ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Rapid Palatal Expansion Does Not Appear To Cause Buccal Gingival Recession In Adolescent Patient, But May Predispose Patient To Future Gingival Recession
Clinical Question In adolescent patients, does rapid palatal expansion cause buccal gingival recession?
Clinical Bottom Line In adolescent patients, rapid palatal expansion does not seem to cause buccal gingival recession, but does cause buccal alveolar plate thinning and increase incidences of dehiscence that can predispose patients to gingival recession. This statement is supported several studies, including a systematic review, but the quality of evidence is low due to lack of controls, lack of human studies, small subject groups, and lack of evidence directly relating rapid palatal expansion to gingival recession.
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) 22827478Lione/2013Ages 7-17Systematic Review
Key resultsThis systematic review did not report any findings of buccal gingival recession as a result of rapid maxillary expansion. However, it did report that buccal plate thinning does initially occur, but by 3-6 months post-removal of expansion device, buccal plate thickness is normal when compared to control groups.
#2) 16769493Garib/2006Ages 11-14; girlsCase Series
Key resultsThis study showed that rapid maxillary expansion causes buccal plate thinning and bone dehiscence on anchored teeth (premolars and molars), but gingival recession did not follow upon removal of device. Although rapid palatal expansion did not cause buccal gingival recession upon removal of expanders, it is possible that buccal plate thinning and dehiscence predisposes subjects to gingival recession, initiated by tooth brushing trauma and inflammation.
Evidence Search "rapid maxillary expansion" AND "adverse effects"
Comments on
The Evidence
Lione and colleagues systematic review included primarily retrospective studies in addition to case controlled, prospective and randomized controlled trials with comprehensive search details. In addition, each study was assessed for validity. Qualifying for this systemic review include 30 articles. The number of subjects were not listed and a meta-analysis was not performed. Garib and colleagues clinical trial include 8 female subjects split into two equal groups. The groups were similar at the start, all subjects complete the study, and each group was treated similarly. Follow-up and compliance was adequate, bias and competing interests are unlikely, and this study was not double-blinded.
Applicability In general, evidence supports that rapid palatal expansion does not produce any long-term periodontal side effects. Application of rapid palatal expanders in adolescent patients should continue to be used with proper technique and protocol. Although evidence indicates that buccal plate thinning is reversible upon removal of expander, no evidence was found pertaining to the reversibility of dehiscence. Because dehiscence can predispose patients to gingival recession, patients should be instructed in proper tooth brushing technique and oral hygiene care to prevent trauma and inflammation to the gingiva, thus helping to prevent gingival recession.
Specialty/Discipline (Orthodontics) (Periodontics)
Keywords Rapid palatal expansion, rapid maxillary expansion, gingival recession
ID# 2425
Date of submission: 02/28/2013spacer
E-mail critchfield@livemail.uthscsa.edu
Author Cameron Critchfield
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail BRYKC@uthscsa.edu
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