Evaluation of Rapid Maxillary Expansion Facilitated by Micro-osteoperforation in Adolescent Patients With Skeletal Maxillary Constriction

Study Overview
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Brief Summary
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The aim of this study is to evaluate and compare the effect of rapid maxillary expansion with and without microosteoperforation in patients with skeletal maxillary constriction.Theoretically, the force generated by the activation of the Hyrax expander leads initially to the compression of the periodontal ligament, bending of the alveolar bone, and tipping of the anchor teeth. This in turn contributes to the unfavorable changes in the supporting tissues; such as root resorption, buccal crown tipping, reduction of buccal bone thickness, marginal bone loss and alveolar bone fenestration and dehiscence. In this trial, it is assumed that by reducing the cortical bone resistance, using micro-osteoperforation (MOP), the alveolar bone bending and buccal tipping that usually occur during expansion will be reduced and thus facilitating the bone expansion.

Detailed Description
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The study consists of 2 groups that are divided divided equally and randomly.The first group will receive a tooth borne Hyrax expander supported on first premolar and first permanent molar , whereas the second group will receive the same appliance associated with microosteoperforation(MOP). The MOP will be performed on the buccal segment bilaterally along the maxilla starting from the distal of the canine till the distal of the first permanent molar. The assessment will be done using CBCT scans immediately after expansion and 6 months postretention.

Official Title
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Evaluation of Rapid Maxillary Expansion Facilitated by Micro-osteoperforation in Adolescent Patients With Skeletal Maxillary Constriction

Conditions
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Posterior Crossbite

Intervention / Treatment
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* Device: tooth borne hyrax expander
* Procedure: microosteoperforation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female adolescent patients with an age range 11- 14 years. Having apical constricted maxillary arch reflected by posterior cross-bite and verified through Howe's analysis on the dental study models. Normal vertical growth pattern. Fully erupted maxillary first premolars and first permanent molars. Exclusion Criteria: Previous orthodontic treatment. Any congenital anomalies, systemic disease, or asymmetries that might have an influence on tooth movement. Active periodontal affection or severe gingival inflammation.

Ages Eligible for Study
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Minimum Age: 11 Years
Maximum Age: 14 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: tooth borne hyrax expander group<br>patients of this group will receive a tooth borne hyrax expander anchored to the first premolars and first permanent molars . | Device: tooth borne hyrax expander<br>* ready made four stainless steel bands will be supported on the first premolars and first permanent molars and to which the palatal expander will be soldered to form the Hyrax,.The appliance will be activated one quarter turn per day untill reaching maximum amount of lateral expansion of the jack screw. the patients will be recalled twice per week to evaluate the progress of treatment.<br>|
| Experimental: tooth borne hyrax expander with microosteoperforation<br>patients of this group will receive a tooth borne hyrax expander anchored to the first premolars and first permanent molars and microosteoperforation . | Procedure: microosteoperforation<br>* ready made four stainless steel bands supported on the first premolars and first permanent molars and to which the palatal expander will be soldered to form the Hyrax.No activation will be provided to the hyrax expander before the micro-osteoperforation is performed. Microosteoperforation will applied bilaterally on the buccal surface between the roots of teeth at the level of mucoginival junction, starting from the distal of canine till the distal of the first permanent molar using a small sized surgical bur mounted on a hand piece .<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dental tipping. | it will be measured in degree on Cone beam computed tomography image using a software | an average1 year | 
| Alveolar bending | it will be measured in degree on Cone beam computed tomography image using a software | an average1 year | 
| Dental changes(transverse). | it will be measured in mm on Cone beam computed tomography image using a software | an average1 year | 
| Skeletal changes(transverse, anteroposterior and vertical) | it will be measured in mm on Cone beam computed tomography image using a software | an average1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pattern of expansion | it will be assessed on Cone beam computed tomography image and in mm clinically with boley gauge. | an average1 year |