Journal of Cranio-Maxillo-Facial Surgery xxx (2014) 1e6

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Journal of Cranio-Maxillo-Facial Surgery

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Short-term skeletal and dental changes following bone-borne versus

tooth-borne surgically assisted rapid maxillary expansion: A
randomized clinical trial studyq
Mohammad Zandi a, Amirfarhang Miresmaeili b, *, Ali Heidari a
a
Department of Oral and Maxillofacial Surgery (Head: Mohammad Zandi, DDS, MSc.), Hamedan University of Medical Sciences, Hamedan, Iran
b
Department of Orthodontics (Head: Amirfarhang Miresmaeili, DDS, MSc.), Hamedan University of Medical Sciences, Shahid Fahmideh Street, Hamedan,
Iran

a r t i c l e i n f o a b s t r a c t

Article history: Aim: To evaluate and compare the short-term (post-retention) skeletal and dental changes following
Paper received 27 November 2013 bone-borne and tooth-borne surgically assisted rapid maxillary expansion (SARME) using cone beam
Accepted 10 February 2014 computed tomography (CBCT).
Subjects and methods: In this randomized clinical study, 30 patients with transverse maxillary deficiency
Keywords: underwent either tooth-borne (n ¼ 15) or bone-borne (n ¼ 15) SARME. Before treatment and immedi-
Tooth-borne
ately after the consolidation period, CBCT was obtained and the nasal floor width, interdental root dis-
Bone-borne
tance, palatal bone width and interdental cusp distance were measured at first premolar and first molar
Rapid maxillary expansion
Cone beam computed tomography
regions of maxilla.
Results: Twenty eight patients completed the study protocol. In both tooth-borne (n ¼ 13) and bone-
borne (n ¼ 15) groups the highest degree of expansion occurred in the dental arch, followed by
palatal bone, and nasal floor (V-shaped widening in coronal dimension). The amount and pattern of
expansion was comparable between anterior and posterior maxillary regions in each group (parallel
posteroanterior expansion) and between the two groups.
Conclusion: Dental and skeletal effects of tooth-borne and bone-borne devices were comparable. The
overall complication rate was negligible. Selection of an expansion device should be based on each in-
dividual patient’s requirements. Future long-term clinical trial studies to evaluate the stability and
relapse of these two techniques are recommended.
Ó 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights
reserved.

1. Introduction the midpalatal and lateral maxillary sutures and increased skeletal
resistance, surgically assisted rapid maxillary expansion (SARME) is
Maxillary transverse (horizontal) deficiency may exist as an the treatment of choice. In these cases, traditionally, a tooth-borne
isolated entity or may be associated with other dentofacial de- palatal expander (Hass or Hyrax appliance) is used to do the
formities such as cleft palate, mandibular prognathism, mandibular maxillary expansion. Because these appliances are fixed to the
deficiency, and anterior open bite. It is typically characterized by teeth, they deliver a large amount of force into the anchor teeth,
unilateral or bilateral crossbites, crowded teeth, and a constricted periodontal tissues, and alveolar bone during expansion, and may
and tapered maxillary arch. In children and growing adolescents, cause buccal tipping of the anchor teeth, outward rotation of the
conventional orthodontic rapid maxillary expansion can success- palatal bone segments, and complications such as buccal root
fully be accomplished to treat maxillary constriction. However, in exposure of anchor teeth, periodontal problems, buccal root
non-growing adolescents and adult patients, because of fusion of resorption, and speech difficulties (Harzer et al., 2006; Aziz and
Tanchyk, 2008; Koudstaal et al., 2009; Verstraaten et al., 2010). To
q The trial is registered at irct.ir, number IRCT138904124303N1.
avoid these complications, several types of bone-borne devices,
* Corresponding author. Tel.: þ98 811 8239064, þ98 9121395653 (mobile);
which deliver expansion force directly to the palatal bone, have
fax: þ98 811 8234014.
E-mail addresses: amirfarhang@yahoo.com, miresmaeili@umsha.ac.ir been introduced. It has been reported that bone-supported devices
(A. Miresmaeili). have several advantages over tooth-supported expanders including

http://dx.doi.org/10.1016/j.jcms.2014.02.007
1010-5182/Ó 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Zandi M, et al., Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically
assisted rapid maxillary expansion: A randomized clinical trial study, Journal of Cranio-Maxillo-Facial Surgery (2014), http://dx.doi.org/10.1016/
j.jcms.2014.02.007
2 M. Zandi et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2014) 1e6

