Rapid maxillary expansion: dento-skeletal effects of the Surpe protocol

OBJECTIVE: The aim of this study was to evaluate, using three-dimensional CBCT analysis, the dental, alveolar, and skeletal effects of rapid maxillary expansion performed according to the Super Rapid Palatal Expansion (SURPE) protocol, characterized by the concentration of screw activations within a short time interval and reduced reliance on patient compliance.

MATERIALS AND METHODS: Sixteen adolescent patients (7 males and 9 females; aged 11-15 years) presenting with transverse maxillary deficiency were treated with a tooth-borne Hyrax expander anchored to the maxillary first permanent molars. CBCT scans were acquired before treatment (T0) and approximately one month after completion of the expansion phase (T1). Dental variables (tipping and intermolar width), alveolar parameters (buccal, mesial, distal, and palatal bone thicknesses; CEJ-buccal alveolar bone distance), and skeletal variables (intraforaminal width and anterior and posterior midpalatal suture opening) were analyzed. Statistical analysis included the Shapiro-Wilk test, paired t-test, or Wilcoxon signed-rank test, with significance set at p < 0.05.

RESULTS: A statistically and clinically significant increase in intermolar width was observed, along with a non-parallel, fan-shaped opening of the midpalatal suture, characterized by greater anterior than posterior expansion. Buccal tipping of posterior teeth was detected, consistent with findings reported for conventional rapid maxillary expansion protocols. Alveolar changes included a significant but limited reduction in buccal cortical thickness and mesial and distal bone thickness, mainly in molar regions, accompanied by a significant increase in palatal bone thickness. In most sites, these changes were below 1 mm. A significant increase in the CEJ-buccal alveolar bone distance was observed only at one molar site, with no evidence of clinically relevant periodontal compromise.

CONCLUSIONS: The SURPE protocol produces dentoalveolar and skeletal effects comparable to those reported for conventional tooth-borne rapid maxillary expansion, without indicating increased short-term biological risk.

CLINICAL SIGNIFICANCE: SURPE may be considered a clinically effective and efficient alternative to traditional rapid maxillary expansion protocols, allowing reduced treatment duration and improved control of the expansion phase while maintaining acceptable periodontal safety in adolescent patients.

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