Influence of different types of rapid maxillary expansion on root resorption: a systematic review

doi:10.7518/hxkq.2021.01.006

Abstract

Abstract: Objective

This study aimed to assess the influence of different types of rapid maxillary expansion on root resorption (RR).

Methods

Literature searches were carried out electronically in five English and two Chinese databases. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies, and case-control studies were included. The data were extracted by three authors. The risk of bias in the RCTs and nonrandomized studies were assessed in accordance with corresponding scales.

Results

Among the 400 articles identified, seven were included for the final analysis. Three studies were graded as high value of evidence, while two and another two studies were graded as moderate value and low value, respectively. According to the available evidence, the tooth-borne maxillary expansion caused more obvious RR of anchorage teeth than the bone-borne one. In addition, the Haas-type palatal acrylic pads could not effectively reduce the degree of RR. The difference in the design of the retainer between the tooth-borne maxillary expansion (the use of a band or wire framework to connect the anchorage tooth) did not cause the difference in the incidence and degree of RR.

Conclusion

Clinical evidence suggested that bone-borne maxillary expansion may decrease the amount of RR, while the amounts of resorption did not significantly differ between Haas and Hyrax and between different retainer types of Hyrax.

Key words: rapid maxillary expansion, bone-borne maxillary expansion, tooth-borne maxillary expansion, root resorption, systematic review

CLC Number:

R 783.5

Xia Kai, Sun Wentian, Yu Liyuan, Liu Jun. Influence of different types of rapid maxillary expansion on root resorption: a systematic review[J]. West China Journal of Stomatology, 2021, 39(1): 38-47.

Figures/Tables 7

Tab 1

Tab 2

Tab 3

Characteristics of the included studies

作者	研究类型	样本量	性别（男/女）	年龄/岁	扩弓装置类型	加力策略	上颌扩开宽度/mm	检测手段
Kayalar 等^[16]	RCT	20	9/11	19.37	牙支持式（Hyrax-4，6带环+框架）&骨-牙混合支持式（6带环+腭部微种植钉）	2次 $?$ d^-1（0.25 mm/次），共14 d	7	锥形束CT
Dindaro?lu等^[17]	RCT	33	16/17	12.8	牙支持式（Hyrax-4，6带环）&牙-组织混合支持式（Haas-4，6带环+亚克力基托）	0.5 mm $?$ d^-1，直至上磨牙腭尖接触下磨牙颊尖	Hyrax，6.55±1.26； Haas，6.32±1.28	锥形束CT
Yildirim 等^[25]	分口试验	20	9/11	14.31	牙支持式（亚克力夹板）&骨支持式（腭部微种植钉）	未知	未知	微型CT
Martins 等^[24]	分口试验	9	4/5	15.2	牙支持式（Hyrax-4，6带环+框架）&牙支持式（6带环+框架）&对照组（下颌未治疗的前磨牙）	第1天打开0.8 mm，之后2次/天（0.25 mm/次），共14 d	6.4	组织学
Lemos Rinaldi等^[23]	回顾队列	45	15/30	11.3	牙支持式（Hyrax）&牙-组织混合支持式（Haas）	0.4 mm·d^-1或0.8 mm·d^-1	8.0	锥形束CT
Erverdi 等^[22]	非随机同期对照	19	9/10	15.1	牙支持式（铸造冠夹板设计）&牙-组织混合支持式（Haas-4，6带环+亚克力基托）	2次 $?$ d^-1（0.2 mm/次），直至双侧2 mm过矫治	未知	组织学
Odenrick 等^[15]	非随机同期对照	9	4/5	11.5	牙支持式（Hyrax-4，6带环+框架）&牙-组织混合支持式（Haas-4，6带环+亚克力基托+框架）	1次或2次 $?$ d^-1（0.2 mm/次）	7	组织学

