Minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) in adult patients

Office-based Surgically Assisted Rapid Maxillary Expansion Under Simple Local Anesthesia (LIGHT SARPE)

INTRODUCTION

This study evaluates a novel technique for surgically assisted rapid maxillary expansion (SARPE) performed under local anesthesia, termed LIGHT SARPE, with the aim of minimizing morbidity and improving patient comfort. Traditional SARPE methods, involving chisels and general anesthesia, can cause significant postoperative discomfort and complications. The LIGHT SARPE technique, performed in an office setting, uses a minimally invasive approach involving piezoelectric surgery for osteotomies and a temporary anchorage device for maxillary expansion.

MATERIALS AND METHODS

A retrospective analysis of 30 patients who underwent this procedure at the Face Surgery Center in Parma, Italy, between 2020 and 2023 was conducted.

RESULTS

The average surgery time was 21 minutes, and postoperative complications were minimal. Key outcomes showed a mean maxillary expansion of 7.2 mm in the anterior maxillary distance, with no significant correlation between expansion degree and complications. The procedure was well tolerated, with most complications, such as palatal mucosa dehiscence and temporary sensory impairment, resolving without further intervention. LIGHT SARPE demonstrated advantages over conventional SARPE, including reduced discomfort, shorter operative times, and fewer complications, while preserving periodontal integrity. The technique's effectiveness, minimal invasiveness, and adaptability for diverse clinical cases suggest its potential as a preferred treatment option for maxillary transverse deficiency in skeletally mature patients.

CONCLUSION

The study concludes that LIGHT SARPE is a promising evolution of SARPE, offering significant improvements in predictability, efficacy, and patient outcomes with lower morbidity and costs.

Exploring the potential of minimally invasive surgically assisted rapid maxillary expansion to transform patient outcomes

Maxillary transverse deficiency (MTD) can be treated with Minimally Invasive Surgically Assisted Rapid Maxillary Expansion (MISARME) to improve surgical outcomes in non-growing patients and increase patient satisfaction. The purpose of this study was to compare Surgically Assisted Rapid Maxillary Expansion (SARME) and MISARME in terms of patient outcomes, including blood loss, operation time, edema, pain, and nasal soft tissue changes. This randomized, double-blind clinical trial was conducted on patients who underwent SARME to treat MTD. The primary predictor variable was the type of the SARME technique: SARME or MISARME. The primary outcome was bleeding and operation time. Secondary outcomes were postoperative pain, edema, and nasal soft tissue changes. The study was completed with 35 patients. Blood loss and operation time were significantly higher in the SARME (68.61 ± 28.68 ml-45.27 ± 2.08 min) compared to the MISARME (52.05 ± 14.03 ml-23.82 ± 9.39 min) (P < .05). No statistically significant difference was observed in the mean alar base and nasal widths at any time point within the MISARME(P < .05), while a significant difference was found in the SARME(p > .05). The edema measured between the T1-T0 time points was significantly lower in the MISARME compared to the SARME(P = .002). According to these results, MISARME may improve patient outcomes and reduce undesirable changes in nasolabial soft tissues.

Simultaneous ortho-surgical expansion and protraction of the maxilla in patients with mature midpalatal suture: A technical note

The authors aim to propose combination of Surgically Assisted Miniscrew-Assisted Rapid Palatal Expansion (SAMARPE) with orthopedic traction miniplates placement in cases where a sagittal deficiency coexists with the necessity of carrying out a surgical maxillary expansion. Unlike the conventional orthopedic traction technique, where the miniplates are placed bilaterally in the infrazygomatic crest of the maxillary buttress, in this scenario the upper miniplates should be placed below the LeFort I osteotomy, and therefore a little bit angulated.

Midpalatal suture osteotomy combined with microimplant-assisted rapid palatal expansion for adult maxillary transverse deficiency treatment: a study protocol of a randomised controlled trial

INTRODUCTION

Maxillary transverse deficiency (MTD) is a common type of malocclusion. For adult MTD patients with highly ossified midpalatal sutures, surgically assisted rapid palatal expansion (SARPE) has been the conventional method of maxillary expansion. However, SARPE has the disadvantages of significant trauma, high cost and a high incidence of adverse events. Therefore, we proposed a novel minimally invasive method for maxillary expansion, which is midpalatal suture osteotomy combined with microimplant-assisted rapid palatal expansion (MSO-MARPE). The results are expected to confirm MSO-MARPE as a novel minimally invasive alternative to SARPE in skeletally mature MTD patients.

