Conventional and Miniscrew-Assisted Maxillary Expansion Appliances: A Narrative Review Based on Anchorage Design

Öz

Maxillary transverse deficiency is a common component of orthodontic malocclusion, yet the choice of expansion appliance becomes increasingly complex as skeletal maturity and sutural resistance increase. This narrative review critically compares conventional tooth-borne, tooth–tissue-borne, and bonded expanders with miniscrew-assisted tooth–bone-borne and bone-borne systems, with particular emphasis on how anchorage design influences force transmission, skeletal response, dentoalveolar compensation, periodontal effects, and clinical selection. A structured search of PubMed/MEDLINE, Scopus, and Google Scholar was performed using terms related to maxillary expansion, conventional expanders, miniscrew-assisted rapid palatal expansion (MARPE), hybrid expanders, bone-borne expanders, and maxillary skeletal expanders. Human clinical studies, randomized and nonrandomized comparative studies, and relevant evidence syntheses were prioritized; classic studies were retained when necessary to describe established designs and biological principles. Conventional rapid maxillary expansion remains predictable in growing patients, but part of the observed transverse gain is dentoalveolar and may include buccal tipping and buccal alveolar bone reduction. Miniscrew-assisted systems can increase the skeletal contribution and reduce—rather than eliminate—dental loading, particularly in late adolescents and adults. However, treatment response is not determined by appliance label alone. Age, sex, midpalatal and circummaxillary sutural resistance, palatal bone availability, miniscrew number and position, cortical engagement, appliance rigidity, activation protocol, and periodontal phenotype all modify outcomes. Current evidence does not support a universally superior design. Appliance selection should therefore be individualized according to skeletal maturity, the required magnitude and location of expansion, periodontal risk, available anchorage, and the consequences of possible failure. Better standardized trials with longer follow-up and patient-reported outcomes are required.

Anahtar Kelimeler

• maxillary transverse deficiency
• rapid maxillary expansion
• MARPE
• Miniscrew-Assisted Expansion

Ankraj Tasarımına Göre Konvansiyonel ve Mini Vida Destekli Maksiller Genişletme Apareyleri: Anlatı Derlemesi

Öz

Maksiller transversal yetmezlik, ortodontik maloklüzyonlarda sık karşılaşılan bir problemdir. İskeletsel maturasyonun ilerlemesi ve sutural direncin artmasıyla birlikte uygun genişletme apareyinin seçimi daha karmaşık hâle gelmektedir. Bu anlatı derlemesinde konvansiyonel diş destekli, diş-doku destekli ve bonded genişletme apareyleri ile mini vida destekli diş-kemik destekli ve kemik destekli sistemler; ankraj tasarımının kuvvet iletimi, iskeletsel yanıt, dentoalveolar kompanzasyon, periodontal etkiler ve aparey seçimi üzerindeki etkileri açısından karşılaştırılmıştır. PubMed/MEDLINE, Scopus ve Google Scholar veri tabanlarında maksiller genişletme, konvansiyonel genişletme apareyleri, MARPE, hibrit ve kemik destekli genişletme ile maksiller iskeletsel genişletmeye ilişkin anahtar kelimeler kullanılarak literatür taraması gerçekleştirilmiştir. İnsan klinik çalışmaları, karşılaştırmalı çalışmalar ve ilgili derlemelere öncelik verilmiş; temel biyolojik prensipleri ve aparey tasarımlarını açıklayan klasik çalışmalar da değerlendirilmiştir. Konvansiyonel hızlı maksiller genişletme büyüme dönemindeki hastalarda öngörülebilir bir yöntem olmakla birlikte, elde edilen genişlemenin bir kısmı dentoalveolar kaynaklıdır ve bukkal diş devrilmesi ile alveoler kemikte azalmaya neden olabilmektedir. Mini vida destekli sistemler, özellikle geç adölesan ve erişkinlerde iskeletsel genişleme bileşenini artırabilir ve dental yüklenmeyi azaltabilir. Ancak tedavi yanıtı; yaş, sutural direnç, palatal kemik kalınlığı, mini vida konfigürasyonu, kortikal tutunma, aparey rijitliği, aktivasyon protokolü ve periodontal fenotip gibi faktörlerden etkilenmektedir. Güncel kanıtlar evrensel olarak üstün tek bir aparey tasarımını desteklememektedir. Bu nedenle aparey seçimi; iskeletsel maturasyon, gerekli genişletmenin miktarı ve lokalizasyonu, periodontal risk, mevcut ankraj olanakları ve olası tedavi başarısızlığının sonuçları dikkate alınarak bireyselleştirilmelidir. Daha uzun takip sürelerine sahip, standardize edilmiş yüksek kaliteli klinik çalışmalara gereksinim vardır.

Anahtar Kelimeler

• Maksiller Transversal Yetmezlik
• Hızlı Maksiller Genişletme
• MARPE
• Mini Vida Destekli Genişletme

Kaynakça

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