The three-dimensional influence and clinical significance of anterior traction with rapid expansion during dental replacement
DOI:
https://doi.org/10.2340/aos.v84.44580Keywords:
Tooth malformation, orthodontics, rapid maxillary expansion, Hyrax-typeAbstract
Objectives: This study aimed to investigate the effects of rapid maxillary expansion using a Hyrax-type appliance (RME-Hyrax) with anterior traction on the maxillary arch during mixed dentition and its clinical significance, focusing on changes in arch dimensions, occlusal stability, and masticatory function.
Materials and methods: Forty-two patients with transverse maxillary deficiency were treated with RME-Hyrax, while an untreated control group of 40 received no treatment. Pre- and post-treatment dental casts were analyzed using a 3D scanner. Arch length, width, and occlusal stability were measured. Statistical analysis was performed using paired t-tests and linear regression.
Results: RME significantly increased maxillary arch widths at all measured points: 3CW: +4.06 mm, 4CW: +4.88 mm, 5CW: +4.09 mm, 6MCW: +3.00 mm (all p < 0.001). Mandibular arch widths similarly increased (3CW: +3.18 mm, 4CW: +4.00 mm, 5CW: +4.61 mm, 6MCW: +3.07 mm; all p < 0.001). Buccal movement of first permanent molars was significant in both arches (maxillary: 1.61–1.78 mm, mandibular: 1.52–1.68 mm; all p < 0.001). Occlusal stability improved clinically, evidenced by increased maximum bite area (+19.66 mm², exceeding the 15% threshold for functional gain; p < 0.001) and force (+1.06 kg, surpassing the 0.5 kg minimum meaningful change; p < 0.001), with reduced asymmetry index (-22.03%, p < 0.001). Masticatory efficiency improved from 54.22 to 84.61% (Δ30.39%, < 25% threshold; p < 0.001).
Conclusions: Hyrax-type RME is effective for correcting transverse maxillary deficiencies, expanding both the maxillary and mandibular arches, and improving occlusal and masticatory function. Early intervention can significantly enhance dental and functional health.
Downloads
References
Liddelow GJ, Singer SL, Allan BP, Henry PJ. Interdisciplinary management of type 3 oligodontia: a retrospective case series. J Prosthet Dent. 2024;132(1):S0022-3913(24)00380-9. https://doi.org/10.1016/j.prosdent.2024.05.028 DOI: https://doi.org/10.1016/j.prosdent.2024.05.028
Giovannetti A, Guarnieri R, Petrizzelli F, Lazzari S, Padalino G, Traversa A, et al. Small RNAs and tooth development: the role of mi-croRNAs in tooth agenesis and impaction. J Dent Sci. 2024;19(4):2150–6. https://doi.org/10.1016/j.jds.2024.03.013 DOI: https://doi.org/10.1016/j.jds.2024.03.013
Smith BH. Mammalian life history: weaning and tooth emergence in a seasonal world. Biology. 2024;13(8):612. https://doi.org/10.3390/biology13080612 DOI: https://doi.org/10.3390/biology13080612
Shetty VO, Ravi MS, Shetti S, Bhangare J, Kudalkar V, Dhanshetti S. Assessment of factors associated with mandibular anterior crowding in mixed dentition. J Pharm Bioall Sci. 2024;16(Suppl 3):S2608–14. https://doi.org/10.4103/jpbs.jpbs_386_24 DOI: https://doi.org/10.4103/jpbs.jpbs_386_24
Sandhu A, Sakaria BA, Patel SD, Ahuja G, Jadeja N, Mehta A, et al. The impact of early orthodontic intervention on dental and skeletal development in children with mixed dentition. J Pharm Bioall Sci. 2024;16(Suppl 1):S818–20. https://doi.org/10.4103/jpbs.jpbs_1035_23 DOI: https://doi.org/10.4103/jpbs.jpbs_1035_23
Kulkarni G, Ratre RK, Pushpa S, Pobbithi S, Deshmukh PS, Nagaraju R, et al. Evaluation of cone beam computerized tomography: effects of maxillary bones and their influence on the point of next teeth and canine development. J Pharm Bioall Sci. 2024;16(Suppl 3):S2333–5. https://doi.org/10.4103/jpbs.jpbs_245_24 DOI: https://doi.org/10.4103/jpbs.jpbs_245_24
