title: Cone-beam computed tomographic comparison of surgically assisted rapid palatal expansion and multipiece Le Fort I osteotomy.
abstract: OBJECTIVE
  To examine and compare the skeletal and dental effects of surgically assisted rapid palatal expansion (SARPE) and multipiece Le Fort osteotomy using cone-beam computed tomography (CBCT).
  
  
  METHODS
  This was a prospective cohort study. Patients underwent SARPE or multipiece Le Fort I osteotomy to address maxillary transverse deficiency. CBCT scans were taken preoperatively, immediately postoperatively or after retention, and at least 6 months postoperatively. Four landmark measurements and ratios of dental-to-skeletal change were used to follow skeletal and dental widths in the posterior and anterior maxillary regions. Wilcoxon signed-rank test and Wilcoxon 2-sample rank-sum test were used to compare the landmark measurements and the ratio of dental-to-skeletal change for the 2 surgeries. A P value less than .05 was statistically significant.
  
  
  RESULTS
  Thirteen patients (mean, 28.3 yr old; 7 women) were enrolled: 9 were treated by multipiece Le Fort I osteotomy and 4 were treated by SARPE. The ratios of dental-to-skeletal expansion in the posterior maxilla for the Le Fort procedure and SARPE were 0.70 ± 0.41 and 25.20 ± 15.8, respectively, and the dental-to-skeletal relapses were 1.17 ± 0.80 and -3.63 ± 3.70, respectively. The ratios of dental-to-skeletal expansion in the anterior maxilla for the Le Fort procedure and SARPE were 0.58 ± 0.38 and 31.80 ± 59.4, respectively, and the dental-to-skeletal relapses were 2.25 ± 3.41 and 4.86 ± 8.10, respectively.
  
  
  CONCLUSIONS
  There was greater correlation between dental and skeletal changes in the multipiece Le Fort procedure, indicating bodily separation of the segments, whereas the SARPE showed noteworthy dental and skeletal tipping. Dental relapse was greater than skeletal relapse for these 2 procedures.
authors.affiliation: Private Practice, Saratoga, CA; Former Resident, Division of Orthodontics, Department of Orofacial Sciences, University of California, San Francisco, CA.
authors.forename: William
authors.initials: W
authors.lastname: Yao
authors.affiliation: Resident, Division of Orthodontics, Department of Orofacial Sciences, University of California, San Francisco, CA.
authors.forename: Sona
authors.initials: S
authors.lastname: Bekmezian
authors.affiliation: Resident, Division of Orthodontics, Department of Orofacial Sciences, University of California, San Francisco, CA.
authors.forename: Dan
authors.initials: D
authors.lastname: Hardy
authors.affiliation: President and CEO, Biomedical Computer Research Institute, Philadelphia, PA.
authors.forename: Harvey W
authors.initials: HW
authors.lastname: Kushner
authors.affiliation: Professor, Division of Orthodontics, Department of Orofacial Sciences, University of California, San Francisco, CA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Miller
authors.affiliation: Private Practice, Moraga, CA; Associate Health Science Professor, Division of Orthodontics, Department of Orofacial Sciences, University of California, San Francisco, CA.
authors.forename: John C
authors.initials: JC
authors.lastname: Huang
authors.affiliation: Deputy Clinical Director, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MA. Electronic address: art.miller@ucsf.edu.
authors.forename: Janice S
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003481:Cuspid / Q000000981:diagnostic imaging; D003724:Dental Arch / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D008963:Molar / Q000000981:diagnostic imaging; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods*; D010155:Palatal Expansion Technique / Q000295:instrumentation; D010159:Palate / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012008:Recurrence; D013165:Splints; D055815:Young Adult