Clinical Oral Investigations

, Volume 21, Issue 5, pp 1789–1799 | Cite as

Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial

  • Araci Malagodi de Almeida
  • Terumi Okada Ozawa
  • Arthur César de Medeiros AlvesEmail author
  • Guilherme Janson
  • José Roberto Pereira Lauris
  • Marilia Sayako Yatabe Ioshida
  • Daniela Gamba Garib
Original Article



The purpose of this “two-arm parallel” trial was to compare the orthopedic, dental, and alveolar bone plate changes of slow (SME) and rapid (RME) maxillary expansions in patients with complete bilateral cleft lip and palate (BCLP).

Material and methods

Forty-six patients with BCLP and maxillary arch constriction in the late mixed dentition were randomly and equally allocated into two groups. Computer-generated randomization was used. Allocation was concealed with sequentially, numbered, sealed, opaque envelopes. The SME and RME groups comprised patients treated with quad-helix and Haas/Hyrax-type expanders, respectively. Cone-beam computed tomography (CBCT) exams were performed before expansion and 4 to 6 months post-expansion. Nasal cavity width, maxillary width, alveolar crest width, arch width, palatal cleft width, inclination of posterior teeth, alveolar crest level, and buccal and lingual bone plate thickness were assessed. Blinding was applicable for outcome assessment only. Interphase and intergroup comparisons were performed using paired t tests and t tests, respectively (p < 0.05).


SME and RME similarly promoted significant increase in all the maxillary transverse dimensions at molar and premolar regions with a decreasing expanding effect from the dental arch to the nasal cavity. Palatal cleft width had a significant increase in both groups. Significant buccal inclination of posterior teeth was only observed for RME. Additionally, both expansion procedures promoted a slight reduction of the alveolar crest level and the buccal bone plate thickness.


No difference was found between the orthopedic, dental, and alveolar bone plate changes of SME and RME in children with BCLP. Both appliances produced significant skeletal transverse gains with negligible periodontal bone changes. Treatment time for SME, however, was longer than the observed for RME.

Clinical relevance

SME and RME can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.


Palatal expansion technique Cone-beam computed tomography Cleft lip  Cleft palate 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


This study was not supported by fundings.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Araci Malagodi de Almeida
    • 1
  • Terumi Okada Ozawa
    • 1
  • Arthur César de Medeiros Alves
    • 2
    Email author
  • Guilherme Janson
    • 2
  • José Roberto Pereira Lauris
    • 3
  • Marilia Sayako Yatabe Ioshida
    • 2
  • Daniela Gamba Garib
    • 2
  1. 1.Hospital for Rehabilitation of Craniofacial AnomaliesUniversity of São PauloSão PauloBrazil
  2. 2.Department of Orthodontics, Bauru Dental SchoolUniversity of São PauloSão PauloBrazil
  3. 3.Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru Dental SchoolUniversity of São PauloSão PauloBrazil

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