ability to be placed in an extremely narrow maxilla, avoiding dental Bruges, Belgium) was placed at the end of the surgery at the level
tipping and periodontal problems, avoiding root resorption and of the second premolars, high on the palate. After a latency period
exposure, low palatal profile, and creating true orthopaedic palatal of 7 days, the distractors were activated at an approximate rate of
expansion. However, bone-borne devices are expensive, their 0.5e0.6 mm/day until an overexpansion of 2e3 mm was observed
placement during surgery is time consuming, and their removal on either side. Then, the distractors were locked and kept in place
needs a second operation (Pinto et al., 2001; Gerlach and Zahl, for a consolidation period of approximately 4 months. At the end of
2005; Harzer et al., 2006; Aziz and Tanchyk, 2008; Verstraaten consolidation period, the distractors were removed and a trans-
et al., 2010). palatal retainer was placed. In both groups, cone beam computed
Dental and skeletal changes after either tooth-borne or bone- tomography (CBCT) scans were performed before operation and
borne SARME have been evaluated in several studies (Matteini and immediately after completion of the consolidation period by using
Mommaerts, 2001; Pinto et al., 2001; Gerlach and Zahl, 2005; a Newtom 3G scanner (AFP Imaging, Elmsford, NY, USA). The
Ramieri et al., 2005; Harzer et al., 2006; Lagravère et al., 2006; scanning parameters were 120 kV, 2 mA, with a field of view of 1200
Baraldi et al., 2007; Aziz and Tanchyk, 2008; Altug-Atac et al., and a 0.4-mm voxel size.
2010; Verstraaten et al., 2010; Seeberger et al., 2011). Because bone- To assess the skeletal and dental changes after SARME, the
borne SARME is a relatively new technique (introduced in 1999), following distances (Fig. 1) were measured on the coronal CBCT
most of the previous research on this treatment modality have been images before treatment (BT) and immediately after the end of the
retrospective studies or prospective case report and series consolidation period (AT):
(Mommaerts, 1999; Verstraaten et al., 2010). By reviewing the
published literature, especially systematic review and meta-analysis NFW4: Nasal floor width measured at the area of the first
researches on SARME, the authors of the present study found few premolars, 5 mm above the most inferior part of the nasal floor.
studies directly comparing the dentoskeletal effects of bone-borne NFW6: Nasal floor width measured at the area of the first mo-
and tooth-borne SARME (Suri and Taneja, 2008; Koudstaal et al., lars, 5 mm above the most inferior part of the nasal floor.
2009; Landes et al., 2009; Laudemann et al., 2010; Verstraaten PBW4: Palatal bone width measured at the level of a line con-
et al., 2010; Nada et al., 2012; Vilani et al., 2012). These studies had necting the palatal root apex of the first premolars.
some shortcomings including non-randomized clinical trial design PBW6: Palatal bone width measured at the level of a line
(using various types of expanders and surgical techniques in each connecting the palatal root apex of the first molars.
study group based on practitioners’ preferences) and assessment of IRD4 (Interdental Root Distance 4): The distance between the
dentofacial changes using dental casts and/or plain radiographs palatal root apex of the right and left first premolars.
instead of advanced imaging techniques. Therefore, a randomized IRD6 (Interdental Root Distance 6): The distance between
clinical trial to evaluate and compare the dentoskeletal effects of the palatal root apex of the right and left first molars.
bone-supported versus tooth-supported SARME using an advanced ICD4 (Interdental Cusp Distance 4): The distance between the
imaging technique was required. mesiopalatal cusp tip of the right and left first premolars.
The aim of the present study was to evaluate and compare the
short-term (post-retention) skeletal and dental changes following
bone-borne and tooth-borne SARME using cone beam computed
tomography (CBCT) imaging.

