ORIGINAL ARTICLE

Comparison of treatment outcomes with banded and bonded

RPE appliances

Noel Reed, DDS, MS,a Joydeep Ghosh, DDS, MS,b and Ram S. Nanda, DDS, MS, PhDc
Oklahoma City, Okla

The purpose of this retrospective study was to compare the treatment outcomes with a banded (n = 38)
versus a bonded (n = 55) rapid palatal expansion appliance followed by edgewise orthodontics. Both lateral
cephalometric radiographs and orthodontic study casts were evaluated at pretreatment and posttreatment
time periods. Overall, the banded rapid palatal expansion group had more vertical change than the bonded
group. However, most of these changes were less than 1 or 1 mm and may be considered clinically
insignificant. This study could not establish superiority of one type of rapid palatal expansion technique over
another. (Am J Orthod Dentofacial Orthop 1999;116:31-40)

Rapid palatal expansion (RPE) is a popular
treatment modality for patients who require correction of
transverse discrepancy. This treatment has been associ-
ated with downward movement of the maxillary poste-
From the University of Oklahoma, College of Dentistry.
aIn private practice, Madison, Miss.
bFormer Assistant Professor, Department of Orthodontics.
cProfessor and Chairman, Department of Orthodontics.
Reprint requests to: Ram S. Nanda, DDS, MS, PhD, Professor and Chair,
Department of Orthodontics, University of Oklahoma, College of Dentistry,
1001 Stanton L. Young Blvd, Oklahoma City, OK 73190.
Copyright 1999 by the American Association of Orthodontists.
0889-5406/99/$8.00 + 0 8/1/94271
rior teeth as well as the maxilla.l-7 For patients with pro-
nounced vertical facial growth patterns, these are unde-
sirable side-effects. Many different appliance designs
have been developed to help eliminate some of the extru-
sive effects of palatal expansion.1,3,4,8,9 Asanza et all0 and
Sarver and Johnston11 suggested that the use of a bonded
RPE appliance that incorporates occlusal coverage,
reduced or negated the extrusive side-effects of RPE dur-
ing the initial expansion phase of treatment.
RPE is performed in conjunction with comprehen-
sive orthodontic treatment. The subsequent orthodontic
treatment may significantly affect vertical changes in

Fig 1. Banded rapid palatal appliance used in this study.

31
32 Reed, Ghosh, and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
July 1999

Table I. Changeswith treatment in the banded RPE group. Cephalometric and dental cast measurements for 38 cases
before treatment and at the end of active orthodontic treatment.
Banded means (n=38) Pretreatment Posttreatment

Variables Mean SD Minimum Maximum Mean SD

Maxillary dental cast measurements (mm)