AlHadidi A, Lam PPY, Hassona Y. Developmental and acquired abnormalities of the teeth. Dent Clin N Am. 2024;68(2):227–45. https://doi.org/10.1016/j.cden.2023.09.001 DOI: https://doi.org/10.1016/j.cden.2023.09.001
Zhou C, Duan P, He H, Song J, Hu M, Liu Y, et al. Expert consensus on pediatric orthodontic therapies of malocclusions in children. Int J Oral Sci. 2024;16(1):32. https://doi.org/10.1038/s41368-024-00299-8 DOI: https://doi.org/10.1038/s41368-024-00299-8
Gasparello GG, Júnior SLM, Hartmann GC, Meira TM, Camargo ES, Pithon MM, et al. The influence of malocclusion on social aspects in adults: study via eye tracking technology and questionnaire. Progr Orthod. 2022;23(1):4. https://doi.org/10.1186/s40510-022-00399-3 DOI: https://doi.org/10.1186/s40510-022-00399-3
Atik E, Önde MM, Domnori S, Tutar S, Yiğit OC. A comparison of self-esteem and social appearance anxiety levels of individuals with different types of malocclusions. Acta Odontol Scand. 2021;79(2): 89–95. https://doi.org/10.1080/00016357.2020.1788720 DOI: https://doi.org/10.1080/00016357.2020.1788720
Dias da Cunha L, Rodrigues V, Vieira de Oliveira IC, Pozzobon Pereira AL. Impact of malocclusion and oral habits on oral health-related quality of life and sleep disturbance in young adults: a cross-sectional study. J Orofac Orthoped. 2024. https://doi.org/10.1007/s00056-024-00555-w DOI: https://doi.org/10.1007/s00056-024-00555-w
Bokov P, Dahan J, Boujemla I, Dudoignon B, Delclaux C. The role of atypical deglutition in children and adolescents with moderate to se-vere obstructive sleep apnea syndrome. J Sleep Res. 2024;33(5):e14175. https://doi.org/10.1111/jsr.14175 DOI: https://doi.org/10.1111/jsr.14175
Ovsenik R, Marolt Mušič M, Primožič J. Changes in the swallowing pattern and tongue posture during the transition from deciduous to mixed dentition – a longitudinal ultrasonography study. Eur J Orthod. 2024;46(1):cjad066. https://doi.org/10.1093/ejo/cjad066 DOI: https://doi.org/10.1093/ejo/cjad066
Leite SDC, Herkrath FJ, Vettore MV, Rebelo MAB, de Queiroz AC, Pereira JV, et al. The association between malocclusion and health-related quality of life in adolescents: a mediation analysis. Eur J Oral Sci. 2024;132(1):e12960. https://doi.org/10.1111/eos.12960 DOI: https://doi.org/10.1111/eos.12960
Yalcin A, Aras I, Gode S, Durusoy D, Sezgin B, Eyigor S, et al. Evaluation of swallowing in transverse maxillary deficiency patients before and after rapid maxillary expansion. Angle Orthod. 2023;93(5):552–7. https://doi.org/10.2319/101222-703.1 DOI: https://doi.org/10.2319/101222-703.1
Inchingolo AD, Ferrara I, Viapiano F, Netti A, Campanelli M, Buongiorno S, et al. Rapid maxillary expansion on the adolescent patient: systematic review and case report. Child (Basel). 2022;9(7):1046. https://doi.org/10.3390/children9071046 DOI: https://doi.org/10.3390/children9071046
Rutili V, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Progr Orthod. 2022;23(1):47. https://doi.org/10.1186/s40510-022-00440-5 DOI: https://doi.org/10.1186/s40510-022-00440-5
Wang M, Ma D, Yang X. The impact of different activation protocols of rapid maxillary expansion on external root resorption: a systematic review and meta-analysis. Am J Transl Res. 2024;16(8):3437–48. https://doi.org/10.62347/AHKS7458 DOI: https://doi.org/10.62347/AHKS7458
Serafin M, Fastuca R, Caprioglio A. CBCT analysis of dento- skeletal changes after rapid versus slow maxillary expansion on deciduous teeth: a randomized clinical trial. Journal of Clin Med. 2022;11(16):4887. https://doi.org/10.3390/jcm11164887 DOI: https://doi.org/10.3390/jcm11164887
