Original Article

Skeletal effects of posterior crossbite treatment with either quad helix or

rapid maxillary expansion: a randomized controlled trial with 1-year follow-up
Stina Hanssona; Eva Josefssonb; Henrik Lundc; Silvia Miranda-Bazarganid;
Anders Magnusone; Rune Lindstenf; Farhan Bazarganig

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ABSTRACT
Objectives: To assess skeletal and dental effects and evaluate possible side effects of maxillary
expansion with two different appliances, directly after expansion and 1 year postexpansion.
Materials and Methods: Forty-two patients with unilateral posterior crossbite (mean 9.5 6 0.9
years) were randomized to either rapid maxillary expansion (RME) banded on the deciduous sec-
ond molars and bonded to the primary canines or slow expansion with quad helix (QH) on the
permanent first molars. Cone-beam computed tomography records were taken at baseline,
directly after correction of the posterior crossbite and at follow-up 1 year after expansion.
Results: All patients were analyzed. RME opened the midpalatal suture more anteriorly and inferiorly
(mean 4.1 mm) and less posteriorly and superiorly (mean 1.0 mm). No effect on midpalatal suture
could be shown in the QH group after expansion, P , .001. Buccal bone width had significantly
decreased (P , .001) in the QH group compared with the RME group. Buccal fenestrations and root
resorption on the left first molar had a higher prevalence directly after expansion finished in the QH
group (P ¼ .0086, P ¼ .013) but were not significant at 1-year follow-up (P ¼ .11, P ¼ .22).
Conclusions: Opening of the suture with RME was more anterior and inferior, and the QH did
not open the midpalatal suture at all. More buccal bone loss and fenestrations were seen on the
permanent first molar in patients treated with conventional QH than RME anchored to deciduous
teeth. (Angle Orthod. 2024;94:512–521.)
KEY WORDS: Palatal expansion technique; Crossbite; 3D imaging

INTRODUCTION fixed appliance such as a Hyrax type expander (rapid

maxillary expansion; RME) or slowly with a removable
Posterior crossbite is a common malocclusion in chil- expansion plate or fixed bent steel wire such as a quad
dren, with a prevalence of about 8% to 11%.1 When helix (QH) appliance.3,4 Compared with an expansion
correcting a posterior crossbite due to a constricted plate, the QH is a more successful method in terms of
maxilla, expansion of the maxilla is the gold standard.2 correcting a posterior crossbite and also has a signifi-
Expansion of the maxilla can be done rapidly with a cantly shorter treatment time.5

a
PhD student, Department of Orthodontics, Postgraduate Dental Education Center, and Faculty of Medicine and Health, School of
Medical Sciences, Örebro University, Örebro, Sweden.
b
Assistant Professor, Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden, and
School of Health and Welfare, Jönköping University, Jönköping, Sweden.
c
Associate Professor, Sahlgrenska Academy at Gothenburg University, Department of Oral & Maxillofacial Radiology, Gothenburg, Sweden.
d
Maxillofacial Radiologist, Postgraduate Dental Education Center, Department of Oral & Maxillofacial Radiology, Örebro, Sweden.
e
Statistician, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
f
Associate Professor, Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden and
School of Health and Welfare, Jönköping University, Jönköping, Sweden.
g
Associate Professor, Sahlgrenska Academy at Gothenburg University, Department of Orthodontics, Gothenburg, Sweden.
Corresponding author: Dr Farhan Bazargani, Department of Orthodontics, Sahlgrenska Academy, Gothenburg University, PO Box
450, SE-405 30 Gothenburg, Sweden.
(e-mail: [email protected])
Accepted: March 2024. Submitted: January 2024.
Published Online: May 10, 2024
Ó 2024 by The EH Angle Education and Research Foundation, Inc.

Angle Orthodontist, Vol 94, No 5, 2024 512 DOI: 10.2319/010424-9.1

SKELETAL EFFECTS OF QUAD HELIX AND RAPID MAXILLARY EXPANSION 513

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Figure 1. Flow diagram.

