Palatal bone healing after removal of miniscrew-assisted rapid palatal expansion devices.

To evaluate and compare the long-term skeletal and dentoalveolar outcomes of conventional rapid palatal expansion (RPE) and mini-screw-assisted RPE (MARPE) in adolescent patients. Fourteen patients were recruited from a cohort of patients previously treated with RPE or MARPE appliances with a history of > 10 years post-treatment. Of the initial larger sample population, these 14 patients agreed to return for a follow-up appointment. For the study purposes, the cone-beam computed tomography (CBCT) images acquired at pre-treatment (T0), after maxillary expansion and 6 months of retention (T1), and 10-year post-treatment follow-up period (T2) were utilized. The study variables obtained from the CBCT images comprised skeletal width, palatal suture assessment, buccal and palatal bone thickness, dental tipping, and alveolar bone bending measurements. Statistical comparisons were performed using Mann-Whitney U tests. The level of significance was set at p < 0.05 for all tests. MARPE resulted in more stable skeletal expansion and fewer dental side effects compared to RPE treatment. Patients treated with RPE exhibited an 80% relapse in buccal maxillary width at the premolar after 10 years, compared to a 30% relapse among those treated with MARPE. Several additional parameters showed enhanced relapse in the RPE group compared to the MARPE group, suggesting MARPE treatment results in improved long-term dentoskeletal stability. Treatment with MARPE resulted in more stable long-term skeletal expansion and fewer dental side effects compared to conventional RPE 10 years after the completion of orthodontic treatment.

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.

Volumetric airway changes in adolescents treated with mini-screw assisted rapid palatal expansion (MARPE).

ABSTRACTBackground:Rapid palatal expansion (RPE) effectively corrects transverse maxillary deficiencies. For adults, MARPE (Mini-Screw–Assisted RPE) and SARPE (Surgically Assisted RPE) are two methods that can be used. However, their impact on periodontal health is not well known. Knowing these differential effects can help optimize treatment. The goal of the research was to assess gingival recession, alveolar bone loss, root resorption, and other periodontal health outcomes in patients undergoing MARPE and SARPE procedures.Materials and Methods:This prospective comparative study included 40 adult patients (n = 20 per group) treated with either MARPE or SARPE. Clinical parameters (gingival recession, probing depth, clinical attachment level) and CBCT-derived radiographic parameters (buccal alveolar bone thickness/height, root resorption) were assessed at baseline (T0), postexpansion (T1), and 6 months postretention (T2). Statistical analysis used independent t-tests and repeated-measures ANOVA (P < 0.05).Results:Both groups achieved comparable maxillary expansion (MARPE 6.2 ± 0.8 mm; SARPE 6.5 ± 0.7 mm; P = 0.45). However, the SARPE group showed significantly greater gingival recession (mean change at T2: SARPE 1.1 ± 0.3 mm vs. MARPE 0.3 ± 0.1 mm; P < 0.001) and more reduction in buccal alveolar bone thickness/height (mean change at T2: MARPE −0.2 ± 0.1 mm vs. SARPE −0.8 ± 0.2 mm; P < 0.01). Root resorption was numerically higher in SARPE but not statistically significant (P = 0.09). Probing depth and clinical attachment levels showed no significant differences between groups.Conclusion:MARPE is associated with more favorable periodontal health outcomes, specifically less gingival recession and better buccal alveolar bone preservation, compared with SARPE in adult maxillary expansion. MARPE may offer a biologically gentler approach with reduced periodontal risks.

To evaluate the long-term effects of mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT). A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion-ANS height, ANS-PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated. The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls. MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.

To evaluate the long-term effects on airway in patients with mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls with three-dimensional cone-beam computed tomography (CBCT) analysis. A total of 180 CBCTs of 60 patients were analyzed at different time points, such as pretreatment, postexpansion, and posttreatment. Patients were divided into three groups: mini-screw assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls. The nasal cavity, nasopharyngeal, oropharyngeal, and laryngopharyngeal airway volume and area were measured. Changes in total airway volume, total airway area, minimal cross-sectional area, maxillary intermolar width, external maxillary width, and palatal width were also evaluated. Both MARPE and RPE caused a statistically significant increase in the airway after expansion as compared with the control group, but there was no statistically significant difference in the change in airway between MARPE, RPE, and the control group at posttreatment, except for nasopharyngeal volume, which was significantly increased in the MARPE group. There was no correlation between the amount of expansion and increase in total airway volume. There was a significant increase in total airway volume, total airway area, and minimal cross-sectional area with MARPE and RPE immediately after expansion, but at posttreatment, the changes in the MARPE and RPE groups were similar to the change in the control group. However, MARPE led to a significant long-term increase in nasopharyngeal volume. The amount of expansion did not correlate with the increase in pharyngeal airway volume.