METHODS AND ANALYSIS

A prospective, single-centre, parallel-group randomised controlled trial will be conducted, enrolling 20 adult MTD patients. Participants will be randomised equally to the control and experimental groups. The control group will undergo a Lefort I and median osteotomy and postoperative maxillary expansion with a tooth-borne Hyrax-type expander. The experimental group will undergo a midpalatal suture osteotomy and postoperative maxillary expansion with a microimplant-assisted expander. A series of linear and angular parameters will be measured in the pre- and post-coronal planes before treatment (T0), immediately after expansion (T1) and 6 months after expansion (T2) to evaluate the efficacy of skeletal expansion and dental side effects. The study aims to compare the clinical and cost-effectiveness of SARPE and that of MSO-MARPE. The primary outcome is the contribution of posterior midpalatal expansion immediately after expansion. The secondary outcomes include nasal, sutural, alveolar and dental expansion, pain intensity, operative time and treatment costs. The safety indicator will be the number and incidence of adverse events. The interaction between the control group and the experimental group will be analysed using two independent-sample t-tests or Mann-Whitney U test, and the paired data at different time points will be analysed using paired t-test.

ETHICS AND DISSEMINATION

The trial protocol (version 6.0 13 December 2024) has been approved by the Institutional Review Board of the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine (approval number: SH9H-2023-T309-3). Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2400081545.

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.

Effects of minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) on the nasal cavity and upper airway: a comparative cohort study

This study was performed to evaluate the impact on the upper airway and nasal cavity of a new minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) technique for the treatment of adult patients with transverse maxillary deficiency, in comparison to surgically assisted rapid palatal expansion (SARPE). Computed tomography scans of 21 MISMARPE and 16 SARPE patients were obtained preoperatively (T0) and at the end of the activation period (T1) and analysed. Linear and volumetric measurements were performed in the dental, alveolar, nasal cavity, and oropharynx regions. Generalised estimating equations were used to consider the intervention time and surgery type, and their interaction. In both groups, measurements were increased at T1 (P < 0.001), except for oropharynx volume (P > 0.05). A greater expansion in nasal cavity floor and median palatal suture was shown for MISMARPE when compared to SARPE (P < 0.001), with the same degree of expander activation (P = 0.094). A trapezoidal (coronal plane) and 'V' shape (axial plane) expansion pattern, was observed after MISMARPE. Both surgical techniques were effective for maxillary expansion in adults. However, MISMARPE was performed without osteotomy of the pterygomaxillary suture, in an outpatient setting and with local anaesthesia.

Comparison of the effects of submucosal hyaluronidase and dexamethasone on postoperative edema, pain, trismus, and infection following impacted third molar surgery

BACKGROUND

Limiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications.

METHODS

In groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days.

RESULTS

60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate.

CONCLUSIONS

Hyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost-effective option if postoperative pain control is merely targeted.

TRIAL REGISTRATION

This trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022.

MISMARPE protocol: minimally invasive surgical and miniscrew-assisted rapid palatal expansion

OBJECTIVE

The purpose of this article is to present the MISMARPE technique, a new minimally invasive surgical procedure to treat maxillary transverse atresia in adult patients under local anesthesia and on an outpatient basis.

TECHNIQUE DESCRIPTION

The technique consists of miniscrew-assisted rapid palatal expansion (MARPE) associated with a minimally invasive approach using maxillary osteotomies, latency and activation periods until the desired expansion is achieved. The present MISMARPE technique was performed in 25 consecutive cases with a success rate of 96%, yielding good skeletal outcomes with minimal trauma. The expander appliances, with their anchorage types, and a description of the surgical steps of the MISMARPE technique are presented.

CONCLUSION

MISMARPE is a new and effective alternative for less invasive treatment of maxillary transverse deficiency in adults, compared to conventional surgery. Emphasis is placed on the importance of systematic and well-established protocols, for executing the procedures safely and predictably.