The effect on the midpalatal suture during maxillary principle of ALADAIP (as low as diagnostically accept-
expansion has been discussed, and almost any able being indication-oriented and patient-specific) is
expansion device has been argued to open the midpa- recommended.14
latal suture up to the age of 9 to 10 years.6 The matu- To date, specifically comparing RME and QH in the
ration of the midpalatal suture has been investigated early mixed dentition (EMD), there is no evidence on
in previous radiographic studies, and no child aged which maxillary expansion method is more feasible in
between 5 and 11 years had any fusion of the midpa- correcting a unilateral posterior crossbite with optimal
latal suture.7 However, that study was not assessed in skeletal effects and minimal side effects. The aims of
conjunction with clinical experience. this randomized controlled trial (RCT) were to com-
Side effects of unilateral posterior crossbite correc- pare the RME banded to the deciduous first molars
tion have been described previously. Vertical and hori- and QH banded to the permanent first molars regard-
zontal bone loss has been reported in both slow and ing the effect on the midpalatal suture, dental tipping,
rapid activation protocols using fixed expanders.8,9 A and adverse effects, such as fenestration and dehis-
consequence of bone loss is fenestration or dehis- cence, when correcting unilateral posterior crossbite
cence. Fenestration is defined as loss of the bone cov- in the EMD.
erage of the root with the marginal bone level (MBL)
still intact. Dehiscence appears when the distance MATERIALS AND METHODS
between the cementoenamel junction and the MBL
increases, leading to gingival recession.10 This study was a bicenter, two-arm, parallel-group
Cone-beam computed tomography (CBCT) is, at pre- RCT performed at orthodontic departments in regions
sent, the most reliable imaging method when conven- the of Örebro and Jönköping, Sweden. The regional
tional 2D radiology fails to provide a correct rendering,11 radiation protection committee gave their approval,
as when measuring and evaluating skeletal changes and the Regional Ethical Review Board in Uppsala,
and potential dental side effects. CBCT has high sensi- Sweden, which follows the guidelines of the Declara-
tivity and accuracy, and doses can be kept relatively low tion of Helsinki, approved the study protocol (Dnr:
compared with other radiographic modalities.12,13 The 2018/308).

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514 HANSSON, JOSEFSSON, LUND, MIRANDA-BAZARGANI, MAGNUSON, LINDSTEN, BAZARGANI

Figure 2. Quad helix on permanent first molars (left) and rapid maxillary expander on deciduous molars and deciduous canines (right).

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The sample in this trial was selected from general Randomization
dental practice in Örebro County and Jönköping
All 42 participants were randomly allocated in
County, Sweden. Children who were diagnosed with
blocks of different sizes, using the concealed alloca-
unilateral posterior crossbite and who met the eligibil-
tion principle in a 1:1 ratio, to two groups: a QH group
ity criteria were recruited between May 2019 and Jan-
and an RME group. The randomization procedure was
uary 2021. After receiving oral and written information
as follows: a computer-generated randomization list
about the trial, the included participants and their
was created using SPSS software (version 22.0;
guardians signed the consent form.
The following inclusion criteria had to be fulfilled by SPSS, Chicago, Ill) and stored with a dental nurse
all participants: who was not involved in the trial. Each time a patient
gave his or her consent, the dental nurse was con-
• Unilateral posterior crossbite tacted to provide the information about which type of
• EMD: the maxillary first permanent molars had to be expander the patient would receive (Figure 1).
erupted, and the maxillary deciduous canines and sec-
ond deciduous molars had to be persisting (DS2M1)15 Intervention and Radiographic Examination
• Class I or Class II molar relationship with a maxi-
mum of 5-mm overjet Appliance design (Figure 2) and clinical intervention
were performed in accordance with a previously pub-
Patients with previous or ongoing orthodontic treat- lished study.16 All patients had a CBCT 8 cm 3 8 cm
ment, craniofacial syndromes, or orofacial clefts were scan at baseline (before start of the treatment, T0), at
considered ineligible for the study. finished expansion (T1), and at follow-up (T3) 1 year

Figure 3. Three image planes orthogonal to each other: axial, sagittal, and coronal.

