Rapid maxillary expansion--tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects.

This study evaluated rapid maxillary expansion (RME) dentoskeletal effects by means of computed tomography (CT), comparing tooth tissue-borne and tooth-borne expanders. The sample comprised eight girls aged 11 to 14 years presenting Class I or II malocclusions with posterior unilateral or bilateral crossbite that were randomly divided into two treatment groups, palatal acrylic (Haas-type) and hygienic (Hyrax) expanders. All appliances were activated up to the full seven mm capacity of the expansion screw. The patients were subjected to a spiral CT scan before expansion and after a three-month retention period when the expander was removed. One-millimeter-thick axial sections were scanned parallel to the palatal plane, comprising the dentoalveolar area and the base of the maxilla up to the inferior third of the nasal cavity. Multiplanar reconstruction was used to measure maxillary transverse dimensions and posterior teeth inclination by means of a computerized method. The results showed that RME produced a significant increase in all measured transverse linear dimensions, decreasing in magnitude from dental arch to basal bone. The transverse increase at the level of the nasal floor corresponded to one-third of the amount of screw activation. Tooth-borne (Hyrax) and tooth tissue-borne (Haas-type) expanders tended to produce similar orthopedic effects. In both methods, RME led to buccal movement of the maxillary posterior teeth, by tipping and bodily translation. The second premolars displayed more buccal tipping than the appliance-supporting teeth. The tooth tissue-borne expander produced a greater change in the axial inclination of appliance-supporting teeth, especially first premolars, compared with the tooth-borne expander.