Treatment effects after maxillary expansion using tooth-borne vs tissue-borne miniscrew-assisted rapid palatal expansion appliance

Minimally Invasive Surgically Assisted Miniscrew Anchored Rapid Palatal Expansion (sa-MARPE) Technique: Avoiding Conventional Horizontal Maxillary Osteotomies - A Technical Note

In skeletally mature patients, transverse maxillary deficiency poses a significant challenge due to the rigidity of craniofacial sutures. This technical note describes a minimally invasive, surgically assisted MARPE (sa-MARPE) protocol designed to overcome these limitations while avoiding complete Le Fort I osteotomies. The technique involves three small mucosal incisions and limited piezosurgical osteotomies targeting the midpalatal suture, canine pillars, and pterygomaxillary junctions. By preserving mucosal integrity and vascular supply, this approach reduces postoperative morbidity and enhances recovery. A case involving a 35-year-old woman treated with this protocol using a bone-borne expander (HIMAME) demonstrated stable skeletal expansion and crossbite correction at a 3-year follow-up, with no complications or relapse. This method offers predictable skeletal outcomes with minimal dentoalveolar side effects, making it a viable outpatient alternative to conventional SARPE in adults. Further studies are warranted to validate long-term stability and to compare outcomes with other assisted expansion techniques.

Comparison of Side Effects Between Miniscrew-Assisted Rapid Palatal Expansion (MARPE) and Surgically Assisted Rapid Palatal Expansion (SARPE) in Adult Patients: A Scoping Review

Background/Objectives: The aim of this study is to investigate the side effects of two techniques of rapid maxillary expansion-Surgically Assisted Rapid Palatal Expansion (SARPE) and Miniscrew-Assisted Rapid Palatal Expansion (MARPE)-in adult patients, to guide the selection of the most cost-effective clinical treatment plan. Methods: The review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligibility criteria were defined based on the study objectives. The research team formulated a PICO question to identify relevant studies in the literature. Five databases were queried: MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science, and Embase. Additionally, a manual search was conducted. Results: The computer-assisted search identified 746 articles, of which only 26 fully met the inclusion criteria and were included in the scoping review. Among the included studies, 11 were retrospective, 12 were prospective, and 3 were randomized clinical trials. SARPE was evaluated in 21 studies, MARPE in 4 studies, and 1 article reported complications associated with both techniques. The side effects described in the studies were synthesized and categorized into five groups: expansion failure, asymmetric expansion, dentoalveolar issues, surgical complications, and appliance-related problems. Conclusions: The results indicate that both techniques involve risks. The most reported adverse effects were dentoalveolar and surgical in nature. Dentoalveolar side effects, such as dental tipping, were predominantly associated with the MARPE technique, while surgical complications were more commonly observed with the SARPE technique. Patient age is crucial for treatment choice as well as proper design and planning of the expansion device. Consequently, careful patient selection and treatment planning are essential to minimize the side effects of maxillary expansion in adult patients.

Miniscrew-Assisted Rapid Palatal Expansion: A Scoping Review of Influencing Factors, Side Effects, and Soft Tissue Alterations

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.