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SKELETAL EFFECTS OF QUAD HELIX AND RAPID MAXILLARY EXPANSION 515

Table 1. Description of Anatomical Landmarksa

Anatomical Landmark Description
P1 Position 1, apex of permanent incisor root/
P2 Position 2, apex of permanent first molars palatal root/
P3 Position 3, spina nasalis posterior/
Midpalatal suture Midpalatal suture width inferior (inf) and superior (sup), respectively. Distance between cortical borders of
the suture at the inferior as well as superior part of Os palatinum. Measured in millimeters.
Buccal MBL Marginal bone level at the buccal aspect of the right (dx) and left (sin) first molar, respectively. Distance from
the cementoenamel junction to the marginal bone crest. Measured in millimeters.
Palatal MBL Marginal bone level at the palatal aspect of the right (dx) and left (sin) first molar, respectively. Distance from
the cementoenamel junction to the marginal bone crest. Measured in millimeters.
Buccal bone width Alveolar bone thickness. Buccal bone measured horizontal at the height of the furcation of the mesiobuccal

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root of the first permanent molar. Measured in millimeters.
Palatal bone width Alveolar bone thickness. Palatal bone measured horizontal at the height of the furcation of the palatal root of
the first permanent molar. Measured in millimeters.
Angle Dental inclination. Angle of teeth between the line passing through the palatal root apex and palatal cusp at
the right (1) and left (2) first permanent molar, respectively, and the vertical line parallel to the midsagittal
plane. Measured in degrees.
a
MBL indicates marginal bone level.

after finished expansion. According to the principle of performed according to the definitions and reference
ALADAIP, the volume, voltage, and mA were opti- points as well as positions 1–3 stated in Table 1 and
mized to minimize the radiation given to the patients Figure 4. All measurements were performed by two
but sufficient to be able to answer the questions. The experienced specialists in oral and maxillofacial radiology
CBCT unit used at both centers was the 3D Accuitomo (Dr Miranda-Bazargani, Dr Lund) under optimal viewing
170 manufactured by J Morita (Osaka, Japan), field of conditions. All images were stored and reviewed in a pic-
view size 8 3 8, 90 kVp 45 mA. The effective dose ture archiving and communication system (Sectra, Link-
was 128 mSv on a child phantom.17 öping, Sweden). Remeasurement was performed after
The endpoint in both groups was when the palatal 3 weeks on 10 randomly selected participants to inves-
cusp of the maxillary permanent first molars was in tigate intra- and interexaminer reliability.
contact with the buccal cusp of the mandibular perma-
nent first molars (T1). The appliance was kept as Outcomes
retention for 6 months in both groups before removal The primary outcome was the midpalatal suture
(T2). Between time points T1 and T3, no additional expansion in a coronal and axial view.
orthodontic treatment was carried out on the patients. Secondary outcomes were as follows:
Reformatting of the image volume was done to
achieve an optimal and standardized visualization of the • MBLs, buccal and palatal, on the permanent first molars
facial skeleton in three image planes orthogonal to each • Bone thickness, buccal and palatal, measurement
other: axial, sagittal, and coronal (Figure 3). Assessment from root surface to the cortical bone buccal and
and measurement of the different parameters used were palatal, respectively

Figure 4. Sagittal and axial view of anteroposterior positions 1–3 (P1–3).

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516 HANSSON, JOSEFSSON, LUND, MIRANDA-BAZARGANI, MAGNUSON, LINDSTEN, BAZARGANI

Table 2. Patient Characteristicsa difference of 2 mm (SD 6 1.7) of the midpalatal suture

Treatment Frequency % Mean Age, y (SD, Min, Max) expansion between the groups. The standard deviation
QH was adapted from earlier studies.18,19 The sample size
Boy 14 66.7 calculation indicated that 17 patients would be required
Girl 7 33.3 in each group. To compensate for dropouts, at least 20
Total 21 100.0 9.5 (SD 6 0.9, min 8.4, max 11.4)
RME
patients were included in each group (an additional 15%
Boy 13 61.9 per group). Descriptive data were derived and then a lin-
Girl 8 38.1 ear mixed-models analysis performed.
Total 21 100.0 9.6 (SD 6 1.0, min 8.4, max 12.0) Primary and secondary continuous scaled outcome
a
QH indicates quad helix; RME, rapid maxillary expansion; SD, variables were evaluated as the change from baseline
standard deviation. (T0) with a random intercept linear mixed model. Study

