RESUMO
OBJECTIVES: To identify and qualify the evidence of published studies evaluating whether rapid maxillary expansion (RME) treatment modifies the head and cervical posture in growing patients. MATERIALS AND METHODS: Electronic database searches were conducted until January 2021 using PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and LILACS. Grey literature was explored using ClinicalTrials, OpenGrey and Google Scholar. Trials involving participants who underwent RME were included. Risk of Bias (RoB) assessment was conducted using the Cochrane tool for randomized trials and the Methodological Index for Non-randomized Studies (MINORS) for non-randomized trials. The certainty level of evidence was evaluated through the Grading of Recommendations, Assessment, Development and Evaluation tool (GRADE). RESULTS: Six clinical trials were included. The RoB scores had unclear and high risks of bias. Low certainty of evidence suggested that the effects following RME include a decrease in craniocervical angulation, as well as a very low certainty of evidence for a decrease in head elevation, an increase in cervical lordosis, and an increase in the inclination of the cervical spine. CONCLUSIONS: There is low and very low evidence that RME alters the head and cervical posture in growing patients. Further investigation regarding long-term effects, possible changes due to somatic growth, and clinical relevance is needed.
Assuntos
Técnica de Expansão Palatina , Postura , HumanosRESUMO
Existen numerosos estudios que evalúan la Expansión Rßpida Maxilar (ERM),sin embargo pocos cuantifican de manera integral los cambios esqueléticos y dentarios que se producen en los tres planos del espacio. El propósito del presente estudio fue evaluar los cambios dentarios y esqueléticos producidos por la ERM en sentido anteroposterior, vertical y transversal, mediante Rx lateral estricta, posteroanterior y modelos de estudio. Se colocó el aparato de Haas en 10 pacientes con diagnóstico de mordida cruzada uni o bilateral. El proceso se realizó en 2 fases: activa por 15 días y contención por 3 meses. Se tomaron radiografíasy modelos iniciales y finales (post-contención). Los resultados mostraron que el maxilar superior se desplazó levemente hacia delante y hacia abajo, con el consiguiente aumento de la altura facial media, inferior y total, aunque no hubo rotación mandibular estadísticamente significativa. Frontalmente, se comprobó el patrón triangular de disyunción con base inferior. El arco superior incrementó sus dimensiones intercervicales e intercuspídeas, así como perímetro y longitud de arco,dimensiones palatinas y ßngulo intermolares. Finalmente, comprobamos que el conocimiento de los cambios esqueléticos y dentarios producidos por la ERM es útil para la planeación del tratamiento ortodóncico y para aprovechar eficientemente las ventajas de esta técnica.
There are several studies about Rapid Maxillary Expansion (RME), but only a few ones quantify the skeletal and dental changes produced in the three planes of space comprensively. The aim of this study was to evaluate the skeletal dental changes produced by the RME in anteroposterior, vertical and transversal direction by lateral and frontal radiographs and study models. A Haas expansion appliance was used in 10 patients with unilateral or bilateral crossbite diagnosis. The procedure was developed in 2 phases: active, during 15 days and contention during 3 months. Initial and final (post-contention) radiographs and study models were taken. The results showed that the maxilla moved slightly forward and downward with the subsequent increase of the superior, inferior and total facial heights, however there was not significative mandibular rotation. In the frontal view, the triangular disjunction pattern with its inferior base was verified. The superior arch increase its intercervical and intercuspid dimensions with the subsequent increase in the arch perimeter and arch length, palatine dimensions and intermolar angle were increased too. Finally,we proved that the knowledge of the skeletal and dental changes produced by the RME is useful for the orthodontic treatment planning and to take advantage of this technique efficiently.