Alveolar bone changes after rapid maxillary expansion with tooth-born appliances: a systematic review

• Published in: European journal of orthodontics Vol. 40; no. 3; pp. 296 - 303
• Main Authors: Lo Giudice, Antonino, Barbato, Ersilia, Cosentino, Leandro, Ferraro, Claudia Maria, Leonardi, Rosalia
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 25.05.2018
• Subjects: Alveolar Bone Loss - diagnostic imaging; Alveolar Bone Loss - etiology; Alveolar Bone Loss - physiopathology; Alveolar Process - diagnostic imaging; Alveolar Process - physiopathology; Cone-Beam Computed Tomography - methods; Female; Humans; Male; Maxilla - physiopathology; Orthodontic Anchorage Procedures - adverse effects; Orthodontic Anchorage Procedures - instrumentation; Palatal Expansion Technique - adverse effects; Palatal Expansion Technique - instrumentation; Prospective Studies; Radiography, Dental - methods; Zygoma - diagnostic imaging; Zygoma - pathology
• ISSN: 0141-5387; 1460-2210; 1460-2210
• DOI: 10.1093/ejo/cjx057

Summary Background During rapid maxillary expansion (RME), heavy forces are transmitted to the maxilla by the anchored teeth causing buccal inclination and buccal bone loss of posterior teeth. Objective To systematically review the literature in order to investigate whether RME causes periodontal sequelae, assessed by cone-beam computed tomography (CBCT). Search methods Fifteen electronic databases and reference lists of studies were searched up to March 2017. Selection criteria To be included in the systematic review, articles must be human studies on growing subjects, with transversal maxillary deficiency treated with RME and with assessment of buccal bone loss by CBCT images. Only randomized and non-randomized trials were included. Data collection and analysis Two authors independently performed study selection, data extraction, and risk of bias assessment. Study characteristics (study design, sample size, age, sex, skeletal maturity, type of appliance, daily activation, evaluated linear measurements, observation period, CBCT settings), and study outcomes (loss of buccal bone thickness and marginal bone) were reported according to the PRISMA statement. Results On the basis of the applied inclusion criteria, only six articles, three randomized clinical trials and three controlled clinical trials were included. An individual analysis of the selected articles was undertaken. The risks of bias of the six trials were scored as medium to low. Limitations The results of the present systematic review are based on a limited number of studies and only one study included a control group. Conclusions and implications In all considered studies, significant loss of buccal bone thickness and marginal bone level were observed in anchored teeth, following RME. Further prospective studies correlating the radiological data of bone loss to the periodontal soft tissues reaction after RME are required. A preliminary evaluation of the patient-related risk factors for RR may be advisable when considering to administering RME. Registration This systematic review was registered in the National Institute of Health Research database with an appropriate protocol number (http://www.crd.york.ac.uk/PROSPERO Protocol: CRD42017062645). Funding The present study has not received any contributions from private or public funding agencies.