The Journal of the American Dental Association
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

J Am Dent Assoc, Vol 137, No 1, 44-53.
© 2006 American Dental Association
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lagravère, M. O.
Right arrow Articles by Flores-Mir, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lagravère, M. O.
Right arrow Articles by Flores-Mir, C.
Related Collections
Right arrow Endodontics

CLINICAL PRACTICE

Meta-analysis of immediate changes with rapid maxillary expansion treatment



Manuel O. Lagravère, DDS, MSc, Giseon Heo, PhD, Paul W. Major, DDS, MS, FRCD(C) and Carlos Flores-Mir, DDS, MSc, Cert Orth, PhD


   ABSTRACT
TOP
 ABSTRACT
MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
Background. The authors conducted a literature review to evaluate immediate transverse, anteroposterior, and vertical dental and skeletal changes produced by rapid maxillary expansion (RME).

Types of Studies Reviewed. The authors reviewed clinical trials that assessed immediate dental and/or skeletal changes after RME using cephalometric analysis, model casts or both. No surgical or other simultaneous treatment was accepted during the evaluation period.

Results. The authors searched electronic databases and found 31 articles that met the initial inclusion criteria. The authors later rejected 12 of these articles because they did not report immediate changes, three because they lacked detailed descriptions of their results and two because of their nonconventional appliance designs. Fourteen articles satisfied the final inclusion criteria; however, they had methodological deficiencies.

Clinical Implications. The greatest changes resulting from RME in the studies analyzed were dental and skeletal transverse changes. Few vertical and anteroposterior immediate changes were statistically significant, though they probably are not clinically important.

Key Words: Rapid maxillary expansion; rapid palatal expansion; systematic review; meta-analysis; skeletal changes; dental changes

Maxillary expansion treatments have been used for more than 140 years1 and have been used widely since the mid-1960s.2,3 Various expansion protocols have been applied (slow maxillary expansion, semirapid maxillary expansion, rapid maxillary expansion [RME] and surgically assisted maxillary expansion). All of these treatment modalities have advantages and disadvantages, and their selection depends on the clinician’s choice. RME gained preference from clinicians and researchers; therefore, a large range of studies on this topic has been found.4 These studies vary concerning their sample size, the appliance used and the results obtained.4–6

Schiffman and Tuncay7 published a meta-analysis that summarized all of the maxillary expansion literature available from 1978 to 1999 included in the MEDLINE electronic database. They tried to determine the appropriateness and stability of maxillary expansion. They concluded that, owing to a lack of uniformity between studies and the use of improper study design and results reporting, they could not draw clear conclusions regarding the effects of maxillary expansion procedures on dental and skeletal structures.7 Possible limitations of this meta-analysis were the exclusion of non-English reported studies and a lack of differentiation of the results between maxillary expansion techniques and appliances. Two systematic reviews5,6 showed that a significant amount of literature could be missed if researchers use only MEDLINE to evaluate RME. Several other studies3,8–10 evaluating RME have been published since 1999.

We conducted a systematic review and a meta-analysis of the results to evaluate the immediate transverse, anteroposterior, and vertical dental and skeletal changes produced by RME.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 
We selected the terms or "key words" we used in the literature search with the assistance of a senior librarian who specialized in health sciences databases. The terms are provided in Table 1Go. We conducted computerized searches using the following databases: MEDLINE (from 1966 to week four of December 2004), MEDLINE In-Process & Other Non-Indexed Citations (Jan. 14, 2005), LILACS—a literature database of Latin and Caribbean health research—(from 1982 to January 2005), PubMed (from 1966 to week four of December 2004), EMBASE Excerpta Medica (from 1988 to week three of 2005), Thomsen’s ISI Web of Science (from 1975 to week four of December 2004) and all databases in All Evidence Based Medicine Reviews (Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects and Cochrane Central Register of Controlled Trials) (to the fourth quarter of 2004).


View this table:
[in this window]
[in a new window]
  		TABLE 1 Search results from databases.

 
The authors determined if studies should be included in their meta-analysis by reading the abstracts of the articles identified by the electronic databases.

We determined the following inclusion criteria in advance and applied them to all of the abstracts that resulted from the database searches:

– human clinical trials;
– dental and skeletal measurements made from cephalometric radiographs, dental casts or both;
– no history of surgical or other treatment that would affect the RME effects during the expansion period;
– immediate changes after RME active expansion phase reported.

