{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:43:43Z","timestamp":1790142223701,"version":"4.0.1"},"reference-count":36,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"st1\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To compare the effects of a hybrid miniscrew-supported expander versus a conventional Hyrax (CH) expander in growing patients\n                      <jats:bold>.<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      Forty patients were randomized into two groups: a hybrid Hyrax (HH) expander group using a Hyrax expander with two miniscrews and a CH expander group. The final sample had 18 subjects (8 female, 10 male; initial age of 10.8 years) in the HH group and 14 subjects (6 female, 8 male; initial age of 11.4 years) in the CH group. Cone-beam computed tomography examinations and digital dental models were obtained before expansion and 11 months postexpansion. The primary outcomes included the orthopedic transverse effects of expansion. Intergroup comparison was performed using analysis of covariance (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significantly greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width were found for the HH group. No intergroup differences were observed for dental arch width or shape changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The HH group showed greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width. No differences were observed for intermolar, interpremolar, or intercanine widths; arch length; or arch perimeter. Arch size and shape showed similar changes in both groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/060820-527.1","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T02:05:50Z","timestamp":1610589950000},"page":"178-186","source":"Crossref","is-referenced-by-count":34,"title":["Orthopedic outcomes of hybrid and conventional Hyrax expanders:"],"prefix":"10.2319","volume":"91","author":[{"given":"Daniela","family":"Garib","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Martin","family":"Palomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Pugliese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Carlos","family":"da Cunha Bastos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Magno","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Janson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-91-2-178-b01","series-title":"Angle Orthod","first-page":"200","article-title":"The treatment of maxillary deficiency by opening the midpalatal suture","volume":"35","author":"Haas","year":"1965","unstructured":"Haas\n              AJ.\n            \n          \n          The treatment of maxillary deficiency by opening the midpalatal suture.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t1965;\n\t\t\t\t\t35:\n\t\t\t\t\t200\u2013\n\t\t\t\t\t217."},{"key":"i0003-3219-91-2-178-b02","series-title":"Am J Orthod Dentofacial 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Hyrax","volume":"11","author":"Wilmes","year":"2010","unstructured":"Wilmes\n              B,\n            \n            \n              Nienkemper\n              M,\n            \n            \n              Drescher\n              D.\n            \n          \n          Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid Hyrax.\n\t\t\t\t\tWorld J Orthod.\n\t\t\t\t\t2010;\n\t\t\t\t\t11:\n\t\t\t\t\t323\u2013\n\t\t\t\t\t330."},{"key":"i0003-3219-91-2-178-b04","series-title":"J Clin Orthod","first-page":"665","article-title":"Rapid maxillary expansion using palatal implants","volume":"42","author":"Garib","year":"2008","unstructured":"Garib\n              DG,\n            \n            \n              Navarro\n              R,\n            \n            \n              Francischone\n              CE,\n            \n            \n              Oltramari\n              PV.\n            \n          \n          Rapid maxillary expansion using palatal implants.\n\t\t\t\t\tJ Clin Orthod.\n\t\t\t\t\t2008;\n\t\t\t\t\t42:\n\t\t\t\t\t665\u2013\n\t\t\t\t\t671."},{"key":"i0003-3219-91-2-178-b05","series-title":"Angle Orthod","first-page":"713","article-title":"Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults","volume":"86","author":"Choi","year":"2016","unstructured":"Choi\n              SH,\n            \n            \n              Shi\n              KK,\n            \n            \n              Cha\n              JY,\n            \n            \n              Park\n              YC,\n            \n            \n              Lee\n              KJ.\n            \n          \n          Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2016;\n\t\t\t\t\t86:\n\t\t\t\t\t713\u2013\n\t\t\t\t\t720."},{"key":"i0003-3219-91-2-178-b06","series-title":"Angle 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Toklu\n              M,\n            \n            \n              Germec-Cakan\n              D,\n            \n            \n              Tozlu\n              M.\n            \n          \n          Periodontal, dentoalveolar, and skeletal effects of tooth-borne and tooth-bone-borne expansion appliances.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2015;\n\t\t\t\t\t148:\n\t\t\t\t\t97\u2013\n\t\t\t\t\t109."},{"key":"i0003-3219-91-2-178-b08","series-title":"Angle Orthod","first-page":"233","article-title":"de Medeiros Alves A, Lauris JRP, Garib D. 