Polygraphic Evaluation of the Effects of Different Rapid Maxillary Expansion Appliances on Sleep Quality
Condition: Sleep Apnea Syndromes; Palatal Expansion Technique
MeSH terms: Sleep Apnea Syndromes
Study type: Interventional

Summary: 
      Rapid maxillary expansion (RME) is a commonly used orthodontic treatment in patients with
      maxillary constriction to provide skeletal expansion, correct posterior crossbite and resolve
      naso-respiratory problems by reducing oral respiration.The aim of this randomized controlled
      trial was to evaluate the effects of tooth-borne, tooth tissue-borne and bone-borne RME
      appliances on sleep quality with polygraphy. The null hypothesis was that there is no
      difference for the sleep quality between the appliances.
    

Detailed description: 
      Introduction. The aim of this 3-arm randomized controlled trial (RCT) was to evaluate the
      effects of tooth tissue-borne (KBME), tooth-borne (Hyrax), and bone-borne (MIDME) rapid
      maxillary expansion (RME) appliances on sleep quality with polygraphy.

      Methods. This study was designed in parallel with an allocation ratio of 1:1:1. 46 patients
      with narrow maxilla and OSAS were included in this study and randomly assigned to three
      groups: tooth tissue-borne, tooth-borne and bone-borne expanders. Participants were
      congregated from the Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi
      University, Turkey. In all groups, the expansion appliance was activated one-quarter turn
      twice a day until the desired suture opening was achieved. The primary outcome of this study
      was the correction of posterior crossbite. Secondary outcomes included polygraphic assessment
      of sleep parameters. Each subject participated in 1 overnight sleep test with polygraphy
      before the expansion (T0) and after a 3-month retention phase of treatment (T1). According to
      the results of polygraphy, 7 parameters; (apnea hypopnea index (AHI), number of apnea and
      hypopnea, desaturation index, lowest desaturation, average saturation, supin AHI) were
      examined to evaluate the changes in sleep scores. Kruskal-Wallis analysis and Dunn-Bonferroni
      test were used for inter-group comparisons and Wilcoxon analysis was used for intra-group
      evalaution. P<0.05 was accepted statistically significant. Computer-generated randomization
      was used with group allocation concealed using opaque, sealed envelopes. The outcome assessor
      was blinded to group assignment. The outcome assessor was blinded; however, it was not
      feasible to blind either operator or patients.
    

Intervention name(s): Rapid Maxillary Expansion Treatment
Intervention type(s): Procedure
Intervention description(s): The patients were treated with KBME, Hyrax and MIDME maxillary expansion appliances, respectively. All expansion appliances containing a Hyrax expansion screw positioned parallel to the second premolars and were used to correct the posterior crossbite. In the MIDME group, two mini-screws with a diameter of 1.6 mm and a length of 10 mm are located on the right and left sides between the roots of the 2nd premolar and 1st molar teeth with 60-70° angle. KBME and Hyrax expansion appliances were cemented with glass ionomer cement and MIDME was cemented with using the light-cured composite. Same protocol was applied to all patients during RME treatment. Expansion screws in all groups were activated by two turns a day.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 3-arm parallel trial
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Polygraphy; Obstructive Sleep Apnea; Rapid Maxillary Expansion