Dento-skeletal effect of maxillary expansion appliances in growing children and adolescents with transverse deficiency: a network meta-analysis.

OBJECTIVES

To quantitatively analyze the dentoskeletal effect of various maxillary expansion appliances on growing children and adolescents with transverse maxillary arch deficiency three-dimensionally and to establish the direct and indirect relationship of various maxillary expansion appliances.

MATERIALS AND

METHODS

A comprehensive electronic literature search was conducted through 31 March 2025, using major health science databases. Studies that fulfilled the PICOS inclusion criteria were included. The ROBINS-I and the Cochrane RoB 2 tool was used for the quality assessment of non-randomized and randomized studies, respectively. A random-effects inverse-variance meta-analysis was used to pool the results. Outcome variables assessed were inter-molar width (IMW), maxillary width (MW), nasal width (NW), buccolingual tipping, and alveolar bone thickness. Subgroup analyses were performed by age and study design. Confidence ratings were given using CINeMA.

RESULTS

For dento-skeletal changes, Hybrid Hyrax and MARPE produced significantly higher increases in NW [mean difference, MD: 0.80 (95% confidence interval, CI: 0.43; 1.17); P < .0001 and MD: 0.83 (95% CI: 0.45; 1.20); P < .0001], respectively, whereas Leaf Expander showed significantly smaller increase in NW [MD: -1.24; (95% CI: -2.08; -0.040); P = .0037]. Hybrid Hyrax and MARPE had the highest probability of being ranked first, and Leaf Expander the last. For the effect on the periodontium, Quad Helix was least desirable, producing the greatest buccolingual tipping MD: 1.40 (95% CI: 0.50; 2.30); P = .002].

CONCLUSION

Due to low to moderate level of evidence, findings of the network analysis should be interpreted with caution. The network meta-analysis showed that all appliances increased IMW, MW, without significant differences. MARPE and Hybrid Hyrax were more effective in expanding the nasal cavity width. The Quad Helix showed increased buccolingual tipping with reduced buccal bone thickness and increased palatal bone thickness compared with others. Further high-quality studies are required to obtain more robust results.