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Dental arch size and shape after maxillary expansion in bilateral complete cleft palate: a comparison of three expander designs.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2019;\n\t\t\t\t\t90:\n\t\t\t\t\t233\u2013\n\t\t\t\t\t238."},{"key":"i0003-3219-91-2-178-b09","series-title":"Angle Orthod","first-page":"253","article-title":"Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence","volume":"85","author":"Lin","year":"2015","unstructured":"Lin\n              L,\n            \n            \n              Ahn\n              HW,\n            \n            \n              Kim\n              SJ,\n            \n            \n              Moon\n              SC,\n            \n            \n              Kim\n              SH,\n            \n            \n              Nelson\n              G.\n            \n          \n          Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2015;\n\t\t\t\t\t85:\n\t\t\t\t\t253\u2013\n\t\t\t\t\t262."},{"key":"i0003-3219-91-2-178-b10","series-title":"Angle Orthod","first-page":"548","article-title":"Rapid maxillary expansion-tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects","volume":"75","author":"Garib","year":"2005","unstructured":"Garib\n              DG,\n            \n            \n              Henriques\n              JF,\n            \n            \n              Janson\n              G,\n            \n            \n              Freitas\n              MR,\n            \n            \n              Coelho\n              RA.\n            \n          \n          Rapid maxillary expansion-tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2005;\n\t\t\t\t\t75:\n\t\t\t\t\t548\u2013\n\t\t\t\t\t557."},{"key":"i0003-3219-91-2-178-b11","series-title":"Orthod Craniofac Res","first-page":"1","article-title":"Orthodontic measurements on digital study models compared with plaster models: a systematic review","volume":"14","author":"Fleming","year":"2011","unstructured":"Fleming\n              PS,\n            \n            \n              Marinho\n              V,\n            \n            \n              Johal\n              A.\n            \n          \n          Orthodontic measurements on digital study models compared with plaster models: a systematic review.\n\t\t\t\t\tOrthod Craniofac Res.\n\t\t\t\t\t2011;\n\t\t\t\t\t14:\n\t\t\t\t\t1\u2013\n\t\t\t\t\t16."},{"key":"i0003-3219-91-2-178-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"157","article-title":"Accuracy, reproducibility, and time efficiency of dental measurements using different technologies","volume":"145","author":"Grunheid","year":"2014","unstructured":"Grunheid\n              T,\n            \n            \n              Patel\n              N,\n            \n            \n              De Felippe\n              NL,\n            \n            \n              Wey\n              A,\n            \n            \n              Gaillard\n              PR,\n            \n            \n              Larson\n              BE.\n            \n          \n          Accuracy, reproducibility, and time efficiency of dental measurements using different technologies.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2014;\n\t\t\t\t\t145:\n\t\t\t\t\t157\u2013\n\t\t\t\t\t164."},{"key":"i0003-3219-91-2-178-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"794","article-title":"Validity, reliability, and reproducibility of plaster vs digital study models: comparison of peer assessment rating and Bolton analysis and their constituent measurements","volume":"129","author":"Stevens","year":"2006","unstructured":"Stevens\n              DR,\n            \n            \n              Flores-Mir\n              C,\n            \n            \n              Nebbe\n              B,\n            \n            \n              Raboud\n              DW,\n            \n            \n              Heo\n              G,\n            \n            \n              Major\n              PW.\n            \n          \n          Validity, reliability, and reproducibility of plaster vs digital study models: comparison of peer assessment rating and Bolton analysis and their constituent measurements.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2006;\n\t\t\t\t\t129:\n\t\t\t\t\t794\u2013\n\t\t\t\t\t803."},{"key":"i0003-3219-91-2-178-b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"e117","article-title":"Effect of bone thickness on alveolar bone-height measurements from cone-beam computed tomography images","volume":"139","author":"Sun","year":"2011","unstructured":"Sun\n              Z,\n            \n            \n              Smith\n              T,\n            \n            \n              Kortam\n              S,\n            \n            \n              Kim\n              DG,\n            \n            \n              Tee\n              BC,\n            \n            \n              Fields\n              H.\n            \n          \n          Effect of bone thickness on alveolar bone-height measurements from cone-beam computed tomography images.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2011;\n\t\t\t\t\t139:\n\t\t\t\t\te117\u2013\n\t\t\t\t\te127."