Comparison of Dentoskeletal Effects of Rapid Maxillary Expansion Using Different Expanders in Unilateral Cleft Lip and Palate: A Systematic Review

Abstract

Objective: To systematically evaluate and compare the dentoskeletal effects of rapid maxillary expansion (RME) using different expander designs in patients with unilateral cleft lip and palate (UCLP).

Design: Systematic review and meta-analysis registered with PROSPERO (CRD420251015273).

Setting: Electronic databases (PubMed, Scopus, Google Scholar, Cochrane) were searched for studies published in English up to July 2024.

Patients, Participants: Seven studies (n = 208 UCLP patients; age 8–15 years) met the inclusion criteria. Participants presented with transverse maxillary deficiency and had undergone primary cleft repair.

Interventions: Different RME appliances (fan-type, inverted mini-Hyrax, modified Haas, and variants) were compared with conventional Hyrax expanders.

Main Outcome Measure(s): Anterior and posterior maxillary width changes, skeletal parameters (SNA, FH-ANS), dental crown and apical widths, nasal and airway changes, dehiscence, and buccal bone thickness.

Results: All appliances produced significant transverse expansion, predominantly dentoalveolar in nature. Meta-analysis of three studies showed no statistically significant difference between intervention and Hyrax groups for anterior maxillary width (MD −0.23; 95% CI −0.92 to 0.46; p = 0.51) or posterior maxillary width (MD −0.92; 95% CI −4.78 to 2.94; p = 0.64). Airway and nasal septum changes were minimal. Risk of bias was generally low to moderate.

Conclusions: RME effectively increases transverse maxillary width in UCLP patients. Differences among tooth-borne expanders appear minimal in the short term, with expansion largely dentoalveolar. High-quality long-term trials are required to clarify skeletal effects and stability.