Zusammenfassung
Ziel der vorliegenden Arbeit war, die transversalen, sagittalen und vertikalen skelettalen
Langzeitveränderungen nach forcierter Gaumennahterweiterung (RME) zu beurteilen. Dazu
wurden Daten aus klinischen Studien entnommen, welche die skelettalen Veränderungen
anhand kephalometrischer Messwerte untersucht hatten. Patienten, die während der aktiven
Expansionsphase chirurgische oder andere ergänzende Behandlungsmaßnahmen erhielten,
wurden nicht akzeptiert. Mit Unterstützung eines erfahrenen Bibliothekars, der sich
auf medizinische Datenbanken spezialisiert hatte, wurde eine systematische Literaturrecherche
in Online-Datenbanken (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations,
Cochrane-Datenbank, ASP Journal Club, DARE, CCTR, Embase, Web of Sciences und Lilacs)
durchgeführt. Abstracts, die den Vorauswahlkriterien zu genügen schienen, wurden einvernehmlich
ausgewählt. Danach wurden die Originalarbeiten gelesen und die Qualität der ausgewählten
Studien mithilfe einer Methodik-Checkliste bewertet. Außerdem wurden ihre Literaturverzeichnisse
nach bisher nicht gefundenen Artikeln per Hand durchsucht. Ausgeschlossen wurden Studien,
die keine geeignete Kontrollgruppe zum Herausrechnen normaler wachstumsbedingter Veränderungen
verwendet hatten. Insgesamt vermaßen nur drei Artikel die GNE-Stabilität nach Abschluss
der aktiven Dehnphase (einer vermaß transversale Veränderungen, zwei sagittale und
vertikale Veränderungen) und alle drei Studien wiesen methodische Schwächen auf. Dies
schränkt die Aussagekraft der erhaltenen Informationen ein. Eine individuelle Analyse
der Artikel ergab, dass die dauerhafte skelettale Verbreiterung der Maxilla bei Behandlung
von Jugendlichen vor der Pubertät ungefähr 25 % der gesamten Zahnbogenexpansion betrug.
Bei noch jüngeren Patienten sind nach Gaumennahterweiterung bessere transversale Langzeitergebnisse
zu erwarten. Die Gaumennahterweiterung scheint zu keinen signifikanten sagittalen
oder vertikalen Veränderungen in der Position von Ober- und Unterkiefer zu führen.
Die Schlussfolgerungen aus dieser systematischen Literaturrecherche sind in ihrer
Gültigkeit eingeschränkt, da sie nicht auf dem höchsten Evidenzniveau getroffen werden
konnten. Dazu wären randomisierte klinische Langzeituntersuchungen erforderlich.
Abstract
The objective was to evaluate long-term transverse, anteroposterior and vertical skeletal
changes after rapid maxillary expansion (RME). The data were clinical trials that
assessed skeletal changes through cephalometric analysis. No surgical or other simultaneous
treatment during the evaluation period was accepted. Electronic databases (PubMed,
Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Database of Systematic
Reviews, ASP Journal Club, DARE, CCTR, Embase, Web of Sciences and Lilacs) were searched
with the help of a senior Health Sciences librarian. Abstracts that appeared to fulfill
the initial selection criteria were selected by consensus. The original articles were
retrieved. A methodological checklist was used to evaluate the quality of the selected
articles. Articles without an adequate control group to factor out growth changes
were excluded. Only three articles (one measuring transverse and two anteroposterior
and vertical changes) measured RME stability after active expansion, all of them had
some methodological flaws, which limit the attainable conclusions. An individual analysis
of these articles was made. Long-term transverse skeletal maxillary increase is approximately
25 % of the total dental expansion for prepubertal adolescents. Better long-term outcomes
are expected in transverse changes because of RME in less skeletally mature patients.
RME appears not to produce clinically significant anteroposterior or vertical changes
in the position of the maxilla and mandible. The conclusions from this systematic
review should be considered with caution because only a secondary level of evidence
was found. Long-term randomized clinical trials are needed.
Schlüsselwörter
forcierte Gaumennahterweiterung - skelettale Veränderungen
Key words
rapid maxillary expansion - skeletal changes - rapid palatal expansion
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1 Der Artikel erschien erstmals in: The Angle Orthodontist 2005; 75: 1046-1052. Der
Abdruck erfolgt mit freundlicher Genehmigung der E. H. Angle Foundation.
Dr. C. Flores-Mir
Faculty of Medicine and Dentistry · Room 4051 A Dentistry / Pharmacy Centre University
of Alberta
CAN-Alberta
Edmonton T6G 2N8
Email: carlosflores@ualberta.ca
