Clinical Paper Orthognathic Surgery| Volume 50, ISSUE 8, P1059-1068, August 2021

Nasomaxillary effects of miniscrew-assisted rapid palatal expansion and two surgically assisted rapid palatal expansion approaches

Published:January 18, 2021DOI:


      This retrospective study was performed to evaluate nasomaxillary changes in 36 patients at an advanced stage of skeletal maturity who underwent miniscrew-assisted rapid palatal expansion (MARPE) or surgically assisted rapid palatal expansion (SARPE) with/without an alar base cinch. Cone beam computed tomography images taken before and after expansion were analysed. Changes in the width of the dental arch (D66S, D66I), maxillary base (MxMol), and nasal floor and nasal cavity in the molar and canine regions (NaFMol, NaFCan, NaCMol, NaCCan) were compared, as well as changes in the choanal aperture (CA) and nasal soft tissue (NW). The MARPE technique produced smaller dental changes (D66S; P = 0.025) and greater nasomaxillary expansion (MxMol, P = 0.010; NaCMol, P = 0.016; NaCCan, P = 0.017; NaFMol, P = 0.001; CA, P = 0.002) than both SARPE techniques. Changes in NW did not differ significantly between the groups (P = 0.200). MARPE uniformly increased the anterior and posterior widths of the nasal cavity. SARPE expanded the nasal cavity in a ‘V-shape’ pattern. Changes in the nasal cavity and choanal aperture related to the amount of dental arch expansion were greater for MARPE than for SARPE. All three approaches increased the width of the nasal soft tissue, although the cinch in SARPE limited this increase.

