Análise comparativa de expansores maxilares empregados em pacientes com fissura labiopalatina
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Jan 31, 2025
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Resumo
Objetivo: Realizar uma revisão integrativa de literatura para comparar os efeitos causados por diferentes tipos de expansores maxilares em pacientes com fissura labiopalatina (FLP). Métodos: Foi realizada uma revisão nas bases de dados PubMed e Biblioteca Virtual em Saúde (BVS), no período de 2016 a 2023, na língua inglesa e com os descritores “Cleft Palate” e “Palatal Expansion Technique”. Resultados: Após exclusão de duplicatas e leitura dos títulos e resumos, 12 artigos preencheram os critérios de elegibilidade para leitura na íntegra. Expansores Haas/Hyrax, mini-Hyrax, tipo Leque, expansor com abertura diferencial (EDO) ou ósseo palatino suportado foram utilizados para expansão maxilar rápida e Quadrihélice para expansão maxilar lenta. Em geral, Hyrax e Quadrihélice podem ser igualmente indicados. EDO promoveu maior aumento na largura intercanina do que intermolar e o expansor palatino ósseo suportado produziu expansão esquelética alveolar sem efeitos dentários adversos. Considerações finais: Este trabalho compara vários aparelhos destinados à expansão maxilar rápida ou lenta, sendo vantajosa uma maior expansão maxilar em região anterior do que posterior em pacientes com FLP. É essencial que o ortodontista analise, para cada caso clínico, os efeitos causados pelos expansores maxilares, visando atingir resultados eficazes e minimizar possíveis efeitos adversos.
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Como Citar
AlvesA. H. C., SolidônioR. B., SalesS. M., SalgadoA. D. Y., CarvalhoM. L., FonteneleA. L. D., RibeiroL. L., SilvestreF. A., LomonacoD., & MoreiraM. M. (2025). Análise comparativa de expansores maxilares empregados em pacientes com fissura labiopalatina. Revista Eletrônica Acervo Saúde, 25, e15159. https://doi.org/10.25248/reas.e15159.2025
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Revisão Bibliográfica
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Referências
1. ALKADHI OH, et al. Effect of Maxillary Expansion on the Maxillary Arch Width in Patients with Bilateral Cleft Palate: A Review. Children, 2023; 10(5): 762.
2. ALLAREDDY V, et al. Orthodontic Preparation for Secondary Alveolar Bone Grafting in Patients with Complete Cleft Lip and Palate. Oral Maxillofac Surg Clin North Am., 2020; 32(2): 205-217.
3. ALVES ACM, et al. Maxillary expander with differential opening vs Hyrax expander: A randomized clinical trial. Am J Orthod Dentofacial Orthop., 2020; 157(1): 7-18.
4. AYUB PV, et al. Intercenter comparison of slow and rapid maxillary expansion in unilateral complete cleft lip and palate. Dental Press J Orthod., 2022; 27(3): e2220233.
5. BITTENCOURT DUTRA DOS SANTOS P, et al. Association Between Dental Arch Widths and Interarch Relationships in Children With Operated Unilateral Complete Cleft Lip and Palate. Cleft Palate Craniofac J., 2015; 52(6): e196-200.
6. BRUNETTO M, et al. Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study. Am J Orthod Dentofacial Orthop., 2013; 143: 633-44.
7. CALIL LR, et al. Comparison of conventional and differential rapid maxillary expansion in patients with complete bilateral cleft lip and palate: evaluation by means of digital dental models. Internacional de fissuras orofaciais e anomalias relacionadas. 2015.
8. CASSI D, et al. Dentoalveolar Effects of Early Orthodontic Treatment in Patients With Cleft Lip and Palate., J Craniofac Surg., 2017; 28(8): 2021-2026.
9. CARDINAL L, et al. The impact of rapid maxillary expansion on maxillary first molar root morphology of cleft subjects. Clin Oral Investig., 2018; 22(1): 369-376.
