Effectiveness of miniscrew-assisted rapid maxillary expansion: a systematic review and meta-analysis

Abstract

Objectives: To compare the effectiveness and side effects of miniscrew-assisted rapid maxillary expansion (MARME) with conventional rapid maxillary expansion (RME) in the treatment of transverse maxillary deficiency.

Materials and methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched in the MEDLINE, Embase, and Cochrane Central databases. The quality of included RCTs was evaluated using the Cochrane risk-of-bias tool. The primary outcome was the extent of dentoskeletal expansion achieved. Secondary outcomes were the dental and periodontal side effects. We calculated summary weighted mean differences (MD) with 95% confidence intervals (CI) using random-effects meta-analysis.

Results: Six RCTs involving 287 participants met the inclusion criteria. Compared to conventional RME, MARME was associated with a greater palatal suture opening (mm) measured at the anterior nasal spine (MD = 1.21, 95% CI 0.75 to 1.66), first premolars (MD = 1.13, 95% CI 0.72 to 1.55), first molars (MD = 1.18, 95% CI 0.28 to 2.09), and posterior nasal spine (MD = 1.14, 95% CI 0.30 to 1.98), increased palatal width (mm) at the first molars (MD = 0.75, 95% CI 0.30 to 1.20), and reduced buccal inclination (degrees) of the first premolars (MD = - 6.06, 95% CI - 10.36 to - 1.76) and first molars (MD = - 3.17, 95% CI - 5.35 to - 0.99).

Conclusions: MARME is associated with the following advantages over traditional tooth-borne RME: increased palatal suture opening, increased palatal width, and reduced buccal tooth inclination.

Registration: This study is registered with PROSPERO, CRD42021256750.

Clinical relevance: MARME may be preferred over conventional RME in cases with fused mid-palatal sutures or where further buccal tooth inclination is undesirable.

Keywords: Alveolar bone loss; Bone screws; Malocclusion; Maxilla; Orthodontic appliances, fixed; Palatal expansion technique.