We determined if studies should be included in our meta-analysis by reading the abstracts of the articles identified by the electronic databases. We made the selections independently using the inclusion criteria and then comparing the results (interexaminer {kappa} = 0.900). In cases of discrepancies, we made a consensus decision. We gathered articles from the abstracts from each database that apparently fulfilled the inclusion criteria based on the abstract information. Before making a final inclusion decision, we obtained articles for which the abstract did not provide sufficient information to make a decision regarding the selection. We also searched the reference lists of the selected articles for additional relevant publications that may have been missed in the database searches.

We gathered and evaluated all of the selected complete articles to determine if we wanted to include them in the final selection. We used the selection criteria again to make this final decision. In cases of discrepancies, we made a consensus decision (interexaminer {kappa} = 0.995). In cases in which relevant data were missing from the article, we made an effort to contact the authors to obtain the required extra information. We evaluated the articles that satisfied the inclusion criteria following the methodological criteria listed in the BoxGo. We have used these criteria previously.6


View this table:
[in this window]
[in a new window]
  		BOX Methodological criteria.

 
We conducted the meta-analysis on the selected studies following a two-step procedure. The first step consisted of testing the hypothesis that the true treatment effects were the same in all the studies selected. There were two possible sources of variation in estimating the effect size from different studies: between-study and within-study variance. If the difference between studies was only due to random variation, the effect estimates were considered to be homogeneous. The variation also could arise owing to systematic differences between studies. If this was so, we considered the effect estimates to be heterogeneous.11

In the second step, we made calculations using two ways of combining several study estimates. For homogeneous studies, we applied the fixed-effect model to obtain statistical inferences. Each study estimate was weighed as inversely proportional to its variance. For heterogeneous studies, we applied the random-effects model to obtain the statistical inferences. The random-effects model takes care of the two sources of variations, between and within study variance, to weigh each study estimate.12


   RESULTS
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
DISCUSSION
 CONCLUSIONS
 REFERENCES
 
We initially selected 31 abstracts from the electronic databases. PubMed had the greatest diversity of the abstracts we selected (23, 74.2 percent) among the database search engines we used. A majority (21, 67.7 percent) of these abstracts also appeared in other database results. Only eight (25.8 percent) of the selected abstracts were not included in PubMed. We identified two additional abstracts (6.5 percent) using MEDLINE, two (6.5 percent) using Thomsen’s ISI Web of Science and six (19.4 percent) using LILACS. The search results and the final number of abstracts selected according to the inclusion criteria from the various databases are provided in Table 1Go.

Of the 31 abstracts, we rejected 12 because they failed to report immediate changes after the activation phase of RME and instead reported changes only after the retention phase.3,8,9,13–21 Another one reported changes in an overall manner with no specific details,22 and two others gave neither time specification nor had a clear treatment protocol.23,24 We attempted to contact the authors of these studies by electronic mail, but we received no response throughout the preparation of this article, so we rejected them. We rejected two additional studies25,26 because they included all anterior teeth in the acrylic coverage of the expansion appliance. The figureGo shows an overview of the process for selecting the final articles.



View larger version (59K):
[in this window]
[in a new window]
  		Figure. Flow diagram of the literature search and selection process.

 
Of the 14 studies that reported immediate changes, eight measured dental and skeletal changes through radiographs,27–34 three measured dental and skeletal changes through radiographs and dental casts,35–37 and three measured only dental changes through dental casts.10,38,39 A description of the selected studies is summarized in Table 2Go.


View this table:
[in this window]
[in a new window]
  		TABLE 2 Description of studies included in the final selection process.

 
We pooled measurement landmarks that were reported in two or more studies into a meta-analysis. The pooled estimates and their respective confidence intervals are shown in Table 3Go (page 49).


View this table:
[in this window]
[in a new window]
  		TABLE 3 Pooled estimate of immediate changes and 95 percent confidence intervals.

 
Transverse dental changes. When we measured maxillary intermolar width via posterior anterior (PA) cephalometric radiographs and models, we found an increase of 6.04 and 6.74 millimeters, respectively. The maxillary inter-molar mesioapex root width increased 4.44 mm. The maxillary intermolar angulation increased approximately 3.10 degrees, though this increase was not statistically significant in the model casts. Maxillary intercanine width increased 5.35 mm when measured from the crown apex. When viewing transverse changes on the incisors, PA cephalometric radiographs showed a 3.9 mm increase in the maxillary interincisal apex width and a 2.98 mm increase in the midline diastema. The average mandibular intermolar width increase measured on models and PA cephalometric radiographs was small (0.49 mm each) and was not statistically significant.