},{"key":"i0003-3219-91-2-178-b15","series-title":"Am J Orthod Dentofacial Orthop","first-page":"S79","article-title":"Effects of bonded rapid palatal expansion on the transverse dimensions of the maxilla: a cone-beam computed tomography study","volume":"137","author":"Christie","year":"2010","unstructured":"Christie\n              KF,\n            \n            \n              Boucher\n              N,\n            \n            \n              Chung\n              CH.\n            \n          \n          Effects of bonded rapid palatal expansion on the transverse dimensions of the maxilla: a cone-beam computed tomography study.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2010;\n\t\t\t\t\t137:\n\t\t\t\t\tS79\u2013\n\t\t\t\t\tS85."},{"key":"i0003-3219-91-2-178-b16","series-title":"Am J Orthod Dentofacial Orthop","first-page":"66","article-title":"Midpalatal miniscrews for orthodontic anchorage: factors affecting clinical success","volume":"137","author":"Kim","year":"2010","unstructured":"Kim\n              YH,\n            \n            \n              Yang\n              SM,\n            \n            \n              Kim\n              S,\n            \n            et al.\n          \n          Midpalatal miniscrews for orthodontic anchorage: factors affecting clinical success.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2010;\n\t\t\t\t\t137:\n\t\t\t\t\t66\u2013\n\t\t\t\t\t72."},{"key":"i0003-3219-91-2-178-b17","series-title":"Int J Oral Maxillofac Implants","first-page":"875","article-title":"Assessment of potential orthodontic mini-implant insertion sites based on anatomical hard tissue parameters: a systematic review","volume":"27","author":"AlSamak","year":"2012","unstructured":"AlSamak\n              S,\n            \n            \n              Gkantidis\n              N,\n            \n            \n              Bitsanis\n              E,\n            \n            \n              Christou\n              P.\n            \n          \n          Assessment of potential orthodontic mini-implant insertion sites based on anatomical hard tissue parameters: a systematic review.\n\t\t\t\t\tInt J Oral Maxillofac Implants.\n\t\t\t\t\t2012;\n\t\t\t\t\t27:\n\t\t\t\t\t875\u2013\n\t\t\t\t\t887."},{"key":"i0003-3219-91-2-178-b18","series-title":"Angle Orthod","first-page":"702","article-title":"Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: a prospective randomized clinical trial","volume":"88","author":"Celenk-Koca","year":"2018","unstructured":"Celenk-Koca\n              T,\n            \n            \n              Erdinc\n              AE,\n            \n            \n              Hazar\n              S,\n            \n            \n              Harris\n              L,\n            \n            \n              English\n              JD,\n            \n            \n              Akyalcin\n              S.\n            \n          \n          Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: a prospective randomized clinical trial.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2018;\n\t\t\t\t\t88:\n\t\t\t\t\t702\u2013\n\t\t\t\t\t709."},{"key":"i0003-3219-91-2-178-b01","series-title":"Angle Orthod","first-page":"200","article-title":"The treatment of maxillary deficiency by opening the midpalatal suture","volume":"35","author":"Haas","year":"1965","unstructured":"Haas\n              AJ.\n            \n          \n          The treatment of maxillary deficiency by opening the midpalatal suture.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t1965;\n\t\t\t\t\t35:\n\t\t\t\t\t200\u2013\n\t\t\t\t\t217."},{"key":"i0003-3219-91-2-178-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"830","article-title":"Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism","volume":"137","author":"Lee","year":"2010","unstructured":"Lee\n              KJ,\n            \n            \n              Park\n              YC,\n            \n            \n              Park\n              JY,\n            \n            \n              Hwang\n              WS.\n            \n          \n          Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2010;\n\t\t\t\t\t137:\n\t\t\t\t\t830\u2013\n\t\t\t\t\t839."},{"key":"i0003-3219-91-2-178-b03","series-title":"World J Orthod","first-page":"323","article-title":"Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid Hyrax","volume":"11","author":"Wilmes","year":"2010","unstructured":"Wilmes\n              B,\n            \n            \n              Nienkemper\n              M,\n            \n            \n              Drescher\n              D.\n            \n          \n          Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid Hyrax.\n\t\t\t\t\tWorld J Orthod.\n\t\t\t\t\t2010;\n\t\t\t\t\t11:\n\t\t\t\t\t323\u2013\n\t\t\t\t\t330."},{"key":"i0003-3219-91-2-178-b04","series-title":"J Clin Orthod","first-page":"665","article-title":"Rapid maxillary expansion using palatal implants","volume":"42","author":"Garib","year":"2008","unstructured":"Garib\n              DG,\n            \n            \n              Navarro\n              R,\n            \n            \n              Francischone\n              CE,\n            \n            \n              Oltramari\n              PV.\n            \n          \n          Rapid maxillary expansion using palatal implants.\n\t\t\t\t\tJ Clin Orthod.\n\t\t\t\t\t2008;\n\t\t\t\t\t42:\n\t\t\t\t\t665\u2013\n\t\t\t\t\t671."