Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis

Valentina Rutili; Michele Nieri; Debora Franceschi; Felicita Pierleoni; Veronica Giuntini; Lorenzo Franchi

doi:10.1186/s40510-022-00440-5

Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis

Prog Orthod. 2022 Dec 12;23(1):47. doi: 10.1186/s40510-022-00440-5.

Authors

Valentina Rutili¹, Michele Nieri², Debora Franceschi², Felicita Pierleoni², Veronica Giuntini², Lorenzo Franchi^{3

4}

Affiliations

¹ Postgraduate Program in Orthodontics, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy.
² Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy.
³ Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy. lorenzo.franchi@unifi.it.
⁴ Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA. lorenzo.franchi@unifi.it.

Abstract

Background: No systematic review and meta-analysis are present in the literature comparing patient-reported outcome measures (PROMs) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients.

Objective: The objective of this systematic review was to compare PROMs in RME versus SME in growing patients.

Materials and methods: Electronic search in PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey was conducted. Only RCTs were included. Inclusion criteria were: growing patients in the mixed dentition or early permanent dentition, mild-to-moderate maxillary transverse deficiency, dental crowding, treatment with fixed expanders for rapid and slow maxillary expansion. Risk of bias was assessed using RoB 2. GRADE statement was performed. The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied.

Results: Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at low risk of bias, while one was at risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I² = 95%, 2 studies, GRADE very low). Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P < 0.0001, I² = 6%, 2 studies, GRADE moderate). There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction.

Conclusions: Pain intensity was significantly lower in SME compared to RME during the first week of treatment. For the following weeks, there were no differences in pain between the two protocols.

Keywords: Meta-analysis; Pain; Proms; Rapid maxillary expansion; Slow maxillary expansion; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Deglutition
Dentition, Mixed*
Humans
Pain
Palatal Expansion Technique*
Patient Reported Outcome Measures