Algharbi Muteb, Bazargani Farhan, Dimberg Lillemor
Department of Orthodontics, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
Eur J Orthod. 2018 Jan 23;40(1):97-106. doi: 10.1093/ejo/cjx035.
There is no consensus in the literature regarding which rapid maxillary expansion (RME) design or activation rate benefits the patients the most. Therefore, the primary aim of this systematic review was to see whether there is a difference in the skeletal and dentoalveolar effects of different RME appliances in children and growing adolescents. The secondary aim was to see whether these effects are different when using different activation protocols for these appliances.
The search was done in three databases (PubMed, Cochrane Library, and Web of Science). The following inclusion criteria were used: randomized controlled trial, prospective controlled studies, 15 or more patients in each study, human subjects up to 18 years of age, and RME effects had to be assessed by computed tomography/cone beam computed tomography.
Quality of the methodology was classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines as high, moderate, or low.
The search resulted in 145 titles and abstracts; 109 of them were excluded based on pre-established criteria. Thirty-six full-text articles were assessed for eligibility and 18 of which satisfied the inclusion criteria. Finally, seven articles were deemed eligible for full inclusion and revealed that all appliances and protocols showed significant expansion in the mid-palatal suture. No evidence was found for the cause of dental tipping.
In this systematic review, having different age groups in each study and using different anatomical landmarks and outcome measures for assessing the skeletal and dental effects made it difficult to conduct a meta-analysis.
There is moderate evidence that all designs produce significant expansion at the mid-palatal suture. However, lack of studies comparing appliances and protocols has been found. Finally, no evidence-based conclusions could be drawn about the appliance effect on teeth tipping.
No appliance appears to be superior when it comes to expansion in the mid-palatal suture. Therefore, the tooth-borne appliance might be preferable until further high-quality studies conclude otherwise.
The project was funded through the Department of Orthodontics, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
This systematic review was not registered in any external databases.
关于哪种快速上颌扩弓（RME）设计或激活速率对患者最为有益，文献中尚无共识。因此，本系统评价的主要目的是观察不同RME矫治器在儿童和青少年生长发育阶段对骨骼和牙牙槽骨的影响是否存在差异。次要目的是观察在使用这些矫治器时采用不同激活方案，这些影响是否有所不同。
检索了三个数据库（PubMed、Cochrane图书馆和Web of Science）。采用了以下纳入标准：随机对照试验、前瞻性对照研究、每项研究中15名或更多患者、18岁及以下的人类受试者，且RME效果必须通过计算机断层扫描/锥形束计算机断层扫描进行评估。
根据推荐分级评估、制定与评价（GRADE）指南，将方法学质量分为高、中、低三个等级。
检索得到145篇标题和摘要；根据既定标准排除了其中109篇。对36篇全文进行了资格评估，其中18篇符合纳入标准。最后，7篇文章被认为完全符合纳入要求，结果显示所有矫治器和方案均使腭中缝有显著扩展。未发现牙齿倾斜原因的相关证据。
在本系统评价中，每项研究中年龄组不同，且使用不同的解剖标志和结局指标来评估骨骼和牙齿的影响，这使得进行荟萃分析变得困难。
有中等证据表明，所有设计均可使腭中缝产生显著扩展。然而，发现缺乏比较矫治器和方案的研究。最后，无法得出关于矫治器对牙齿倾斜影响的循证结论。
在腭中缝扩展方面，似乎没有哪种矫治器更具优势。因此，在有进一步高质量研究得出其他结论之前，牙支持式矫治器可能更可取。
该项目由瑞典厄勒布鲁地区厄勒布鲁研究生牙科教育中心正畸科资助。
本系统评价未在任何外部数据库中注册。