10. DALESSANDRI D, et al. Rapid palatal expander vs. quad-helix in the orthodontic treatment of cleft lip and palate patients. Minerva Stomatol., 2016; 65(2): 97-103.
11. DE ALMEIDA AM, et al. Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial. Clin Oral Investig., 2017; 21(5): 1789-1799.
12. DE MEDEIROS ALVES AC, et al. Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial. Clin Oral Investig., 2016; 20: 1837–1847.
13. FIGUEIREDO DS, et al. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop., 2014; 146(1): 73-81.
14. FIGUEIREDO DS, et al. Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders. Dental Press J Orthod., 2016; 21(6): 82-90.
15. FRANCISCO I, et al. Cleft Orthodontic Care in Europe: A Cross-Sectional Survey. Healthc, 2022; 10(8): 1555.
16. FREITAS JA, et al. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRACUSP)–part 2: pediatric dentistry and orthodontics. J Appl Oral Sci., 2012; 20: 268–281.
17. GARIB D, et al. Dentoskeletal outcomes of a rapid maxillary expander with differential opening in patients with bilateral cleft lip and palate: A prospective clinical trial. Am J Orthod Dentof Orthop., 2016; 150(4): 564-574.
18. GARIB D, et al. Orthopedic outcomes of hybrid and conventional Hyrax expanders. Angle Orthod., 2021; 91(2): 178-186.
19. GRAÇA IC, et al. Condylar Changes after Maxillary Expansion in Children with Cleft Lip and Palate-A Three-Dimensional Retrospective Study. Biomimetics (Basel), 2022; 7(2): 73.
20. GREGÓRIO L, et al. Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial. Angle Orthod., 2019; 89(4): 583-589.
21. HEIDBUCHEL KL, et al. Effects of early treatment on maxillary arch development in BCLP. A study on dental casts between 0 and 4 years of age. J Craniomaxillofac Surg., 1998; 26(3): 140-7.
22. INCHINGOLO AD, et al. Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report. Children (Basel), 2022; 9(7): 1046.
23. JAIN S, et al. Maxillary expansion in cleft lip and palate cases- a review. International Journal of Advanced Research, 2015; 3(9): 1455-1461.
24. LAGRAVERE MO, et al. Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial. Am J Orthod Dentofacial Orthop., 2010; 137(3): 304.e1-12.
25. LEE KJ, et al. Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism. Am J Orthod Dentofacial Orthop., 2010; 137: 830–9.
26. LI WR. Stability of orthodontic treatment in the patients with cleft lip and palate. Zhonghua Kou Qiang Yi Xue Za Zhi, 2018; 53(9): 585-589.
27. LIU Y, et al. Suture cartilage formation pattern varies with different expansive forces. Am J Orthod Dentofacial Orthop. 2014; 146(4): 442-450.
28. MARAZITA ML e MOONEY MP. Current concepts in the embryology and genetics of cleft lip and cleft palate. Clin Plast Surg., 2004; 31(2): 125-40.
29. MATHEW A, et al. Stress and displacement pattern evaluation using two different palatal expanders in unilateral cleft lip and palate: a three-dimensional finite element analysis. Prog Orthod., 2016; 17(1): 38.
30. MEAZZINI MC, et al. Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J., 2019; 56(2): 159-167.
31. MENG WY, et al. The comparison of biomechanical effects of the conventional and bone-borne palatal expanders on late adolescence with unilateral cleft palate: a 3-dimensional finite element analysis. BMC Oral Health, 2022; 22(1): 600.
32. MORDENTE CM, et al. Upper airway assessment using four different maxillary expanders in cleft patients: A cone-beam computed tomography study. Angle Orthod., 2016; 86(4): 617-24.
33. OKADA W, et al. Interdisciplinary treatment of an adult with complete bilateral cleft lip and palate. Am J Orthod Dentofacial Orthop., 2012; 141(4 Suppl): S149-58.