Chen R. Effects of rapid maxillary expansion on anchorage alveolar bone meta-analysis. Acta Odontol Scand. 2023;81(7):499–507. https://doi.org/10.1080/00016357.2023.2199862 DOI: https://doi.org/10.1080/00016357.2023.2199862
Machado Pasqua BP, Sendyk M, Barros André C, Batista de Paiva J, Wilmes B, Rino Neto J. Periodontal evaluation after maxillary expan-sion with a tooth-bone-borne expander in growing patients: a randomized clinical trial. J Orofac Orthoped. 2024. https://doi.org/10.1007/s00056-024-00536-z DOI: https://doi.org/10.1007/s00056-024-00536-z
Marañón-Vásquez GA, de Andrade ACDV, Maia LC, Dos Santos RL, Tanaka OM, Paranhos LR et al. Effect of treatment of transverse maxil-lary deficiency using rapid palatal expansion on oral health-related quality of life in children: complementary results for a controlled clini-cal trial. Clin Oral Invest. 2024;28(10):525. https://doi.org/10.1007/s00784-024-05902-0 DOI: https://doi.org/10.1007/s00784-024-05902-0
de Araújo MC, Bocato JR, Berger SB, Oltramari PVP, de Castro Ferreira Conti AC, de Almeida MR, et al. Perceived pain during rapid maxil-lary expansion in children with different expanders. Angle Orthod. 2021;91(4):484–9. https://doi.org/10.2319/092820-829.1 DOI: https://doi.org/10.2319/092820-829.1
Cheung GC, Dalci O, Mustac S, Papageorgiou SN, Hammond S, Darendeliler MA, et al. The upper airway volume effects produced by Hy-rax, Hybrid-Hyrax, and Keles keyless expanders: a single-centre randomized controlled trial. Eur J Orthod. 2021;43(3):254–64. https://doi.org/10.1093/ejo/cjaa031 DOI: https://doi.org/10.1093/ejo/cjaa031
Maspero C, Cavagnetto D, Fama A, Giannini L, Galbiati G, Farronato M. Hyrax versus transverse sagittal maxillary expander: an assess-ment of arch changes on dental casts. A retrospective study. Saudi Dent J. 2020;32(2):93–100. https://doi.org/10.1016/j.sdentj.2019.06.003 DOI: https://doi.org/10.1016/j.sdentj.2019.06.003
Dai J, Guo X, Zhang H, Xie H, Huang J, Huang Q, et al. Cone-beam CT landmark detection for measuring basal bone width: a retrospective validation study. BMC Oral Health. 2024;24(1):1091. https://doi.org/10.1186/s12903-024-04798-2 DOI: https://doi.org/10.1186/s12903-024-04798-2
Yang G, Xiang X, Tong X, Li Y, Liu Y. Mandibular response after rapid maxillary expansion in mixed dentition children with different vertical growth patterns: a retrospective study. J Clin Pediatr Dent. 2024;48(5):69–78. https://doi.org/10.22514/jocpd.2024.105 DOI: https://doi.org/10.22514/jocpd.2024.105
Janssens Y, Foley PF, Beyling F, Stamm T, Schwestka-Polly R, Schmid JQ. Quality of occlusal outcome in adult Class II patients treated with completely customized lingual appliances and Class II elastics compared to adult Class I patients. Eur J Orthod. 2024;46(5):cjae031. https://doi.org/10.1093/ejo/cjae031 DOI: https://doi.org/10.1093/ejo/cjae031
Pamukçu H, Özsoy S, Aksoy PC, Polat Özsoy Ö. Evaluation of maxillary dimensional changes in the mixed dentition: clear aligners vs acrylic expanders. Angle Orthod. 2024;94(4):392–9. https://doi.org/10.2319/121523-833.1 DOI: https://doi.org/10.2319/121523-833.1
Pithon MM, Marañón-Vásquez GA, da Silva LP, Coqueiro RDS, Lacerda Dos Santos R, Tanaka OM, et al. Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: a randomized controlled trial. Am J Orthod Dentofac Orthoped. 2022;161(2):172–81. https://doi.org/10.1016/j.ajodo.2021.08.015 DOI: https://doi.org/10.1016/j.ajodo.2021.08.015
Moravedje Torbaty P, Suh H, Tai SK, Baird M, Boyd RL, Oh H. Vertical and transverse treatment effects of Invisalign First system com-pared to Hyrax maxillary expanders with fixed appliances in mixed dentition patients. Angle Orthod. 2024;94(5):496–503. https://doi.org/10.2319/121023-818.1 DOI: https://doi.org/10.2319/121023-818.1
