Join me for a summary of  Akram Alhuwaizi’s lecture on MARPE – Miniscrew assisted rapid palatal expansion. This summary explores MARPE from a clinical aspect, assessing the advantages and disadvantages, followed by a case discussion of success and failure, a discussion of MSE and lessons learned for designing MARPE.

The full lecture is available on Akram’s youtube channel:

Maxillary Skeletal Expansion using MARPE from A to Z (Updated) - YouTube

Introduction

Purpose of expansion

Correction of crossbite

Creating space

Pre myofunctional treatment

Widening smiles

Methods available

Removable appliance

Quad Helix

Rapid Maxillary Expander RME

Surgically assisted Rapid Palatal Expansion SARPE

Expansion methods

Ideal features of expansion appliances are to achieve bodily movement, minimal compliance required from the patient, applicable to a range of ages and straightforward for patients

MARPE experience

Case 1

Attended Peter Ngan lecture Arab conference

Surgical case requiring expansion – 2019

4 palatal TADs

FAILIURE – TADs moved, one got embedded into the palatal tissue, no significant expansion occurred

Cause of failure

Hyrax position:

Too posterior = near to Pterygo palatine suture and the zygomatic buttress which causes more resistance to the expansion

No guiding arms, greatert risk of dental movements but they help in seating of the appliance

Lack of guiding arm allowed rotation of the device by failure of only one TAD.

TADs

Length: Short: Ideally bi-cortical engagement to avoid bending and increase retention

Appliance design

There was a play between the TAD and the device

Lab fabricated loops, not precision fit

Case 2

Design

Used 2 TADs 2mm D/12mm L

Guiding arms to the 1st molars

Hyrax more anterior

Good fit abutment / screw and expander

Longer screws – bicortical engagement

Younger patient and female

Successful palatal expansion