Inter-1st premolar width 30.93 1.48 27.92 35.16 35.84 1.83
Inter-1st molar width 42.35 2.31 36.51 46.88 44.87 2.18
Cephalometric measurements
Skeletoangular
SNA 80.96 3.44 73.40 89.70 80.62 3.31
SNB 79.20 3.03 74.60 88.40 78.87 2.84
ANB 1.75 2.21 2.50 5.30 1.74 2.04
Facial angle 91.99 2.48 87.40 98.40 92.09 2.60
FMA 21.18 3.53 12.90 28.60 21.51 3.75
GoGn/SN 32.45 3.65 24.00 38.20 33.02 3.63
PP/SN 6.39 3.26 0.50 13.60 6.50 3.26
Saddle angle 121.92 5.56 111.00 133.80 122.03 5.51
Gonial angle 125.73 4.86 115.80 134.20 125.12 5.41
Y-Axis/FH 54.77 2.60 49.40 58.70 55.33 2.77
Skeletolinear
SNPerp at S-A 63.04 4.90 53.20 73.10 63.27 5.02
Ar-A 86.17 5.42 76.50 97.90 87.32 5.04
Ar-Gn 110.28 6.40 94.30 126.30 113.60 5.89
ANS-SN 52.75 3.58 44.50 58.50 54.25 3.09
PNS-SN 46.27 3.18 40.00 52.30 47.62 3.15
Lower anterior face height 68.52 5.10 59.70 83.10 71.26 5.26
Total anterior face height 118.93 7.23 106.40 134.80 123.28 6.66
Lower posterior face height 45.23 4.19 32.20 52.10 47.06 4.41
Total posterior face height 75.70 5.64 60.90 86.20 78.45 5.87
Dentoangular
Anatomical occlusal plane/SN 15.26 4.60 5.50 27.00 16.16 4.01
Functional occlusal plane/SN 14.79 6.04 3.90 27.30 13.89 4.54
U1/SN 102.43 7.83 85.30 122.20 106.68 5.05
U1/NA 21.48 7.40 6.50 36.70 26.07 6.37
UL6/SN 22.13 4.98 8.40 35.00 19.75 5.74
UL6/PP 15.74 4.83 5.20 29.20 13.26 5.63
Interincisal angle 137.78 10.27 118.70 157.50 127.45 7.16
L1/NB 19.00 6.27 0.60 31.10 24.75 5.58
IMPA 87.06 5.56 73.40 96.80 92.72 5.97
LL6/MP 12.55 4.65 0.90 20.80 16.96 4.66
Dentolinear
U1-SN 80.96 5.36 69.90 89.90 83.38 4.75
U1-NA 5.47 1.76 2.00 9.30 5.96 1.95
UL6-SNPerp at S 29.83 4.96 19.00 40.20 30.65 4.73
UL6-PP 18.75 2.85 11.90 25.60 19.90 2.27
UL6-SN 66.79 5.02 56.00 77.50 69.47 4.22
L1-NB 4.32 2.02 0.40 10.10 5.92 1.92
L1-MP 39.91 3.08 33.40 47.40 41.65 2.72
LL6-MPPerp at posterior symphasis 33.38 2.10 29.10 39.70 33.34 2.39
LL6-MP 27.26 2.47 22.60 32.50 29.09 2.80
Overbite 2.56 2.30 2.50 7.30 1.83 0.77
Overjet 3.23 1.73 0.30 8.70 2.33 0.72

*Significant values (P < .05).

the dental occlusion and the face.12 The bite opening
side-effects seen with palatal expansion may settle dur-
ing edgewise treatment once occlusal interferences are
eliminated. However, information is lacking on the
final outcomes of orthodontic treatment with RPE
appliances using bonded posterior occlusal coverage
versus no occlusal coverage. The focus of this study
was to compare treatment outcomes, with special
emphasis on vertical dentofacial changes, between a
banded versus a bonded RPE appliance.
American Journal of Orthodontics and Dentofacial Orthopedics Reed, Ghosh, and Nanda 33
Volume 116, Number 1

Change with treatment

Minimum Maximum Mean SD Minimum Maximum P value

31.98 39.59 4.91 1.83 1.59 9.15 .0001*

40.93 51.68 2.51 1.76 0.37 8.23 .0001*

71.80 87.20 0.34 1.49 3.30 3.30 .1693

72.50 86.70 0.33 1.05 2.80 1.60 .0602
3.30 4.70 0.01 1.03 1.70 2.90 .9378
87.40 98.40 0.10 1.04 1.70 3.40 .5483
13.00 30.30 0.33 1.53 2.80 3.90 .1865
24.50 39.60 0.57 1.59 2.60 3.70 .034*
0.50 13.50 0.11 0.94 1.50 2.90 .4749
110.40 133.70 0.11 1.36 2.30 4.60 .6273
113.80 136.00 0.61 1.78 5.90 4.70 .0407*
50.20 60.10 0.57 1.04 1.40 3.00 .0019*

51.40 74.80 0.23 1.84 3.30 4.00 .449

78.10 97.40 1.15 2.07 2.20 6.30 .0015*
103.70 128.90 3.32 3.17 2.00 13.40 .0001*
49.60 61.60 1.50 1.42 1.20 5.40 .0001*
42.00 54.20 1.36 1.23 0.60 5.00 .0001*
61.00 86.00 2.74 2.62 2.90 11.20 .0001*
109.10 139.20 4.35 3.44 2.30 15.10 .0001*
37.50 54.50 1.83 2.75 6.60 8.80 .0002*
64.20 89.10 2.75 2.95 2.80 11.10 .0001*