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groups (RME vs. QH), time (T1, T3), and their interac-
tions were fixed factors. The analyses were adjusted for
• Permanent first molar angles in relation to the mid- the baseline outcome (T0) as a covariate and study cen-
sagittal vertical line ters as a fixed factor. The estimated marginal mean dif-
• Fenestration, dehiscence, and root resorption of the ferences between study groups were reported with 95%
permanent first molars confidence intervals (CIs). Inter- and intraexaminer intra-
class correlation (ICC) was performed between the two
Blinding examiners.
Due to the study design, blinding was applicable
only for outcome assessments. RESULTS
Forty-two patients, with a mean age of 9.5 years (SD 6
Sample Size and Statistics
0.9 years), were randomized to either treatment with QH
The calculated sample size for each group was based or RME (Table 2). All patients were analyzed. Twenty
on a significance level of .05 and 90% power to detect a patients were recruited from Örebro County and 22 from

Table 3. Midpalatal Suture Openinga

T0 T1 T3
Mean (SD) Mean (SD) b
Mean Difference (95% CI) P Mean (SD) Mean Differenceb (95% CI) P
P1 (anterior)
Midpalatal suture (sup)
QH group 0.1 (0.2) 0.1 (0.2) Ref.c 0.1 (0.1) Ref.
RME group 0.1 (0.3) 3.0 (1.6) 2.9 (2.4 to 3.4) ,.001 0.2 (0.7) 0.1 (0.4 to 0.6) .67
Midpalatal suture (inf)
QH group 0.1 (0.2) 0.3 (0.4) Ref. 0.1 (0.2) Ref.
RME group 0.6 (1.2) 4.1 (2.2) 3.1 (2.5 to 3.7) ,.001 1.1 (1.8) 0.3 (0.3 to 0.9) .34
P2 (first molar)
Midpalatal suture (sup)
QH group 0.0 (0.1) 0.1 (0.3) Ref. 0.0 (0.0) Ref.
RME group 0.0 (0.0) 2.0 (0.9) 1.9 (1.6 to 2.2) ,.001 0.0 (0.0) 0.0 (0.3 to 0.3) .97
Midpalatal suture (inf)
QH group 0.2 (0.3) 0.6 (0.6) Ref. 0.2 (0.4) Ref.
RME group 0.2 (0.4) 2.4 (0.9) 1.7 (1.4 to 2.1) ,.001 0.3 (0.4) 0.0 (0.3 to 0.4) .86
P3 (posterior)
Midpalatal suture (sup)
QH group 0.0 (0.0) 0.0 (0.1) Ref. 0.0 (0.0) Ref.
RME group 0.0 (0.1) 1.0 (0.8) 0.9 (0.6 to 1.2) ,.001 0.0 (0.2) 0.0 (0.2 to 0.3) .91
Midpalatal suture (inf)
QH group 0.0 (0.0) 0.0 (0.1) Ref. 0.0 (0.0) Ref.
RME group 0.0 (0.0) 1.1 (1.0) 1.1 (0.7 to 1.4) ,.001 0.0 (0.2) 0.0 (0.3 to 0.4) .79
a
Measured in millimeters at three anteroposterior positions, P1–P3, and superoinferior, superior (sup) and inferior (inf). A comparison
between RME and QH groups with linear mixed model. CI indicates confidence interval; QH, quad helix; RME, rapid maxillary expansion; SD,
standard deviation.
b
Primary outcomes were evaluated as the change from baseline (T0) with a random intercept linear mixed model. Study groups, center,
time (T1, T3), and their interactions were fixed factors and the baseline outcome (T0) as a covariate, and the model’s estimated marginal mean
differences between study groups were reported with 95% CIs.
c
Ref. Quad helix group is used as the reference value.

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SKELETAL EFFECTS OF QUAD HELIX AND RAPID MAXILLARY EXPANSION 517

there was a statistically significant difference between

groups (P , .001), At follow-up, the difference between
groups was no longer statistically significant due to new
bone formation at the suture in the RME group.

