Miniscrew-assisted rapid palatal expansion (MARPE) protocols applied in different ages and stages of maturation of the midpalatal suture: cases report

Marcelo De Melo Quintela,Wilson Roberto Sendyk,Angélica Castro Pimentel,Isaias Donizeti Silva,Heloísa Fonseca Marão ,Katty Lalangui Vera ,Jaime Cordova Peralta ,Caio Vinícius Gonçalves Roman-Torres ,Sabrina Rossi ,Letícia Alecrim De Souza

doi:10.33448/rsd-v10i11.19480

Abstract

Objective: To evaluate the Microimplant-assisted Rapid Palatal Expansion (MARPE), considered an alternative to surgical interventions for disjunction of the midpalatal suture in adolescent patients and young adults with maxillary transverse deficiency. The stage of ossification of the midpalatal suture, bone quality and adequate activation protocols are factors that can influence the quantity and quality of the orthopedic separation. Methodology: This paper demonstrates the application of MARPE in an unfavorable case report, of an adult patient with total crossbite, in an advanced stage of fusion of the palatine and maxillary processes, with poverty in the posterior bone volume, in comparison with the same therapy in an adolescent at an earlier stage of sutural maturation. In both cases, after tomographic examinations and oral scanning, the installations and recommended activation protocol were performed. These were not sufficient in the case of the adult patient, and generated side effects that, to be overcome, required changes in activations and additional maneuvers. Results: The application of MARPE may require clinical versatility to adopt differentiated protocols in relation to chronological age, bone thickness and sutural ossification stage. Conclusion: In the end, new computer tomography scans and a clinical examination showed satisfactory results in both patients. In the unfavorable case, the opening of the midpalatal suture occurred at more modest levels, but it was sufficient to correct the posterior crossbite.

Highlights

Rapid maxillary expansion (RME) has proven protocols with a high success rate when applied to children with maxillary transverse deficiency
Microimplant-assisted Rapid Palatal Expansion (MARPE) was introduced in a South Korean article that described the clinical case of an adult patient in which RME anchored in miniscrews prevented surgical disjunction (Lee et al, 2010)
This device was chosen for the RME of the case described in spite of the literature maintaining the indication of conventional expansion, which was discarded after consulting the family explaining that, if the MARPE was successful, it could have less side effects on the teeth

Summary

Introduction

Rapid maxillary expansion (RME) has proven protocols with a high success rate when applied to children with maxillary transverse deficiency. In order to prevent such undesirable effects and optimize the expansion potential in different ages and maturation stages, MARPE (miniscrew-assisted rapid palatal expander) emerged. In this device, four miniscrews are usually installed in. MARPE was introduced in a South Korean article that described the clinical case of an adult patient in which RME anchored in miniscrews prevented surgical disjunction (Lee et al, 2010). The expansion stability with MARPE was evaluated in 69 adult patients, with a maximum age of 28 years (Choi et al, 2016). This article presents two case reports that exemplify the behavior of MARPE in different age groups and in different stages of sutural ossification. The complications and the means of obtaining success in the application of clinical protocols of activations are described, as well as the procedures that can be incorporated into our practice when dealing with transversal jaw deficiency through MARPE

Methodology

Findings

Discussion

Conclusion