Unwanted craniofacial fractures in MARPE/MASPE patients: a hidden risk?

BackgroundThis prospective randomized clinical trial aimed to evaluate the immediate and short-term skeletal, dentoalveolar, and periodontal effects of rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE) in adolescent and young adult patients.MethodsThis study followed a two-arm, parallel, randomized clinical trial design that recruited patients with transverse maxillary deficiency in a 1:1 allocation ratio. Forty patients (14 men and 26 women) requiring maxillary expansion were randomly allocated to the RPE (n = 20, age = 14.0 ± 4.5) or MARPE (n = 20, age = 14.1 ± 4.2) groups. The assignment was performed via computer-generated block randomization, with a block size of four. Upon identical (35 turns) amount of expansion, low-dose cone-beam computed tomography images were taken before treatment (T0), immediately after expansion (T1), and after a 3-month consolidation period (T2). The primary outcome of this study comprised the assessment of midpalatal suture separation. Secondary outcomes included, skeletal, dentoalveolar, and periodontal measurements, which were performed at each time point.ResultsThe frequency of midpalatal suture separation was 90% (18/20) and 95% (19/20) for the RPE and MARPE groups, respectively. A greater increase in nasal width in the molar region (M-NW) and greater palatine foramen (GPF) was observed immediately after the expansion (T1-T0) and consolidation periods (T2-T0) in the MARPE group compared to the RPE group (P < 0.05). The MARPE and RPE groups showed similar dentoalveolar changes except for the maxillary width (PM-MW, M-MW). The MARPE group presented greater bilateral first premolar (PM-MW) and molar (M-MW) maxillary width in relation to the RPE group (P < 0.05). Through the expansion and consolidation periods (T2-T0), lesser buccal displacement of the anchor teeth was observed in the MARPE group (PM-BBPT, PM-PBPT, M-BBPT [mesial and distal roots], and M-PBPT)( P < 0.05).ConclusionsMidpalatal suture separation was observed in 90% and 95% of patients in the RPE and MARPE groups, respectively. Both RPE and MARPE groups exhibited significant triangular basal bone expansion and skeletal relapse during consolidation. Under identical amounts of expansion, the MARPE group showed lower decrease in the skeletal, dentoalveolar and periodontal variables after consolidation. The reinforcement of RPE with miniscrews contributes to the maintenance of the basal bone during consolidation period.Trial registration WHO Institutional Clinical Trials Registry Platform (IRB No. KCT0006871 / Registration date 27/12/2021).

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.

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

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.

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

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.

Evaluation of nasal septum deviation via reformatted computed tomography (CT) imaging following expansion using RPE and MARPE.

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

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.

Maxillary transverse deficiency (MTD) is a common affliction among orthodontic patients, affecting 8%-17% of the population. Historically, MTDs have been treated using rapid palatal expanders (RPEs), typically anchored on molar and premolar teeth; however, their efficacy in achieving true skeletal expansion decreases dramatically during adolescence. For patients with mature sutures, a surgically assisted rapid palatal expansion (SARPE) was the only choice until the advent of miniscrew-assisted rapid palatal expansion (MARPE). In MARPE, the expansion screw is anchored on the basal bone through miniscrews. This provides a minimally invasive alternative to SARPE, while facilitating transverse maxillary expansion in older patients. There are many designs of MARPE in use. MARPE causes an increase in the width of the maxilla, with a more parallel separation of the midpalatal suture (MPS), with expansion effects reaching almost till the midfacial regions, minimal dentoalveolar effects, an increase in the airway, and effects are seen on the concomitant soft tissues. While the effects of MARPE have been well documented, the factors affecting its success are less understood. This position article on MARPE highlights the factors affecting the success and failure of MARPE. Procedures like corticopunctures and minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) are being used to supplement MARPE and improve its success rate. Overall, MARPE is a highly successful procedure, well-accepted by patients and practitioners, and should be used when indicated, following the proper diagnosis of a true skeletal transverse deficiency of the maxilla.

Long-term effects of conventional and miniscrew-assisted rapid palatal expansion on root resorption

ObjectiveComparing nasal cavity and pharyngeal airway volumes and minimum cross-sectional areas in nongrowing patients who underwent miniscrew-assisted rapid palatal expansion (MARPE) or surgically assisted rapid maxillary expansion (SARME) with and without pterygomaxillary disjunction (PD).MethodsPretreatment and post-expansion cone beam computed tomography scans of 30 patients (mean age 18.6 years), diagnosed with maxillary transverse deficiency, were grouped into three (n = 10 each) according to expansion protocol 1) MARPE; 2) SARME without PD [SARME-PD(–)]; 3) SARME with PD [SARME-PD(+)]. In NemoStudio software, eleven linear measurements were used to evaluate nasal and maxillary skeletal parameters. Eight airway measurements were used to evaluate the volume and minimum cross-section of the nasal cavity, nasopharynx, retropalatal region, and retroglossal region. Intragroup and intergroup changes were evaluated for statistical significance at P < 0.05.ResultsNasal lateral, nasal floor, external maxillary, palatal, and maxillary intermolar widths significantly increased in all groups. In MARPE, nasal cavity and nasopharynx volumes and minimum cross-sectional area increased significantly. Nasopharyngeal volume increased significantly in SARME-PD(–), whereas nasal cavity volume and minimum cross-sectional area decreased significantly in SARME-PD(+). MARPE group showed greater expansion in nasal lateral width than SARME-PD(–) and SARME-PD(+) groups. Mean changes in nasal cavity volume, minimum cross-sectional area, and nasopharyngeal volume were significantly greater in MARPE than in SARME-PD(+).ConclusionsMARPE group showed greater increases in linear and volumetric measurements. However, differences were statistically insignificant compared to SARME-PD(–). Retropalatal and retroglossal parameters were unaffected in all groups. PD did not provide substantial advantage.

SummaryBackgroundMiniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy.ObjectivesThis systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects.Search methodsSeven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020.Selection criteriaRandomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes.Data collection and analysisInclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality.ResultsEight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days.LimitationsOne of the main drawbacks was the lack of high-quality prospective studies in the literature.Conclusions and implicationsMARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended.RegistrationPROSPERO (CRD42020176618).FundingNo grants or any other support funding were received.

Nasomaxillary effects of miniscrew-assisted rapid palatal expansion and two surgically assisted rapid palatal expansion approaches

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.