***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives To evaluate and compare the effects of tooth-borne ( TB ) and tooth-bone-borne ( TBB ) rapid maxillary expansion ( RME ) on nasal airflow and resistance . Material and methods Fifty-four consecutive patients who met the eligibility criteria were recruited from September 2010 to December 2015 . Of these 54 subjects , 40 agreed to participate in the part of the study involving evaluation of nasal flow and resistance . The 40 subjects were allocated to either the TB group , mean age 9.7 years ( SD 1.5 ) , or the TBB group , mean age 10.2 years ( SD 1.4 ) . All subjects performed rhinomanometric registration at baseline ( T0 ) , but only 30 attended the post-expansion registration ( T1 ) , of whom 16 had been r and omized to the TB group and 14 to the TBB group . The study outcomes , nasal airflow and nasal airway resistance , were evaluated with linear regression adjusted for baseline variable of the outcome to compare the study groups with complete cases strategy as well as after multiple imputation ( MI ) . R and omization Participants were r and omly allocated in blocks of different sizes , using the concealed allocation principle in a 1:1 ratio . The r and omization list was computer generated to ensure homogeneity between groups . Blinding Blinding was done only for outcome assessor due to clinical limitations . The care providers at the ENT unit who conducted all the rhinomanometry examinations were blinded to which group the patients were allocated to . Results Complete case analysis showed significantly higher post-expansion nasal airflow values for the TBB group compared with the TB group , mean difference 51.0 cm3/s ( P = 0.018 ) . The evaluation after MI showed a similar significant mean difference , 52.7 cm3/s ( P = 0.020 ) in favour of the TBB group when taking into account the missing values from the T1 examination . Even reduction in nasal airway resistance showed similar pattern in favour of the TBB group . Limitations Our results represent the short-term effects . A longer follow-up period would have been preferable . Conclusions The TBB RME induced significantly higher nasal airway flow and lower nasal resistance values than TB RME . It might be wiser to use TBB RME in cases with constricted maxilla and upper airway obstruction . Registration This trial was not registered in any external sites . Protocol The protocol was not published before trial commencement Background During rapid maxillary expansion ( RME ) , heavy forces are transmitted to the maxilla by the anchored teeth causing buccal inclination and buccal bone loss of posterior teeth . Objective To systematic ally review the literature in order to investigate whether RME causes periodontal sequelae , assessed by cone-beam computed tomography ( CBCT ) . Search methods Fifteen electronic data bases and reference lists of studies were search ed up to March 2017 . Selection criteria To be included in the systematic review , articles must be human studies on growing subjects , with transversal maxillary deficiency treated with RME and with assessment of buccal bone loss by CBCT images . Only r and omized and non-r and omized trials were included . Data collection and analysis Two authors independently performed study selection , data extraction , and risk of bias assessment . Study characteristics ( study design , sample size , age , sex , skeletal maturity , type of appliance , daily activation , evaluated linear measurements , observation period , CBCT setting s ) , and study outcomes ( loss of buccal bone thickness and marginal bone ) were reported according to the PRISMA statement . Results On the basis of the applied inclusion criteria , only six articles , three r and omized clinical trials and three controlled clinical trials were included . An individual analysis of the selected articles was undertaken . The risks of bias of the six trials were scored as medium to low . Limitations The results of the present systematic review are based on a limited number of studies and only one study included a control group . Conclusions and implication s In all considered studies , significant loss of buccal bone thickness and marginal bone level were observed in anchored teeth , following RME . Further prospect i ve studies correlating the radiological data of bone loss to the periodontal soft tissues reaction after RME are required . A preliminary evaluation of the patient-related risk factors for RR may be advisable when considering to administering RME . Registration This systematic review was registered in the National Institute of Health Research data base with an appropriate protocol number ( http://www.crd.york.ac.uk/ PROSPERO Protocol : CRD42017062645 ) . Funding The present study has not received any