Advanced Orthodontics

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.