MISMARPE / DOME what is it?

Join me for a look at maxillary expansion combining both surgery with miniscrews. Seemingly opposite ideas have been brought together to offer potentially greater versatility in expansion, with less surgical complexity andcomplications.

MISMARPE – minimally invasive surgery miniscrew assistedrapid palatal expansion Haas 2021

Or

DOME Distraction Osteogenesis Maxillary Expansion Liu2017

Protocol

·     Osteotomy

o  Anterior vertical incision interdental toperiform fossa

o  Lateral incisions to the base of zygomaticprocess of maxilla

o  Without releasing the pterygomaxillary suture

o  Activate in surgery up to 20x ensure diastema

o  Duration 24 minutes (14.4-32) Junior 2021

o  Less pain – Mild on VAS

·     Expansion

o  7 days no expansion

o  Expansion of rate 0.25 - 0.50 mm,

§ Some until diastema and slow to 0.25 per day

Advantages

·     Less osteotomies required

·     Under sedation or local anaesthetic

·     Greater anchorage for force delivery throughminiscrews

·     Less intra-operative haemorrhage – due to a lackof pterygopalatine disjunction

·     Parallel expansion – Lin 2015 Vs V shapeexpansion

Age

Limitation of MARPE was age, with 20-30 years females 94% 20-30years males 80%, MARPE success 30-37 = 20% Olivera 2021, MISMARPE 96% successage 20-59, 24 patients majority over 30 years old Piccoli 2023.

Expansion amount

·     Direct comparison show no significant differenceda Silva 3mm, and no difference in molar angulation 2023

Indicated for:

·     Failed MAPRE

·     Age- greater 30 females and 25 for males

Could MISMARPE / DOME replaceSARPE?