Vertical and anteroposterior dental changes. When analyzing dental changes in the lateral plane, we found that the maxillary molar cusp was extruded 0.53 mm using the palatal plane as a reference (P < .05). An increase of 1.29 mm in overjet was observed. Change in angulation of the maxillary incisor to sella nasion (SN) plane (0.86 degrees) was significant (P < .05), while change in the mandibular incisor (2.31 degrees) was not significant (P > .05).

Transverse skeletal changes. With respect to transverse skeletal changes, the only statistically significant changes were nasal cavity width (intercondyle width) and left jugale-right jugale (interalveolar width) landmarks of 2.14 mm and 2.73 mm, respectively.

Vertical and anteroposterior skeletal changes. Concerning skeletal lateral changes, the only statistically significant changes observed were changes in the mandibular plane (with respect to the palatal plane and SN plane) being 1.65 and 1.97 degrees, respectively. The angulation of the palatal plane with respect to the SN plane was not significant (0.30 degrees; P > .05).

Methodological quality of the final selected studies. When applying the methodological criteria evaluation on the selected studies, none of the studies had a number of check marks that were more than 50 percent of the total. All of the studies had methodological problems regarding sample selection, description and statistical approach (Table 4Go).


View this table:
[in this window]
[in a new window]
  		TABLE 4 Methodological assessment of final selected studies.*

 

   DISCUSSION
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
CONCLUSIONS
 REFERENCES
 
A previous meta-analysis7 that evaluated the stability of maxillary expansion found some limitations (languages of publications considered and combination of different expansion appliance results). Our meta-analysis focused on the evaluation of immediate transverse, anteroposterior, and vertical dental and skeletal changes produced by RME.

The inclusion criteria we used in our meta-analysis focused mainly on the report of immediate changes after the active phase in RME (before screw fixation for the retention period). Since this activation phase varied from two to four weeks on average, the need for a control was not considered necessary since growth is not an influential factor during this short time lapse.20,23,24,26–40 We could not analyze the direction and magnitude trends of the excluded studies because of the reasons for their rejection: failing to report immediate changes,3,8,9,13–21 overall changes,22–24 and inclusion of anterior teeth in the expansion appliance.25,26

The greatest dental and skeletal changes occurred at the dentition, especially in the transverse dental dimension. This confirms results from various studies,3,9,26,41–43 including some3,9,26 we did not include in our final selection, which used tooth-anchored appliances for maxillary expansion. Exerting the expansion force on the teeth produced some undesirable effects such as dental tipping28,44 and root resorption.38,45 An average of 6.7 mm of expansion was obtained, measured from the molar crowns, while a 4.5 mm expansion increase was observed on the molar root apex. This corroborates the concept that using an RME tooth–anchored appliance will produce tipping28 of the tooth (an average of 3 degrees) instead of true skeletal expansion, though this tipping is not considered clinically significant.

The greatest dental and skeletal changes occurred at the dentition, especially in the transverse dental dimension.

We rejected two studies25,26 because their appliance designs were based on posterior and anterior tooth anchorage, which significantly differed from the other appliance designs that used posterior teeth anchorage only. This exclusion decision was supported by our findings. When comparing the expansion increase on molars, canines and mid-line diastema, we found that the greatest expansion was at the molars with progressively reduced expansion in the anterior part of the arch. This can be explained by the fact that the appliances used for RME exert their force directly on the posterior teeth46 used for anchorage. This also supports the theory that a significant portion of expansion is dental instead of solely skeletal.

Some authors have suggested that application of RME will cause an opening of the bite due to the molar extrusion.47,48 According to the results obtained in our study, the molar has only 0.5 mm extrusion, which is not clinically significant.

A previous study reported that no significant long-term anteroposterior changes occurred after RME treatments.5 In our study, though changes in the anteroposterior angulation of the maxillary and mandibular incisors were not significantly changed, we found an increase of 1.29 mm in the overjet. This could have been caused by the minor anteroposterior change with respect to the angle between points A and B in which point A moved forward 0.87 degrees, while point B retruded 0.62 degrees.