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        • Haas A.J.
        The treatment of maxillary deficiency by opening the midpalatal suture.
        Angle Orthod. 1965; 35: 200-217<0200:TTOMDB>2.0.CO;2
        • Bishara S.E.
        • Staley R.N.
        Maxillary expansion: clinical implications.
        Am J Orthod Dentofacial Orthop. 1987; 91: 3-14
        • Angell E.H.
        Treatment of irregularity of the permanent or adult teeth.
        Dent Cosmos. 1860; 1: 540-544
        • McNamara J.A.
        Maxillary transverse deficiency.
        Am J Orthod Dentofacial Orthop. 2000; 117: 567-570
        • Handelman C.
        Palatal expansion in adults: the nonsurgical approach.
        Am J Orthod Dentofacial Orthop. 2011; 140: 462-468
        • Garib D.G.
        • Henriques J.F.C.
        • Janson G.
        • de Freitas M.R.
        • Fernandes A.Y.
        Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation.
        Am J Orthod Dentofacial Orthop. 2006; 129: 749-758
        • Garrett B.J.
        • Caruso J.M.
        • Rungcharassaeng K.
        • Farrage J.R.
        • Kim J.S.
        • Taylor G.D.
        Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography.
        Am J Orthod Dentofacial Orthop. 2008; 134: 8.e1-8.e11
        • Cureton S.L.
        • Cuenin M.
        Surgically assisted rapid palatal expansion: orthodontic preparation for clinical success.
        Am J Orthod Dentofacial Orthop. 1999; 116: 46-59
        • Choi S.H.
        • Shi K.K.
        • Cha J.Y.
        • Park Y.C.
        • Lee K.J.
        Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults.
        Angle Orthod. 2016; 86: 713-720
        • Lee K.j.
        • Park Y.c.
        • Park J.y.
        • Hwang W.s.
        Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism.
        Am J Orthod Dentofacial Orthop. 2010; 137: 830-839
        • Lim H.M.
        • Park Y.C.
        • Lee K.J.
        • Kim K.H.
        • Choi Y.J.
        Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion.
        Korean J Orthod. 2017; 47: 313-322
        • Baccetti T.
        • Franchi L.
        • McNamara J.A.
        An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth.
        Angle Orthod. 2002; 72: 316-323<0316:AIVOTC>2.0.CO;2
        • Collins P.C.
        • Epker B.N.
        The alar base cinch: a technique for prevention of alar base flaring secondary to maxillary surgery.
        Oral Surg Oral Med Oral Pathol. 1982; 53: 549-553
        • Cevidanes L.
        • Oliveira A.E.F.
        • Motta A.
        • Phillips C.
        • Burke B.
        • Tyndall D.
        Head orientation in CBCT-generated cephalograms.
        Angle Orthod. 2009; 79: 971-977
        • Ramieri G.A.
        • Nasi A.
        • Dell’Acqua A.
        • Verzé L.
        Facial soft tissue changes after transverse palatal distraction in adult patients.
        Int J Oral Maxillofac Surg. 2008; 37: 810-818
        • Chung C.H.
        • Goldman A.M.
        Dental tipping and rotation immediately after surgically assisted rapid palatal expansion.
        Eur J Orthod. 2003; 25: 353-358
        • Seong E.H.
        • Choi S.H.
        • Kim H.J.
        • Yu HS Park YC
        • Lee K.J.
        Evaluation of the effects of miniscrew incorporation in palatal expanders for young adults using finite element analysis.
        Korean J Orthod. 2018; 48: 81-89
        • Kurt G.
        • Altug-Ata̧ A.T.
        • Ataç M.S.
        • Karasu H.A.
        Stability of surgically assisted rapid maxillary expansion and orthopedic maxillary expansion after 3 years’ follow-up.
        Angle Orthod. 2010; 80: 613-619
        • Prado G.P.R.
        • Furtado F.
        • Aloise A.C.
        • Biló J.P.R.
        • Masako Ferreira L.
        • Pereira M.D.
        Stability of surgically assisted rapid palatal expansion with and without retention analyzed by 3-dimensional imaging.
        Am J Orthod Dentofacial Orthop. 2014; 145: 610-616
        • Anttila A.
        • Finne K.
        • Keski-Nisula K.
        • Somppi M.
        • Panula K.
        • Peltomäki T.
        Feasibility and long-term stability of surgically assisted rapid maxillary expansion with lateral osteotomy.
        Eur J Orthod. 2004; 26: 391-395
        • Görgülü S.
        • Gokce S.M.
        • Olmez H.
        • Sagdic D.
        • Ors F.
        Nasal cavity volume changes after rapid maxillary expansion in adolescents evaluated with 3-dimensional simulation and modeling programs.
        Am J Orthod Dentofacial Orthop. 2011; 140: 633-640
        • Tausche E.
        • Hansen L.
        • Hietschold V.
        • Lagravère M.O.
        • Harzer W.
        Three-dimensional evaluation of surgically assisted implant bone-borne rapid maxillary expansion: a pilot study.
        Am J Orthod Dentofacial Orthop. 2007; 131: S92-S99
        • Asscherickx K.
        • Govaerts E.
        • Aerts J.
        • Vande Vannet B.
        Maxillary changes with bone-borne surgically assisted rapid palatal expansion: a prospective study.
        Am J Orthod Dentofacial Orthop. 2016; 149: 374-383
        • Clement E.
        • Krishnaswamy N.
        Skeletal and dentoalveolar changes after skeletal anchorage-assisted rapid palatal expansion in young adults: a cone beam computed tomography study.
        APOS Trends Orthod. 2017; 7: 113
        • Zandi M.
        • Miresmaeili A.
        • Heidari A.
        Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically assisted rapid maxillary expansion: a randomized clinical trial study.
        J Craniomaxillofac Surg. 2014; 42: 1190-1195
        • Deeb W.
        • Hansen L.
        • Hotan T.
        • Hietschold V.
        • Harzer W.
        • Tausche E.
        Changes in nasal volume after surgically assisted bone-borne rapid maxillary expansion.
        Am J Orthod Dentofacial Orthop. 2010; 137: 782-789
        • Seeberger R.
        • Kater W.
        • Davids R.
        • Thiele O.C.
        Long term effects of surgically assisted rapid maxillary expansion without performing osteotomy of the pterygoid plates.
        J Craniomaxillofac Surg. 2010; 38: 175-178
        • Shin H.
        • Hwang C.J.
        • Lee K.J.
        • Choi Y.J.
        • Han S.S.
        • Yu H.S.
        Predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion in young adults: a preliminary study.
        Korean J Orthod. 2019; 49: 360-371
        • Liu S.Y.C.
        • Guilleminault C.
        • Huon L.K.
        • Yoon A.
        Distraction osteogenesis maxillary expansion (DOME) for adult obstructive sleep apnea patients with high arched palate.
        Otolaryngol Head Neck Surg. 2017; 157: 345-348
        • Aslan S.
        • Yilmazer C.
        • Yildirim T.
        • Akkuzu B.
        • Yilmaz I.
        Comparison of nasal region dimensions in bilateral choanal atresia patients and normal controls: a computed tomographic analysis with clinical implications.
        Int J Pediatr Otorhinolaryngol. 2009; 73: 329-335
        • Likus W.
        • Bajor G.
        • Gruszczyńska K.
        • Baron J.
        • Markowski J.
        Nasal region dimensions in children: a CT study and clinical implications.
        Biomed Res Int. 2014; 2014: 13-16
        • Warren D.W.
        • Hairfield W.M.
        • Seaton D.L.
        • Hinton V.A.
        The relationship between nasal airway cross-sectional area and nasal resistance.
        Am J Orthod Dentofacial Orthop. 1987; 92: 390-395
        • Nada R.M.
        • van Loon B.
        • Schols J.G.J.H.
        • Maal T.J.J.
        • de Koning M.J.
        • Mostafa Y.A.
        • Kuijpers-Jagtman A.M.
        Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion.
        Eur J Oral Sci. 2013; 121: 450-456
        • Wriedt S.
        • Kunkel M.
        • Zentner A.
        • Wahlmann U.W.
        Surgically assisted rapid palatal expansion. An acoustic rhinometric, morphometric and sonographic investigation.
        J Orofac Orthop. 2001; 62: 107-115
        • Storto C.J.
        • Garcez A.S.
        • Suzuki H.
        • Cusmanich K.G.
        • Elkenawy I.
        • Moon W.
        • Suzuki S.S.
        Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion.
        Angle Orthod. 2019; 89: 713-720
        • Hur J.s.
        • Kim H.h.
        • Choi J.y.
        • Suh S.h.
        • Baek S.h.
        Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid structure interaction analysis.
        Korean J Orthod. 2017; 47: 353-364
        • William Arnett G.
        • Bergman R.T.
        Facial keys to orthodontic diagnosis and treatment planning—part II.
        Am J Orthod Dentofacial Orthop. 1993; 103: 299-312
        • Huang J.
        • Li C.Y.
        • Jiang J.H.
        Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis.
        Head Face Med. 2018; 14: 6
        • Kim K.B.
        • Adams D.
        • Araújo E.A.
        • Behrents R.G.
        Evaluation of immediate soft tissue changes after rapid maxillary expansion.
        Dental Press J Orthod. 2012; 17: 157-164
        • Alves N.
        • Oliveira T.F.M.
        • Pereira-Filho V.A.
        • Gonçales E.S.
        • Gabrielli M.A.C.
        • Passeri L.A.
        Nasolabial changes after two different approaches for surgically assisted rapid maxillary expansion.
        Int J Oral Maxillofac Surg. 2017; 46: 1088-1093