Tab 3

Tab 4

The main results of the included studies

作者	牙根吸收测量指标	随访时间	扩弓装置类型	样本量	位点	牙根吸收测量结果	吸收后修复
Kayalar 等^[16]	前磨牙根长/mm：颊/舌侧牙尖至根尖的距离；第一磨牙根长/mm：根分叉至近颊/远颊/腭根根尖的距离	治疗前（T0）；保持14 d后（T1）；保持6个月后（T2）	Hyrax式	10	P1B（T0-T1）	0.10±0.28	未知
					P1L（T0-T1）	0.28±0.28
					M1MB（T0-T1）	0.12±0.26
					M1DB（T0-T1）	0.20±0.32
					M1P（T0-T1）	0.19±0.25
					P1B（T0-T2）	0.30±0.36
					P1L（T0-T2）	1.06±0.65
					M1MB（T0-T2）	0.30±0.25
					M1DB（T0-T2）	0.65±0.65
					M1P（T0-T2）	0.42±0.35
			骨-牙混合支持式	10	P1B（T0-T1）	0.28±0.57
					P1L（T0-T1）	0.32±0.32
					M1MB（T0-T1）	0.18±0.21
					M1DB（T0-T1）	0.25±0.21
					M1P（T0-T1）	0.22±0.27
					P1B（T0-T2）	0.36±0.56
					P1L（T0-T2）	0.50±0.45
					M1MB（T0-T2）	0.54±0.41
					M1DB（T0-T2）	0.57±0.38
					M1P（T0-T2）	0.39±0.22
作者	牙根吸收测量指标	随访时间	扩弓装置类型	样本量	位点	牙根吸收测量结果		吸收后修复
Yildirim 等^[25]	牙根体积/mm³：治疗后拔除第一前磨牙使用微型CT计算吸收陷窝面积	保持3个月后	Haas式	20	aL	0.359±0.395		未知
					aB	0.511±0.430
					mL	0.347±0.522
					mB	0.676±0.637
					cL	0.055±0.070
					cB	0.300±0.513
			骨支持式	20	aL	0.025±0.019
					aB	0.050±0.080
					mL	0.019±0.037
					mB	0.009±0.018
					cL	0.010±0.021
					cB	0.015±0.026
Lemos Rinaldi等^[23]	牙根根长/mm：上颌第一磨牙近中颊尖牙尖至根尖的长度	治疗前（T0）；保持6个月后（T1）	Hyrax式（0.4 mm·d^-1）	18	M1MB（T0-T1）	0.28±0.07		未知
			Haas式（0.4 mm·d^-1）	11	M1MB（T0-T1）	0.40±0.07
			Haas式（0.8 mm·d^-1）	16	M1MB（T0-T1）	0.51±0.05
Dindaro?lu 等^[17]	牙根体积/mm³：治疗前后建模计算差值	治疗前6个月（T0）；加力结束（T1）；保持 6月后（T2）	Hyrax式	32	P1（T0-T1）	40.86±23.28		治疗结束6个月后所有位点均观察到修复，但在保持期中仍有活跃的吸收进程
					P2（T0-T1）	37.64±35.35
					M1（T0-T1）	83.12±44.04
					P1（T1-T2）	4.43±24.79
					P2（T1-T2）	11.65±27.28
					M1（T1-T2）	20.34±61.07
					P1（T0-T2）	36.43±24.36
					P2（T0-T2）	25.99±32.55
					M1（T0-T2）	32.78±47.80
			Haas式	34	P1（T0-T1）	31.07±24.39
					P2（T0-T1）	33.60±32.13
					M1（T0-T1）	72.52±47.63
					P1（T1-T2）	10.34±24.32
					P2（T1-T2）	8.66±30.36
					M1（T1-T2）	25.14±49.69
					P1（T0-T2）	20.73±30.16
					P2（T0-T2）	24.94±25.13
					M1（T0-T2）	47.38±37.51
Martins 等^[24]	治疗结束后拔牙进行组织学检测，测定牙根颈部中部1/3颊舌侧及邻面吸收面积/μm²	保持3个月后	Hyrax式 Hyrax框架式	54 54	P1 P1	34,824 27,843	69,660 65,531	均观察到修复，但仅有1例达到完全修复
Martins 等^[24]	治疗结束后拔牙进行组织学检测，测定牙根颈部中部1/3颊舌侧及邻面吸收面积/μm²	保持3个月后						均观察到修复，但仅有1例达到完全修复
Erverdi 等^[22]	治疗结束后拔牙进行组织学检测，测定最大吸收陷窝的深度/μm	保持3个月后	牙支持式（夹板式） Haas式	16 22	P1 P1	327.50±226.53 337.04±298.55		未知
Erverdi 等^[22]	治疗结束后拔牙进行组织学检测，测定最大吸收陷窝的深度/μm	保持3个月后						未知
Odenrick 等^[15]	治疗结束后拔牙进行组织学检测，测定累及牙骨质及牙本质的吸收陷窝深度/μm	保持后（时间不同）	Hyrax式	4	P1或P2	平均90~470（Haas较Hyrax大）		部分位点观察到修复，但无纤维连接
Odenrick 等^[15]	治疗结束后拔牙进行组织学检测，测定累及牙骨质及牙本质的吸收陷窝深度/μm	保持后（时间不同）	Haas式	5	P1或P2	平均90~470（Haas较Hyrax大）		部分位点观察到修复，但无纤维连接

