## 4 Discussion
### Treatment Effects at Different CVM Stages  
The recent appearance of miniscrew-supported palatal expanders, both tooth-bone-borne (tooth and miniscrews) and bone-borne devices, has widened the opportunity to correct transversal maxillary deficiency in adult patients. Previously published articles suggested that the midpalatal suture interdigitation becomes closer with age and skeletal maturity [32; 33]. They report that routine clinical applications of tooth-borne expanders are limited to younger and growing patients, with a different device design. The use of skeletal anchorage with two or four miniscrews as points of resistance to the applied expansion force allows a skeletal effect in adult patients as well, with minimum or negligible dental compensation. Studies conducted using CBCT to measure maxillary expansion in adult patients produced different results, compared to tooth-borne palatal expanders with miniscrew-supported devices. Molar-supporting expanders allow dentoalveolar expansion with significant molar buccal inclination (3.65\({}^{\circ}\) [PERSON] et al.) and maxillary bending of 3.65\({}^{\circ}\), resulting in a poor skeletal effect. Bone-borne devices showed limited dental and maxillary bending, allowing a significant bone expansion at the sutural level [12; 18]. These results are similar to those found in the present study, where the expansion produced almost no effect on the first molar torque values (values ranged between \(-\)0.08 to 2.15). More \begin{table}
\begin{tabular}{c c c c c} \hline \hline  & **Group 1 (CS1–CS2)** & **Group 2 (CS3–CS4)** & **Group 3 (CS5–CS6)** & **Intergroup** \\ \cline{2-5}  & **T1–T0** & **T1–T0** & **T1–T0** & **_p-Value_ \\ \hline
**N** & 21 & 28 & 19 & \\ \hline
**Torque (\({}^{\circ}\))** & & & & \\ \hline \(1.6\) & \(-0.60\pm 4.76\) & \(-2.17\pm 8.43\) & \(-0.62\pm 5.43\) & \\ \hline \(p\)-_value_ & _0.567_ & _0.185_ & _0.624_ & \\ \hline \(1.5\) & \(8.04\pm 7.21\) & \(4.25\pm 6.90\) & \(6.32\pm 6.63\) & \\ \hline \(p\)-_value_ & _0.067_ & _0.009_ & \(<\)_0.001_ & \\ \hline \(1.4\) & \(4.00\) [1.55, 11.35] & \(1.65\) [\(-2.35\), 8.35] & \(5.20\) [2.10, 9.35] & \\ \hline \(p\)-_value_ & _0.083_ & _0.161_ & _0.001_ & \\ \hline \(1.3\) & \(-0.40\) [\(-1.12\), 4.70] & \(-1.35\) [\(-7.98\), 2.52] & \(-0.75\) [\(-3.85\), 0.62] & \\ \hline \(p\)-_value_ & _1.000_ & _0.284_ & _0.338_ & \\ \hline \(2.3\) & \(2.70\) [\(-4.45\), 5.60] & \(-2.80\) [\(-4.60\), 1.40] & \(-2.20\) [\(-7.00\), 3.00] & \\ \hline \(p\)-_value_ & _0.765_ & _0.194_ & _0.145_ & \\ \hline \(2.4\) & \(6.99\pm 6.66\) & \(2.50\pm 5.99\) & \(5.45\pm 7.54\) & \\ \hline \(p\)-_value_ & _0.006_ & _0.036_ & _0.005_ & \\ \hline \(2.5\) & \(1.30\pm 2.05\) & \(4.11\pm 8.19\) & \(2.09\pm 7.22\) & \\ \hline \(p\)-_value_ & _0.387_ & _0.028_ & _0.224_ & \\ \hline \(2.6\) & \(-0.08\pm 7.77\) & \(-1.72\pm 6.51\) & \(-1.42\pm 6.46\) & \\ \hline \(p\)-_value_ & _0.965_ & _0.173_ & _0.35_ & \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Differences over time in torque measurements (N = 68). Results are expressed as mean \(\pm\) standard deviation or median [interquartile range]; intergroup _p_-value = one-way analysis of variance with group as factor or Kruskal-Wallis test _p_-value. Intragroup T1-T0 _p_-value = paired _t_-test _p_-value, or [PERSON]’s signed rank test _p_-value. changes were found at the premolar level, with values as high as 8.05\({}^{\circ}\), but even at this level, no differences were found among the three groups. At the canine level, no significant differences were found intergroup or over time, except for the right canine in Group 1, which showed an approximately 9\({}^{\circ}\) change. Effects of hybrid expanders on young and older patients were evaluated by [PERSON] et al. in 2016, comparing CBCTs before and after appliance removal; the therapy proved to be effective and gave positive skeletal effects with mild molar tipping, even though the older subjects appeared to have more dental tipping [34].