5.60 25.70 0.91 2.91 6.50 6.40 .0632

3.70 24.50 0.90 4.79 10.70 8.50 .2526
93.40 117.80 4.24 6.98 11.10 17.20 .0006*
14.10 40.10 4.58 7.29 9.40 18.10 .0004*
7.30 34.10 2.38 5.33 15.40 8.60 .0091*
3.10 29.10 2.47 5.23 16.90 5.70 .006*
114.60 147.00 10.32 10.99 36.30 14.00 .0001*
11.10 37.90 5.75 5.79 5.50 19.10 .0001*
75.40 107.90 5.66 5.69 6.10 19.20 .0001*
4.10 26.40 4.42 4.30 1.50 16.70 .0001*

73.90 92.50 2.42 2.58 1.60 9.80 .0001*

1.90 11.30 0.49 1.70 4.10 3.60 .0821
19.40 39.80 0.82 1.83 2.20 5.40 .009*
14.30 25.80 1.16 1.49 1.50 6.40 .0001*
58.70 78.80 2.67 2.27 0.50 10.50 .0001*
2.00 10.00 1.60 1.51 1.50 5.10 .0001*
36.70 48.80 1.74 1.65 2.00 6.80 .0001*
28.80 37.60 0.04 1.38 3.00 2.60 .8615
24.30 34.10 1.83 1.49 0.90 4.90 .0001*
0.10 3.50 0.73 2.16 5.50 3.80 .0448*
0.30 4.30 0.89 1.75 6.70 2.00 .0033

MATERIAL AND METHODS to 16 years 8 months and records of 55 patients treated

with a bonded RPE appliance, 38 females and 17 males
Records of 38 patients treated with a banded RPE with a mean age of 13 years 3 months and a range of
appliance, 33 females and five males with a mean age 10 years 3 months to 17 years 5 months were available
of 12 years 9 months and a range of 10 years 1 month for study. All patients were white and received nonex-
34 Reed, Ghosh, and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
July 1999

Table II. Changes with treatment in the bonded RPE group. Cephalometric and dental cast measurements for 55
cases before treatment and at the end of active orthodontic treatment.
Bonded means (n=55) Pretreatment Posttreatment

Variables Mean SD Minimum Maximum Mean SD

Maxillary dental cast measurements (mm)

Inter-1st premolar width 33.05 1.85 29.78 40.14 37.65 1.65
Inter-1st molar width 43.76 2.14 37.52 49.26 49.16 2.13
Cephalometric measurements
Skeletoangular
SNA 80.52 3.07 73.80 87.40 79.85 3.02
SNB 77.72 2.90 70.20 83.60 77.92 3.00
ANB 2.80 1.89 1.80 7.10 1.94 1.75
Facial angle 90.09 2.90 83.00 95.80 90.67 3.18
FMA 21.80 5.44 9.60 33.60 21.44 5.75
GoGn/SN 32.65 5.12 22.00 43.40 32.53 5.20
PP/SN 8.57 3.11 2.80 15.60 8.84 3.50
Saddle angle 123.71 4.37 114.30 133.00 123.85 4.40
Gonial angle 123.61 6.10 112.20 139.20 122.98 6.39
Y-Axis/FH 56.06 3.21 50.00 64.00 56.20 3.46
Skeletolinear
SNPerp at S-A 62.90 4.56 51.00 72.40 62.88 4.83
Ar-A 87.02 4.68 78.60 97.80 88.16 4.82
Ar-Gn 109.16 6.06 95.90 124.90 113.37 6.38
ANS-SN 53.48 3.27 46.90 60.30 55.20 3.41
PNS-SN 45.07 3.17 39.80 55.50 46.42 3.32
Lower anterior face height 67.18 5.64 56.00 80.60 69.36 6.06
Total anterior face height 118.57 7.53 106.80 138.40 122.87 7.86
Lower posterior face height 45.62 4.95 34.80 58.20 48.13 4.81
Total posterior face height 75.35 6.53 60.00 99.70 78.65 6.67
Dentoangular
SN/anatomical occlusal plane 16.29 4.47 6.30 31.00 15.62 4.29
SN/Functional occlusal plane 15.33 6.99 4.00 45.20 12.82 5.57
U1/SN 102.06 6.36 87.20 113.10 108.42 5.20
U1/NA 21.53 6.72 5.20 35.40 28.55 5.13
UL6/SN 23.60 5.66 10.10 40.40 22.21 5.08
UL6/PP 15.04 5.10 0.50 26.10 13.37 4.69
Interincisal angle 133.22 10.57 114.70 155.90 123.06 6.79
L1/NB 22.44 5.91 9.60 32.20 26.45 5.13
IMPA 91.70 5.92 79.60 104.10 95.84 5.83
LL6/MP 11.38 4.92 1.50 22.80 12.88 4.69
Dentolinear
U1-SN 81.25 4.57 73.30 92.60 82.75 4.76
U1/NA 5.40 1.80 0.70 10.30 5.78 1.63
UL6-SNPerp at S 29.49 4.38 17.90 37.30 30.99 4.89
UL6-PP 18.05 2.71 12.20 25.90 19.67 2.60
UL6-SN 65.53 4.81 56.50 82.70 68.85 4.69
L1-NB 5.09 2.07 1.40 10.60 5.81 1.90
L1MP 40.85 3.26 34.00 49.50 41.86 3.65
LL6-MPPerp at posterior symphasis 31.87 2.50 26.50 36.80 31.98 2.65
LL6-MP 27.76 2.99 22.80 35.80 29.57 2.80
Overbite 3.54 1.96 1.20 8.70 1.77 0.70
Overjet 3.64 1.55 0.40 8.00 2.57 0.62