2. Material and methods

Thirty consecutive patients with transverse maxillary deficiency

who were referred by orthodontists for SARME to the Department
of Oral and Maxillofacial Surgery were included in this prospective
randomized clinical study. Patients were randomly assigned to
bone-borne (n ¼ 15) and tooth-borne (n ¼ 15) groups using a
computer generated random sequence. The patients were aged
between 15 and 27 years, and consisted of 11 males and 19 females.
The inclusion criteria included skeletal maturity and the presence
of one or more of the clinical signs of transverse maxillary defi-
ciency such as dental crossbite, crowded teeth, and constricted
maxillary arch. The exclusion criteria were congenital maxillofacial
deformities, prior orthodontic and surgical treatment on maxilla,
prior maxillary trauma, and transverse maxillary deficiency that
could be corrected by orthodontic treatment alone.
This study was approved by the Research Ethics Committee of
the University, and the written informed consent of all patients was
obtained.
The surgical procedure, which was the same for all patients and
performed by the same surgeon, consisted of osteotomy of the
lateral maxillary wall from the piriform rim to the pterygomaxillary
junction, midline osteotomy between the central incisors, and
pterygomaxillary disjunction, not including the releasing of the
nasal septum. In the tooth-borne group, a Hyrax appliance (Den-
taurum, Ispringen, Germany) was passively bonded to the maxil- Fig. 1. The distances measured at the first premolar (A) and first molar (B) regions:
lary first premolars and the first molars before surgery. In the NFW, Nasal floor width; IRD, Interdental root distance; PBW, Palatal bone width; ICD,
bone-borne group, a transpalatal distractor (TPD, Surgi-Tec, Interdental cusp distance, 4: first premolar area, 6: first molar area.

Please cite this article in press as: Zandi M, et al., Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically
assisted rapid maxillary expansion: A randomized clinical trial study, Journal of Cranio-Maxillo-Facial Surgery (2014), http://dx.doi.org/10.1016/
j.jcms.2014.02.007
 M. Zandi et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2014) 1e6 3

ICD6 (Interdental Cusp Distance 6): The distance between the Table 2
mesiopalatal cusp tip of the right and left first molars. Skeletal and dental changes (in mm) following SARME within tooth-borne group
(n ¼ 13).

For calculation of the amount of expansion at any area of in- Variables AT  BT Mean 95% CID Sig. (2-tailed)
terest, pretreatment distance was subtracted from posttreatment difference
Mean  SD Lower Upper
distance (AT  BT). To determine the inter-observer and intra-
NFW4 1.62  0.65 0.08 0.31 0.46 0.673
observer reliability, all measurements were performed twice with NFW6 1.54  0.52
an 8-week interval, and by two observers who were blind to the PBW4 4.38  1.75 0.46 0.20 1.12 0.152
type of treatment being used at the time of measurements. PBW6 3.92  1.48
ICD4 7.23  2.77 0.11 0.87 1.10 0.803
Statistical analyses were carried out using SPSS version 16.0
ICD6 7.12  2.87
(SPSS inc., Chicago, IL, USA). At first, descriptive statistics were NFW4 1.62  0.65 2.77 3.75 1.79 0.000
calculated to give a rough outline of the results. The Levene’s test PBW4 4.38  1.75
was used to test the equality of variances. For comparison of out- PBW4 4.38  1.75 2.85 4.18 1.52 0.001
comes between the two pooled, independent groups (tooth-borne ICD4 7.23  2.77
NFW6 1.54  0.52 2.38 3.23 1.54 0.000
versus bone-borne SARME) an unpaired Student’s t-test was used.
PBW6 3.92  1.48
To analyse the skeletal and dental changes after SARME within each PBW6 3.92  1.48 3.20 4.61 1.77 0.000
group, the paired t-tests were applied. Using Pearson’s correlation ICD6 7.12  2.87
test, the level of the inter-observer and intra-observer agreements PBW4 4.38  1.75 1.00 2.18 0.18 0.189
was evaluated. In this study, p < 0.05 was considered statistically IRD4 5.38  2.01
PBW6 3.92  1.48 0.89 2.14 0.37 0.152
significant. IRD6 4.81  2.09