Secondary Outcomes
Table 4, Table 5, and Figure 6 present the second-
ary outcomes. Buccal MBL in the QH group length-
ened significantly compared with the RME group
between T0 and T1, which indicated decreased bone
volume buccally on both the right (P ¼ .0055) and the

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left side (P ¼ .0013). Between T0 and T3, the signifi-
cance was present only at the right side (P ¼ .035),
not the left (P ¼ .16). Palatal MBL between groups
had no significant difference at any time point.
Buccal bone width decreased in the QH group. The
buccal bone width was, on average, 1.9 to 2.0 mm in
both groups before treatment. At finished expansion
(T1), the bone had decreased to 0.5–0.6 mm in the
QH group. In the RME group, the buccal bone width
maintained 1.5–1.7 mm at T1. This difference was sta-
tistically significant (P , .001).
The palatal bone width at T0 was 1.2–1.5 mm. In
the RME group, the palatal bone width decreased at
T1 compared with baseline but had increased in both
groups at follow-up (T0–T3) but significantly more so
in the QH group.
The frequency of buccal fenestration of the first per-
manent molar was statistically significant in the QH
group compared with the RME group (T0–T1; P ¼
Figure 5. In a coronal view, the opening of the midpalatal suture
.0086) on both the left and the right side. One year
directly after rapid maxillary expansion (upper). In an axial view, the later, the difference was no longer significant. Palatal
opening of the midpalatal suture directly after rapid maxillary fenestration was present at baseline in both groups.
expansion (lower). After finished expansion, palatal fenestration was regis-
tered only in the RME group, but there was no signifi-
Jönköping County. The examiners of the CBCT scans cant difference between groups. No palatal fenestration
(Dr Miranda-Bazargani, Dr Lund) had excellent (..9) cor- was present in any group at follow-up (T3).
relation on the primary outcome. The lowest values found Root resorption was measured in four degrees of
were found in intraexaminer measuring angles (.0.7), severity.21 No resorption, grade 0, or slight resorption,
which is considered moderate ICC.20 grade 1, defined as up to half of the dentin thickness
to the pulp, was found more on the left first molar in
the QH group (P ¼ .013) between T0 and T1 but was
Primary Outcome not significant at follow-up (P ¼ .22). Moderate, grade
The primary outcomes are shown in Table 3 and 2, or severe, grade 3, resorption was not found in any
Figure 5. In the QH group, no opening of the midpalatal of the patients.
suture was shown after expansion or at follow-up com-
pared with baseline. The opening of the midpalatal DISCUSSION
suture, in a coronal view, in the RME group was con- Most previously published studies assessed the
firmed to be slightly triangular. The midpalatal suture immediate effects of different expansion devices and
opened 4.1 mm inferiorly compared with 3.0 mm superi- very seldom evaluated the long-term effects and sta-
orly. In an axial view, the midpalatal suture opened more bility of the treatments. The finding of this longitudinal
anteriorly, 4.1 mm at position 1, 2.4 mm at position 2, RCT showed that the midpalatal suture did not open
and 1.1 mm at position 3. At all three positions, as well in the QH group as earlier suggested.6 In an axial
as the superior and inferior part of the midpalatal suture, view, the suture in the RME group opened most

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518 HANSSON, JOSEFSSON, LUND, MIRANDA-BAZARGANI, MAGNUSON, LINDSTEN, BAZARGANI

Table 4. Comparing Secondary Outcomes at Position 2 Between the RME and QH Groups With a Linear Mixed Modela
T1 T3
T0
Mean (SD) Mean (SD) b
Mean Difference (95% CI) P Mean (SD) Mean Differenceb (95% CI) P
Buccal MBLdx
QH group 0.8 (0.2) 1.3 (0.6) Ref.c 1.1 (0.4) Ref.
RME group 1.1 (0.5) 0.9 (0.4) 0.4 (0.8 to 0.1) .0055 0.9 (0.3) 0.3 (0.6 to 0.02) .035
Buccal MBLsin
QH group 0.9 (0.3) 1.5 (1.0) Ref. 1.1 (0.6) Ref.
RME group 0.8 (0.4) 0.8 (0.4) 0.6 (1.0 to 0.3) .0013 0.8 (0.4) 0.3 (0.7 to 0.1) .16
Palatal MBLdx
QH group 1.1 (0.5) 1.1 (0.5) Ref. 1.2 (0.5) Ref.
RME group 0.9 (0.4) 1.2 (0.5) 0.1 (0.2 to 0.4) .58 1.0 (0.5) 0.1 (0.4 to 0.2) .42

