapid maxillary expansion; Miniscrew assisted rapid palatal expansion; Maxillary skeletal expansion

Figure

  • Figure 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

  • Figure 2 Forest plots of skeletal expansion. PNS, midpalatal suture at the posterior nasal spine; ANS, midpalatal suture at the anterior nasal spine; CI, confidence interval.

  • Figure 3 Forest plots of alveolar molar width (AMW) expansion. CI, confidence interval.

  • Figure 4 Forest plots of dental expansion. ICW, inter-canine width; IPMW, inter-premolar width; IMW, inter-molar width; CI, confidence interval.

  • Figure 5 Funnel plots of skeletal, alveolar molar width, and dental expansion from meta-analysis. PNS, midpalatal suture at the posterior nasal spine; ANS, midpalatal suture at the anterior nasal spine; ICW, inter-canine width; IPMW, inter-premolar width; IMW, inter-molar width.

  • Figure 6 Trim and fill funnel plots of the skeletal, alveolar molar width, and dental expansion from the meta-analysis. Blue diamonds, mean effect size before trim and fill method; Red diamonds, mean effect size after trim and fill method; PNS, posterior nasal spine; ANS, anterior nasal spine; ICW, inter-canine width; IPMW, inter-premolar width; IMW, inter-molar width.

  • Figure 7 Summary of the adjusted pooled mean estimate of the skeletal, alveolar molar width and dental expansion, unit is millimeters (mm). ZMW, zygomatic width; NW, nasal width; J-J, jugular width; PNS, midpalatal suture at the posterior nasal spine; ANS, midpalatal suture at the anterior nasal spine; AMW, alveolar molar width; ICW, inter-canine width; IPMW, inter-premolar width; IMW, inter-molar width.


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