Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy

Abstract

The use of maxillary expanders has the effect of distancing the maxillary bones at the level of the median palatal suture. During maxillary expansion, the main resistance forces occur at the zygomatico-maxillary sutures, and not in the median palatal suture, which is the basic principle on which this method is based. In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. The mid-palatal suture was separated in 88.88% of cases, buccal bone height of the alveolar crest had decreased at first molar both at oral and palatal level by approximately 2.07 mm in 40.7% of cases whilst the remaining 59.3% showed insignificant bone loss, with canines exhibiting buccal tipping of 4.10° in 62.5% of cases. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.

Success and complication rate of miniscrew assisted non-surgical palatal expansion in adults - a consecutive study using a novel force-controlled polycyclic activation protocol

“…The most frequent complication observed using MARPE were inflammation and hyperplasia of the mucosa around the miniimplant/screw or loosening or deformation of the screws used. A decrease in bone level and thickness at first molars was observed in 41% and undesirable effects like ulcerations, oedema of the palatal mucosa were observed in 22% of cases [ 15 ]. In a retrospective study on 69 patients, 5% of the miniscrews dislodged during expansion and 13% showed clinically visible mobility [ 16 ].…”

Success And Complication Rate of Miniscrew Assisted Non-Surgical Palatal Expansion In Adults - A Consecutive Study Using A Novel Force-Controlled Polycyclic Activation Protocol

“…The most frequent complication observed using MARPE were in ammation and hyperplasia of the mucosa around the miniimplant/screw or loosening or deformation of the screws used. A decrease in bone level and thickness at rst molars was observed in 41% and undesirable effects like ulcerations, oedema of the palatal mucosa were observed in 22% of cases [14]. In a retrospective study on 69 patients, 5% of the miniscrews dislodged during expansion and 13% showed clinically visible mobility [15].…”

“…In adults it represents a treatment solution that can potentially reduce the complications of SARPE and is minimally invasive, secure, and reliably stable [11]. However, when MARPE is used with a rapid continuously opening expansion protocol in adult patients (two activations per day, achieving 0.4mm), the overload of the hardware (appliance and miniscrews) or of the involved anatomical structures can lead to unsatisfactory results [12][13][14][15]. In order to reduce these side effects, the rigidity of the expander used in this current study was improved and a novel 2-stage protocol was applied for miniscrew assisted palatal expansion (without Rapid expander activation) (MAPE) [16].…”

Class II treatment of transverse maxillary deficiency with a single bone-borne appliance and hybrid clear aligner approach in an adult patient: A case report

“…Several intraoral tooth-borne appliances for Class II correction do not require patient compliance, but all of them are inevitably affected by loss of anterior anchorage [25] . Despite some reports of complications after the use of a bone-borne rapid maxillary expander, including eye impairment, orbital microfracture, facial asymmetry [26] , and other issues [27] , the risk of these undesired phenomena was reduced by planning a gentle screwactivation protocol (1 turn/day) and monitoring this phase weekly. Moreover, the patient is a young adult, and therefore highly unlikely to encounter these complications, which are usually corre-Please cite this article as: M. Palone et al, Class II treatment of transverse maxillary deficiency with a single bone-borne appliance and hybrid clear aligner approach in an adult patient: a case report, Journal of the World Federation of Orthodontists, https://doi.org/10.1016/ j.ejwf.2021.12.004 lated with advanced skeletal maturity and increased bone density [28] .…”