},{"key":"i0003-3219-91-2-178-b05","series-title":"Angle Orthod","first-page":"713","article-title":"Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults","volume":"86","author":"Choi","year":"2016","unstructured":"Choi\n              SH,\n            \n            \n              Shi\n              KK,\n            \n            \n              Cha\n              JY,\n            \n            \n              Park\n              YC,\n            \n            \n              Lee\n              KJ.\n            \n          \n          Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2016;\n\t\t\t\t\t86:\n\t\t\t\t\t713\u2013\n\t\t\t\t\t720."},{"key":"i0003-3219-91-2-178-b06","series-title":"Angle Orthod","first-page":"764","article-title":"Effectiveness of maxillary protraction using a hybrid Hyrax-facemask combination: a controlled clinical study","volume":"85","author":"Nienkemper","year":"2015","unstructured":"Nienkemper\n              M,\n            \n            \n              Wilmes\n              B,\n            \n            \n              Franchi\n              L,\n            \n            \n              Drescher\n              D.\n            \n          \n          Effectiveness of maxillary protraction using a hybrid Hyrax-facemask combination: a controlled clinical study.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2015;\n\t\t\t\t\t85:\n\t\t\t\t\t764\u2013\n\t\t\t\t\t770."},{"key":"i0003-3219-91-2-178-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"97","article-title":"Periodontal, dentoalveolar, and skeletal effects of tooth-borne and tooth-bone-borne expansion appliances","volume":"148","author":"Gunyuz Toklu","year":"2015","unstructured":"Gunyuz Toklu\n              M,\n            \n            \n              Germec-Cakan\n              D,\n            \n            \n              Tozlu\n              M.\n            \n          \n          Periodontal, dentoalveolar, and skeletal effects of tooth-borne and tooth-bone-borne expansion appliances.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2015;\n\t\t\t\t\t148:\n\t\t\t\t\t97\u2013\n\t\t\t\t\t109."},{"key":"i0003-3219-91-2-178-b08","series-title":"Angle Orthod","first-page":"233","article-title":"de Medeiros Alves A, Lauris JRP, Garib D. Dental arch size and shape after maxillary expansion in bilateral complete cleft palate: a comparison of three expander designs","volume":"90","author":"Pugliese","year":"2019","unstructured":"Pugliese\n              F,\n            \n            \n              Palomo\n              JM,\n            \n            \n              Calil\n              LR,\n            \n          \n          de Medeiros Alves A, Lauris JRP, Garib D. Dental arch size and shape after maxillary expansion in bilateral complete cleft palate: a comparison of three expander designs.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2019;\n\t\t\t\t\t90:\n\t\t\t\t\t233\u2013\n\t\t\t\t\t238."},{"key":"i0003-3219-91-2-178-b09","series-title":"Angle Orthod","first-page":"253","article-title":"Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence","volume":"85","author":"Lin","year":"2015","unstructured":"Lin\n              L,\n            \n            \n              Ahn\n              HW,\n            \n            \n              Kim\n              SJ,\n            \n            \n              Moon\n              SC,\n            \n            \n              Kim\n              SH,\n            \n            \n              Nelson\n              G.\n            \n          \n          Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2015;\n\t\t\t\t\t85:\n\t\t\t\t\t253\u2013\n\t\t\t\t\t262."},{"key":"i0003-3219-91-2-178-b10","series-title":"Angle Orthod","first-page":"548","article-title":"Rapid maxillary expansion-tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects","volume":"75","author":"Garib","year":"2005","unstructured":"Garib\n              DG,\n            \n            \n              Henriques\n              JF,\n            \n            \n              Janson\n              G,\n            \n            \n              Freitas\n              MR,\n            \n            \n              Coelho\n              RA.\n            \n          \n          Rapid maxillary expansion-tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2005;\n\t\t\t\t\t75:\n\t\t\t\t\t548\u2013\n\t\t\t\t\t557."},{"key":"i0003-3219-91-2-178-b11","series-title":"Orthod Craniofac Res","first-page":"1","article-title":"Orthodontic measurements on digital study models compared with plaster models: a systematic review","volume":"14","author":"Fleming","year":"2011","unstructured":"Fleming\n              PS,\n            \n            \n              Marinho\n              V,\n            \n            \n              Johal\n              A.\n            \n          \n          Orthodontic measurements on digital study models compared with plaster models: a systematic review.\n\t\t\t\t\tOrthod Craniofac Res.\n\t\t\t\t\t2011;\n\t\t\t\t\t14:\n\t\t\t\t\t1\u2013\n\t\t\t\t\t16."},{"key":"i0003-3219-91-2-178-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"157","article-title":"Accuracy, reproducibility, and time efficiency of dental measurements using different technologies","volume":"145","author":"Grunheid","year":"2014","unstructured":"Grunheid\n              T,\n            \n            \n              Patel\n              N,\n           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