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Skeletal and alveolar changes in conventional rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE): a prospective randomized clinical trial using low-dose CBCT

 Joo-Hee Chun  ;  Amanda Cunha Regal de Castro  ;  Sunmee Oh  ;  Kyung-Ho Kim  ;  Sung-Hwan Choi  ;  Lincoln Issamu Nojima  ;  Matilde da Cunha Gonçalves Nojima  ;  Kee-Joon Lee 
 BMC ORAL HEALTH, Vol.22(1) : 114, 2022-04 
Journal Title
Issue Date
Adolescent ; Child ; Cone-Beam Computed Tomography / methods ; Female ; Humans ; Male ; Maxilla / diagnostic imaging ; Maxilla / surgery ; Neoplasm Recurrence, Local ; Palatal Expansion Technique* ; Palate / diagnostic imaging ; Prospective Studies ; Spiral Cone-Beam Computed Tomography* ; Young Adult
Alveolar bone loss ; Cone-beam computed tomography ; Cranial sutures ; Orthodontic anchorage procedures ; Palatal expansion technique
Background: This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients.

Methods: This study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point.

Results: The frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group (P < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group (P < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P < 0.05).

Conclusions: Midpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period. Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).
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2. College of Dentistry (치과대학) > Dept. of Orthodontics (교정과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Ho(김경호) ORCID logo https://orcid.org/0000-0002-8154-2041
Lee, Kee Joon(이기준) ORCID logo https://orcid.org/0000-0002-0782-3128
Choi, Sung Hwan(최성환) ORCID logo https://orcid.org/0000-0002-1150-0268
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