Skeletal transverse changes with RME have remained controversial. One study39 reported that there were no significant changes while another9 reported the existence of significant changes. Our analysis supports both findings, depending on the landmarks considered. We identified significant skeletal increases for intercondyle (valid only for the mandible) width and maxillary interalveolar width measured from the buccal plates. However, these increases were around 2 to 3 mm, clearly showing that a great portion of the true expansion was dental rather than skeletal.

We found nonsignificant anteroposterior skeletal changes that confirmed results reported by other studies.8,49,50 Concerning vertical skeletal changes after RME treatments, one study reported that there were no statistically significant changes,49 while others affirmed that there were significant vertical changes.8,50 In our study, we identified some statistically significant skeletal vertical changes. Although there was an increase in angulation between the mandibular, SN and palatal planes, this increase ranged between 1 to 2 degrees, which is not clinically significant.

Some studies have reported an indirect expansion occurring on the mandible after an RME treatment.9,51 The results of our meta-analysis did not identify any statistically significant mandibular expansion with the exception of the intercondyle width. Future studies are needed concerning this parameter since this could be a temporary change that could relapse after a period.

Previous systematic reviews5,6 regarding long-term changes after RME reported no clinically significant vertical and anteroposterior changes. Transverse changes were significant when they were compared with the control groups, though these changes were more dental than skeletal in nature. This relates to our meta-analysis in which the most significant changes we found were on the transversal plane and they were more dental than skeletal in nature.

All of the studies had methodological deficiencies. Lack of intra- and interexaminer agreement reporting was common; only one study35 clearly reported these values. The report of confounders and dropouts in the sample analysis, as well as descriptions of the inclusion criteria, was absent in the majority of studies (Table 4Go). Therefore, the scientific evidence we found in this meta-analysis should be interpreted carefully. Clinicians will have to consider their experience, the opinion of experts and the limited evidence on RME to decide whether to use this treatment on patients.

To have a comprehensive picture of RME changes, the information provided in this systematic review with a meta-analysis should be considered simultaneously with two published systematic reviews5,6 about long-term dental and skeletal changes after RME.


   CONCLUSIONS
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
REFERENCES
 
The greatest changes were in the maxillary transverse plane in which the width gained was caused more by dental expansion than true skeletal expansion. Few vertical and anteroposterior changes were statistically significant, and none was clinically significant.


   FOOTNOTES
 

Dr. Lagravère is a doctoral resident, Orthodontic Graduate Program, Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada.


Dr. Heo is an assistant professor of statistics, Orthodontic Graduate Program, Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada.


Dr. Major is a professor and the director, Orthodontic Graduate Program, Department of Dentistry, University of Alberta, Edmonton, Alberta, Canada.


Dr. Flores-Mir is a clinical associate professor, Orthodontic Graduate Program, Department of Dentistry, Faculty of Medicine and Dentistry, Room 4051A, Dentistry/Pharmacy Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2N8, e-mail "carlosflores{at}ualberta.ca". Address reprint requests to Dr Flores-Mir.


   REFERENCES
TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 CONCLUSIONS
 REFERENCES
 

  1. Angell EH. Treatment of irregularity of the permanent or adult teeth. Dent Cosmos 1860;1:99–600.

  2. Haas AJ. The treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod 1965;35:200–17.[Medline]

  3. Cross DL, McDonald JP. Effect of rapid maxillary expansion on skeletal, dental, and nasal structures: a posteroanterior cephalometric study. Eur J Orthod 2000;22:519–28.[Abstract/Free Full Text]

  4. Petren S, Bondemark L, Soderfeldt B. A systematic review concerning early orthodontic treatment of unilateral posterior crossbite. Angle Orthod 2003;73:588–96.[Medline]

  5. Lagravère MO, Major PW, Flores-Mir C. Long-term dental arch changes after rapid maxillary expansion treatment: a systematic review. Angle Orthod 2005;75:155–61.[Medline]

  6. Lagravère MO, Major PW, Flores-Mir C. Skeletal changes with rapid maxillary expansion treatments: a systematic review. Angle Orthod 2005;75:1046–52.

  7. Schiffman PH, Tuncay OC. Maxillary expansion: a meta analysis. Clin Orthod Res 2001;4:86–96.[Medline]

  8. Cozza P, Giancotti A, Petrosino A. Rapid palatal expansion in mixed dentition using a modified expander: a cephalometric investigation. J Orthod 2001;28:129–34.[Abstract/Free Full Text]

  9. Baccetti T, Franchi L, Cameron CG, McNamara JA Jr. Treatment timing for rapid maxillary expansion. Angle Orthod 2001;71:343–50.[Medline]

  10. Lamparski DG Jr, Rinchuse DJ, Close JM, Sciote JJ. Comparison of skeletal and dental changes between 2-point and 4-point rapid palatal expanders. Am J Orthod Dentofacial Orthop 2003;123:321–8.[Medline]

  11. Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F. Methods for meta-analysis in medical research. Chichester, Sussex, England: Wiley; 2000.