*Significant values (P < .05)

traction orthodontic treatment. Patients requiring head-
gear or maxillary molar distalization and orthognathic
surgery were not included in this sample. In the banded
group, there were 34 patients with anterior and/or pos-
terior crossbite and four with a dental compensation for
a transverse discrepancy without an apparent crossbite.
In the bonded group, there were 28 patients with ante-
rior and/or posterior crossbite and 27 with transverse
discrepancy and no apparent crossbite.
The expansion regimen for the banded group was
American Journal of Orthodontics and Dentofacial Orthopedics Reed, Ghosh, and Nanda 35
Volume 116, Number 1

Change with treatment

Minimum Maximum Mean SD Minimum Maximum P value

34.72 41.71 4.60 1.55 0.04 7.86 .0001*

44.51 53.16 5.40 2.08 0.70 11.84 .0001*

73.30 86.20 0.67 1.16 2.80 1.80 .0001*

70.20 84.50 0.20 1.12 2.70 2.30 .1978
2.30 6.20 0.86 1.24 3.60 1.70 .0001*
82.10 96.70 0.57 0.99 1.30 2.70 .0001*
8.30 33.10 0.36 1.34 3.80 2.90 .0503
21.00 45.00 0.12 1.30 3.20 2.30 .4853
1.80 17.70 0.28 1.39 4.10 4.20 .1439
115.50 132.90 0.13 1.70 4.00 3.80 .5608
109.10 139.40 0.63 1.85 4.40 4.90 .0151*
50.00 64.30 0.14 0.91 1.80 2.00 .2521

49.60 74.60 0.02 1.24 3.00 2.30 .9054

79.50 99.70 1.14 1.63 2.80 5.10 .0001*
102.70 130.60 4.20 2.85 1.30 10.40 .0001*
47.80 63.20 1.72 1.22 1.20 5.10 .0001*
40.50 56.80 1.35 1.29 1.40 4.90 .0001*
54.70 82.30 2.18 2.38 2.70 7.30 .0001*
110.10 142.50 4.30 3.09 1.50 11.30 .0001*
38.90 59.20 2.51 2.49 1.80 8.40 .0001*
66.20 103.40 3.30 2.80 1.70 10.30 .0001*

6.30 28.80 0.67 3.14 14.30 4.20 .0085*

2.30 27.90 2.51 6.00 28.90 10.50 .003*
96.10 122.10 6.35 7.33 7.20 23.30 .0001*
18.50 41.80 7.01 7.63 6.40 24.00 .0001*
14.00 36.40 1.39 5.25 13.10 9.40 .0545
4.60 25.20 1.67 5.46 12.70 10.60 .0272*
111.10 139.80 10.16 9.46 29.00 8.80 .0001*
16.60 38.00 4.01 4.29 7.00 13.70 .0001*
84.00 111.30 4.15 4.37 6.10 11.30 .0001*
0.80 25.50 1.49 4.31 6.90 11.30 .0128*