34. OZAWA TO, et al. Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial. Orthod Craniofac Res., 2021; 24(2): 288-295.
35. PUGLIESE F, et al. Dental arch size and shape after maxillary expansion in bilateral complete cleft palate: A comparison of three expander designs. Angle Orthod., 2020; 90(2): 233-238.
36. ROCHA MO, et al. Plaque index and gingival index during rapid maxillary expansion of patients with unilateral cleft lip and palate. Dental Press J Orthod., 2017; 22(6): 43-48.
37. RUTILI V, et al. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Prog Orthod., 2022; 23(1): 47.
38. SINGH H, et al. Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial. Braz J Otorhinolaryngol., 2021; 87(3): 315-325.
39. WAHAJ A e AHMED I. Comparison of Intercanine and Intermolar Width Between Cleft Lip Palate and Normal Class I Occlusion Group. J Coll Physicians Surg Pak, 2015; 25(11): 811-4.
40. WORLEY ML, et al. Cleft Lip and Palate. Clin. Perinatol, 2018.
2. ALLAREDDY V, et al. Orthodontic Preparation for Secondary Alveolar Bone Grafting in Patients with Complete Cleft Lip and Palate. Oral Maxillofac Surg Clin North Am., 2020; 32(2): 205-217.
3. ALVES ACM, et al. Maxillary expander with differential opening vs Hyrax expander: A randomized clinical trial. Am J Orthod Dentofacial Orthop., 2020; 157(1): 7-18.
4. AYUB PV, et al. Intercenter comparison of slow and rapid maxillary expansion in unilateral complete cleft lip and palate. Dental Press J Orthod., 2022; 27(3): e2220233.
5. BITTENCOURT DUTRA DOS SANTOS P, et al. Association Between Dental Arch Widths and Interarch Relationships in Children With Operated Unilateral Complete Cleft Lip and Palate. Cleft Palate Craniofac J., 2015; 52(6): e196-200.
6. BRUNETTO M, et al. Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study. Am J Orthod Dentofacial Orthop., 2013; 143: 633-44.
7. CALIL LR, et al. Comparison of conventional and differential rapid maxillary expansion in patients with complete bilateral cleft lip and palate: evaluation by means of digital dental models. Internacional de fissuras orofaciais e anomalias relacionadas. 2015.
8. CASSI D, et al. Dentoalveolar Effects of Early Orthodontic Treatment in Patients With Cleft Lip and Palate., J Craniofac Surg., 2017; 28(8): 2021-2026.
9. CARDINAL L, et al. The impact of rapid maxillary expansion on maxillary first molar root morphology of cleft subjects. Clin Oral Investig., 2018; 22(1): 369-376.
10. DALESSANDRI D, et al. Rapid palatal expander vs. quad-helix in the orthodontic treatment of cleft lip and palate patients. Minerva Stomatol., 2016; 65(2): 97-103.
11. DE ALMEIDA AM, et al. Slow versus rapid maxillary expansion in bilateral cleft lip and palate: a CBCT randomized clinical trial. Clin Oral Investig., 2017; 21(5): 1789-1799.
12. DE MEDEIROS ALVES AC, et al. Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial. Clin Oral Investig., 2016; 20: 1837–1847.
13. FIGUEIREDO DS, et al. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop., 2014; 146(1): 73-81.
14. FIGUEIREDO DS, et al. Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders. Dental Press J Orthod., 2016; 21(6): 82-90.
15. FRANCISCO I, et al. Cleft Orthodontic Care in Europe: A Cross-Sectional Survey. Healthc, 2022; 10(8): 1555.
16. FREITAS JA, et al. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRACUSP)–part 2: pediatric dentistry and orthodontics. J Appl Oral Sci., 2012; 20: 268–281.
17. GARIB D, et al. Dentoskeletal outcomes of a rapid maxillary expander with differential opening in patients with bilateral cleft lip and palate: A prospective clinical trial. Am J Orthod Dentof Orthop., 2016; 150(4): 564-574.
