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

• Siddhisaributr P
• Khlongwanitchakul K
• Anuwongnukroh N
• Manopatanakul S
• Viwattanatipa N

• KMID: 2529942
• DOI: http://doi.org/10.4041/kjod21.256

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

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

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  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.

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

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

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  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.

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  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.

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  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.

Reference

1. Kapetanović A, Theodorou CI, Bergé SJ, Schols JGJH, Xi T. 2021; Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis. Eur J Orthod. 43:313–23. DOI: 10.1093/ejo/cjab005. PMID: 33882127. PMCID: PMC8186837.

2. Baccetti T, Franchi L, Cameron CG, McNamara JA Jr. 2001; Treatment timing for rapid maxillary expansion. Angle Orthod. 71:343–50.

3. Melsen B, Melsen F. 1982; The postnatal development of the palatomaxillary region studied on human autopsy material. Am J Orthod. 82:329–42. DOI: 10.1016/0002-9416(82)90467-5. PMID: 6961805.

4. Jimenez-Valdivia LM, Malpartida-Carrillo V, Rodríguez-Cárdenas YA, Dias-Da Silveira HL, Arriola-Guillén LE. 2019; Midpalatal suture maturation stage assessment in adolescents and young adults using cone-beam computed tomography. Prog Orthod. 20:38. DOI: 10.1186/s40510-019-0291-z. PMID: 31591660. PMCID: PMC6779683. PMID: b6634e4c7d1148e7bb8374c227540c31.

5. Handelman CS, Wang L, BeGole EA, Haas AJ. 2000; Nonsurgical rapid maxillary expansion in adults: report on 47 cases using the Haas expander. Angle Orthod. 70:129–44. DOI: 10.1043/0003-3219(2000)070<0129:NRMEIA>2.0.CO;2. PMID: 10833001.

6. Carvalho PHA, Moura LB, Trento GS, Holzinger D, Gabrielli MAC, Gabrielli MFR, et al. 2020; Surgically assisted rapid maxillary expansion: a systematic review of complications. Int J Oral Maxillofac Surg. 49:325–32. DOI: 10.1016/j.ijom.2019.08.011. PMID: 31500954.

7. Tang H, Liu P, Liu X, Hou Y, Chen W, Zhang L, et al. 2021; Skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) in young adults. Angle Orthod. 91:301–6. DOI: 10.2319/052920-491.1. PMID: 33492395. PMCID: PMC8084465.

8. Baik HS, Kang YG, Choi YJ. 2020; Miniscrew-assisted rapid palatal expansion: a review of recent reports. J World Fed Orthod. 9(3S):S54–8. DOI: 10.1016/j.ejwf.2020.08.004. PMID: 33023733.

9. Sarraj M, Akyalcin S, He H, Xiang J, AlSaty G, Celenk-Koca T, et al. 2021; Comparison of skeletal and dentoalveolar changes between pure bone-borne and hybrid tooth-borne and bone-borne maxillary rapid palatal expanders using cone-beam computed tomography. APOS Trends Orthod. 11:32–40. DOI: 10.25259/APOS_160_2020.

10. Lee SY, Choi YJ. 2017; Reader's forum: skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: a cone-beam computed tomography study. Korean J Orthod. 47:213–4. DOI: 10.4041/kjod.2017.47.4.213. PMID: 28670561. PMCID: PMC5466902.

11. Li N, Sun W, Li Q, Dong W, Martin D, Guo J. 2020; Skeletal effects of monocortical and bicortical mini-implant anchorage on maxillary expansion using cone-beam computed tomography in young adults. Am J Orthod Dentofacial Orthop. 157:651–61. Erratum in: Am J Orthod Dentofacial Orthop 2020; 158:318. DOI: 10.1016/j.ajodo.2019.05.021. PMID: 32354438.

12. Brunetto DP, Sant'Anna EF, Machado AW, Moon W. 2017; Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE). Dental Press J Orthod. 22:110–25. DOI: 10.1590/2177-6709.22.1.110-125.sar. PMID: 28444019. PMCID: PMC5398849.

13. Calil RC, Marin Ramirez CM, Otazu A, Torres DM, Gurgel JA, Oliveira RC, et al. 2021; Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 159:e93–101. DOI: 10.1016/j.ajodo.2020.09.011. PMID: 33288357.

14. Choi SH, Shi KK, Cha JY, Park YC, Lee KJ. 2016; Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults. Angle Orthod. 86:713–20. DOI: 10.2319/101415-689.1. PMID: 26938955. PMCID: PMC8600851.

15. Lim HM, Park YC, Lee KJ, Kim KH, Choi YJ. 2017; Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion. Korean J Orthod. 47:313–22. DOI: 10.4041/kjod.2017.47.5.313. PMID: 28861393. PMCID: PMC5548712.

16. Cantarella D, Dominguez-Mompell R, Mallya SM, Moschik C, Pan HC, Miller J, et al. 2017; Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod. 18:34. DOI: 10.1186/s40510-017-0188-7. PMID: 29090368. PMCID: PMC5663987.

