Alveolar bone changes after tooth-borne surgically assisted rapid maxillary expansion: A three-dimensional study

Abstract

Introduction: Surgically assisted rapid maxillary expansion (SARME) with a dental-anchorage appliance can induce dental and skeletal complications adjacent to the teeth supporting the device. The purpose of this study was to quantify the dentoskeletal changes observed after SARME using a tooth-borne device.

Materials and methods: Cone beam CT images from 39 patients were compared between the preoperative (T1) and the postoperative period (T2). The mean time to complete the second imaging was 13.8 ± 6.9 months after the SARME. Dental and bone parameters were assessed: the vestibular bone height (BH), the bone thickness (BT), the existence of fenestrations, and the root resorption at the level of first upper premolar (P1) and the first upper molar (M1). The maxillary expansion parameters were also collected.

Results: Both vertical and horizontal vestibular bone loss were observed mainly in the first upper molar sectors: The BT decreased from 0.93 ± 0.50 mm to 0.53 ± 0.51 mm (p < 0.0001) and the BH decreased from 1.84 ± 1.05 mm to 0.93 ± 1.02 mm (p < 0.0001) for tooth #16. The bone loss also affected the first upper premolars but in a more limited manner. Significant fenestrations were observed at the apex of the mesio-vestibular root of teeth #16 and #26. We noted significant root resorption affecting the mesio-, disto-vestibular and palatal roots of tooth #16 (mean reductions of 0.32, 0.35, and 0.55 mm, respectively; p < 0.05), and the palatal root of tooth # 26 (loss of 0.58 mm; p = 0.004). The mean bone expansion was 3.76 mm and 1.41 mm at the premolar and molar levels, respectively (p < 0.0001), while a mean 6.24 mm and 4.23 mm inter-cuspid expansion was noted at the P1 and M1 levels (p < 0.0001).

Conclusion: Our results document the vestibular bone changes and low root resorption, mostly in the molar sectors, associated with SARME using dental-anchorage devices.

Keywords: Dentofacial deformities; Maxillary expansion; SARME; Surgical expansion.