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Palatal MBLsin
QH group 1.0 (0.2) 1.3 (0.6) Ref. 1.3 (0.5) Ref.
RME group 0.9 (0.4) 1.2 (0.4) 0.1 (0.4 to 0.2) .58 1.1 (0.4) 0.1 (0.4 to 0.1) .32
Buccal bone widthdx
QH group 1.9 (0.8) 0.5 (0.5) Ref. 0.9 (0.5) Ref.
RME group 1.9 (0.8) 1.5 (0.6) 1.0 (0.8 to 1.3) , .001 1.4 (0.6) 0.6 (0.3 to 0.8) ,.001
Buccal bone widthsin
QH group 2.0 (0.6) 0.6 (0.6) Ref. 0.9 (0.5) Ref.
RME group 1.9 (0.8) 1.7 (0.6) 1.1 (0.9 to 1.4) , .001 1.5 (0.6) 0.6 (0.3 to 0.8) ,.001
Palatal bone widthdx
QH group 1.5 (0.7) 2.8 (1.0) Ref. 2.2 (0.9) Ref.
RME group 1.5 (0.7) 1.4 (0.7) 1.4 (1.8 to 1.0) , .001 1.6 (0.8) 0.6 (1.0 to 0.2) .0021
Palatal bone widthsin
QH group 1.2 (0.6) 2.7 (0.9) Ref. 2.1 (0.9) Ref.
RME group 1.2 (0.7) 1.4 (0.5) 1.3 (1.7 to 0.9) , .001 1.6 (0.8) 0.5 (0.9 to 0.1) .011
Angle 1dx, °
QH group 14.4 (4.9) 18.3 (4.8) Ref. 14.0 (4.1) Ref.
RME group 11.9 (5.1) 15.5 (4.6) 1.4 (3.6 to 0.9) .23 14.4 (5.5) 2.0 (0.2 to 4.2) .079
Angle 2sin, °
QH group 14.8 (5.2) 21.1 (7.7) Ref. 16.5 (6.2) Ref.
RME group 14.6 (6.5) 17.2 (5.6) 3.9 (6.4 to 1.4) .0031 15.3 (5.2) 0.9 (3.4 to 1.6) .46
a
CI indicates confidence interval; MBL, marginal bone level; QH, quad helix; RME, rapid maxillary expansion; SD, standard deviation.
b
Outcomes were evaluated as the change from baseline (T0) with a random intercept linear mixed model. Study groups, center, time (T1,
T3), and their interactions were fixed factors and the baseline outcome (T0) as a covariate, and the model’s estimated marginal mean differ-
ences between study groups were reported with 95% CIs.
c
Ref.: Quad helix group is used as the reference value.

anteriorly, consistent with earlier studies,22–24 and in The endpoint of the first permanent molars, however, was
a coronal view, the suture opened most inferiorly. the same in both groups. Previous studies have favored
This is likely due to the resistance of the more rigid using primary teeth as anchorage for maxillary expansion
circummaxillary sutures25 and might also be due the due to the preservation of buccal bone on the permanent
fact that the RME in this trial was anchored to the first molars as well as more stable expansion in the ante-
deciduous teeth. Deciduous teeth have theoretically rior area.28,29 In this study, bite blocks were used on the
somewhat lower anchorage value because of their deciduous second molars in both groups during the
short roots and are not as stable as the permanent expansion phase for disarticulation and elimination of
first molars are. The increased angulation of the occlusal interferences and the bite force. Bite blocks have
molars in this study is explained by alveolar bending been proven to be well accepted by patients.16
as well as dental tipping.19 QH is preferred by general practitioners for correct-
A sound conclusion was not made as to whether slow ing unilateral posterior crossbites.30 With the current
or rapid maxillary expansion has the least periodontal side knowledge, it is recommended to raise awareness of
effects.26 In this RCT, QH showed more bone loss than buccal fenestrations that were found in as many as
rapid expansion did, which extends the knowledge of ear- one-third of all first molars treated with QH, a side
lier studies.9,27 In the present study, the QH was anchored effect worth considering when choosing appliances. At
on the first permanent molars, and the RME was follow-up, however, the presence of fenestrations had
anchored on the second deciduous molars and deciduous decreased to one-fifth. This could be explained by
canines, which, to some extent, explains the favorable uprighting and/or relapse of the molars after removal
outcome for the first permanent molars in the RME group. of the appliance.