BT: before treatment; AT: after treatment; SD: standard deviation; CID: confidence
interval of the difference; NFW4 and NFW6: nasal floor width at the first premolar
and first molar regions, respectively; PBW4 and PBW6: palatal bone width at the
3. Results
first premolar and first molar regions, respectively; IRD4 and IRD6: interdental root
distance at the first premolar and first molar regions, respectively; ICD4 and ICD6:
Thirty patients were entered into this study, but 2 patients did interdental cusp distance at the first premolar and first molar regions, respectively.
not complete the research protocol and were excluded. The age and
sex data of the remaining 28 patients is presented in Table 1; no
difference was observed among the groups. The duration of the increase in interdental root distance was not significantly different
surgical procedure ranged between 60 and 90 min. Mean appliance from that in palatal bone width (Table 2).
opening in the tooth-borne and bone-borne groups were In the bone-borne group, in both first premolar and first molar
7.8  2.8 mm and 7.3  2.0 mm, respectively. It was not significantly regions, the dental arch showed the greatest expansion, followed
different between the two groups. by the palatal bone and the nasal floor. In the region of the first
The only complication observed in this study was mild extrusion premolars, the mean expansion gain at the areas of the dental arch,
of a first premolar to which the expansion device was anchored in palatal bone, and nasal floor were 6.73  2.15, 4.53  2.02, and
one patient. Except for oedema and haematoma, the remaining 27 1.47  0.52, respectively (p < 0.001). In the first molar region, the
patients had no significant problem intra- or postoperatively. mean expansion gain observed at the areas of the dental arch,
Intra- and inter-observer correlations were performed at a palatal bone, and nasal floor were 6.53  2.67, 4.33  1.23, and
confidence interval of 95%. In the study, intra-observer and inter- 1.33  0.49, respectively (p < 0.004). Dental and skeletal changes
observer correlations ranged from 0.70 (for NFW4) to 0.96 (for observed in the first premolar region did not significantly differ
ICD6) and from 0.60 (for NFW6) to 0.95 (for IRD6), respectively (p from that in the molar region. Furthermore, in both first premolar
value ranged from 0.0001 to 0.001). and molar regions, the mean expansion gain at the area of the root
Evaluation of the skeletal and dental changes after SARME apices does not differ from that at the area of the palatal bone
within tooth-borne group revealed that in the first premolar region (Table 3).
the greatest expansion occurred in the dental arch (7.23  2.77), Comparison of the dentoskeletal changes after SARME between
followed by palatal bone (4.38  1.75) and nasal floor (1.62  0.65). tooth-borne and bone-borne groups revealed that the amount and
All the differences were statistically significant (p < 0.001). Simi- pattern of the expansion at various areas did not differ significantly
larly, expansion of the dentoskeletal structures in the first molar between the two groups (Table 4).
region occurred mostly in the dental area (7.12  2.87), followed by
palatal bone (3.92  1.48) and nasal floor (1.54  0.52); all the
4. Discussion
differences were statistically significant (p < 0.0001). The amount
and pattern of expansion observed in the first premolar region did
Practical clinical experience has shown that SARME is reliable
not significantly differ from that in the first molar region. In addi-
and effective for the correction of transverse maxillary deficiency in
tion, in both first premolar and molar regions, the amount of
skeletally mature patients. However, there is no consensus in the
literature regarding the type of distractor (tooth-borne or bone-
Table 1
Demographic data of the patients. borne) that should be used in SARME to provide the best dental
and skeletal results and stability (Suri and Taneja, 2008;
Tooth-borne Bone-borne p-value
Verstraaten et al., 2010; Vilani et al., 2012).
group (n ¼ 13) group (n ¼ 15)
Tooth-borne devices transmit the expansion force to the anchor
Age (years)
teeth and may cause buccal tipping of the anchor teeth, maxillary
Range 15e27 15e23
Mean (SD) 20.31 (3.64) 19.4 (2.53) NS dentoalveolar tipping and several complications including peri-
Gender odontal problems, root resorption, tooth extrusion, cortical bone
Female 9 (69%) 10 (67%) NS resorption and fenestration, speech problems, and relapse. It is
Male 4 (31%) 5 (33%) claimed that bone-borne devices, which deliver the expansion
NS: nonsignificant; SD: standard deviation. force directly to the palatal bone, produce parallel expansion of the

Please cite this article in press as: Zandi M, et al., Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically
assisted rapid maxillary expansion: A randomized clinical trial study, Journal of Cranio-Maxillo-Facial Surgery (2014), http://dx.doi.org/10.1016/
j.jcms.2014.02.007
4 M. Zandi et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2014) 1e6

