Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

Risk factors for gingival recessions after orthodontic treatment: a systematic review

BACKGROUND/OBJECTIVES

To systematically review the available evidence concerning the risk factors for gingival recessions (GR) after orthodontic treatment (OT).

DATA COLLECTION AND ANALYSIS

Data was obtained and collected by systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023. Controlled trials, cohort, case-control or cross-sectional studies describing GR or clinical crown height (CCH) after OT were included. The risk of bias in the selected studies was evaluated with the methodological index for non-randomized studies.

RESULTS

Forty-eight articles were included, investigating the following six risk factors for GR: 1. OT (n = 21), 2. Type of orthodontic intervention (n = 32), 3. Patient's baseline occlusal and skeletal characteristics (n = 14), 4. Mucogingival characteristics (n = 10), 5. Oral hygiene (n = 9), and 6. Others (n = 12). Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively. 10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed. The evidence surrounding maxillary expansion and orthodontic retention was too heterogeneous to allow for? definitive conclusions. Pre-treatment angle classification, ANB, overjet, overbite, arch width and mandibular divergence were found not to be associated with GR (9/14), while pre-treatment crossbite, symphysis height and width were (5/7 studies). A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not. Oral hygiene, sex, treatment duration, and oral piercings were found not to be linked with GR in orthodontic patients, while GR was reported to increase with age in orthodontic patients by 50 per cent of the articles investigating this factor. The mean risk of bias for comparative and not comparative studies was 14.17/24 and 9.12/16.

LIMITATIONS

The selected studies were quite heterogeneous regarding study settings, variables reported and included very limited sample sizes.

CONCLUSION

Although studies regarding the risk factors for GR are relatively abundant, they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results. Uniform reporting guidelines are urgently needed for future research.

PROSPERO REGISTRATION

CRD42020181661.

FUNDING

This research received no funding.

Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment

INTRODUCTION

This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults.

METHODS

The sample comprised 17 patients (mean age, 26 ± 11 years) selected for the MARPE group and 15 (mean age, 28.5 ± 10.5 years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups.

RESULTS

MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE.

CONCLUSIONS

The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.

Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances?

PURPOSE

For surgically assisted rapid palatal expansion (SARPE), studies comparing different devices are missing. The aim was to evaluate expansion, relapse, and the complication rates for 3 different appliances.

PATIENTS AND METHODS

In this retrospective cohort study, tooth-borne (TB, n = 29), bone-borne (BB, n = 12), or orthodontic mini-implant (OMI)-borne (n = 13) appliances were used for SARPE in 2 clinical centers. Patients presenting with a maxillary width discrepancy greater than 5 mm were included. Measurements of cast models and radiographs were performed preoperatively, immediately after consolidation, and at 1 year postoperatively. All distances were measured between canines, premolars, and molars. Complications (tooth damage, infection, technical failure) were evaluated. The outcome variables were expansion, relapse, and complications. Type of appliance was selected as predictor variable. Within- and between-group differences regarding expansion, relapse, and complications for the 3 appliances were statistically analyzed.

RESULTS

In 54 patients (aged 28.8 ± 8.6 years), mean expansion (±standard deviation) for the TB, BB, and OMI appliances immediately after consolidation was 5.29 ± 1.39 mm, 5.22 ± 1.72 mm, and 3.81 ± 2.19 mm, respectively, at the dental level, and 5.51 ± 1.40 mm, 4.66 ± 2.03 mm, and 3.51 ± 1.66 mm, respectively, at the bone level. Mean (±standard deviation) relapse for the TB, BB, and OMI appliances at 1 year postoperatively measured 1.44 ± 1.01 mm, 0.76 ± 1.37 mm, and 0.27 ± 1.63 mm, respectively, at the tooth level and 1.19 ± 0.93 mm, 0.71 ± 0.96 mm, and 0.12 ± 1.56 mm, respectively, at the bone level. Analysis of variance and the Tukey test showed significant differences between the TB and OMI appliances for expansion and relapse (P = .034 and P = .024, respectively). The overall complication rate differed significantly (P < .001), with rates of 17.2%, 66.7%, and 15.4% for the TB, BB, and OMI appliances, respectively.

CONCLUSIONS

BB and OMI appliances resulted in less relapse. Owing to the high complication rate, the further use of BB appliances is questionable.