title: Surgically Assisted Rapid Palatomaxillary Expansion With or Without Pterygomaxillary Disjunction: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  The purpose of this review was to evaluate the outcome measurements of anterior expansion, posterior expansion, and complications after surgically assisted rapid palatal expansion (SARPE) with or without pterygomaxillary disjunction (PMD).
  
  
  METHODS
  A computerized database search was performed using PubMed, CINAHL, Cochrane, Scopus, and Web of Science. Then, a computerized search was conducted in Google Scholar and ProQuest to overcome publication bias.
  
  
  RESULTS
  From the original 125 combined results, 3 met the inclusion criteria. The Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project assessed 2 articles as weak and 1 as moderate. The systematic review included a total of 48 patients (11 male and 37 female). For 25 patients, SARPE was performed with PMD and for 23 patients SARPE was performed without PMD. A tooth-borne fixed hyrax-type palatal expansion screw appliance was used for all cases, activated 1 to 2 mm intraoperatively, and, after a latency period of 3 to 7 days, activated 0.5 to 0.6 mm per day for 38 patients and 0.25 mm for the other 10 until adequate expansion. Postexpansion retention was performed using ligature wired hyrax in 18 patients for 4 months. Comparisons were based on cone-beam computed tomographic projections, study models only, or a combination of study models, anteroposterior cephalometric radiographs, and occlusal radiographs. The time to measure the changes ranged from before fixed orthodontic retention to 6 months after the completion of active expansion. A meta-analysis was possible only for anterior (intercanine) and posterior (inter-molar) dental expansions.
  
  
  CONCLUSIONS
  The literature is inconclusive regarding the effect of PMD on the outcomes of SARPE. Further controlled trials are needed.
authors.affiliation: Senior Student of Dentistry, University of California-Los Angeles, Los Angeles, CA. Electronic address: ahsangsari@ucla.edu.
authors.forename: Adrien
authors.initials: A
authors.lastname: Hamedi Sangsari
authors.affiliation: Senior Student, Professional Program for International Dentists, School of Dentistry, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Pooyan
authors.initials: P
authors.lastname: Sadr-Eshkevari
authors.affiliation: Senior Consultant Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Dam
authors.affiliation: Senior Registrar, Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Reinhard E
authors.initials: RE
authors.lastname: Friedrich
authors.affiliation: Professor, Department of Clinical Dentistry; Chair, Division of Diagnostic and Surgical Sciences; Chair, Section of Oral and Maxillofacial Surgery, School of Dentistry, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Earl
authors.initials: E
authors.lastname: Freymiller
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Rashad
mesh_terms: D002508:Cephalometry / Q000379:methods; D054893:Cone-Beam Computed Tomography / Q000379:methods; D006801:Humans; D016382:Orthodontic Appliance Design; D009967:Orthodontic Appliances; D010155:Palatal Expansion Technique / Q000295:instrumentation; D010159:Palate / Q000601:surgery*; D056739:Pterygopalatine Fossa / Q000601:surgery*