18. GARIB D, et al. Orthopedic outcomes of hybrid and conventional Hyrax expanders. Angle Orthod., 2021; 91(2): 178-186.
19. GRAÇA IC, et al. Condylar Changes after Maxillary Expansion in Children with Cleft Lip and Palate-A Three-Dimensional Retrospective Study. Biomimetics (Basel), 2022; 7(2): 73.
20. GREGÓRIO L, et al. Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial. Angle Orthod., 2019; 89(4): 583-589.
21. HEIDBUCHEL KL, et al. Effects of early treatment on maxillary arch development in BCLP. A study on dental casts between 0 and 4 years of age. J Craniomaxillofac Surg., 1998; 26(3): 140-7.
22. INCHINGOLO AD, et al. Rapid Maxillary Expansion on the Adolescent Patient: Systematic Review and Case Report. Children (Basel), 2022; 9(7): 1046.
23. JAIN S, et al. Maxillary expansion in cleft lip and palate cases- a review. International Journal of Advanced Research, 2015; 3(9): 1455-1461.
24. LAGRAVERE MO, et al. Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial. Am J Orthod Dentofacial Orthop., 2010; 137(3): 304.e1-12.
25. LEE KJ, et al. Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism. Am J Orthod Dentofacial Orthop., 2010; 137: 830–9.
26. LI WR. Stability of orthodontic treatment in the patients with cleft lip and palate. Zhonghua Kou Qiang Yi Xue Za Zhi, 2018; 53(9): 585-589.
27. LIU Y, et al. Suture cartilage formation pattern varies with different expansive forces. Am J Orthod Dentofacial Orthop. 2014; 146(4): 442-450.
28. MARAZITA ML e MOONEY MP. Current concepts in the embryology and genetics of cleft lip and cleft palate. Clin Plast Surg., 2004; 31(2): 125-40.
29. MATHEW A, et al. Stress and displacement pattern evaluation using two different palatal expanders in unilateral cleft lip and palate: a three-dimensional finite element analysis. Prog Orthod., 2016; 17(1): 38.
30. MEAZZINI MC, et al. Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J., 2019; 56(2): 159-167.
31. MENG WY, et al. The comparison of biomechanical effects of the conventional and bone-borne palatal expanders on late adolescence with unilateral cleft palate: a 3-dimensional finite element analysis. BMC Oral Health, 2022; 22(1): 600.
32. MORDENTE CM, et al. Upper airway assessment using four different maxillary expanders in cleft patients: A cone-beam computed tomography study. Angle Orthod., 2016; 86(4): 617-24.
33. OKADA W, et al. Interdisciplinary treatment of an adult with complete bilateral cleft lip and palate. Am J Orthod Dentofacial Orthop., 2012; 141(4 Suppl): S149-58.
34. OZAWA TO, et al. Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial. Orthod Craniofac Res., 2021; 24(2): 288-295.
35. PUGLIESE F, et al. Dental arch size and shape after maxillary expansion in bilateral complete cleft palate: A comparison of three expander designs. Angle Orthod., 2020; 90(2): 233-238.
36. ROCHA MO, et al. Plaque index and gingival index during rapid maxillary expansion of patients with unilateral cleft lip and palate. Dental Press J Orthod., 2017; 22(6): 43-48.
37. RUTILI V, et al. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Prog Orthod., 2022; 23(1): 47.
38. SINGH H, et al. Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial. Braz J Otorhinolaryngol., 2021; 87(3): 315-325.
39. WAHAJ A e AHMED I. Comparison of Intercanine and Intermolar Width Between Cleft Lip Palate and Normal Class I Occlusion Group. J Coll Physicians Surg Pak, 2015; 25(11): 811-4.
40. WORLEY ML, et al. Cleft Lip and Palate. Clin. Perinatol, 2018.