Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal Do Rio de Janeiro, Av. Pedro Calmon, 550, 21941-901, Rio de Janeiro, Brazil.
BMC Oral Health. 2022 Apr 8;22(1):114. doi: 10.1186/s12903-022-02138-w.
This prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients.
This study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point.
The frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group (P < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group (P < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P < 0.05).
Midpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period. Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).
本前瞻性随机临床试验旨在评估快速腭扩张（RPE）和微型螺钉辅助 RPE（MARPE）对青少年和年轻成人患者的即刻和短期骨骼、牙牙槽和牙周的影响。
本研究采用两臂平行随机临床试验设计，按照 1:1 的分配比例招募横向上颌骨发育不足的患者。40 名（14 名男性和 26 名女性）需要上颌扩张的患者被随机分配到 RPE（n=20，年龄=14.0±4.5）或 MARPE（n=20，年龄=14.1±4.2）组。通过计算机生成的块随机化进行分组，块大小为 4。在相同（35 圈）扩张量的情况下，在治疗前（T0）、扩张后即刻（T1）和 3 个月的巩固期（T2）拍摄低剂量锥形束 CT 图像。本研究的主要结果包括评估鼻中隔缝合分离。次要结果包括在每个时间点进行的骨骼、牙牙槽和牙周测量。
RPE 和 MARPE 组的鼻中隔缝合分离频率分别为 90%（18/20）和 95%（19/20）。与 RPE 组相比，MARPE 组在扩张后即刻（T1-T0）和巩固期（T2-T0）时，磨牙区的鼻宽度（M-NW）和更大的腭中缝（GPF）增加更大（P<0.05）。MARPE 和 RPE 组除上颌宽度（PM-MW、M-MW）外，牙牙槽变化相似。MARPE 组的上颌双侧第一前磨牙（PM-MW）和磨牙（M-MW）宽度大于 RPE 组（P<0.05）。通过扩张和巩固期（T2-T0），MARPE 组的锚牙颊侧移位较少（PM-BBPT、PM-PBPT、M-BBPT[近远中根]和 M-PBPT）（P<0.05）。
RPE 和 MARPE 组分别有 90%和 95%的患者出现鼻中隔缝合分离。RPE 和 MARPE 组在巩固期均表现出明显的三角基骨扩张和骨骼复发。在相同的扩张量下，MARPE 组在巩固后骨骼、牙牙槽和牙周变量的下降幅度较低。微型螺钉增强 RPE 有助于在巩固期维持基骨。
WHO 机构临床试验注册平台（IRB 编号：KCT0006871/注册日期：2021 年 12 月 27 日）。