Tab 4

Fig 1

Tab 5

Fig 2

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步骤	Pubmed	Embase	CENTRAL	Web of science	CNKI	CBM	SIGLE
1	“Palatal Expansion Technique”[Mesh] （2 612）	maxillary expan*.mp. （1 397）	maxillary expan*.mp. OR Palatal Expansion Technique（360）	maxillary expan*（4 646）	扩弓（1 038）	扩弓（697）	Maxillary expan*（5）
2	maxillary expan* （1 375）	palatal expansion OR palatal expan*.mp.（953）	Palatal Expansion Technique OR palatal expan*.mp.（231）	palatal expan*（3 509）	牙根吸收（1 666）	牙根吸收（830）	palatal expan*（2）
3	palatal expan* （2 766）	“Root Resorption” OR root resorp*.mp.（20 647）	“Root Resorption” OR root resorp*.mp.（409）	root resorp* （8 234）	1 AND 2 （9）	1 AND 2 （9）	root resorp*（10）
4	“Root Resorption” [Mesh]（3 343）	1 OR 2（1 967）	1 OR 2（397）	1 OR 2（5 986）			1 OR 2（6）
5	root resorp*（4 571）	3 AND 4（58）	3 AND 4（17）	3 AND 4（185）			3 AND 4（0）
6	1 OR 2 OR 3（3 038）
7	4 OR 5（4 571）
8	6 AND 7（122）

项目	条目	低偏倚风险标准
对象选择	暴露队列的代表性	完全或基本代表社区群体平均指标
	非暴露队列的选择	与暴露队列来自同一社区群体
	暴露队列的确认方法	有可靠记录或调查
	研究开始前队列中无结局事件	是
可比性	基于设计或分析的可比性	研究控制了重要因素或其他混杂因素
结局	结局事件的评估	独立、盲法评估或记录
	随访时间是否足够以观察结局事件	是
	随访的充分性	无失访或失访数较少不致偏倚或对失访进行描述

作者	研究设计	研究类型	评级
Kayalar等^[16]	RCT	前瞻性	A
Dindaro?lu等^[17]	RCT	前瞻性	A
Yildirim等^[25]	分口试验	前瞻性	B
Martins等^[24]	分口试验	前瞻性	A
Lemos Rinaldi等^[23]	回顾队列	回顾性	B
Erverdi等^[22]	非随机同期对照	前瞻性	C
Odenrick等^[15]	非随机同期对照	前瞻性	C

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