Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE)

Abstract

Introduction: Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). Objective: The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA).Methods: All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained.Conclusion: It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.

Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion

“…Every patient was treated by the maxillary skeletal expansion type II appliance (BioMaterials Korea, Seoul, Korea) developed by Dr. Moon and colleagues 18 ( Figure 1). The appliance consisted of bands to the permanent first molars and four holes for mini-implants.…”

Asymmetric nasomaxillary expansion induced by tooth‐bone‐borne expander producing differential craniofacial changes

“…Various types of tooth‐bone‐borne rapid palatal expanders (TBB‐RPEs) supported by skeletal anchorage devices have been developed to maximize the skeletal effect of maxillary basal expansion, particularly in young adults with transverse discrepancy . Although TBB‐RPE may have dentoalveolar and periodontal side effects around the supported teeth when compared to a pure bone‐borne rapid palatal expander (BB‐RPE), it has the advantages of better rigidity to overcome the sutural tissue resistance with less palatal tissue impingement than BB‐RPE .…”

“…Although TBB‐RPE may have dentoalveolar and periodontal side effects around the supported teeth when compared to a pure bone‐borne rapid palatal expander (BB‐RPE), it has the advantages of better rigidity to overcome the sutural tissue resistance with less palatal tissue impingement than BB‐RPE . Non‐surgical TBB‐RPE is currently regarded as superior to both conventional tooth‐borne rapid palatal expansion (TB‐RPE) and surgically assisted rapid palatal expansion (SARPE) during early adulthood …”

Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander

“…Compared to other miniscrew-assisted expanders, the MSE may present some restrictions. In particular, this appliance must be placed in a more posterior position, between the maxillary first molars (barely anterior to the soft palate), in order to concentrate the forces closer to the pterygoid plates that induce great resistance to palatal expansion (Figure 1a,b) [12,23,24]. In addition, the design of the MSE requires a perfect parallelism of the four miniscrews with the nasal septum, with the body of the appliance itself firmly guiding the insertion of the miniscrews.…”