74.90 93.40 1.50 1.76 2.60 5.20 .0001*

2.40 10.20 0.37 1.61 3.20 3.90 .0901
19.60 39.20 1.49 1.56 1.20 4.10 .0001*
14.30 25.50 1.62 1.81 1.70 8.60 .0001*
62.10 83.70 3.32 2.28 2.90 9.00 .0001*
2.30 9.90 0.72 1.16 2.20 3.00 .0001*
35.40 49.50 1.01 1.54 2.70 4.30 .0001*
25.20 36.90 0.10 1.17 3.00 2.90 .5143
25.30 37.00 1.81 1.52 2.80 5.10 .0001*
0.00 2.90 1.78 1.78 6.60 3.30 .0001*
1.50 4.80 1.07 1.73 6.20 3.30 .0001*

two turns per day for 1 week followed by one turn per
day, the bonded group was expanded one to two turns
per day until the required expansion was achieved.
After expansion, the appliance was left in place for a
mean time in the banded group of 4.9 months 1.8
months with a range of 1.5 to 9.2 months. In the
bonded group, the RPE appliance was left in place
for a mean time of 5.6 months 1.6 months with a
range of 2 to 10.2 months. The mean total orthodon-
tic treatment time was 23 months for the banded
36 Reed, Ghosh, and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
July 1999

Table III. Comparison of differences in amount of change with treatment between the banded and bonded RPE groups
Change with treatment

Variables Banded group Bonded group

Mean SD Minimum Maximum Mean SD

Maxillary dental cast measurements (mm)

Inter-1st premolar width 4.91 1.83 1.59 9.15 4.60 1.55
Inter-1st molar width 2.51 1.76 0.37 8.23 5.40 2.08
Cephalometric measurements
Skeletoangular
SNA 0.34 1.49 3.30 3.30 0.67 1.16
SNB 0.33 1.05 2.80 1.60 0.20 1.12
ANB 0.01 1.03 1.70 2.90 0.86 1.24
Facial angle 0.10 1.04 1.70 3.40 0.57 0.99
FMA 0.33 1.53 2.80 3.90 0.36 1.34
GoGn/SN 0.57 1.59 2.60 3.70 0.12 1.30
PP/SN 0.11 0.94 1.50 2.90 0.28 1.39
Saddle angle 0.11 1.36 2.30 4.60 0.13 1.70
Gonial angle 0.61 1.78 5.90 4.70 0.63 1.85
Y-Axis/FH 0.57 1.04 1.40 3.00 0.14 0.91
Skeletolinear
SNPerp at S-A 0.23 1.84 3.30 4.00 0.02 1.24
Ar-A 1.15 2.07 2.00 6.30 1.14 1.63
Ar-Gn 3.32 3.17 2.00 13.40 4.20 2.85
ANS-SN 1.50 1.42 1.20 5.40 1.72 1.22
PNS-SN 1.36 1.23 0.60 5.00 1.35 1.29
Lower anterior face height 2.74 2.62 2.90 11.20 2.18 2.38
Total anterior face height 4.35 3.44 2.30 15.10 4.30 3.09
Lower posterior face height 1.83 2.75 6.60 8.80 2.51 2.49
Total posterior face height 2.75 2.95 2.80 11.10 3.30 2.80
Dentoangular
SN/Anatomic occlusal plane 0.91 2.91 6.50 6.40 0.67 3.14
SN/Functional occlusal plane 0.90 4.79 10.70 8.50 2.51 6.00
U1/SN 4.24 6.98 11.10 17.20 6.35 7.33
U1/NA 4.58 7.29 9.40 18.10 7.01 7.63
UL6/SN 2.38 5.33 15.40 8.60 1.39 5.25
UL6/PP 2.47 5.23 16.90 5.70 1.67 5.46
Interincisal angle 10.32 10.99 36.30 14.00 10.16 9.46
L1/NB 5.75 5.79 5.50 19.10 4.01 4.29
IMPA 5.66 5.69 6.10 19.20 4.15 4.37
LL6/MP 4.42 4.30 1.50 16.70 1.49 4.31
Dentolinear
U1-SN 2.42 2.58 1.60 9.80 1.50 1.76
U1-NA 0.49 1.70 4.10 3.60 0.37 1.61
UL6-SNPerp at S 0.82 1.83 2.20 5.40 1.49 1.56
UL6-PP 1.16 1.49 1.50 6.40 1.62 1.81
UL6-SN 2.67 2.27 0.50 10.50 3.32 2.28
L1-NB 1.60 1.51 1.50 5.10 0.72 1.16
L1-MP 1.74 1.65 2.00 6.80 1.01 1.54
LL6-MPPerp at pst sym 0.04 1.38 3.00 2.60 0.10 1.17
LL6-MP 1.83 1.49 0.90 4.90 1.81 1.52
Overbite 0.73 2.16 5.50 3.80 1.78 1.78
Overjet 0.89 1.75 6.70 2.00 1.07 1.73

