title: Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial.
abstract: OBJECTIVE
  The purpose of this "two-arm parallel" trial was to compare the orthopedic, dental, and alveolar bone plate changes of slow (SME) and rapid (RME) maxillary expansions in patients with complete bilateral cleft lip and palate (BCLP).
  
  
  METHODS
  Forty-six patients with BCLP and maxillary arch constriction in the late mixed dentition were randomly and equally allocated into two groups. Computer-generated randomization was used. Allocation was concealed with sequentially, numbered, sealed, opaque envelopes. The SME and RME groups comprised patients treated with quad-helix and Haas/Hyrax-type expanders, respectively. Cone-beam computed tomography (CBCT) exams were performed before expansion and 4 to 6 months post-expansion. Nasal cavity width, maxillary width, alveolar crest width, arch width, palatal cleft width, inclination of posterior teeth, alveolar crest level, and buccal and lingual bone plate thickness were assessed. Blinding was applicable for outcome assessment only. Interphase and intergroup comparisons were performed using paired t tests and t tests, respectively (p < 0.05).
  
  
  RESULTS
  SME and RME similarly promoted significant increase in all the maxillary transverse dimensions at molar and premolar regions with a decreasing expanding effect from the dental arch to the nasal cavity. Palatal cleft width had a significant increase in both groups. Significant buccal inclination of posterior teeth was only observed for RME. Additionally, both expansion procedures promoted a slight reduction of the alveolar crest level and the buccal bone plate thickness.
  
  
  CONCLUSIONS
  No difference was found between the orthopedic, dental, and alveolar bone plate changes of SME and RME in children with BCLP. Both appliances produced significant skeletal transverse gains with negligible periodontal bone changes. Treatment time for SME, however, was longer than the observed for RME.
  
  
  CONCLUSIONS
  SME and RME can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.
authors.affiliation: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Sílvio Marchione, 3-20, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-900, Brazil.
authors.forename: Araci Malagodi
authors.initials: AM
authors.lastname: de Almeida
authors.affiliation: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Rua Sílvio Marchione, 3-20, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-900, Brazil.
authors.forename: Terumi Okada
authors.initials: TO
authors.lastname: Ozawa
authors.affiliation: Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-901, Brazil. arthurcesar_88@hotmail.com.
authors.forename: Arthur César de Medeiros
authors.initials: ACM
authors.lastname: Alves
authors.affiliation: Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-901, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Janson
authors.affiliation: Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru Dental School, University of São Paulo, Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-901, Brazil.
authors.forename: José Roberto Pereira
authors.initials: JRP
authors.lastname: Lauris
authors.affiliation: Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-901, Brazil.
authors.forename: Marilia Sayako Yatabe
authors.initials: MSY
authors.lastname: Ioshida
authors.affiliation: Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Doutor Octávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, São Paulo, Bauru, ZIP CODE 17012-901, Brazil.
authors.forename: Daniela Gamba
authors.initials: DG
authors.lastname: Garib
mesh_terms: D002648:Child; D002971:Cleft Lip / Q000000981:diagnostic imaging* / Q000628:therapy*; D002972:Cleft Palate / Q000000981:diagnostic imaging* / Q000628:therapy*; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008297:Male; D010155:Palatal Expansion Technique / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Cleft lip; Cleft palate; Cone-beam computed tomography; Palatal expansion technique