[Structural changes in the craniofacial complex induced by microimplant-supported skeletal expander - MSE. a review].

Revista Cientifica Odontologica Pub Date : 2025-05-16 eCollection Date: 2025-04-01 DOI:10.21142/2523-2754-1302-2025-243
Diana Cecilia Zárate-Guerra, Gissella Gutiérrez-Tapia
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Abstract

Objective: The review aimed to assess the structural changes in the craniofacial complex following maxillary expansion assisted by micro-implants, known as the "Miniscrew assisted rapid palatal expander" (MARPE) in patients with maxillary transverse deficiency.

Materials and methods: The research included a specific type of expander called "Maxillary Skeletal Expander" (MSE) the design features a posteriorly positioned screw aligned with the zygomatic buttress, supported by four micro-implants located paramedial to the midpalatal suture with bicortical engagement of the palatal vault and the nasal floor. Four databases (PubMed, Scopus, Embase and ScienceDirect) were reviewed until July 2024. Studies reporting skeletal and dentoalveolar changes in patients with transverse maxillary deficiency evaluated using cone-beam computed tomography (CBCT) were selected. The methodology was ensured using the PRISMA checklist.

Results: 13 articles were selected according to the inclusion criteria. Regarding skeletal changes, the disjunction in the axial cut is parallel or nearly parallel, both in lineal and angular measurements (the posterior nasal spine represents between 82% and 101% in relation to anterior nasal spine) Two studies report a deviation in the disjunction at the ANS level of 1.1mm (+/- 1mm) in half of the sample, between one side and the other. Parallelism depends on the disarticulation of the pterygopalatine suture. A correlation was reported between bicortical anchorage anc the opening of this suture (P=0.0003) in 55.6% of the evaluated patients. In the coronal cut the expansion is pyramidal with an upper vertex, and the fulcrum would be located at the most external and inferior point of the frontozygomatic suture, allowing a rotation of 0.6° of the zygomaticomaxillary complex for each millimeter of expansion. Regarding dentoalveolar changes, studies find an average buccal inclination of the upper first molars of 3°.

Conclusions: Maxillary expansion assisted by micro-implants significantly impacts craniofacial structures. Furthermore, by ensuring orthopedic movements in young and young adult patients, adverse dental and periodontal effects associated with compensatory or non-skeletal expansion are reduced. Further studies on larger populations are required to confirm these effects.

Abstract Image

Abstract Image

微植入骨扩展器(MSE)对颅面复合体结构的影响。审查)。
目的:评价上颌横向缺陷患者在“微型辅助快速腭扩张器”(MARPE)辅助下上颌扩张后颅面复合体的结构变化。材料和方法:该研究包括一种特殊类型的扩张器,称为“上颌骨骼扩张器”(MSE),其设计特点是后部定位螺钉与颧骨支撑对齐,由四个微植入物支撑,这些植入物位于中腭缝合旁,双皮质接合腭穹窿和鼻底。四个数据库(PubMed, Scopus, Embase和ScienceDirect)被审查到2024年7月。采用锥束计算机断层扫描(CBCT)评估上颌横向缺陷患者的骨骼和牙槽骨变化。使用PRISMA核对表确保了方法。结果:按照纳入标准筛选出13篇文章。关于骨骼变化,轴向切口的分离在直线和角度测量上都是平行或接近平行的(鼻后棘相对于鼻前棘的比例在82%到101%之间)。两项研究报告,在一半的样本中,一侧和另一侧在ANS水平上的分离偏差为1.1mm (+/- 1mm)。平行度取决于翼腭缝合线的脱离。在55.6%的评估患者中,双皮质锚固与缝线打开之间存在相关性(P=0.0003)。在冠状切口中,扩张呈锥体状,有一个上顶点,支点位于额颧缝线的最外侧和最下方,每扩张一毫米,允许颧腋复合体旋转0.6°。关于牙槽牙的变化,研究发现上颌第一磨牙的平均颊倾角为3°。结论:微种植体辅助上颌扩张对颅面结构有显著影响。此外,通过确保青年和青年成人患者的矫形运动,减少与代偿性或非骨骼扩张相关的不良牙齿和牙周影响。需要对更大的人群进行进一步的研究来证实这些影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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