The stability of surgically assisted rapid maxillary expansion (SARME): A systematic review

Nikhil Gogna; A S Johal; Pratik K Sharma

doi:10.1016/j.jcms.2020.07.003

The stability of surgically assisted rapid maxillary expansion (SARME): A systematic review

J Craniomaxillofac Surg. 2020 Sep;48(9):845-852. doi: 10.1016/j.jcms.2020.07.003. Epub 2020 Jul 14.

Authors

Nikhil Gogna¹, A S Johal², Pratik K Sharma³

Affiliations

¹ Department of Orthodontics, The Royal London Hospital, Whitechapel, London, E1 1BB, UK. Electronic address: drnikhilgogna@hotmail.com.
² Centre for Oral Bioengineering, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK. Electronic address: a.s.johal@qmul.ac.uk.
³ Centre for Oral Bioengineering, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK. Electronic address: p.k.sharma@qmul.ac.uk.

PMID: 32732085
DOI: 10.1016/j.jcms.2020.07.003

Abstract

Background: This systematic review was conducted to determine the stability of surgically assisted rapid maxillary expansion (SARME) for correction of transverse maxillary deficiency, the effect of distractor type (tooth-borne vs. bone-borne) and the influence of a retainer on post-expansion stability.

Methods: The review was conducted applying the PICO criteria. Electronic database searches of published literature (MEDLINE via PubMed), Ovid via MEDLINE, the Cochrane Oral Health Group's Trial Register, Cochrane Central Register of Controlled Trials, (CENTRAL) and unpublished literature were accessed until January 2019. Search terms included SARME, 'stability', 'relapse', 'surgery', 'expansion' and 'maxillary expansion'.

Results: Five hundred and ten studies were identified overall and 15 studies were included (3 RCTs, 2 prospective & 10 retrospective) following initial screening and data extraction of full texts. The quality of evidence was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for prospective & retrospective studies. The heterogeneity of the retrieved articles prohibited quantitative analysis. Overall, the studies were either of high risk of bias or low quality. Qualitative analysis reveals SARPE to achieve expansion at the inter-canine region of 4-for inter 6 mm, inter-molar region of 6-8.9 mm, and skeletal level of 2.3-3.1 mm with relapse rates in the region of 0.1-2.3 mm (inter-canine), 0.2-3 mm (inter-molar) and 0-1.8 mm (skeletal) reported.

Conclusion: Qualitative evaluation suggests SARPE results in significant expansion at the dental and skeletal level and that this appears to be stable. Existing literature is equivocal on the clinical benefits of a retention device or distractor type (bone-borne vs. tooth borne) on stability. This review has unearthed the need for high quality prospective RCTs to fully understand the stability of SARME, particularly with relation to varying distractor types and use of retention devices. As such, the inferences drawn should be considered with some discretion based on the quality of the available evidence.

Keywords: Maxillary expansion; Relapse; Stability; Surgical expansion.

Publication types

Systematic Review

MeSH terms

Maxilla*
Molar
Palatal Expansion Technique*
Prospective Studies
Retrospective Studies