*Significant values (P < .05).

group and 24.5 months for the bonded group. The The banded RPE appliance used in this study con-
expansion and retention regimens were based on clin- sisted of an all-wire framework with an expansion
icians preferences and their diagnoses of patients indi- screw soldered to bands on the maxillary permanent
vidual malocclusions. first molars and first premolars. The expansion screw
American Journal of Orthodontics and Dentofacial Orthopedics Reed, Ghosh, and Nanda 37
Volume 116, Number 1

Cohen and Silverman8 and modified9 with the addi-

tion of palatal soft tissue acrylic coverage. The
bonded RPE appliance used an expansion screw to be
Difference placed closer to the palate and therefore allowed the
Minimum Maximum Amount P value force to be placed closer to the center of resistance of
the maxilla. The buccal surfaces of the maxillary
posterior teeth were etched, and the appliance was
0.04 7.86 NA .4052
cemented with chemical cure bonding material. Figs
0.70 11.84 2.89 .0001*
1 and 2 illustrate the RPE appliances used in this
study.
2.80 1.80 NA .2619 Preorthodontic and postorthodontic treatment lat-
2.70 2.30 0.53 .023* eral cephalometric radiographs and orthodontic study
3.60 1.70 0.85 .0006*
casts were evaluated. Each film was traced and digi-
1.30 2.70 0.47 .0318*
3.80 2.90 0.69 .0264* tized. Fifty radiographs were traced and digitized for
3.20 2.30 0.69 .0301* measurement of error. All angular measurements
4.10 4.20 NA .4905 showed less than 0.75 of error with the exception of
4.00 3.80 NA .9335 SN to functional occlusal plane angle (0.83 of error at
4.40 4.90 NA .9744
P = .01) and interincisal angle (1.0 of error at P =
1.80 2.00 0.43 .0462*
.003). All linear measurements showed less than 0.5
3.00 2.30 NA .4706 mm of error. The error for measurements on the dental
2.80 5.10 NA .973 casts was less than 0.25 mm.
1.30 10.40 NA .1722 To determine if two subsamples of patients
1.20 5.10 NA .4467
treated with banded and bonded rapid palatal expan-
1.40 4.90 NA .9869
2.70 7.30 NA .2963 sion appliances were matched, a Student t test was
1.50 11.30 NA .9451 performed on the means of pretreatment dental and
1.80 8.40 NA .2272 skeletal measurements. It was found that the two
1.70 10.30 NA .3706 subsamples were equally matched because a large
majority of the measurements were not significantly
14.30 4.20 1.58 .015*
28.90 10.50 NA .155 different.
7.20 23.30 NA .1641
6.40 24.00 NA .1245 RESULTS
13.10 9.40 NA .3801 Changes with Treatment in the Banded and
12.70 10.60 NA .4766 Bonded Groups
29.00 8.80 NA .9413
7.00 13.70 NA .1202 Tables I and II describe the changes with treatment
6.10 11.30 NA .1706 for the banded and bonded RPE groups. Paired t tests
6.90 11.30 2.93 .0019* were used to analyze the pretreatment and posttreat-
ment changes. In the banded group, there was a mean
2.60 5.20 NA .0587
net expansion between the maxillary first premolars of
3.20 3.90 NA .7383
1.20 4.10 NA .0672 4.9 mm (P < .001) whereas maxillary permanent first
1.70 8.60 NA .177 molar width changed by a mean 2.5 mm (P < .001).
2.90 9.00 NA .1845 The bonded group had a mean net expansion between
2.20 3.00 0.88 .0036* the maxillary first premolars of 4.6 mm (P < .001)
2.70 4.30 0.73 .0329*
whereas maxillary permanent first molar width
3.00 2.90 NA .6038
2.80 5.10 NA .9548 changed by a mean 5.4 mm (P < .001).
6.60 3.30 1.05 .0163* Tables I and II show that the changes in most skele-
6.20 3.30 NA .6852 tal angular measurements with treatment in both
groups were statistically significant. However, the
banded group showed a statistically significant change
with treatment in the means for angles SN to GoGn and
and frame were placed as close to the roof of the Y-axis at P < .05.
palate as possible without impinging on the palatal With the exception of measurement Sella Nasion
soft tissue. The bonded RPE appliance with posterior perpendicular at S to point A that reflected sagittal
occlusal coverage used in this study was described by change of the maxilla, all skeletal linear measures of
38 Reed, Ghosh, and Nanda
Fig 2. Posttreatment differences in the amount of skeletal and dental changes, reflecting vertical height,