  12. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ 2000;320:1574–7.[Abstract/Free Full Text]

  13. Erverdi N, Sabri A, Kucukkeles N. Cephalometric evaluation of Haas and Hyrax rapid maxillary appliances in the treatment of the skeletal maxillary transverse deficiency. J Marmara Univ Dent Fac 1993;1:361–6.[Medline]

  14. Ursi WJ, Dale RCXS, Claro CA, Chagas RV, Almeida G. Transversal changes produced by the bonded rapid maxillary expander, evaluated by posteroanterior cephalographs [in Portuguese]. Ortodontia 2001;34(3):43–55.

  15. Gryson JA. Changes in mandibular interdental distance concurrent with rapid maxillary expansion. Angle Orthod 1977;47(3):186–92.[Medline]

  16. Linder-Aronson S, Lindgren J. The skeletal and dental effects of rapid maxillary expansion. Br J Orthod 1979;6(1):25–9.[Medline]

  17. Schneidman E, Wilson S, Erkis R. Two-point rapid palatal expansion: an alternate approach to traditional treatment. Pediatr Dent 1990;12(2):92–7.[Medline]

  18. Memikoglu TU, Iseri H. Effects of a bonded rapid maxillary expansion appliance during orthodontic treatment. Angle Orthod 1999;69:251–6.[Medline]

  19. Ciambotti C, Ngan P, Durkee M, Kohli K, Kim H. A comparison of dental and dentoalveolar changes between rapid palatal expansion and nickel-titanium palatal expansion appliances. Am J Orthod Dentofacial Orthop 2001;119(1):11–20.[Medline]

  20. Basciftci FA, Mutlu N, Karaman AI, Malkoc S, Kucukkolbasi H. Does the timing and method of rapid maxillary expansion have an effect on the changes in nasal dimensions? Angle Orthod 2002;72(2):118–23.[Medline]

  21. Sarver DM, Johnston MW. Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances. Am J Orthod Dentofacial Orthop 1989;95:462–6.[Medline]

  22. Gray LP. Results of 310 cases of rapid maxillary expansion selected for medical reasons. J Laryngol Otol 1975;89:601–14.[Medline]

  23. Timms DJ. A study of basal movement with rapid maxillary expansion. Am J Orthod 1980;77:500–7.[Medline]

  24. Siqueira DF, Almeida RR, Henriques JFC. Frontal cephalometric comparative study of dentoskeletal effects induced by three rapid maxillary expansion appliances [in Portuguese]. Rev Dent Press Ortodon Ortopedi Facial 2002;7(6):27–47.

  25. Basciftci FA, Karaman AI. Effects of a modified acrylic bonded rapid maxillary expansion appliance and vertical chin cap on dentofacial structures. Angle Orthod 2002;72(1):61–71.[Medline]

  26. Doruk C, Bicakci AA, Basciftci FA, Agar U, Babacan H. A comparison of the effects of rapid maxillary expansion and fan-type rapid maxillary expansion on dentofacial structures. Angle Orthod 2004;74(2):184–94.[Medline]

  27. Akkaya S, Lorenzon S, Ucem TT. A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 1999;21(2):175–80.[Abstract/Free Full Text]

  28. Asanza S, Cisneros GJ, Nieberg LG. Comparison of Hyrax and bonded expansion appliances. Angle Orthod 1997;67(1):15–22.[Medline]

  29. da Silva Filho OG, Boas MC, Capelozza Filho L. Rapid maxillary expansion in the primary and mixed dentitions: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 1991;100(2):171–9.[Medline]

  30. da Silva Filho OG, Montes LA, Torelly LF. Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod Dentofacial Orthop 1995;107:268–75.[Medline]

  31. Almeida G, Capelozza Filho L, Trinidade ASJ. Rapid maxillary expansion: a prospective study [in Portuguese]. Ortodontia 1999;32(1):45–56.

