Korean J Orthod.  2023 Jul;53(4):241-253. 10.4041/kjod23.036.

Skeletal and dentoalveolar effects of different types of microimplant-assisted rapid palatal expansion

• Choi HY
• Lee SM
• Lee JW
• Chung DH
• Lee MH

• KMID: 2545040
• DOI: http://doi.org/10.4041/kjod23.036

Abstract

Objective
To evaluate the following null hypothesis: the skeletal and dentoalveolar expansion patterns in the coronal and axial planes are not different with two different types of microimplant-assisted rapid palatal expansion (MARPE) systems.
Methods
Pretreatment (T0) and post-MARPE (T1) cone-beam computed tomography (CBCT) images of 32 patients (14 males and 18 females; mean age, 19.37) were analyzed. We compared two different MARPE systems. One MARPE system included the maxillary first premolars, maxillary first molars, and four microimplants as anchors (U46 type, n = 16), while the other included only the maxillary first molars and microimplants as anchors (U6 type, n = 16).
Results
In the molar region of the U6 and U46 groups, the transverse expansion at the midnasal, basal, alveolar, and dental levels was 2.64, 3.52, 4.46, and 6.32 mm and 2.17, 2.56, 2.73, and 5.71 mm, respectively. A significant difference was observed in the posterior alveolar-level expansion (p = 0.036) and posterior basal-bone-level expansion (p = 0.043) between the groups, with greater posterior skeletal and alveolar expansion in the U6 group.
Conclusions
Compared with the U46 group, the U6 group showed greater posterior expansion at the alveolar and basal-bone levels, with an almost parallel split. Both groups showed a pyramidal expansion pattern in the coronal view.

Keyword

Microimplant-assisted rapid palatal expansion; Maxillary transverse discrepancy; Cone-beam computed tomography; Bicortical engagement

Figure

• 

  Figure 1 MARPE appliances. A, U46 type (MSE-12; Biomaterials, Seoul, Korea). B, U6 type (MSE-12; Biomaterials). MARPE, microimplant-assisted rapid palatal expansion.

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  Figure 2 Re-orientation A, Sagittal view: palatal plane is parallel to the axial plane. B, Coronal view: 3D image, the line joining the lower margins of the orbits is parallel to the axial plane. C, D, Axial view: Lines passing through the palatal root canals of the bilateral maxillary first premolars (C) and first molars (D).

• 

  Figure 3 Landmarks used in this study. 1, The most lateral point of the nasofrontal suture. 2, The most lateral point of the nasal cavity. 3, The most inferolateral point of the zygomaticomaxillary suture. 4, Ectocanine, the most inferolateral point on the alveolar ridge at the center of the maxillary canine. 5, Ectopremolare, the most inferolateral point on the alveolar ridge at the center of the maxillary first premolar. 6, Ectomolare, the most inferolateral point on the alveolar ridge at the center of the maxillary first molar. The measurement definitions are presented in Table 1.

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  Figure 4 Skeletal expansion measurement. A, The distance between the most lateral points of the nasal cavity was measured for the midnasal-level premolar width. The distance between the most medial points on the basal bone at the junction of the lateral wall of the maxillary sinus and the buccal cortex of the maxillary alveolar bone was measured for the basal-bone-level premolar width. B, The distance between the most lateral points of the nasal cavity was measured for the midnasal-level molar width. The distance between the most medial points on the basal bone at the junction of the lateral wall of the maxillary sinus and the buccal cortex of the maxillary alveolar bone was measured for the basal-bone-level molar width. BL_PMW, basal bone level premolar width; BL_MW, basal bone level molar width; MNL_PMW, midnasal level premolar width; MNL_MW, midnasal level molar width.

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  Figure 5 Linear dental measurement. IPW, and IMW were measured using a 3D coordinate system. 3D, three-dimensional; IPW, inter-premolar width; IMW, inter-molar width.

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  Figure 6 Dental angular measurement. A, The angle between the lines joining the bilateral fossa and palatal root apices of the maxillary first premolars was measured as the inter-premolar angle. B, The angle between the lines joining the bilateral fossa and palatal root apices of the maxillary first molars was measured as the inter-molar angle.

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  Figure 7 Bicortical engagement at the palate and nasal floor by microimplants. A, Coronal view. B, Sagittal view.

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  Figure 8 Comparison of the skeletal, alveolar, and dental maxillary expansion in the premolar and molar regions between the U6 and the U46 groups.

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  Figure 9 A, Distance from the ANS to the posterior microimplant in the U46 group (mean, 29.26 mm), B, distance from the ANS to the posterior microimplant in the U6 group (mean, 38.91 mm). ANS, anterior nasal spine.

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