Maxillary expansion in adults: MARPE

Rapid palatal expansion (RPE) consists of the correction of palatal defects in the transverse direction and is mainly performed in young patients before closure of the palatal suture. In adolescents and adults the success rate is lower as the suture has already closed.

What factors influence this procedure?

Age is the main factor in performing the ERP. Increasing the maxillary transverse size by rapid expansion in patients who already have the suture closed can lead to problems such as inclination of the supporting teeth due to appliance pressure, gingival recession and high recurrence rates.

The alternative method to this treatment is surgically assisted expansion (SARPE), although the complications of this method and the high cost limit the use of this treatment.

MARPE: an alternative method to ERP

Currently there are procedures for maxillary expansion in adults using micro-screws, also known as MARPE.

It is possible to expand the maxilla when the expansion force can divide the suture. Micro-screws are used to apply a higher level of force than is possible with standard appliances, so that expansion of the basal bone may be possible.

Types of MARPE designs

There are several MARPE appliance designs: one type uses only the micro-screw support, another uses resin that adapts to the palatal mucosa and the micro-screws and finally another one uses the appliance supported by the molars and micro-screws. The placement is a simple procedure and is performed under local anesthesia. The most common areas when 4 micro-screws are used are paramedial to the palatal raphe away from the dental roots. Once in place, the forces applied through the micro-screws are distributed throughout the palate.

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Complications of the MARPE technique

Complications are usually rare and include inflammation and mucosal hyperplasia in the areas surrounding the micro-screws. It is important to emphasize the practice of good oral hygiene and to make patients aware of this. In cases where the space between the appliance and the palatal mucosa is not sufficient, hyperplasia associated with local pain may occur.

In some patients, the force produced by the microscrew against the structures is not sufficient to open the palatal suture, as in some cases, the suture is too imbricated and the microscrews can become deformed without opening the suture. In this case, the SARPE option, by surgery, would be the only possible option. Recent research shows that the non-surgical methodology of microscrew-assisted palatal expansion can be easily performed in adults. This method is an alternative for patients with transverse defects who have completed the growth stage and are seeking to avoid surgical treatment and the complications that can come with it. For more information, contact a specialist in Dentistry and Stomatology.