Table 3 SARME are controversial, and few studies have directly compared
Skeletal and dental changes (in mm) following SARME within bone-borne group these two techniques.
(n ¼ 15).
In the study, in both tooth-borne and bone-borne groups, we
Parameters Mean  SD Mean 95% CID Sig. observed that the dental arch, the palatal vault, and the nasal floor
(AT  BT) difference (2-tailed) widened posteroanteriorly in a nearly parallel fashion (viewed
Lower Upper
from occlusal aspect). Accordingly, Chamberland and Proffit (2011),
NFW4 1.47  0.52 0.14 0.15 0.42 0.334
NFW6 1.33  0.49 and Koudstaal et al. (2009) found that tooth-borne devices caused
PBW4 4.53  2.02 0.20 0.65 1.05 0.621 parallel expansion of the dental arch in an anterioposterior plane.
PBW6 4.33  1.23 However, Kilic et al. (2013) and Han et al. (2006) demonstrated a
ICD4 6.73  2.15 0.20 0.50 0.90 0.550
higher amount of expansion in the first premolar area than in the
ICD6 6.53  2.67
NFW4 1.47  0.52 3.06 4.20 1.94 0.000 molar area following tooth-borne SARME. Zemann et al. (2009)
PBW4 4.53  2.02 reported a higher amount of expansion in the intercanine area
PBW4 4.53  2.02 2.20 3.38 3.99 0.001 than between the molars, while Anttila et al. (2004) reported the
ICD4 6.73  2.15 opposite. Seeberger et al. (2011) reported a V-shaped opening of
NFW6 1.33  0.49 3.00 3.75 2.24 0.000
the nasal floor and the palatal arch, but a parallel expansion of the
BPW6 4.33  1.23
PBW6 4.33  1.23 2.20 3.59 0.81 0.004 tooth-bearing parts of the alveolar crest following tooth-borne
ICD6 6.53  2.67 SARME, while Goldenberg et al. (2008) suggested that the great-
PBW4 4.53  2.02 0.13 0.44 0.71 0.628 est expansion occurred in the most inferior and anterior region of
IRD4 4.40  1.68
the maxilla.
PBW6 4.33  1.23 0.17 0.76 0.43 0.560
IRD6 4.50  1.83
A factor that may affect the pattern of dental and skeletal
expansion in posteroanterior plane, and its importance in SARME is
BT: before treatment; AT: after treatment; SD: standard deviation; CID: confidence
highly controversial in the literature is the pterygomaxillary suture
interval of the difference; NFW4 and NFW6: nasal floor width at the first premolar
and first molar regions, respectively; PBW4 and PBW6: palatal bone width at the osteotomy. Study by Bays and Greco (1992) on tooth-borne SARME
first premolar and first molar regions, respectively; IRD4 and IRD6: interdental root revealed more expansion in posterior than anterior region of the
distance at the first premolar and first molar regions, respectively; ICD4 and ICD6: maxilla when pterygomaxillary disjunction was performed, while
interdental cusp distance at the first premolar and first molar regions, respectively.
Vasconcelos et al. (2006) and Han et al. (2006) observed the
opposite. Studies by Matteini and Mommaerts (2001), Pinto et al.
palatal halves, keeping segmental and tooth tipping and associated (2001), and Ramieri et al. (2005) on bone-borne SARME demon-
complications to a minimum (Gerlach and Zahl, 2005; Harzer et al., strated parallel dental arch expansion when TPD was placed at the
2006; Suri and Taneja, 2008; Koudstaal et al., 2009; Verstraaten molar level and pterygomaxillary disjunction was performed, and
et al., 2010). However, the results of studies evaluating dental and more expansion in anterior than posterior dental arch when TPD
skeletal changes following either tooth-borne or bone-borne was placed at the premolar molar level and no pterygomaxillary
disjunction was done. However, in this study, in spite of placing the
TPD at the level of the premolar teeth and performing pter-
Table 4
Comparison of the skeletal and dental changes following SARME between tooth- ygomaxillary osteotomy, we observed that the dental arch, the
borne and bone-borne groups (in mm). palatal vault, and the nasal floor widened in a nearly parallel
fashion, which was in agreement with the findings of the research
Parameters Tooth-borne Bone-borne Mean Sig.
group (n ¼ 13) group (n ¼ 15) difference (2-tailed) by Koudstaal et al. (2009). These variations in the pattern of
expansion following SARME may be partly related to the technique
Mean  SD Mean  SD
used for pterygomaxillary disjunction. Improper placement and
NFW4 inclination of the osteotome at the pterygomaxillary suture may
BT 22.54  2.85 21.60  3.16 0.94 0.419
lead to partial separation of the suture and limited widening of the
AT 24.15  2.82 23.07  3.37 1.09 0.368
AT  BT 1.61  0.65 1.47  0.52 0.15 0.506 posterior maxillary area (Pereira et al., 2012).
NFW6 In the study, assessment of the coronal CBCT images showed that
BT 26.31  2.78 25.00  3.30 1.31 0.271 both tooth-borne and bone-borne techniques resulted in outward
AT 27.85  2.82 26.33  3.44 1.51 0.219 rotation (tipping) of the maxillary dentoalveolar segments. The
AT  BT 1.54  0.52 1.33  0.49 0.21 0.291
SPW4
greatest expansion occurred at the dental arch level with a pro-
BT 19.88  5.39 19.53  3.33 0.35 0.835 gressive reduction in expansion toward the nasal floor (V-shaped
AT 24.19  5.03 24.07  3.62 0.12 0.940 expansion). In agreement with the findings of this study, most of the
AT  BT 4.31  1.77 4.53  2.02 0.22 0.758 previous researches reported rotational movement (tipping) of the
SPW6
maxillary segments after both tooth-borne and bone-borne SARME
BT 24.42  4.18 25.67  2.16 1.24 0.322
AT 28.35  3.68 30.00  2.85 1.65 0.192 (Goldenberg et al., 2008; Koudstaal et al., 2009; Chamberland and
AT  BT 3.92  1.48 4.33  1.23 0.41 0.432 Proffit, 2011; Kilic et al., 2013), although Zemann et al. (2009) and
DPW4 Pinto et al. (2001) observed little tipping of the maxillary segments
BT 22.96  3.84 21.87  2.92 1.09 0.400 after tooth-borne and bone-borne SARME, respectively.
AT 29.46  4.54 28.80  2.96 0.66 0.647
AT  BT 6.51  1.76 6.93  2.52 0.42 0.640
Bone-borne devices are placed at a higher position in the palatal
DPW6 vault than tooth-borne appliances, and are claimed to expand the
BT 30.88  5.34 29.67  3.31 1.21 0.468 dentoalveolar segments in a parallel fashion. However, in SARME,
AT 37.92  3.92 36.20  3.53 1.72 0.232 there is more resistance to expansion at the level of palatal roof
AT  BT 7.12  2.87 6.53  2.67 0.59 0.583
than at the dental arch area, because the two maxillary halves are
BT: before treatment; AT: after treatment; SD: standard deviation; NFW4 and still connected to the skull even after completion of the osteoto-
NFW6: nasal floor width at the first premolar and first molar regions, respectively; mies, and the mucoperiosteum over the midpalatal suture gives
PBW4 and PBW6: palatal bone width at the first premolar and first molar regions,
respectively; IRD4 and IRD6: interdental root distance at the first premolar and first
resistance to expansion. Therefore, the centre of resistance to
molar regions, respectively; ICD4 and ICD6: interdental cusp distance at the first expansion is always far from the position of the distractor which is
premolar and first molar regions, respectively. usually several millimetres below the palatal roof. For these

