Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial
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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.
SME and RME can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.
KeywordsPalatal 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.
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 was obtained from all individual participants included in the study.
- 1.Freitas JAS, Garib DG, Oliveira M, Lauris RC, Almeida AL, Neves LT, Trindade-Suedam IK, Yaedú RY, Soares S, Pinto JH (2012) Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP-Part 2: Pediatric Dentistry And Orthodontics. J Appl Oral Sci 20:268–281CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Haas A (1961) Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod 31:73–90Google Scholar
- 20.Isaacson RJ, Ingram AH (1964) Forces produced by rapid maxillary expansion: II. Forces present during treatment. Angle Orthod 34:261–270Google Scholar
- 24.European Comission (2011) Radiation protection no 172: cone beam CT for dental and maxillofacial radiology. Evidence based guidelines. A report prepared by the SEDENTEXCT project. Publications office, Luxembourg CityGoogle Scholar
- 25.American Academy of Oral and Maxillofacial Radiology (2013) Clinical recommendations regarding use of cone beam computed tomography in orthodontics. [corrected]. Position statement by the American Academy of oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol 116:238–257CrossRefGoogle Scholar
- 33.de Medeiros Alves ACM, Garib DG, Janson G, Almeida AM, Calil LR (2015) Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial. Clin Oral Investig. doi: 10.1007/s00784-015-1675-1 PubMedGoogle Scholar