Orthodontic expanders are commonly associated with children and adolescents, but advancements in orthodontic technology have made upper jaw expansion a viable option for adults as well. For those experiencing issues such as crossbite, upper jaw constriction, or dental crowding, adult orthodontic expanders can offer effective solutions.
Video: MARPE for Adult Orthodontic Expansion
Dr. Boss explains who may benefit from MARPE, how age and anatomy affect treatment, and what expansion can—and cannot—do for breathing.
Read the video transcript: MARPE, age, breathing, and bite correction
Transcript lightly edited for clarity.
Who may benefit from MARPE?
MARPE expanders are getting a lot of attention on social media, but what are they, and who can they actually benefit?
MARPE stands for miniscrew-assisted rapid palatal expansion. It uses temporary anchor screws in the roof of the mouth to help widen an upper jaw that is too narrow. A typical candidate is an adult patient in their 20s or sometimes even into their 30s with a narrow upper jaw, often showing up as a crossbite of the back teeth.
But age alone doesn’t decide it. We measure the upper jaw, we look at the bone, we look at the teeth positions, and we compare that to the lower jaw. A relatively wide lower jaw can cause a mismatch as well. Expansion generally becomes more difficult and less predictable the older we get. That’s because the palatal suture and the surrounding skeletal structures become more resistant to that separation, but there’s not a certain age that rules you in or out.
If width is the main issue and your age or anatomy are making the MARPE approach less predictable, a surgically assisted expansion, or SARPE, may be a better approach. If there are also jaw asymmetries and we need to move the jaw either forward or backward, MARPE only creates width, so it’s not well suited to treat those types of cases. Jaw surgery, or orthognathic surgery, would be a better treatment option.
Expansion, breathing, and sleep apnea
Expansion can help nasal airflow in certain individuals. However, it’s not a magic sleep apnea solution or a routine first-line treatment for adult sleep apnea. Sleep apnea involves more than just the width of your nose. That’s why we coordinate with sleep physicians and ENTs instead of just assuming that everybody with adult sleep apnea needs expansion.
For certain patients, moving both the jaws forward with jaw surgery can have a substantial improvement of obstructive sleep apnea. However, that’s a different treatment, and it addresses a different part of the airway.
The easiest way to understand expansion and its relationship to the floor of the nose is thinking about the complex as a triangle. The top of the triangle represents the nasal airway; the bottom of the triangle represents the palate. When you expand down here, because it’s opening the base of a triangle, you don’t get as much expansion up here as you do down here. That’s because of the surrounding sutures and the skeletal structures that are resisting that separation. A millimeter of expansion of the palate doesn’t mean a millimeter of improvement in the nasal airway. It also doesn’t tell us how much your breathing will actually improve.
Planning adult jaw expansion and next steps
At Boss Orthodontics, our lab takes the 3D scan we did at your consultation visit and meshes it with a 3D X-ray. Together, we plan the position of your screws and the length of the screw to engage the bone available appropriately. That helps provide a stable support for the appliance, although careful planning can’t guarantee that the bones will separate. If we’re not seeing the expansion we need, we reassess.
If widening the upper jaw is still the right goal, the next step could be a referral to the oral surgeon to do some release cuts to help the bones expand. An unsuccessful MARPE attempt doesn’t mean that we’re out of options.
MARPE may be a good fit for a younger adult in their 20s or even into their early 30s who has a narrow palate, with or without a crossbite. At your free consultation, we’ll review your anatomy and your bite and discuss whether a MARPE, a surgically assisted expander, or a different approach makes sense for you.
Understanding Adult Palatal Expanders
A palate expander for adults is a custom-fitted orthodontic device designed to widen the upper jaw (maxilla). Unlike traditional expanders used in younger patients, adult treatments often require specialized appliances due to the increased rigidity of mature bone structures.
