Department of Restorative Dentistry, Endodontics Division, State University of Campinas - Unicamp, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil.
Post-Graduation Program in Dentistry, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil.
Orthod Craniofac Res. 2022 Aug;25(3):320-335. doi: 10.1111/ocr.12556. Epub 2021 Dec 14.
This study aimed to systematically review the current evidence on the occurrence of pulp changes as side effects from orthopaedic rapid maxillary expansion (ORME) or surgically assisted rapid maxillary expansion (SARME).
An electronic search was performed in eleven databases. The eligibility criteria included clinical studies assessing vitality, sensibility or dimensions of the pulp chamber of permanent teeth before and after ORME or SARME, without restrictions on publication year or language. The risk of bias was analysed with the NIH 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group' and the 'JBI for quasi-experimental studies' tool. The GRADE tool was used to assess the certainty of evidence.
The initial search resulted in 1,197 records, from which only seven before-after studies were included. There was a change in the pulpal blood flow (PBF) of maxillary incisors and canines up to 5 days after SARME, which gradually returned after 7 days to 3 months. After ORME, one study observed an increased PBF and one study observed a reduced PBF, which gradually returned after the end of expansion. Two studies observed that both ORME and SARME caused temporary changes in pulp sensibility. Three studies observed a significant reduction in the pulp chamber after ORME or SARME. The outcomes presented a very low certainty of evidence.
Although limited, the evidence shows that ORME and SARME caused temporary changes in pulp vitality and sensibility, with the possibility of inducing a reduction in pulp chamber dimensions.
本研究旨在系统回顾关于正畸快速上颌扩张（ORME）或手术辅助快速上颌扩张（SARME）引起牙髓变化的现有证据。
在十一个数据库中进行电子检索。纳入标准包括评估恒牙牙髓活力、感觉或牙髓腔尺寸在 ORME 或 SARME 前后变化的临床研究，不限制发表年份或语言。使用 NIH“无对照前后（预-后）研究质量评估工具”和 JBI“准实验研究工具”分析偏倚风险。使用 GRADE 工具评估证据的确定性。
最初的搜索产生了 1197 条记录，其中只有 7 项前后对照研究被纳入。SARME 后 5 天内上颌切牙和尖牙的牙髓血流（PBF）发生变化，7 天后至 3 个月逐渐恢复。ORME 后，一项研究观察到 PBF 增加，一项研究观察到 PBF 减少，扩张结束后逐渐恢复。两项研究观察到 ORME 和 SARME 均导致牙髓感觉暂时改变。三项研究观察到 ORME 或 SARME 后牙髓腔明显缩小。研究结果的证据确定性非常低。
尽管证据有限，但表明 ORME 和 SARME 可引起牙髓活力和感觉的暂时变化，并可能导致牙髓腔尺寸减小。