Please cite this article in press as: Zandi M, et al., Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically
assisted rapid maxillary expansion: A randomized clinical trial study, Journal of Cranio-Maxillo-Facial Surgery (2014), http://dx.doi.org/10.1016/
j.jcms.2014.02.007
 M. Zandi et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2014) 1e6 5

reasons, bone-borne devices act like a lever and cause outward Ethical approval
rotation rather than parallel expansion of the palatal halves. Hamedan University of Medical Sciences Ethics Committee.
In this study, the pattern and amount of expansion following
tooth-borne and bone-borne SARME were not significantly Support
different between the two groups. Most of the previous studies on This study was supported by Dental Research Center, Hamedan
SARME were consisted of case reports or series. The results of the University of Medical Sciences, Hamedan, Iran.
few papers that directly compared the dentoskeletal effects of
tooth-borne and bone-borne SARME were in agreement with the
findings of the present study (Koudstaal et al., 2009; Landes et al., Funding
2009; Laudemann et al., 2010; Nada et al., 2012). In a randomized None.
clinical trial study by Koudstaal et al. (2009), the dentoskeletal ef-
fects of tooth-borne (using Hyrax) and bone-borne (using TPD and Competing interest
Rotterdam) SARME were evaluated and compared. Assessments of None declared.
pretreatment and posttreatment dental casts and cephalograms
revealed no significant difference between the two groups. In a References
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Please cite this article in press as: Zandi M, et al., Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically
assisted rapid maxillary expansion: A randomized clinical trial study, Journal of Cranio-Maxillo-Facial Surgery (2014), http://dx.doi.org/10.1016/
j.jcms.2014.02.007