Altieri Federica, Cassetta Michele
Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy.
Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy.
Am J Orthod Dentofacial Orthop. 2022 Apr;161(4):e336-e344. doi: 10.1016/j.ajodo.2021.11.007. Epub 2022 Jan 5.
This parallel cohort study aimed to assess the dentoalveolar, skeletal, periodontal, and airway effects of tooth-borne (hyrax) and computer-guided miniscrew-supported rapid palatal expansion appliances.
Thirty-six subjects were randomly allocated into 2 groups. Eighteen subjects (mean age, 12.2 years; male-to-female ratio, 10:8) were assigned to receive treatment with the hyrax appliance (group A), and 18 subjects were treated with the computer-guided miniscrew-supported appliance (group B). The same type of expansion screw and expansion protocol was used in both groups. Linear and angular measurements of skeletal, dentoalveolar, periodontal, and nasal floor changes were performed on the pretreatment and posttreatment cone-beam computed tomography images (6-month follow-up). Descriptive statistics and the independent Student t test were used for the statistical analysis. Intraoperator reliability was evaluated using a 2 sample t test. The level of significance was P ≤0.05.
Ten subjects were censured because posttreatment cone-beam computed tomography imaging was not performed because of the coronavirus disease 2019 pandemic. In the remaining 26 subjects, increases in linear measurements were observed in both groups. The transversal skeletal increase was greater and statistically significant in the group treated with the bone-borne expander (P ≤0.05). The dentoalveolar transverse diameters were greater in the tooth-supported expander group, with no statistically significant difference between the groups. The buccal inclination of the maxillary first molar was observed in the group with the tooth-borne expander, with a statistically significant difference between the 2 groups. A slight reduction of buccal and palatal thicknesses at the level of the maxillary first molars was observed in both groups, smaller in the skeletal expander group, with a statistically significant difference between the 2 groups only on the right buccal cortical plate. The width of the nasal floor increased more in the group with skeletal expander with a statistically significant difference of 2 mm.
Computer-guided miniscrew-supported maxillary expanders allowed a greater transversal increase of the nasal-maxillary skeletal structures by reducing the dentoalveolar side effects of the tooth-supported devices.
本平行队列研究旨在评估牙支持式（扩弓器）和计算机引导的微型螺钉支持的快速腭扩展矫治器对牙槽骨、骨骼、牙周和气道的影响。
36名受试者被随机分为2组。18名受试者（平均年龄12.2岁；男女比例为10:8）被分配接受扩弓器治疗（A组），18名受试者接受计算机引导的微型螺钉支持矫治器治疗（B组）。两组使用相同类型的扩展螺钉和扩展方案。在治疗前和治疗后（6个月随访）的锥形束计算机断层扫描图像上对骨骼、牙槽骨、牙周和鼻底变化进行线性和角度测量。采用描述性统计和独立样本t检验进行统计分析。使用两样本t检验评估术者间的可靠性。显著性水平为P≤0.05。
10名受试者因2019年冠状病毒病大流行未进行治疗后的锥形束计算机断层扫描成像而被剔除。在其余26名受试者中，两组均观察到线性测量值增加。骨支持式扩弓器治疗组的横向骨骼增加更大且具有统计学意义（P≤0.05）。牙支持式扩弓器组的牙槽横向直径更大，两组间无统计学显著差异。在牙支持式扩弓器组观察到上颌第一磨牙的颊向倾斜，两组间有统计学显著差异。两组在上颌第一磨牙水平的颊侧和腭侧厚度均略有减小，骨骼扩弓器组减小幅度较小，仅在右侧颊侧皮质板上两组间有统计学显著差异。骨骼扩弓器组鼻底宽度增加更多，统计学显著差异为2毫米。
计算机引导的微型螺钉支持的上颌扩弓器通过减少牙支持式装置的牙槽骨副作用，使鼻上颌骨骼结构实现更大的横向增加。