Li L, Zhai M, Cheng C, Cui S, Wang J, Zhang Z, et al. Mechanically induced M2 macrophages are involved in bone remodeling of the mid-palatal suture during palatal expansion. Progr Orthod. 2024;25(1):30. https://doi.org/10.1186/s40510-024-00529-z DOI: https://doi.org/10.1186/s40510-024-00529-z
Türker G, Çoban G, Bayraktar AÜ, Kurt G, Kılıç E, Alkan A. Three-dimensional palatal morphology and upper arch changes following non-surgical and surgical maxillary expansion in adults. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022;134(4):425–31. https://doi.org/10.1016/j.oooo.2022.02.013 DOI: https://doi.org/10.1016/j.oooo.2022.02.013
Silva I, Miranda F, Bastos JCDC, Garib D. Comparison of alveolar bone morphology after expansion with hybrid and conventional Hyrax expanders. Angle Orthod. 2024;94(4):414–20. https://doi.org/10.2319/092623-650.1 DOI: https://doi.org/10.2319/092623-650.1
Tarraf NE, Dalci O, Dalci K, Altug AT, Darendeliler MA. A retrospective comparison of two protocols for correction of skeletal Class III mal-occlusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask. Progr Orthod. 2023;24(1):3. https://doi.org/10.1186/s40510-022-00446-z DOI: https://doi.org/10.1186/s40510-022-00446-z
Silveira GS, Abreu LG, Palomo JM, da Matta Cid Pinto LS, de Sousa AA, Gribel BF, et al. Mini Hyrax vs Hyrax expanders in the rapid pala-tal expansion in adolescents with posterior crossbite: a randomized controlled clinical trial. Progr n Orthod. 2021;22(1):30. https://doi.org/10.1186/s40510-021-00365-5 DOI: https://doi.org/10.1186/s40510-021-00365-5
Pasqua BPM, André CB, Paiva JB, Tarraf NE, Wilmes B, Rino-Neto J. Dentoskeletal changes due to rapid maxillary expansion in growing patients with tooth-borne and tooth-bone-borne expanders: a randomized clinical trial. Orthod Craniofac Res 2022;25(4):476–84. https://doi.org/10.1111/ocr.12559 DOI: https://doi.org/10.1111/ocr.12559
Krebs A. Expansion of the midpalatal suture, studied by means of metallic implants. Acta Odontol Scand. 1959;17(4):491–501. https://doi.org/10.3109/00016355908993936 DOI: https://doi.org/10.3109/00016355908993936
Bearn D. Orthodontics and dentofacial orthopedics. J Orthod. 2002;29(2):154. https://doi.org/10.1093/ortho/29.2.154-a DOI: https://doi.org/10.1093/ortho/29.2.154-a
Kaur G, Kumari G, Sharma S. Functional matrix hypothesis: a review of literature. Surf Plasmon Resonan. 2021;1(2):33–42. https://doi.org/10.52152/spr/2021.115 DOI: https://doi.org/10.52152/spr/2021.115
Chan RSM, Wong WWS, Zhou TY, Liu Y, Tsang HT, Luk CL, et al. Human-AI collaboration improves adults’ oral biomechanical functions: a multi-centre, self-controlled clinical trial. J Dent. 2024;150:105354. https://doi.org/10.1016/j.jdent.2024.105354 DOI: https://doi.org/10.1016/j.jdent.2024.105354
Li S, Bao H, Su X, Xiong L, Yin Q, Gu D, et al. Orthodontic maxillary molar movement-induced zygomatic pillar remodeling and its conse-quences on occlusal characteristics and stress distribution. Clin Oral Invest. 2024;28(7):374. https://doi.org/10.1007/s00784- 024-05713-3 DOI: https://doi.org/10.1007/s00784-024-05713-3
Ciavarella D, Lorusso M, Fanelli C, Ferrara D, Laurenziello M, Montaruli G, et al. Evaluation of occlusal force in Class II subdivision malocclusion. J Oral Rehabil. 2024;51(9):1813–20. https://doi.org/10.1111/joor.13736 DOI: https://doi.org/10.1111/joor.13736
Published
Issue
Section
License
Copyright (c) 2025 Naizheng Gou, Xiaoqin Wang, Haiyan Li, Zuoying Dong
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes high quality original research papers as well as critical reviews relevant on diseases of the oral cavity, their treatment, epidemiology and associated biomaterials and their development.