between the banded (Ba) and bonded (Bo) RPE groups. Angular changes in the FMA and Y-axis angle
although small are significantly different; linear changes were statistically insignificant. (*P < .05.)
the facial skeleton demonstrated significant increases
in both groups, including an inferior movement of the
palatal plane and increases in anterior and posterior
face heights.
The inclination of the anatomic occlusal plane
demonstrated no significant change with treatment in
the banded group, but decreased 0.7 with treatment (P
< .01) in the bonded group.
The maxillary permanent first molars in the banded
group extruded relative to the palatal plane by 1.2 mm
(P < .001) and 2.7 mm relative to the SN line (P < .001)
whereas in the bonded group they extruded relative to
the palatal plane by 1.6 mm (P < .001) and 3.3 mm to
the SN line (P < .001).
Comparison of Treatment Changes Between the
Bonded and Banded Groups
Table III compares the changes with treatment
between the banded and bonded groups. Whereas the
change in the first premolar arch width was not signif-
icantly different between the banded and bonded
groups, the change in the permanent first molar width
was more than twice as much in the bonded group and
statistically significant at P < .001.
Overall, vertical skeletal changes in the banded
RPE group were greater than that of the bonded RPE
group. The differences in the measurements Frankfort
American Journal of Orthodontics and Dentofacial Orthopedics
July 1999
mandibular plane angle and SN to GoGn were larger
in the banded group each by 0.7, and Y-axis was
larger by 0.4. These differences were statistically sig-
nificant at P < .05. Changes in SN to palatal plane
angle and gonial angle were not significantly different
between groups.
The linear measurements of vertical skeletal
changes were not different between the two groups.
When dental angular changes were compared, SN
plane to anatomical occlusal plane increased more in
the banded group by 1.6 (P < .05).
When dental linear changes were compared, the
maxillary permanent first molars extruded a mean of
1.2 mm relative to the palatal plane in the banded group
as compared to 1.6 mm in the bonded group. This was
not a significantly different amount between the two
groups (P = .18).
Correlation of Variables
Vertical maxillary molar change was compared
with the amount of maxillary expansion, chronologic
age, the amount of time that the appliance was in place,
and measurements of vertical change in the face.
A Pearsons correlation analysis for the entire sam-
ple found that the increase in maxillary interdental
width was not correlated to the amount of time that the
RPE appliance was in place, chronologic age, or any of
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 116, Number 1
the vertical change indicators tested. The change in
inclination of the mandibular plane was not correlated
to the initial value or to the amount of maxillary expan-
sion. Changes in arch width at the first premolars and
at the permanent first molars were not correlated with
each other. Vertical change of the maxillary first molar
was not correlated to the amount of time that the RPE
appliance was in place, initial mandibular plane angle,
change in mandibular plane angle, or Y-axis angle.
However, vertical change in the maxillary first molar to
Sella Nasion plane was mildly correlated to the change
in lower anterior and posterior face heights r = 0.59 at
P < .001 and r = 0.44 at P < .001, respectively).
DISCUSSION
The correction of transverse discrepancies with the
use of RPE appliances has gained professional accep-
tance in treatment. In growing patients, RPE treatment
has been advocated for correction of transverse dis-
crepancies as an initial phase of treatment followed by
full banded/bonded appliance therapy. It has been
demonstrated that RPE causes variable amounts of
dental tipping and inferior movement of the palatal
plane that are undesirable side-effects particularly in
patients with open bite tendency.l-7 The benefit of pos-
terior occlusal coverage biteplane therapy to intrude or
maintain vertical position of the posterior teeth has
been reported.13 RPE has therefore been combined
