Rapid maxillary expansion (RME) is an effective approach for treating transverse maxillary deficiencies. It can be performed conventionally using the Hybrid Rigid Expansion (HYRAX) appliance or with bone anchorage in the MARPE technique. There is evidence that failure to open the pterygopalatine suture (PPS) may be a limiting factor. The present study aimed to evaluate the effect of RME on the PPS using MARPE and HYRAX appliances, and to assess the pattern of the midpalatal suture (MPS) opening. Thirty-one patients were selected (HYRAX group: n = 17, mean age 14.7 ± 0.8 years; MARPE group: n = 14, mean age 16.2 ± 2 years). Cone-beam computed tomography was performed at two time points: before RME (T1) and after RME (T2). Dolphin Imaging software was used for orientation and measurements. To assess method error, this process was repeated in six patients after a 15-day interval. All measurements were performed by the same examiner, who was randomly assigned. The Intraclass Correlation Coefficient indicated excellent reproducibility of the method. In the HYRAX group, posterior nasal spine (PNS) opening was 75% of the opening of the anterior nasal spine (ANS), while in the MARPE group, PNS opening was 87% of the ANS opening. PPS disarticulation occurred in 35% of HYRAX patients, whereas in the MARPE group, PPS was disrupted in 58% of patients. Despite the higher incidence of PPS opening in the MARPE group compared to the HYRAX group, there was no statistically significant difference between the groups (p = 0.224). Although the MARPE group showed a tendency toward a more parallel opening of the MPS compared to the HYRAX group, there was no difference in the prevalence of PPS disarticulation after RME in both groups. It is suggested that PPS may be a limiting factor for MPS opening, as in patients in whom it was disrupted, the of MPS opening pattern was nearly perfectly parallel.
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