Objectives: The objectives of the study were to compare the skeletal, dentoalveolar, and periodontal changes between two types of microimplant-assisted rapid maxillary expansion appliances: The bone-anchored maxillary expanders (BAME) and the tooth-bone-anchored maxillary skeletal expander (MSE). Materials and Methods: Thirty-four patients with a transverse maxillary deficiency were divided into two groups; the first group (16 patients, average age 14.9 years) was treated with the MSE appliance, and the second group (18 patients, average age 13.8 years) was treated with the BAME appliance. Cone-beam computed tomography scans were taken at pre-treatment (T1) and immediately post-expansion (T2) to measure the changes in midpalatal suture opening, total expansion (TE), alveolar bone bending, dental tipping (DT), and buccal bone thickness. Data were analyzed using paired t-test and two-sample t-test. Results: Midpalatal suture separation was found in 100% of the patients in both groups. The TE at the first molar was 5.9 mm in the MSE group and 4.7 mm in the BAME group. The skeletal contributions were 56% and 83% of TE for the MSE and BAME groups, respectively. Significantly less dental buccal tipping and buccal bone loss were found with the BAME group. The midpalatal suture in both groups exhibited a parallel opening pattern in the axial plane. Conclusion: The use of BAME appliance resulted in greater skeletal effects, less dental tipping, and less buccal bone reduction compared to MSE appliance (immediately after maxillary expansion).

There is no universal agreement as to which type of orthodontic or orthopedic treatment deserves early intervention. In addition, there is a need for more information as to which treatments are the most effective and less costly if they are initiated timely in the mixed dentition. Early timely treatment may benefit young patients with a maxillary transverse deficiency with or without a posterior crossbite that requires maxillary expansion. It may also be indicated in children with anteroposterior jaw discrepancy that requires chin cup or maxillary protraction. In this paper, the authors will focus on early maxillary expansion to facilitate the eruption of maxillary laterals. In specific, the authors will present a contemporary protocol using a bonded maxillary expander as anchorage for treatment of unerupted maxillary laterals. The use of this protocol was illustrated with two case reports to enable clinicians to routinely achieve a beautiful smile on a young patient by timely alignment of the maxillary incisors.

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