  32. Kawakami RY, Henriques JFC, Pinzan A, de Freitas MR, Janson G. Comparison of dentoskeletal effects produced by two types of rapid maxillary expansion appliances by means of lateral cephalometric evaluation [in Portuguese]. Ortodontia 1999;32(3):8–27.

  33. Faltin KJ, Moscatiello VA, Barrios EC. Faltin Jr’s palatal expander: dentofacial changes resulting from rapid maxillary expansion [in Portuguese]. Rev Dent Press Ortodon Ortopedi Facial 1999;4(4):5–13.

  34. Mazzieiro ET, Henriques JFC, Freitas MR. Study of frontal cephalometric the dentoskeletal changes after the rapid maxillary expansion [in Portuguese]. Ortodontia 1996;29(1):31–42.

  35. Sari Z, Uysal T, Usumez S, Basciftci FA. Rapid maxillary expansion: is it better in the mixed or in the permanent dentition? Angle Orthod 2003;73:654–61.[Medline]

  36. Sandikcioglu M, Hazar S. Skeletal and dental changes after maxillary expansion in the mixed dentition. Am J Orthod Dentofacial Orthop 1997;111:321–7.[Medline]

  37. Bhatt AK, Jacob PP. Skeletal and dental changes in rapid maxillary expansion. J Indian Orthod Soc 1978;10(1–2):17–27.[Medline]

  38. Akkaya S, Lorenzon S, Ucem TT. Comparison of dental arch and arch perimeter changes between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 1998;20(3):255–61.[Abstract/Free Full Text]

  39. Cozzani M, Rosa M, Cozzani P, Siciliani G. Deciduous dentition-anchored rapid maxillary expansion in crossbite and non-crossbite mixed dentition patients: reaction of the permanent first molar. Prog Orthod 2003;4:15–22.[Medline]

  40. Byrum AG Jr. Evaluation of anterior-posterior and vertical skeletal change vs. dental change in rapid palatal expansion cases as studied by lateral cephalograms. Am J Orthod 1971;60:419.[Medline]

  41. Harrison JE, Ashby D. Orthodontic treatment for posterior cross-bites. Cochrane Database Syst Rev 2001(1):CD000979.

  42. Handelman CS, Wang L, BeGole EA, Haas AJ. Nonsurgical rapid maxillary expansion in adults: report on 47 cases using the Haas expander. Angle Orthod 2000;70(2):129–44.[Medline]

  43. McNamara JA Jr, Baccetti T, Franchi L, Herberger TA. Rapid maxillary expansion followed by fixed appliances: a long-term evaluation of changes in arch dimensions. Angle Orthod 2003;73:344–53.[Medline]

  44. Capelozza Filho L, Cardoso Neto J, da Silva Filho OG, Ursi WJ. Non-surgically assisted rapid maxillary expansion in adults. Int J Adult Orthodon Orthognath Surg 1996;11(1):57–66.[Medline]

  45. Darendeliler MA, Strahm C, Joho JP. Light maxillary expansion forces with the magnetic expansion device: a preliminary investigation. Eur J Orthod 1994;16:479–90.[Abstract/Free Full Text]

  46. Chaconas SJ, Caputo AA. Observation of orthopedic force distribution produced by maxillary orthodontic appliances. Am J Orthod 1982;82:492–501.[Medline]

  47. Memikoglu TU, Iseri H. Nonextraction treatment with a rigid acrylic, bonded rapid maxillary expander. J Clin Orthod 1997;31(2):113–8.[Medline]

  48. Iseri H, Ozsoy S. Semirapid maxillary expansion: a study of long-term transverse effects in older adolescents and adults. Angle Orthod 2004;74(1):71–8.[Medline]

  49. Chang JY, McNamara JA Jr, Herberger TA. A longitudinal study of skeletal side effects induced by rapid maxillary expansion. Am J Orthod Dentofacial Orthop 1997;112:330–7.[Medline]

  50. Garib DG, Henriques JFC, Janson GP. Longitudinal cephalometric appraisal of rapid maxillary expansion effects [in Portuguese]. Rev Dent Press Ortodon Ortopedi Facial 2001;6(5):17–30.

  51. Sandstrom RA, Klapper L, Papaconstantinou S. Expansion of the lower arch concurrent with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 1988;94:296–302.[Medline]





This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lagravère, M. O.
Right arrow Articles by Flores-Mir, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lagravère, M. O.
Right arrow Articles by Flores-Mir, C.
Related Collections
Right arrow Endodontics

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS