Treatment timing for rapid maxillary expansion

The aim of this study was to evaluate the short-term and long-term treatment effects of rapid maxillary expansion in 2 groups of subjects treated with the Haas appliance. Treatment outcomes were evaluated before and after the peak in skeletal maturation, as assessed by the cervical vertebral maturation (CVM) method, in a sample of 42 patients compared to a control sample of 20 subjects. Posteroanterior cephalograms were analyzed for the treated subjects at T1 (pretreatment), T2 (immediate post-expansion) and T3 (long-term observation), and were available at T1 and at T3 for the controls. The mean age (years: months) at T1 was 11:10 for both the treated and the control groups. The mean ages at T3 also were comparable (20:6 for the treated group and 17:8 for the controls). Following expansion and retention (2 months on average), fixed standard edgewise appliances were placed. The study included transverse measurements on dentoalveolar structures, maxillary and mandibular bases and other craniofacial regions (nasal, zygomatic, orbital, and cranial). Treated and control samples were divided into 2 groups according to individual skeletal maturation. The early-treated and early-control groups had not reached the pubertal peak in skeletal growth velocity at T1 (CVM 1 to 3), whereas the late-treated and late-control groups were during or slightly after the peak at T1 (CVM 4 to 6). The group treated before the pubertal peak showed significantly greater short-term increases in the width of the nasal cavities. In the long-term, maxillary skeletal width, maxillary intermolar width, lateronasal width, and lateroorbitale width were significantly greater in the early-treated group. The late-treated group exhibited significant increases in lateronasal width and in maxillary and mandibular intermolar widths. Rapid Maxillary Expansion treatment before the peak in skeletal growth velocity is able to induce more pronounced transverse craniofacial changes at the skeletal level.