The effect of maxillary protraction, with or without rapid palatal expansion, on airway dimensions: A systematic review and meta-analysis

Authors:

ABSTRACT

Aim

The use of maxillary protraction appliances (MPAs) and Facemask (FM), with or without a rapid maxillary expansion
(RME), have become a routine orthopaedic treatment procedure for the treatment of Class III in growing individuals; several authors
have suggested that maxillary protraction could have a positive impact on airway dimensions. The purpose of this systematic review and
meta-analysis was to assess the efficacy of maxillary protraction appliances (MPAs), with or without a rapid maxillary expansion (RME),
on airway dimensions in children in mixed or early permanent dentition.

Methods

An electronic search was
performed on PubMed, Medline, Scopus, The Cochrane Library, EMBASE and the System for Information on Grey Literature in Europe
until November 30th, 2019. The Newcastle-Ottawa (NOS) scale was used to assess the studies’ quality. Review Manager 5.3 (provided
by the Cochrane Collaboration) was used to synthesize the effects on airway dimensions.

Results

After full text assessment, 8
studies were included in the qualitative and quantitative synthesis. NOS scores ranged 6 to 9 indicating high quality. The effects of two
therapeutic protocols were compared, treatment with MPAs only (113 subjects treated - 65 controls) and the treatment with MPAs +
RME (137 subjects treated- 87 controls). The MPAs only treatment group displayed a significantly increase in nasopharyngeal airway
dimension at PNS-AD1 (random: mean difference, 1.39 mm, 95% CI, 0.32 mm, 2.47 mm, p= 0.01) and at PNS-AD2 (random: mean
difference, 1.70 mm, 95% CI, 1.14 mm, 2.26 mm, p= 0.00001). No statistically significant changes were found post treatment in MPAs +
RME treatment groups at PNS-AD1 (P= 0.15), PNS-AD2 (P= 0.17), McNamara’s upper pharynx (MPAs + RME P= 0.05, MPAs P= 0.99)
and McNamara lower pharynx (MPAs + RME P= 0.25, MPAs P= 0.40).

Conclusion

MPAs only treatment can increase the
pharyngeal thickness after treatment both at PNS-A1 and PNS-AD2. MPA+ RME had no effect on sagittal widths compared with
controls, but the effect on the transverse dimension could not be assessed.

PLUMX METRICS