Evaluation of Sagittal and Vertical Changes in Maxillary Dental, Skeletal, and Soft Tissue Following Surgically Assisted Rapid Maxillary Expansion: A Retrospective Longitudinal Study

Abstract

Objective: To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected. Materials and Methods: The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n ¼ 112), intra-and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4). Results: The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P < 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons. Conclusions: Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

Sagittal and Vertical Changes of the Maxilla after Surgically Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis

“…In addition, another seven articles were included after being referenced by the included articles. Ultimately, after undergoing a comprehensive assessment based on the predetermined inclusion criteria, a total of 7 articles were deemed eligible and subsequently included in the final analysis [9,11,[14][15][16][17][18]. The other 19 articles were excluded due to the following reasons: nine lacked maxillary cephalometric measurements [8,13,[20][21][22][23][24][25][26]; three were focused on nonsurgical RPE [27][28][29]; three included patients with orthodontic tooth movement between the two time points of obtaining radiological images [10,30,31]; two were systematic reviews [32,33]; one was reported again in a later study by the same team [34]; and one was a case series with limited sample size [35].…”

“…The risk of bias assessment (Table 2) was conducted on all seven articles to ascertain their strength of evidence. Based on this evaluation, three of the studies were identified as having a medium risk of bias [16][17][18], while the other four studies were deemed to have a high risk of bias [9,11,14,15]. The most common sources of bias were "sample randomization" and "blind assessments".…”

“…Table 3 presents the primary characteristics of the seven articles that were included in the analysis. They included three retrospective cohort studies [14,16,17], and four retrospective case series [9,11,15,18]. The number of total patients was 136, with 126 given tooth-borne expanders and 10 given bone-borne expanders.…”

“…All the articles [9,11,[14][15][16][17][18] included in the study recorded maxillary displacement in the sagittal direction after SARPE with different parameters (Table 4). Statistically significant changes were observed in the following parameters:…”

Photographic analysis of orofacial soft tissue alterations related to rapid maxillary expansion in pediatric patients

“…These movements can cause the mandible to rotate backward and downward, resulting in an increase in facial height. It has been reported that RME can also cause changes in soft tissues due to the movements in the maxillary segments and maxillofacial sutures [16][17][18][19]. Furthermore, studies utilizing posteroanterior radiographs have reported increases in nasal, maxillary and zygomatic width following RME, reflecting changes in hard tissues [18,20,21].…”