University of Connecticut Health, Division of Orthodontics, Farmington, CT, United States.
University of Connecticut Health, Division of Orthodontics, Farmington, CT, United States.
Int Orthod. 2021 Mar;19(1):37-50. doi: 10.1016/j.ortho.2021.01.004. Epub 2021 Jan 28.
This systematic review assessed the effects of tooth-borne (TB), tooth-bone-borne (TBB) and bone-borne (BB) micro-implant assisted rapid maxillary expansion (RPE) on airway dimensions and function in young children and adolescents (10- to 17-years-old).
Unrestricted search in 5 electronic databases until June 6th, 2020 was undertaken. This was supplemented with search in 6 additional resources for published, unpublished and ongoing trials up. Randomized (RCT) and non-randomized (Non-RCT) prospective studies that assessed the influence of the mini-screw-assisted rapid palatal expansion (MARPE) approach on airway and breathing in young children and adolescents were included. Two reviewers performed the study selection and data extraction blindly and in duplicate by two authors while disagreements. A random-effects model with a 95% confidence interval (CI), I2 and Chi tests were done. ROBINS-I, Cochrane Risk of Bias and GRADE tools were used. Reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Overall, 518 articles were retrieved; only 3 studies (2 RCT and one non-RCT) met the inclusion criteria. Both TB RPE and BB RPE improved on a short-term basis the dimensions of the airway, though the difference was not significant (P>0.05). TBB RPE significantly improved nasal airflow [(Mean difference (MD) 52.7 cm/s, 95% confidence interval (95% CI) 9.0-96.4), P=0.020)], reduced nasal resistance (MD -0.20Pa/cm, 95% (-0.38)-(-0.02), P=0.028), and changed respiratory muscle strength variables (P>0.05). No correlation was found between the anatomical dimensions of the airway and the functional airway parameters (P>0.05).
The short-term airway volumetric changes secondary to MARPE were not significant. The influence of MARPE appliances on breathing is still not clear. Registration PROSPERO database (CRD42020183340).
本系统评价评估了牙（TB）、牙骨（TBB）和骨（BB）微植入物辅助快速上颌扩张（RPE）对 10-17 岁儿童和青少年气道尺寸和功能的影响。
对截至 2020 年 6 月 6 日的 5 个电子数据库进行无限制搜索，并补充对 6 个额外资源进行已发表、未发表和正在进行的试验的搜索。纳入了评估微型螺钉辅助快速腭扩张（MARPE）方法对上气道和呼吸影响的随机（RCT）和非随机（非 RCT）前瞻性研究。两名审查员由两名作者进行了研究选择和数据提取，同时存在分歧。采用具有 95%置信区间（CI）、I2 和 Chi 检验的随机效应模型。使用 ROBINS-I、Cochrane 偏倚风险和 GRADE 工具。本综述的报告基于系统评价和荟萃分析的首选报告项目（PRISMA）指南。
总体而言，共检索到 518 篇文章；仅 3 项研究（2 项 RCT 和 1 项非 RCT）符合纳入标准。TB RPE 和 BB RPE 均在短期内改善气道尺寸，但差异无统计学意义（P>0.05）。TBB RPE 显著改善鼻气流[（平均差异（MD）52.7cm/s，95%置信区间（95%CI）9.0-96.4），P=0.020]，降低鼻阻力（MD-0.20Pa/cm，95%（-0.38）-（-0.02），P=0.028），并改变呼吸肌力量变量（P>0.05）。气道解剖学尺寸与功能性气道参数之间未发现相关性（P>0.05）。
MARPE 引起的短期气道容积变化不显著。MARPE 器具对呼吸的影响尚不清楚。在 PROSPERO 数据库（CRD42020183340）中进行注册。