contributions from private or public funding agencies OBJECTIVES To evaluate and compare perceived pain intensity , discomfort , and jaw function impairment during the first week with tooth-borne or tooth-bone-borne rapid maxillary expansion ( RME ) appliances . MATERIAL S AND METHODS Fifty-four patients ( 28 girls and 26 boys ) with a mean age of 9.8 years ( SD 1.28 years ) were r and omized into two groups . Group A received a conventional hyrax appliance and group B a hybrid hyrax appliance anchored on mini-implants in the anterior palate . Question naires were used to assess pain intensity , discomfort , analgesic consumption , and jaw function impairment on the first and fourth days after RME appliance insertion . RESULTS Fifty patients answered both question naires . Overall median pain on the first day in treatment was 13.0 ( range 0 - 82 ) and 3.5 ( 0 - 78 ) for groups A and B , respectively , with no significant differences in pain , discomfort , analgesic consumption , or functional jaw impairment between groups . Overall median pain on the fourth day was 9.0 ( 0 - 90 ) and 2.0 ( 0 - 71 ) for groups A and B , respectively , with no significant differences between groups . There were also no significant differences in pain levels within group A , while group B scored significantly lower concerning pain from molars and incisors and tensions from the jaw on day 4 than on the first day in treatment . There was a significant positive correlation between age and pain and discomfort on the fourth day in treatment . No correlations were found between sex and pain and discomfort , analgesic consumption , and jaw function impairment . CONCLUSIONS Both tooth-borne and tooth-bone-borne RME were generally well tolerated by the patients during the first week of treatment BACKGROUND The effectiveness of intraoral appliances ( IOA ) , maxillary expansion ( ME ) , and maxillom and ibular advancement ( MMA ) in the treatment of children and adults with obstructive sleep apnea ( OSA ) has not yet been adequately assessed . METHODS An umbrella review was performed based on established guidelines for evidence -based medicine . Data synthesis was performed only from r and omized controlled trials with Paule-M and el r and om-effects meta-analyses / meta-regressions using mean differences ( MDs ) and 95 % confidence intervals ( CIs ) and was followed by the qualitative evaluation of the meta- evidence . RESULTS 29 systematic review s were included , 7 of which provided quantitative data . IOA were effective in improving apnea hypopnea index ( AHI ) compared to both , placebo appliances  ( 12 trials ; 525 patients ; MD = -11.70 ; 95 % CI : [ -15.38 ; -8.01 ] ; p<0.001 ) and no treatment ( 1 trial ; 24 patients ; MD = -14.30 ; [ -21.59 ; -7.01 ] ; p<0.001 ) . Only the former comparison was supported by robust meta- evidence . Effectiveness of IOA  as measured by the Epworth Sleepiness Scale , on the other h and , was not supported by robust meta- evidence . No r and omized or prospect i ve controlled trials were found on the effectiveness of ME ( conventional or surgically assisted ) and MMA . CONCLUSION Intraoral appliances are effective in reducing AHI and their use is substantiated by robust evidence . There is no evidence from high- quality research to support treatment with ME ( conventional or surgically assisted ) or MMA in patients with OSA Objective Rapid maxillary expansion ( RME ) is used to exp and the maxilla and increase arch perimeter ; yet , there are few reports on its effects on the sphenoid bone . With cone-beam computed topography ( CBCT ) , it is possible to visualize sphenoid bone changes . The purpose of this study was to investigate sphenoid bone changes observed in conjunction with RME treatments , using CBCT . Methods Sixty patients ( 34 women and 26 men , aged 11–17 years ) underwent RME as part of their orthodontic treatment . Patients were r and omly assigned to one of three groups : a tooth-anchored group , a bone-anchored group , or a control group . Initial CBCT scans were performed preceding the RME treatment ( T1 ) and again directly after the completion of expansion ( T2 ) . Statistical analysis included ANOVA , descriptive statistics , and the intraclass correlation coefficient ( ICC ) . Results The reliability of the l and mark location was at least 0.783 , and the largest ICC mean measurement error was 2.32 mm . With regard to distances , the largest change was 0.78 mm , which was not statistically significant ( p > 0.05 ) . Statistical significance was established in patient groups of the same sex and treatment type for the following distance measurements : right anterior lateral pterygoid plate to the right edge of the hypophyseal fossa ( d2 ) , anterior distance between the medial pterygoid plates ( d4 ) , and