Effects of SARPE and MISMARPE on correction of transverse maxillary deficiency: A preliminary comparative evaluation

AIM

The present study was designed to compare, on cone-beam computed tomography imaging, the skeletal and dental effects of the SARPE (Surgically assisted rapid palatal expansion) and MISMARPE (Minimally Invasive Surgical and Miniscrew-Assisted Rapid Palatal Expansion) techniques.

MATERIALS AND METHODS

The sample of adult patients with transverse maxillary deficiency (TMD) was divided into two groups, and scans were obtained preoperatively (T0) and immediately after completion of expansion (T1). The posterior and anterior linear transverse distances of the maxilla and the angulation of the maxillary first molars were evaluated. The data were entered into a generalized estimating equations model to verify the postoperative effects of the different techniques.

RESULTS

None of the techniques caused any appreciable change in the angulation of the molars. The skeletal changes were similar, with significantly greater gains in the nasal fossa and intermaxillary distance when using the MISMARPE.

CONCLUSION

The technique can be an effective and lower morbidity alternative to SARPE.

Can different osteotomies have an influence on surgically assisted rapid maxillary expansion? A systematic review

The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.

Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis

INTRODUCTION

Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures.

OBJECTIVE

The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis.

MATERIAL AND METHODS

Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures.

RESULTS

Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest).

CONCLUSIONS

Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

Endoscopically Assisted LeFort I Osteotomy for Minimally Invasive Orthognathic Surgery: A Technical Note

Minimally invasive surgery in orthognathic surgery has gained popularity in recent years. This is mainly due to the benefit to the patient of achieving a better postoperative period and a faster recovery. However, one of the main difficulties is the lack of direct vision, which is a concern for the surgeon. For this reason, this technical note aims to propose endoscopically assisted LeFort I osteotomy for MI orthognathic surgery.

Three-dimensional dentoskeletal changes following minimally invasive surgically assisted rapid palatal expansion: a prospective study

Dentoskeletal changes in minimally invasive surgically assisted rapid palatal expansion (SARPE) were evaluated using cone beam computed tomography (CBCT). This was a prospective study of 30 patients who underwent minimally invasive SARPE performed under local anaesthesia plus sedation by the same surgeon, in an ambulatory setting. Pre- and postoperative CBCT images were obtained for each patient. A statistically significant increase in the linear transverse dimensions of the maxilla occurred systematically. In the canine region, a mean increase of 5.84 mm occurred at the apex level and 7.82 mm at the crown level. These dimensions were 4.83 mm and 7.68 mm, respectively, in the molar region. The cross-sectional area of the maxilla increased by a mean 12.9 mm² at the palate level and 23.3 mm² at the crown level. Dental inclination to the buccal aspect was detected (mean 6.1° at the canines and 8.4° at the first molars). The alveolar process tipped buccally 10° at the molar level. Nasal width increased a mean of 3.0 mm at the canine level. Through a three-dimensional analysis, this study found that minimally invasive SARPE was effective in the correction of transverse maxillary discrepancies> 5 mm in non-growing patients. Although dental inclination to the buccal aspect occurred, significant expansion of the maxilla at the skeletal and dentoalveolar levels was confirmed.

Obstructive sleep apnea: a review for the orthodontist

INTRODUCTION

Obstructive sleep apnea (OSA) affects an important part of the population and is characterized by recurrent total or partial obstruction of the upper airway (UA) during sleep, negatively affecting the quality of life of patients in the short and long terms, and constituting an important public health problem for the society. The field of expertise of orthodontists is closely related to the UA, placing them in a strategic position to diagnose air passage failures and intervene when necessary. Orthodontists, as health professionals, must know how to recognize respiratory problems and manage them appropriately, when indicated.

OBJECTIVE

Thus, this paper aims to review and critically evaluate the related literature, to provide orthodontists with updated knowledge on the diagnosis and therapy related to OSA. Science and technology are constantly evolving; thus, the literature was also reviewed considering new technologies available in consumer-targeted applications and devices for the diagnosis, monitoring, and treatment of sleep-disordered breathing.