The Effect And Stability In Patients After Surgically Assisted Rapid Maxillary Expansion:A Meta-Analysis

Objective: The aim of this systematic review was to analyze the effect and stability in patients with maxillary transverse deficiency(MTD)submitted to surgically assisted rapid maxillary expansion(SARME),in order to provide some scientific basis for the treatment of such patients.Methods: A literature search,only in Chinese and English,of PubMed,Medline,EMBASE,Central Register of Controlled Trials,Cochrane library,CNKI,Wanfang,CBM,etc.from the inception to May 31,2015 was conducted comprehensively to collected the randomized controlled trials(RCT)and non-randomized controlled trials,like controlled clinical trials(CCT),retrospective cases study,prospective cases study,etc.about the stability of MTD after SARME.Two reviewers with professional training made the literature selection following the inclusion and exclusion criteria,and used the methodological index for nonrandomized studies(MINORS)to evaluated the screend literature,then collected data and information of the medium and higher quality literatures critically and independently.The extracted information was analyzed using Revman5.3 while the others were evaluated by descriptive analysis.The weighted mean difference(WMD)and 95% confidence interval(95%CI)were pooled.The effects and stability in patients with MTD submitted to SARME were evaluated mainly by the change of teeth,maxilla,nasal cavity.Results: Totally 13 studies and 403 cases,12 ranked as moderate quality and 1 ranked as high quality,were included.The results of Meta-analysis showed that: 1.The stability of the teeth: The difference of the first molar(WMD=-1.03,95%CI:-2.00~-0.06),canine(WMD=-1.26,95%CI:-2.02~-0.49)at post-operation and the follow-up had statistical significance.The intermolar width and the intercanine width had a little relapse,about 1.03 mm and 1.26 mm respectively;2.The long term effect of the teeth: the difference of the first molar(WMD=5.15,95%CI:4.03~6.28),canine(WMD=3.89,95%CI:2.98~4.80)at preoperation and the follow-up had statistical significance.The intermolar width increased about 5.15 mm,and the intercanine width increased about 3.89mm;3.the stability of the maxilla: the maxillary alveolar width of the first molar(WMD=-0.43,95%CI:-1.82~0.97)at post-operation and the follow-up had no statistical significance,showing a long term stability;4,The long term effect of the maxillar: the maxillary alveolar width of the first molar(WMD=3.28,95%CI:1.91 ~ 4.64)at preoperation and the follow-up had statistical significance.The maxillary alveolar width increased about 3.28mm;5.The long term effect and stability of the nasal airway: there wasn't enough information to make the meta-analysis because of the variety in the method and the time of the measurement,so just made descriptive analysis: in the short term,the function of the nasal airway improved significantly,while in the long term it needed further confirmation.Conclusion: Based on the available evidence,the intercanine width and the intermolar width and the maxillary alveolar width of the patients with maxillary transverse deficiency had a significant increase which kept a good stbility with only a little relapse in the teeth as a result of surgically assisted rapid maxillary expansion.The nasal airway improved significantly in the short term,but the long-term effects and the stability needed further research.There was limited high-quality literature and a lack of randomized controlled trials in the final studys included of this research,which somehow affected the reliability of the results.This conclusion still needed to be further proved by more high-quality,strictly-designed,multicenter,large-scale researchs.