anterior distance between the left medial and lateral plates ( d8 ) . Conclusions In this study , there were no clinical ly significant changes in the sphenoid bone due to RME treatments regardless of sex or treatment type AIM To evaluate and compare the short-term ( post-retention ) skeletal and dental changes following bone-borne and tooth-borne surgically assisted rapid maxillary expansion ( SARME ) using cone beam computed tomography ( CBCT ) . SUBJECTS AND METHODS In this r and omized clinical study , 30 patients with transverse maxillary deficiency underwent either tooth-borne ( n = 15 ) or bone-borne ( n = 15 ) SARME . Before treatment and immediately after the consolidation period , CBCT was obtained and the nasal floor width , interdental root distance , palatal bone width and interdental cusp distance were measured at first premolar and first molar regions of maxilla . RESULTS Twenty eight patients completed the study protocol . In both tooth-borne ( n = 13 ) and bone-borne ( n = 15 ) groups the highest degree of expansion occurred in the dental arch , followed by palatal bone , and nasal floor ( V-shaped widening in coronal dimension ) . The amount and pattern of expansion was comparable between anterior and posterior maxillary regions in each group ( parallel posteroanterior expansion ) and between the two groups . CONCLUSION Dental and skeletal effects of tooth-borne and bone-borne devices were comparable . The overall complication rate was negligible . Selection of an expansion device should be based on each individual patient 's requirements . Future long-term clinical trial studies to evaluate the stability and relapse of these two techniques are recommended INTRODUCTION The purpose of this study was to compare the transverse , vertical , and anteroposterior skeletal and dental changes in adolescents receiving expansion treatment with tooth-borne and bone-anchored exp and ers .  Immediate and long-term changes were measured on cone-beam computed tomography ( CBCT ) images . METHODS Sixty-two patients needing maxillary expansion were r and omly allocated to 1 of 3 groups : traditional hyrax tooth-borne exp and er , bone-anchored exp and er , and control . CBCT images were taken at baseline , immediately after expansion , after removal of the appliance ( 6 months ) , and just before fixed bonding ( 12 months ) . Repeated measures multivariate analysis of variance ( MANOVA ) was applied to the distances and angles measured to determine the statistical significance in the immediate and long time periods . Bonferroni post-hoc tests were used to identify significant differences between the treatment groups . RESULTS Immediately after expansion , the subjects in the tooth-borne exp and er group had significantly more expansion at the crown level of the maxillary first premolars ( P = 0.003 ) . Dental crown expansion was greater than apical expansion and skeletal expansion with both appliances . The control group showed little change ( growth ) over the 6-month interval . At 12 months , no group had a statistically significant difference in angle changes , suggesting symmetric expansion . Both treatment groups had significant long-term expansion at the level of the maxillary first molar crown and root apex , first premolar crown and root , alveolus in the first molar and premolar regions , and central incisor root . Tooth-borne expansion result ed in significantly more long-term expansion at the maxillary premolar crown and root than did bone-borne expansion . CONCLUSIONS Both exp and ers showed similar results . The greatest changes were seen in the transverse dimension ; changes in the vertical and anteroposterior dimensions were negligible . Dental expansion was also greater than skeletal expansion INTRODUCTION The purpose s of this study were to evaluate and compare the periodontal , dentoalveolar , and skeletal effects of tooth-borne and tooth-bone-borne expansion devices using cone-beam computed tomography . METHODS Twenty-five patients requiring maxillary expansion were r and omly allocated into 2 groups . A tooth-borne hyrax appliance was used in the first group , consisting of 13 patients ( 8 girls , 5 boys ; mean age , 14.3 ± 2.3 years ) , and a tooth-bone-borne hybrid hyrax appliance was used in the second group of 12 patients ( 6 girls , 6 boys ; mean age , 13.8 ± 2.2 years ) . Cone-beam computed tomography records were taken before and 3 months after expansion , and periodontal , dentoalveolar , and skeletal measurements 
    Output:
    
Conclusions Limited evidence from r and omized trials indicates that bone-borne or hybrid tooth-bone-borne RME might present advantages in terms of increased sutural opening , reduced tooth tipping , and lower nasal airway resistance compared to conventional tooth-borne RME .