This review was undertaken to compare the effects of surgically assisted rapid palatal expansion (SARPE) and mini-screw assisted rapid palatal expansion (MARPE). Discrepancies in the transverse relation between maxillary and mandibular dentition can result in the development of posterior cross bite. For the correction of posterior cross bite, maxillary expansion is frequently undertaken. The conventional approach for maxillary expansion includes expansion screw being anchored to the maxillary teeth and is known and rapid palatal expansion (RPE) appliance. However, RPE can only be applied in growing individuals and is not as effective in late adolescents and adults. In such patients, surgically assisted rapid palatal expansion (SARPE) technique is used to expand the maxillary arch. As this procedure involves surgery, it deters many patients from choosing SARPE as a treatment option. Recently a non-surgical technique of expansion of maxillary arch has been introduced that can be applied to late adolescents and adults using palatal mini-screws. This technique is known as mini-screw assisted rapid palatal expansion (MARPE). In this review, the studies in the current literature regarding the SARPE and MARPE expansion techniques as compared to conventional RPE were included. It was observed that both SARPE and MARPE are effective methods for achieving maxillary expansion. With both techniques being effective, the advantage of MARPE over SARPE is the non-surgical approach which leads to higher patient acceptance and lower rate of complications.

Long-term evaluation of soft-tissue changes after miniscrew-assisted and conventional rapid palatal expansion using voxel-based superimposition of cone-beam computed tomography scans

Background: This meta-analysis aimed to evaluate the dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) compared with conventional rapid palatal expansion (CRPE) in growing patients (≤16 years). Methods: A systematic and comprehensive literature search was carried out independently by two reviewers using both MeSH terms and free-text keywords across PubMed, the Cochrane Library, and Embase, with studies published through February 2025 included. The risk of bias was assessed using the Cochrane ROB 2.0 tool. The GRADE system was employed to determine evidence quality. Results: Of the 462 initially screened articles, 6 met the inclusion criteria and were selected for quantitative synthesis. Most studies had a low risk of bias with some concerns in reporting. The pooled standardized mean difference (SMD) for tooth inclination changes in CRPE compared with MARPE was 0.98 (95% confidence interval (CI), 0.54 to 1.42; p &lt; 0.01). The test for overall effect was significant (p &lt; 0.01), but no significant differences were found between the subgroups. The pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.69 (95% CI, 0.37 to 1.00; p &lt; 0.01). The test for overall effect was significant (p &lt; 0.01), and there were substantial differences between the subgroups. The supporting evidence ranged in certainty from moderate to low. Conclusions: MARPE was more effective than CRPE in minimizing the buccal tipping and buccal bone loss of the maxillary first premolars and first molars. However, to further confirm these outcomes and guide evidence-based clinical practice, well-designed randomized controlled trials with long-term follow-up are necessary.

Purpose The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon (n = 23), PAOO (n = 28), and MARPE (n = 28) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area Conclusions All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.

