Dataset Information

Long-term effects of mini-screw-assisted rapid palatal expansion on airway.

ABSTRACT:

Objectives

To evaluate the long-term effects on airway in patients with mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls with three-dimensional cone-beam computed tomography (CBCT) analysis.

Materials and methods

A total of 180 CBCTs of 60 patients were analyzed at different time points, such as pretreatment, postexpansion, and posttreatment. Patients were divided into three groups: mini-screw assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls. The nasal cavity, nasopharyngeal, oropharyngeal, and laryngopharyngeal airway volume and area were measured. Changes in total airway volume, total airway area, minimal cross-sectional area, maxillary intermolar width, external maxillary width, and palatal width were also evaluated.

Results

Both MARPE and RPE caused a statistically significant increase in the airway after expansion as compared with the control group, but there was no statistically significant difference in the change in airway between MARPE, RPE, and the control group at posttreatment, except for nasopharyngeal volume, which was significantly increased in the MARPE group. There was no correlation between the amount of expansion and increase in total airway volume.

Conclusions

There was a significant increase in total airway volume, total airway area, and minimal cross-sectional area with MARPE and RPE immediately after expansion, but at posttreatment, the changes in the MARPE and RPE groups were similar to the change in the control group. However, MARPE led to a significant long-term increase in nasopharyngeal volume. The amount of expansion did not correlate with the increase in pharyngeal airway volume.

SUBMITTER: Mehta S

PROVIDER: S-EPMC8028479 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Microimplant-assisted rapid palatal expansion is increasingly used clinically; however, the effect on the upper airway volume in patients with maxillary transverse deficiency has not been thoroughly evaluated yet. The following electronic databases were searched up to August 2022: Medline via Ovid, Scopus, Embase, Web of Science, Cochrane Library, Google Scholar, and ProQuest. The reference lists of related articles were also reviewed by manual search. The Revised Cochrane Risk of Bias Tool for randomized trials (ROB2) and the Risk of Bias in non-randomized Studies of Interventions (ROBINS-I) tool were used to evaluate the risks of bias of the included studies. The mean differences (MD) and 95% confidence intervals (CI) of changes in nasal cavity and upper airway volume were analyzed using a random-effects model, and subgroup and sensitivity analyses were also performed. Two reviewers independently completed the process of screening studies, extracting data, and assessing the quality of studies. In total, twenty-one studies met the inclusion criteria. After assessing the full texts, only thirteen studies were included, with nine studies selected for quantitative synthesis. Oropharynx volume increased significantly after immediate expansion (WMD: 3156.84; 95% CI: 83.63, 6230.06); however, there was no significant change in nasal volume (WMD: 2527.23; 95% CI: -92.53, 5147.00) and nasopharynx volume (WMD: 1138.29; 95% CI: -52.04, 2328.61). After retention a period, significant increases were found in nasal volume (WMD: 3646.27; 95% CI: 1082.77, 6209.77) and nasopharynx volume (WMD: 1021.10; 95% CI: 597.11, 1445.08). However, there was no significant change after retention in oropharynx volume (WMD: 789.26; 95% CI: -171.25, 1749.76), palatopharynx volume (WMD: 795.13; 95% CI: -583.97, 2174.22), glossopharynx volume (WMD: 184.50; 95% CI: -1745.97, 2114.96), and hypopharynx volume (WMD: 39.85; 95% CI: -809.77, 889.46). MARPE appears to be linked with long-term increases in nasal and nasopharyngeal volume. However, high-quality clinical trials are required to further verify the effects of MARPE treatment on the upper airway.

Project description:BackgroundMiniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy.ObjectivesThis systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects.Search methodsSeven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020.Selection criteriaRandomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes.Data collection and analysisInclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality.ResultsEight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%-96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm-3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm-7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days.LimitationsOne of the main drawbacks was the lack of high-quality prospective studies in the literature.Conclusions and implicationsMARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended.RegistrationPROSPERO (CRD42020176618).FundingNo grants or any other support funding were received.