17. Colak O, Paredes NA, Elkenawy I, Torres M, Bui J, Jahangiri S, et al. 2020; Tomographic assessment of palatal suture opening pattern and pterygopalatine suture disarticulation in the axial plane after midfacial skeletal expansion. Prog Orthod. 21:21. DOI: 10.1186/s40510-020-00321-9. PMID: 32686018. PMCID: PMC7370251. PMID: d48b855ae99f48ea93dcefe40cb63710.

18. Ngan P, Nguyen UK, Nguyen T, Tremont T, Martin C. 2018; Skeletal, dentoalveolar, and periodontal changes of skeletally matured patients with maxillary deficiency treated with microimplant-assisted rapid palatal expansion appliances: a pilot study. APOS Trends Orthod. 8:71–85. DOI: 10.4103/apos.apos_27_18.

19. Shin H, Hwang CJ, Lee KJ, Choi YJ, Han SS, Yu HS. 2019; Predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion in young adults: a preliminary study. Korean J Orthod. 49:360–71. DOI: 10.4041/kjod.2019.49.6.360. PMID: 31815104. PMCID: PMC6883215.

20. Clement EA, Krishnaswamy NR. 2017; Skeletal and dentoalveolar changes after skeletal anchorage-assisted rapid palatal expansion in young adults: a cone beam computed tomography study. APOS Trends Orthod. 7:113–9. DOI: 10.4103/2321-1407.207220.

21. Lee SR, Lee JW, Chung DH, Lee SM. 2020; Short-term impact of microimplant-assisted rapid palatal expansion on the nasal soft tissues in adults: a three-dimensional stereophotogrammetry study. Korean J Orthod. 50:75–85. DOI: 10.4041/kjod.2020.50.2.75. PMID: 32257933. PMCID: PMC7093666.

22. Jesus AS, Oliveira CB, Murata WH, Gonçales ES, Pereira-Filho VA, Santos-Pinto A. 2021; Nasomaxillary effects of miniscrew-assisted rapid palatal expansion and two surgically assisted rapid palatal expansion approaches. Int J Oral Maxillofac Surg. 50:1059–68. DOI: 10.1016/j.ijom.2020.12.014. PMID: 33478814.

23. Feldmann I, Bondemark L. 2006; Orthodontic anchorage: a systematic review. Angle Orthod. 76:493–501.

24. de Oliveira CB, Ayub P, Ledra IM, Murata WH, Suzuki SS, Ravelli DB, et al. 2021; Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment. Am J Orthod Dentofacial Orthop. 159:733–42. DOI: 10.1016/j.ajodo.2020.03.024. PMID: 33931257.

25. Elkenawy I, Fijany L, Colak O, Paredes NA, Gargoum A, Abedini S, et al. 2020; An assessment of the magnitude, parallelism, and asymmetry of micro-implant-assisted rapid maxillary expansion in non-growing patients. Prog Orthod. 21:42. DOI: 10.1186/s40510-020-00342-4. PMID: 33225406. PMCID: PMC7680816.

26. Li Q, Tang H, Liu X, Luo Q, Jiang Z, Martin D, et al. 2020; Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion. Angle Orthod. 90:432–41. DOI: 10.2319/080919-522.1. PMID: 33378437. PMCID: PMC8032299.

27. Moon HW, Kim MJ, Ahn HW, Kim SJ, Kim SH, Chung KR, et al. 2020; Molar inclination and surrounding alveolar bone change relative to the design of bone-borne maxillary expanders: a CBCT study. Angle Orthod. 90:13–22. DOI: 10.2319/050619-316.1. PMID: 31461306. PMCID: PMC8087056.

28. Nguyen H, Shin JW, Giap HV, Kim KB, Chae HS, Kim YH, et al. 2021; Midfacial soft tissue changes after maxillary expansion using micro-implant-supported maxillary skeletal expanders in young adults: a retrospective study. Korean J Orthod. 51:145–56. DOI: 10.4041/kjod.2021.51.3.145. PMID: 33984222. PMCID: PMC8133895.

29. Park JJ, Park YC, Lee KJ, Cha JY, Tahk JH, Choi YJ. 2017; Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: a cone-beam computed tomography study. Korean J Orthod. 47:77–86. DOI: 10.4041/kjod.2017.47.2.77. PMID: 28337417. PMCID: PMC5359634.

30. MacGinnis M, Chu H, Youssef G, Wu KW, Machado AW, Moon W. 2014; The effects of micro-implant assisted rapid palatal expansion (MARPE) on the nasomaxillary complex--a finite element method (FEM) analysis. Prog Orthod. 15:52. DOI: 10.1186/s40510-014-0052-y. PMID: 25242527. PMCID: PMC4148550.

31. Coloccia G, Inchingolo AD, Inchingolo AM, Malcangi G, Montenegro V, Patano A, et al. 2021; Effectiveness of dental and maxillary transverse changes in tooth-borne, bone-borne, and hybrid palatal expansion through cone-beam tomography: a systematic review of the literature. Medicina (Kaunas). 57:288. DOI: 10.3390/medicina57030288. PMID: 33808680. PMCID: PMC8003431. PMID: 55ce59b708964f12ba7014ad08600e94.

32. Bortolotti F, Solidoro L, Bartolucci ML, Incerti Parenti S, Paganelli C, Alessandri-Bonetti G. 2020; Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials. Eur J Orthod. 42:434–40. DOI: 10.1093/ejo/cjz057. PMID: 31365925.