Private practice, Racine, Wis.
Departments of Developmental Sciences and Orthodontics, School of Dentistry, Marquette University, Milwaukee, Wis.
Am J Orthod Dentofacial Orthop. 2024 Nov;166(5):445-457.e2. doi: 10.1016/j.ajodo.2024.06.017. Epub 2024 Jul 23.
The objective of this study was to evaluate the short-term and long-term hard-tissue changes with miniscrew-assisted rapid palatal expansion (MARPE) and rapid palatal expansion (RPE) compared with a matched control group with voxel-based superimposition using 3-dimensional cone-beam computed tomography (CBCT) scans.
A total of 180 CBCT scans were analyzed for 60 patients with a mean age of 13.9 years at 3 time points: pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were divided into 3 groups: MARPE, RPE, and controls. Voxel-based superimposition was performed for CBCTs from T1 to T2 and T1 to T3 using the anterior cranial base as a reference. The hard-tissue surfaces were extracted after the superimposition procedure. Nine landmarks were analyzed: nasion, A-point, pogonion, left and right alar bases, zygoma, and gonion. Within-group changes were analyzed using linear mixed-effects models, including a random intercept per subject and the mixed effect of time (T1, T2, or T3) with test P values adjusted for multiple testing using Tukey's method. Between-group changes were analyzed using linear mixed-effects models, including a random intercept per subject and the mixed effects of time, group, and group × time interaction with P values adjusted for multiple testing using the Benjamin-Hochberg false discovery rate method.
In the short term, both MARPE and RPE led to a significant downward movement of the right gonion and lateral movement of the right alar base compared with controls at T2 (P <0.05). In addition, MARPE led to a significant downward movement of pogonion and left gonion. RPE led to a significant downward movement of the A-point and lateral movement of the left alar base compared with controls at T2 (P <0.05). However, in the long-term, no changes were observed between the groups at T3.
There were significant differences in pogonion, alar base, and gonion between MARPE, RPE, and control groups in the short term. However, all the hard-tissue changes were transient, as there were no differences between the 3 groups in the long term.
本研究的目的是通过三维锥形束计算机断层扫描（CBCT）评估使用微型螺钉辅助快速腭扩张（MARPE）和快速腭扩张（RPE）与匹配对照组相比的短期和长期硬组织变化，采用基于体素的叠加方法。
对 60 名平均年龄为 13.9 岁的患者的 180 个 CBCT 扫描进行分析，在 3 个时间点进行分析：治疗前（T1）、扩张后（T2）和治疗后（T3）。患者分为 3 组：MARPE、RPE 和对照组。使用前颅底作为参考，对 T1 至 T2 和 T1 至 T3 的 CBCT 进行基于体素的叠加。叠加后提取硬组织表面。分析 9 个标志点：鼻根点、A 点、颏顶点、左右鼻翼基底、颧骨和下颌角。使用线性混合效应模型分析组内变化，包括每个受试者的随机截距和时间（T1、T2 或 T3）的混合效应，并使用 Tukey 方法调整多重测试的检验 P 值。使用线性混合效应模型分析组间变化，包括每个受试者的随机截距和时间、组和组×时间交互的混合效应，并使用 Benjamin-Hochberg 假发现率方法调整多重测试的 P 值。
短期内，与对照组相比，MARPE 和 RPE 在 T2 时均导致右侧下颌角向下移动和右侧鼻翼基底向外移动（P<0.05）。此外，MARPE 导致颏顶点和左侧下颌角向下移动。与对照组相比，RPE 在 T2 时导致 A 点向下移动和左侧鼻翼基底向外移动（P<0.05）。然而，在长期内，T3 时各组之间没有观察到变化。
MARPE、RPE 和对照组在短期内在颏顶点、鼻翼基底和下颌角方面存在显著差异。然而，所有的硬组织变化都是暂时的，因为在长期内三组之间没有差异。