with posterior occlusal coverage as a bonded expander
in an attempt to couple the beneficial effects of the
RPE appliance with that of the biteplane. Previous
studies noted that the vertical effects could be partially
or completely controlled with bonded devices; but,
their observations were limited to the duration of the
use of the RPE appliances including a 3 month stabi-
lization period.10,11 However, information on the final
outcomes on completion of treatment was unavailable.
This study compared the vertical change between
banded and bonded RPE groups over the entire period
of orthodontic treatment.
Results of this investigation revealed that angular
measurements reflecting change in the vertical dimension
with treatment were statistically significant. Overall, ver-
tical change in the banded RPE group was greater than
that of the bonded RPE group. The mandibular plane
appeared to rotate in a downward and backward direc-
tion, more in the banded group by 0.7 (P < .05). The Y-
axis in this group was also higher by 0.7 (P < .05). On
the other hand, there were no differences in any linear
measures of skeletal change. Palatal plane dropped infe-
riorly an equal amount in both groups. Anterior and pos-
terior facial heights increased a similar amount in both
groups. However, a vast majority of the differences
Reed, Ghosh, and Nanda 39
between the two treatment modalities were less than 1
mm or 1 and may not be clinically relevant.
The amount of time that the RPE appliances are
held in place may influence a biteplane effect. A Stu-
dent-Newman-Keuls test was applied to determine if
those RPE appliances that were in place for a longer
period of time showed a higher correlation to verti-
cal change in the face than those RPE appliances
that were in place for a shorter time. The sample
was divided into three groups on the basis of length
of time an RPE appliance was in place: less than 4
months, 4 to 6.9 months, and 7 months or longer.
No significant differences were noted. These find-
ings suggested that there may have been insufficient
time for the biteplane effect to occur when the
appliance was in place; or, if the reduced vertical
molar extrusion with the bonded appliancel0,11 did
occur, it may have been diminished or negated by
full appliance treatment effects, settling of teeth,
and growth.
Asanza et al10 and Sarver and Johnston11 from their
clinical studies with RPE appliances found that the
palatal plane drops less at the posterior nasal spine than
at the anterior nasal spine in patients treated with
bonded posterior occlusal coverage RPE appliances
versus those treated with banded RPE appliances.
However, our study at the termination of orthodontic
treatment did not support these findings. There were
no more vertical changes in the palatal plane noted in
our study than those reported by Riolo et al 14 and
therefore could well reflect the normal growth
changes during the period of about 26 months of
orthodontic treatment.
SUMMARY AND CONCLUSIONS
The following conclusions may be drawn from
this study:
1. There were no clinical differences in the amount of
inferior movement of the palatal plane and maxillary
molars between the patients treated with banded and
bonded appliances.
2. Patients with higher mandibular plane inclinations at
the beginning of treatment did not exhibit significantly
greater vertical change with RPE and edgewise ortho-
dontic therapy than those treated with lesser mandibu-
lar plane inclinations.
3. There was greater net maxillary molar expansion in the
bonded RPE group. However, the vertical movement of
the maxillary molar was independent of the amount of
maxillary expansion, the time that the RPE appliance
was in place, and the amount of change in mandibular
plane angle. However, it was mildly correlated to the
change in both lower anterior and posterior vertical
facial heights.
40 Reed, Ghosh, and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
July 1999

4. This study could not establish superiority of one type of
RPE technique over another when banded RPE versus
bonded RPE groups were compared at the completion
of edgewise orthodontic treatment.
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