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SKELETAL EFFECTS OF QUAD HELIX AND RAPID MAXILLARY EXPANSION 519

Table 5. Fenestrations and Root Resorption on the First Permanent Molars (16, 26): Comparison Between RME (n ¼ 21) and QH Groups
(n ¼ 21)a
RME Group (n ¼ 21) QH Group (n ¼ 21) Pb
Buccal fenestration (16 mb)
T0 0 (0%) 0 (0%) NA
T1 0 (0%) 7 (33%) .0086
T3 0 (0%) 4 (19%) .11
Buccal fenestration (26 mb)
T0 0 (0%) 0 (0%) NA
T1 0 (0%) 7 (33%) .0086
T3 0 (0%) 4 (19%) .11
Palatal fenestration (16 p)

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T0 1 (5%) 1 (5%) ..99
T1 4 (19%) 0 (0%) .11
T3 0 (0%) 0 (0%) NA
Palatal fenestration (26 p)
T0 0 (0%) 2 (10%) .49
T1 3 (14%) 0 (0%) .23
T3 0 (0%) 0 (0%) NA
Root resorptionc (16)
T0 any grade 0 (0%) 0 (0%) NA
T1 any grade 1 (5%) 6 (29%) .093
mb 0 0
db 0 2
pal 1 4
T3 any grade 3 (14%) 2 (10%) ..99
mb 0 0
db 0 0
pal 3 2
Location of resorption (16)
T0 any grade 0 (0%) 0 (0%) NA
T1 any grade 1 (5%) 6 (29%) .093
Apical 1 2
Middle 0 2
Cervical 0 2
T3 any grade 3 (14%) 2 (10%) ..99
Apical 3 1
Middle 0 1
Cervical 0 0
Grade 1, slight resorption (16)
T0 0 (0%) 0 (0%) NA
T1 1 (5%) 6 (29%) .093
T3 3 (14%) 2 (10%) .0.99
Root resorptionc (26)
T0 any grade 0 (0%) 0 (0%) NA
T1 any grade 1 (8%) 8 (57%) .013
mb 0 0
db 0 2
pal 1 4
T3 any grade 0 (0%) 3 (21%) .12
mb 0 0
db 0 0
Pal 3 2
Location of resorption (26)
T0 any grade 0 (0%) 0 (0%) NA
T1 any grade 1 (8%) 8 (57%) .013
Apical 1 6
Middle 0 2
Cervical 0 0
T3 any grade 0 (0%) 3 (21%) .22
Apical 0 2
Middle 0 1
Cervical 0 0

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520 HANSSON, JOSEFSSON, LUND, MIRANDA-BAZARGANI, MAGNUSON, LINDSTEN, BAZARGANI

Table 5. Continued
RME Group (n ¼ 21) QH Group (n ¼ 21) Pb
Grade 1, slight resorption (26)
T0 0 (0%) 0 (0%) NA
T1 1 (8%) 8 (57%) .0088
T3 0 (0%) 3 (21%) .12
a
NA indicates not applicable; QH, quad helix; RME, rapid maxillary expansion.
b
Statistical method was Fischer exact test.
c
Root resorption was measured in four degrees of severity: no resorption (grade 0), slight resorption (grade 1), moderate resorption (grade 2),
and severe resorption (grade 3).

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CONCLUSIONS QH anchored to the first permanent molars than
RME on deciduous teeth.
• QH did not open the midpalatal suture in the EMD.
• The opening of the midpalatal suture with the RME ACKNOWLEDGMENTS
was more anterior and inferior. This study was supported by the Regional Research
• More buccal bone loss and fenestration were seen Council. The authors’ work was independent of the funders.
on the permanent first molar in patients treated with This trial was registered at ClinicalTrials.gov, ID NCT04458506
and Researchweb.org project number 260581.

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