ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Clinically-Significant, Long-Term Skeletal Changes From Rapid Maxillary Expansion Can Be Expected In Adolescent Patients Prior To Their Pubertal Growth Spurt
Clinical Question In adolescent patients, what clinically-significant, long-term effect can be expected from the use of rapid maxillary expansion treatment in the transverse, anteroposterior, and vertical dimensions?
Clinical Bottom Line Rapid maxillary expansion (RME) can produce a long-term skeletal increase in the transverse width of the maxilla for patients in their pre-pubertal growth spurt; the skeletal increase is usually about 20-25% of the appliance activation. For pubertal and post-pubertal adolescent patients, there was no clinically significant skeletal increase in maxillary transverse width. RME had no clinically significant effect on anteroposterior or vertical position of the maxilla or mandible.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16448254Lagravere/2005161 Adolescent HumansSystematic Review
Key resultsThe purpose of this systematic review was to evaluate long-term transverse, anteroposterior, and vertical skeletal changes obtained after rapid maxillary expansion (RME) in adolescents. Transverse changes varied from patients receiving treatment before and after the peak pubertal growth spurt. Maxillary transverse width increased significantly (about 3 mm or 20-25% of appliance activation) in pre-pubertal growth peak individuals, but not significantly (0.9 mm) in pubertal and post-pubertal adolescents. RME had no clinically significant effect on the anteroposterior or vertical position of the maxilla or mandible. No p value or confidence interval were reported.
Evidence Search (("Maxillofacial Development"[Mesh]) AND "Palatal Expansion Technique"[Mesh]) AND "Treatment Outcome"[Mesh]
Comments on
The Evidence
This systematic review found evidence using a comprehensive, detailed search for relevant trials. Studies that did not meet the specific inclusion/exclusion criteria were not considered, leaving three studies for this review. Treatment was evaluated on 161 patients (92 treated, 69 controls). Results from this systematic review should be evaluated with caution because only a secondary level of evidence was found. Long-term randomized clinical trials are necessary to reach clinical conclusions about the skeletal effects of rapid maxillary expansion.
Applicability Treatment groups were comprised of 62% females while the control groups were comprised of 42% females. All patients were reported to be adolescents, but the age range and mean ages of males and females for either the experimental or control groups were not reported.
Specialty/Discipline (Orthodontics)
Keywords Orthodontics, Dentofacial orthopedics, Rapid palatal expansion, Rapid maxillary expansion, Long-term treatment outcome, Maxilla, Skeletal
ID# 2155
Date of submission: 10/08/2011spacer
E-mail escott@uthscsa.edu
Author Christopher Escott, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Chandler Kuhlman, Kourtney Kouth (San Antonio, TX) on 11/30/2017
The PubMed database was searched in November 2017 using the terms "(rapid maxillary expansion) AND adolescence" and an article published at a more recent date (2016) confirmed this specific CAT's conclusion with statistical significance (Pubmed ID #27609388) as well as adding a new piece of data. The CAT originally stated that there was no significant evidence for long-term changes in the anteroposterior position. This research states that "there was significant increase in maxillary length (Ptm-ANS)(P<0.01)." However, it did confirm that there was no significant difference in the maxillary sagittal position as stated in the CAT.
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