Transverse Skeletal Effects of Rapid Maxillary Expansion in Pre and Post Pubertal Subjects: A Systematic Review

Abstract

OBJECTIVE: The aim of this systematic review was to assess the transverse skeletal effects of rapid maxillary expansion (RME) in pre and post-pubertal subjects.
 MATERIAL AND METHODS: Five databases were searched till May 2018; Pubmed, Cochrane, Scopus, Lilacs and Web of science in addition to the manual search of other sources. There were no language restrictions. Methodological Index for Non-Randomized Studies MINORS was used to assess the quality and risk of bias of the trials included.
 RESULTS: Six studies were finally included in the qualitative analysis. A meta-analysis wasn’t performed due to the heterogeneity of methodologies and outcomes. All of the included studies showed drawbacks in their structure yielding weak evidence. On the short term, RME caused an increase in the maxillary and lateral-nasal widths in pre-pubertal subjects by 3.4 mm and 3.3 mm, and by 2.8 and 2.2 mm respectively in post-pubertal subjects. Although statistically insignificant, the maxillary width increase was more than that of the post-pubertal subjects by 0.6 mm. Over the long term, expansion produced permanent increases in the transverse dimensions of both the dento-alveolar and skeletal components of the maxilla and circum-maxillary structures in pre-pubertal subjects. The post-pubertal subjects presented with a statistically significant increase only in the later-nasal width by 1.3 mm than the untreated controls with no permanent increase in the skeletal maxillary width.
 CONCLUSION: The literature is very deficient regarding the use of skeletal age as a reference in the treatment of skeletal crossbites using RME. Only weak evidence exists supporting the increased maxillary and lateral-nasal widths after tooth-tissue borne RME in pre-pubertal subjects, with these effects being less in the post-pubertal ones.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)

“… 56 A systematic review published in 2019 included a descriptive analysis of six studies; the results suggested that rapid arch expansion achieved maxillary and nasal lateral wall widening by 3.4 mm and 3.3 mm, respectively; these distances decreased to 2.8 mm and 2.2 mm after puberty. 57 For arch expansion performed before puberty, the width of the upper alveolar seat and maxilla increased continuously and steadily during long-term follow-up; for the arch expansion performed after puberty, only the nasal lateral wall increased by 1.3 mm, compared with the control group, while the maxillary bony width did not increase. A 2016 Cochrane systematic review (quasi-RCT, n = 23 patients; AMSTAR 2 = 15) compared personalized oral appliances with non-intervention treatment in children with OSA (AHI > 1).…”

Pyk2 deficiency enhances bone mass during midpalatal suture expansion

“…The clinical goal of RME is to widen the maxilla transversally, without disturbing the integrity of the midpalatal suture. [28][29][30] A significant decrease in BMD will weaken the suture and will require additional post-expansion (retention) time to allow the suture to recover its original bone density levels. Therefore, higher bone mass in the midpalatal suture is likely to have beneficial effects in reducing the retention period and preventing relapse following expansion.…”

“…The clinical goal of RME is to widen the maxilla transversally, without disturbing the integrity of the midpalatal suture 28‐30 . A significant decrease in BMD will weaken the suture and will require additional post‐expansion (retention) time to allow the suture to recover its original bone density levels.…”

Debates in pediatric obstructive sleep apnea treatment

“… 38 Regarding the optimal age for orthodontic treatment, a systematic review established that rapid arch expansion was significantly more effective before puberty. 39 Another systematic review found that a mandibular advancement device reduced AHI in both younger (6–9.5 years) and older children (9.5–13 years), suggesting that these devices can be used to treat OSA before the age of 13 years. However, no data are available for older adolescents.…”