Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, Dentistry 309, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
Private Orthodontic Practice, Rotterdam, the Netherlands.
Clin Oral Investig. 2022 Oct;26(10):6253-6263. doi: 10.1007/s00784-022-04577-9. Epub 2022 Jun 22.
To provide a higher degree of evidence on the efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults, thereby applying the Dutch Maxillary Expansion Device (D-MED).
D-MED was developed as an individualized, 3D-designed, and fabricated MARPE appliance supported by 4 palatal miniscrews. Patients from the age of 16 onwards with transverse maxillary deficiency were enrolled consecutively. Pre-expansion and immediate post-expansion CBCTs and intra-oral scans were acquired and measurements of skeletal, alveolar, and dental expansion as well as dental and periodontal side-effects were performed.
Thirty-four patients were enrolled (8 men, 26 women) with mean age 27.0 ± 9.4 years. A success rate of 94.1% was achieved (32/34 patients). The mean expansion duration, or mean observation time, was 31.7 ± 8.0 days. The mean expansion at the maxillary first molars (M1) and first premolars (P1) was 6.56 ± 1.70 mm and 4.19 ± 1.29 mm, respectively. The expansion was 60.4 ± 20.1% skeletal, 8.1 ± 27.6% alveolar, and 31.6 ± 20.1% dental at M1 and 92.2 ± 14.5% skeletal, 0.0 ± 18.6% alveolar, and 7.8 ± 17.7% dental at P1, which was both statistically (p < 0.001) and clinically significant. Buccal dental tipping (3.88 ± 3.92° M1; 2.29 ± 3.89° P1), clinical crown height increase (0.12 ± 0.31 mm M1; 0.04 ± 0.22 mm P1), and buccal bone thinning (- 0.31 ± 0.49 mm M1; - 0.01 ± 0.45 mm P1) were observed, while root resorption could not be evaluated.
MARPE by application of D-MED manifested its efficacy in a prospective clinical setting, delivering a high amount of skeletal expansion with limited side-effects in late adolescents and adults.
Higher quality evidence is supportive of MARPE as a safe and successful non-surgical treatment option for transverse maxillary deficiency.
提供关于青少年后期和成年人使用微型螺钉辅助快速腭扩张（MARPE）的疗效的更高证据，从而应用荷兰上颌扩张装置（D-MED）。
D-MED 是作为一种个体化、3D 设计和制造的 MARPE 设备开发的，由 4 个腭微型螺钉支撑。从 16 岁开始，患有横向上颌骨不足的患者连续入组。在扩张前和即刻扩张后进行 CBCT 和口腔内扫描，并进行骨骼、牙槽和牙齿扩张以及牙齿和牙周副作用的测量。
共纳入 34 名患者（8 名男性，26 名女性），平均年龄 27.0±9.4 岁。成功率为 94.1%（32/34 例患者）。扩张持续时间，或平均观察时间为 31.7±8.0 天。上颌第一磨牙（M1）和第一前磨牙（P1）的平均扩张量分别为 6.56±1.70mm 和 4.19±1.29mm。扩张量在 M1 处为 60.4±20.1%骨骼、8.1±27.6%牙槽、31.6±20.1%牙齿，在 P1 处为 92.2±14.5%骨骼、0.0±18.6%牙槽、7.8±17.7%牙齿，均具有统计学意义（p<0.001）和临床意义。颊侧牙齿倾斜（M1 为 3.88±3.92°；P1 为 2.29±3.89°）、临床冠高度增加（M1 为 0.12±0.31mm；P1 为 0.04±0.22mm）和颊侧骨变薄（M1 为-0.31±0.49mm；P1 为-0.01±0.45mm），但无法评估根吸收。
在前瞻性临床环境中应用 D-MED 进行 MARPE 表现出其疗效，在青少年后期和成年人中提供了大量的骨骼扩张，副作用有限。
更高质量的证据支持 MARPE 作为一种安全且成功的非手术治疗横向上颌骨不足的选择。
