Comparative evaluation of median bone regeneration following different surgical treatment methods in surgical assisted maxillary expansion

Sufficient median ossification after surgically assisted maxillary expansion (SAME) facilitates rapid anterior tooth integration and accelerates orthodontic treatment, whereas insufficient ossification may necessitate additional surgery. This study aimed to evaluate the influence of different surgical techniques, distraction devices, and activation protocols on median palatal and alveolar crest ossification, tooth sensitivity, and incisor mobility after SAME. Seventy-one patients (38 males, 33 females; mean age 29.0 ± 7.4 years, range 18-61) underwent SAME using either chisel or piezotome techniques and tooth-borne or bone-borne distractors. Activation protocols varied by initiation time, activation frequency and distraction duration. Median ossification was assessed using postoperative cone beam computed tomography (CBCT) and tooth sensitivity and mobility were evaluated six months postoperatively. No significant influence of surgical technique, distraction device or activation protocol was found on ossification, tooth sensitivity or mobility. However, smokers exhibited significantly reduced ossification compared to non-smokers (p = .015). Logistic regression revealed that greater distraction distance decreased the probability of complete ossification, while the use of bone-borne distractors increased it. In conclusion, optimal ossification after SAME is associated with bone-borne distractors, non-smoking status and shorter distraction distances.