Valentina Rutili, Michele Nieri, Debora Franceschi, Felicita Pierleoni, Veronica Giuntini and Lorenzo Franchi
What did the authors aim to do in this study?
The main objective of this study was to compare the patient reported outcome measures (PROM's) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients.
How did the authors evaluate?
This systematic review was carried out by a detailed analysis of an electronic search in the PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science and OpenGrey databases. Only the randomised controlled trials were included in this study for analysis. The survey covered the period from inception to the last access on November 2021. Two different search strategies using predefined fields and a controlled vocabulary were applied to identify proper articles. The first search strategy was a broad search strategy & the second was a query string that was developed for the PubMed & modified for the other databases respecting the PICOS strategy. After the completion of the search on databases, the results were merged and all records were imported into a reference management software and manually screened to ensure no duplication.
Fig 1. Inclusion & exclusion strategy used for study selection (PICOS)
The inclusion criteria were the 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. The risk of bias was assessed using RoB 2. The GRADE statement was performed.
Fig 2. The risk of bias of included studies
The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied.
What did the authors find?
The two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at a low risk of bias, while one was at a risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients. Pain intensity was significantly lower in SME appliance in the first week of treatment. 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.
What did the authors conclude?
In growing patients, the application of SME reduced pain intensity compared to RME during the first week of treatment.
There were no differences in the first week of treatment for difficulty of speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction between RME and SME appliances.
There were no statistically significant differences in pain between the two protocols for all the following weeks.
What do we think about it?
The correction of transverse discrepancies using fixed appliances have always been a common practice for orthodontists. Based on their mode of action and the time taken to correct the discrepancy, the devices come under two basic divisions, i.e, the Rapid maxillary expansion (RME) & the Slow maxillary expansion (SME). RME is most usually achieved by Hyrax or Hass appliances & SME using Quad helix appliance or W expanders. The palatal expanders are effective in expanding the maxilla together with other positive side effects for the patient, such as increasing the size of the airways in a short time period, influencing voice quality, and improving the hearing. Various studies have compared the pros & cons of both the types of expansion but this systemic review was carried out from a patient - centered perspective. They evaluated the patient reported outcomes (PROM's) along with the comparison between the Rapid & Slow maxillary expansion. But the drawback of utilizing the PROM's is that their standardization is not possible as they are subjective assessments. Also, the articles included in the study had the same review authors, making it a little less reliable. Apart from these, the treatment differences among the studies have also been ignored which can also majorly affect the analysis. But apart from all these factors, the study fully encapsulates all the dentoskeletal effects of both the methods and also the effects from the patient's perspective, which makes it a complete review for clinicians to understand which expansion method to choose and why.
Yorumlar