Abstract
Objectives: This systematic review aimed to evaluate the effectiveness of currently available methods for the diagnosis and monitoring of skeletal, dental, and soft tissue changes, as well as the adequacy of follow-up protocols, in adolescents and adults treated with miniscrew-assisted rapid palatal expansion (MARPE). Materials and Methods: This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive electronic literature search was performed across five databases (PubMed, Scopus, Embase, Cochrane, and Web of Science) to identify prospective and retrospective clinical studies evaluating dental, periodontal, and alveolar bone outcomes associated with MARPE in late adolescent and adult patients. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies and the RoB 2 tool for randomized studies. The certainty of the evidence was evaluated using the GRADE approach. Owing to substantial methodological heterogeneity and limited follow-up duration, a structured qualitative (narrative) synthesis of the results was performed. Results: A total of 20 studies were included in the systematic review. The reported adverse events primarily involved hard and soft tissues and were identified using cone-beam computed tomography (CBCT), clinical and periodontal examination, panoramic and cephalometric radiography, and digital dental casts. Dental effects, including dental tipping, were frequently reported across the included studies. Alveolar bone loss was reported in 11 studies, buccal alveolar bone dehiscence in 3 studies, and failure of palatal suture opening in 6 studies. In most of the included studies, follow-up was either not reported or limited. Conclusions: The MARPE technique appears to be potentially effective in achieving transverse maxillary expansion in late adolescent and adult patients. However, the included studies report possible adverse events affecting periodontal and alveolar bone tissues, such as alveolar bone thinning and gingival hypertrophy, the assessment of which requires an integrated diagnostic approach combining CBCT imaging with clinical and periodontal examination. Overall, the certainty of the available evidence was low to very low, mainly due to a high risk of bias, methodological heterogeneity, and limited or absent follow-up in most studies. Therefore, the results should be interpreted with caution. Well-designed prospective controlled studies with standardized protocols and long-term follow-up are needed to conclusively evaluate the safety and long-term clinical stability of the MARPE technique.