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Review
. 2024 Oct 21;16(10):e72008.
doi: 10.7759/cureus.72008. eCollection 2024 Oct.

Effect of Anchorage Modifications on the Efficacy of Miniscrew-Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis

Yury A Villa-Obando  1 , Sandra M Correa-Osorio  1 , Robinson A Castrillon-Marin  1 , Anny M Vivares-Builes  2 , Carlos M Ardila  3
Affiliations
Review

Effect of Anchorage Modifications on the Efficacy of Miniscrew-Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis

Yury A Villa-Obando et al. Cureus. .

Abstract

Mini-implant-assisted rapid palatal expansion (MARPE) offers a non-surgical alternative for expanding the basal bone, increasing skeletal effects while minimizing undesirable dental side effects. This systematic review and meta-analysis evaluate the effectiveness of MARPE in terms of transverse skeletal development, dentoalveolar changes, and periodontal effects, with consideration of appliance design. A review was conducted across multiple databases, including PubMed, MEDLINE, Embase, Scopus, and Springer, covering studies published between 2005 and 2024. Randomized controlled trials involving MARPE, with specific attention to design variations (e.g., miniscrew type, number, diameter, length, position, and activation protocol), were selected. Transverse skeletal expansion, assessed via changes in the nasal width, was reported in six of seven studies, with an average increase ranging from 0.31 mm to 2.90 mm for MARPE, compared to 0.11 mm to 2.46 mm for conventional Hyrax expanders. Maxillary width expansion ranged from 2.89 mm to 9.08 mm with MARPE and from 2.59 mm to 8.51 mm with Hyrax. Periodontal changes were reported in six studies, although details were generally unclear. The use of four self-drilling miniscrews with once-daily activation over an extended period produced greater nasal width expansion, greater average skeletal expansion of the maxilla, and less dental inclination and dentoalveolar expansion compared to Hyrax. No significant differences were observed between short and long miniscrews, although wider miniscrews resulted in improved outcomes. The MARPE technique, especially when using a design with four self-drilling miniscrews and daily activation until the targeted expansion is reached, offers notable benefits compared to the conventional Hyrax appliance. This method improves both nasal and maxillary skeletal expansion, lessens dental inclination, and reduces negative effects relative to traditional approaches.

Keywords: maxillary expansion; miniscrews; orthodontic anchorage procedures; palatal expansion technique; randomized controlled trials.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MARPE device in position
MARPE: Mini-implant-assisted rapid palatal expansion Image credit: Robinson A. Castrillon-Marin
Figure 2
Figure 2. PRISMA flow diagram
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 3
Figure 3. Traffic light graph of bias risk judgments by domains
Figure 4
Figure 4. Weighted bar chart of the distribution of bias risk judgments within each domain
Figure 5
Figure 5. Comparison of averages of transverse skeletal, dentoalveolar, and periodontal changes according to the design of the MARPE presented by each study
MARPE: Mini-implant-assisted rapid palatal expansion
Figure 6
Figure 6. Meta-analysis of proportions for the success rate
RE: Random effects
See this image and copyright information in PMC

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