MARPE: A Non-Surgical Solution
One innovative approach is the Miniscrew-Assisted Rapid Palatal Expander (MARPE). This device uses Temporary Anchorage Devices (TADs)—small orthodontic screws inserted into the palate—to provide a stable anchor for expansion. MARPE aims to widen the upper jaw without jaw surgery, but successful expansion is not guaranteed. As Dr. Boss explains in the video, age, anatomy, and the resistance of the surrounding bone all affect predictability. If the bones do not separate as planned, the team reassesses whether surgically assisted expansion is appropriate.
SARPE: Surgically Assisted Rapid Palatal Expansion in Orthodontics
Surgically Assisted Rapid Palatal Expansion (SARPE) is another way to expand the upper jaw in an adult patient. A SARPE is a combination orthodontic and oral surgery procedure designed for adults who require significant widening of the upper jaw, but their palate suture is too tight to expand. The procedure involves surgery to create a cut along the midline of the maxilla to loosen the bone, followed by the use of a Rapid Palatal Expander (RPE) to gradually widen the palate over several weeks. This type of expansion protocol for adults is much more invasive than MARPE. It involves an oral surgeon and a recovery period after the jaw surgery.
Three-Piece LeFort I: A Surgical Approach to Jaw Expansion
The Three-Piece LeFort I Osteotomy is a highly effective surgical procedure for widening a narrow upper jaw that also needs additional jaw movement. This procedure is designed to expand the upper jaw when other surgical correction of the upper jaw is needed, such as overbite and underbite corrections in adults.
Benefits of Jaw Expansion in Adults
Utilizing a jaw expander for adults can address several orthodontic concerns:
- Crossbite Correction: A crossbite occurs when the upper teeth bite inside the lower teeth. Expanding the upper jaw aligns the dental arches properly, resolving this misalignment.
- Alleviating Dental Crowding: Limited space in the dental arch can lead to overcrowded or misaligned teeth. Expansion creates additional room, facilitating proper tooth alignment and potentially reducing the need for extractions.
- Breathing Considerations: As Dr. Boss explains in the video, expansion may help nasal airflow in certain patients, but more space in the palate does not predict how much breathing will improve. MARPE is not a routine first-line treatment for adult sleep apnea. When breathing or sleep concerns are present, we coordinate with sleep physicians and ENTs. Learn more about palatal expanders from the American Association of Orthodontists.
Considerations for Adult Patients
While adult orthodontic expanders offer promising results, it’s essential to consult with an experienced orthodontist to determine the most appropriate treatment plan. Factors such as bone density, overall oral health, and specific orthodontic needs will influence the choice of expander and the treatment’s success.
In conclusion, advancements like MARPE and TAD expanders have expanded the horizons of orthodontic treatment for adults. By addressing issues like crossbite, dental crowding, and airway constriction, these devices contribute to improved oral health and overall well-being.
Why Choose Boss Orthodontics for Your MARPE (Miniscrew-Assisted Rapid Palatal Expander) Treatment?
At Boss Orthodontics, we specialize in advanced orthodontic solutions, including MARPE (Miniscrew-Assisted Rapid Palatal Expansion). As board-certified orthodontists, Dr. Hunter and Dr. ReAnn Boss are dedicated to providing high-quality, personalized care to help you achieve a healthier, more functional smile.
MARPE may be an option for adults with a narrow upper jaw. Dr. Boss will evaluate your anatomy and bite to determine whether an adult orthodontic expander is appropriate for you. At your consultation, we will discuss MARPE, surgically assisted expansion, or another approach based on your needs.
Orthodontic technology is evolving rapidly, and at Boss Orthodontics, we stay at the forefront of innovation. By incorporating the latest in 3D imaging, digital scanning, and state-of-the-art palatal expansion techniques, we ensure precise, efficient, and comfortable treatments for our patients.
Trust Boss Orthodontics to deliver expert care and exceptional service—because your smile deserves the best!
Learn more about adult orthodontic treatment and our advanced orthodontic options at Boss Orthodontics, or schedule a free consultation to discuss your bite and goals.
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