ObjectivesTo evaluate the influence of miniscrew-assisted rapid palatal expansion (MARPE) on the interdental papilla height of maxillary central incisors.Materials and methodsPatients who completed MARPE treatment at the Radboud University Medical Center between 2018 and 2021 were included in this retrospective study. The papilla height between the maxillary central incisors was evaluated on frontal intraoral photographs taken before expansion (T0) and 1.5 years after MARPE treatment (T1) using the Jemt classification. The difference in Jemt score at T0 and T1 was the primary outcome variable. In addition, gender, age, Angle classification, MARPE duration, midpalatal suture maturation stage, maximal central diastema (MCD) immediately after expansion, crown width to length ratio (W/L), pretreatment overlap of maxillary central incisors, and the distance between the approximal contact point of the central incisors and the bone crest (CP-B) were also record.ResultsTwenty-two patients were included (2 men, 20 women, mean age 27.3 ± 8.8 years) and 4 patients (18%) showed a significant reduction in the Jemt score following MARPE (p = 0.04), indicating papilla recession. Interdental papilla recession was significantly associated with the increase of CP-B (p = 0.02), smaller W/L (p < 0.01), overlapping of maxillary central incisors (p < 0.01), and smaller MCD immediately after expansion (p = 0.02).ConclusionsOne and a half years after MARPE, 18% of patients exhibited mild recession of papilla height of the maxillary central incisors. Overlapping and smaller W/L of maxillary central incisors were prognostic factors for interdental papilla recession.Clinical relevanceClinicians have to be aware of and inform the patients about the occurrence of papilla recession following MARPE.

Clinicians needed to be aware of the thinness of the palatal bone plate when identifying severe protrusion of maxillary incisors, as this could result in perforation of the palatal bone plate during surgical procedures associated with immediate maxillary implant placement. This study evaluated the thickness of the palatal bone plate, the buccolingual angulation of maxillary incisors, and the correlation between these two parameters in relation to immediate implant placement. Cone-beam computed tomography images of 37 Asian patients (20-60 years old) with no evidence of dental treatment in the maxillary incisor area were collected and classified into groups based on sex and incisor locations. Sagittal slices were used to measure the palatal bone plate thickness at the cervical, middle, and apical levels, and the buccolingual angulation of each tooth was also measured. The intraclass correlation, Shapiro-Wilk test, descriptive analysis, Student's t-test, and Pearson correlation were used for statistical and correlation analyses, with P < .05 applied as the criterion for statistical significance. At the apical level of all inspected teeth and the middle level of lateral incisors, the palatal bone was significantly thicker in males than in females. The inclination of the maxillary lateral incisor showed a moderate negative linear correlation with the palatal bone thickness at the apical level (R = -0.517 and R = -0.579 for males and females, respectively). In an Asian population, an increased buccolingual angulation of the maxillary lateral incisors was correlated with a thinner palatal bone plate at the apical level.

Short-term and long-term effects of miniscrew-assisted and conventional rapid palatal expansion on the cranial and circummaxillary sutures

This literature review examines the success and effectiveness of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in adult orthodontics. Traditional methods like Surgically Assisted Rapid Palatal Expansion (SARPE) have been commonly used for treating transverse maxillary deficiencies in adults, but they come with significant drawbacks, including higher biological and financial costs. MARPE, which utilizes mini screws to apply controlled forces for palatal expansion, offers a less invasive and more precise alternative. The review analyzes several studies and reports on MARPE's success in expanding skeletal and dental structures, improving respiratory function in obstructive sleep apnea (OSA) patients, and minimizing complications like unwanted tooth movement. Despite some challenges, such as asymmetrical expansion, MARPE has demonstrated a high success rate in adult orthodontics and presents a promising treatment option. Further high-quality, long-term studies are recommended to optimize treatment protocols and evaluate potential risks.

Background: Miniscrew-assisted rapid palatal expansion (MARPE) has gained attention as an effective alternative to traditional rapid palatal expansion, particularly in adult patients. This scoping review synthesizes recent evidence to assess the clinical efficacy and safety of MARPE, addressing a gap in comprehensive, up-to-date analyses in this area. Objective: To present the recent assessments concerning MARPE influencing factors, side effects, soft tissue alterations, and airway changes, focusing on comparisons with conventional devices. Methods: Using PRISMA guidelines, we conducted a search of the literature published in 2018-2023 using Medline, Scopus, and Embase databases. This review focused on randomized controlled trials, cohort studies, and other reviews that evaluated the outcomes of MARPE. Results: Our analysis included 75 studies and revealed that MARPE significantly improves suture expansion with fewer dental and skeletal side effects compared to traditional methods. The technique shows high efficacy in subjects up to 25 years of age, with reduced incidence of complications and improved stability of expansion. Conclusions: The results support MARPE as a viable and superior alternative for maxillary expansion in late adolescents and adults. Given its advantages over traditional methods, MARPE should be considered a standard procedure in orthodontic treatment plans. Future research should focus on long-term outcomes and optimization of patient-specific treatment protocols.