Espansione rapida del mascellare superiore: ancoraggio tradizionale versus scheletrico

OBJECTIVES The aims of this study were to evaluate the effects of rapid pal- atal expansion (RME), using tooth-borne (hyrax) and comput- er-guided miniscrew-supported appliances, on the dentoalveolar, skeletal, periodontal structures and airways; and also to com- pare perceived pain intensity and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS Thirty-six subjects were randomly allocated to receive 2 types of RME treatments. Group A received treatment with tooth-borne appli- ance, while group B received a computer-guided miniscrew-sup- ported skeletal RME appliance. Linear and angular measure- ments of dentoskeletal changes were performed on the pre-treat- ment and post-treatment (6 months follow-up) CBCT images. Two rating scales (GRS and FPS) were used to assess pain during the activation phase. The OHIP-14 was used to evalu- ate the impact of RME on OHRQoL before the beginning of the treat- ment, at day 3 and day 7 fol- low-ups. Descriptive statistics methods and Student’s t-test were used, with significance set at P ≤0.05. RESULTS Measurements of dentoskeletal changes were made on a sample of 26 subjects, because 10 of them were censured due to Covid-19. The transversal skeletal increase was greater and statistically sig- nificant in group B (P ≤0.05); fur- thermore, buccal inclination of the maxillary first molar was recorded in group treated with tooth-borne appliance, with significant differ- ences. A slight reduction of buccal and palatal thicknesses at the level of the same dental element was ob- served in both groups, smaller in group B, with statistically signifi- cant difference only on the right buccal cortical plate. None of the subjects has been censured for the assessment of perceived pain and OHRQoL im- pact. The Student’s t-test showed sta- tistically significant higher pain in group B, although only on the first day of screw activation. OHIP-14 questionnaire showed no statisti- cally significant differences. CONCLUSIONS Computer-guided miniscrew- supported maxillary expanders allowed a great transversal in- crease of skeletal structures by reducing dentoalveolar side ef- fects of the tooth-supported de- vices. A higher perceived pain intensity in patients treated using a bone- borne device was limited to the first day of screw activation. There were no statistically significant differences between the 2 types of treatment in terms of their OHRQoL impact. CLINICAL SIGNIFICANCE Miniscrew skeletal anchorage al- lows to obtain advantages on skeletal expansions, nullifying the typical dentoalveolar unwanted effects of traditional orthodontic anchorage on the anchoring teeth. Moreover, subjects treated with bone-borne appliances don’t per- ceive higher levels of pain, com- pared to those treated with tooth- borne appliances.