A DIFFERENT APPROACH TO TRANSVERSE PALATAL EXPANSION: MARPE

(MINISCREW ASSISTED RAPID EXPANDER) OVER RME (RAPID MAXILLARY EXPANDER):

Dr. Aisha A. Riyamy*, Dr. Thuriya Al Rashdi*, Dr PS Viswapurna, Dr GS Prashantha, Dr Mohammad Zeinalddin and Dr Karthik Shetty

Introduction:
One of the most common problems in orthodontic patients is maxillary deficiency. Different treatment approaches have been taken, an example
being rapid maxillary expander (RME). However, expansion using RME is mostly dental after adolescence. As a result, miniscrew assisted rapid
palatal expander (MARPE) came into existence as a non-surgical option with greater stability, orthopedic effects and few dentoalveolar side ef-
fects in young adults. This is a bone –tooth borne appliance which may have two or four screws. The anterior screws are placed in the ruggae ar-
ea, while the posterior screws are placed in the paramedian area (3mm lateral to the suture) at the first bicuspid area.
Objectives:
Highlight the difference between RME and MARPE
Materials and methods:
We searched the databases EBSCO, SCIELO, PubMed/MEDLINE and Google Scholarship
Authors (year) Title Study Type Studies Author’s conclusion
Evaluated
Hakan Ela Three-dimensional Article 70 pts All of the transverse skeletal widths (medial orbital, lateral nasal,
; Juan Martin Palomob evaluation of upper maxillary, and mandibular) and interdental (intermolar, interpre-
(2014) airway following molar, and intercanine) parameters were significantly enlarged in
rapid the RME group.
maxillary expansion Significant increase in nasal passage airway volume in RME
group compared with non- RME group
No difference in oropharyngeal airway passage volume.
ShiYao Liu, TianMin Xu Effects of rapid Systemic re- 12 Suture opening with RME around 12-52.5% of the total screw
and Wei Zou maxillary expansion view expansion.
(2015) on the midpalatal After RME treatment, recalcification of the suture occurs which
suture indicates the stability of treatment.
No evidence if the opening is parallel or triangular.
Low quality articles, so no accurate conclusion .
Macario Camacho, MD; Rapid Maxillary Ex- Systemic re- 17 Improvement in oxygen saturation & spontaneous resolution of
Edward T. Chang, MD, pansion for Pediat- view & meta obstructive sleep apnea following RME treatment.
MS; Sungjin A. Song, ric Obstructive analysis
MD; Jose Abdullatif, MD; Sleep Apnea
Soroush Zaghi, MD; Pao-
la Pirelli, DDS; Victor
Certal, MD, PhD; Chris-
tian Guilleminault, MD
(2016)
Pubmed, Cochrane, Transverse Skeletal Systemic re- 6 Using skeletal age not chronological age as a reference in treat-
Scopus, Lilacs and Web Effects of Rapid view ment of skeletal crossbites. Using RME in pre puberty subjects
of science Maxillary Expan- will increase in maxillary & lateral nasal widths and being stable
(2018) sion in Pre and on long term while having less effects on post puberty subjects.
Post Pubertal Sub- It affects nasal form & function. Mouth breathers will have more
jects chances to have normal nasal breathing.
Ana Julia Guerra,1 Idi- Systematic review Review arti- 23 RME indication: incomplete maxillary bone maturation & trans-
berto Jose Zotarelli Fil- of major considera- cle verse maxillary deficiency.
ho,1,2 Carlos Alberto tions of rapid maxil- RME contraindications: excessive maxillary prognathism, bimax-
Costa Neves Buchala1,2 lary expansion illary protrusion, isolated crossbites & excessive vertical devel-
(2018) opment of the face.

Author (year) Title Study Type Studies Author’s conclusion

Evaluated
Di Luzio C, Bellisario A, Miniscrew - Assist- Systematic 25 articles The miniscrew-assisted rapid palatal expander (MARPE) is char-
Squillace F, Favale M, ed Rapid Palatal review acterized by a decrease in the excessive load performed by con-
Caputo M Expander ventional appliances on the buccal periodontal ligament of teeth
Year: 2017 (Marpe): A Efficient to which they are anchored. Moreover, considerable decrease in
Alternative Treat- accidental movement of anchoring teeth as the support for pala-
ment of axillary tal expansion is osseous and avoids multiple surgeries.
Transverse Defi-
ciency

Author (s): Shin H, Predictors of mid- Preliminary
Hwang CJ, Lee KJ, Choi palatal suture ex- study
YJ, Han SS, Yu HS pansion by minis-
Year: 2019 crew-assisted rapid
palatal expansion in
young adults: A pre-
liminary study
Author (s): Sung-Hwan Nonsurgical minis- Retrospec-
Choi, Kyung-Keun Shi, crew-Assisted rapid tive cohort
Jung-Yul Cha, Young- maxillary expansion study
Chel Park, and Kee-Joon results in accepta-
Lee ble stability in
Year: 2016 young adults
Author (s): Chen Zong, Skeletal and den- Prospective
Bojun Tang, Fang Hua, toalveolar changes study
Hong He, and Peter in the transverse di-
Ngan mension using mi-
Year: 2019 croimplant-assisted
rapid palatal expan-
sion (MARPE) ap-
pliances
31 pa- The findings of this study indicated that age, palate length, and
tients MPSM stage can be predictors of midpalatal suture expansion
by MARPE in young adults.
69 pa- Nonsurgical MARME can be a clinically acceptable and stable
tients treatment modality for young adults with a transverse maxillary
deficiency.
22 pa- The use of MARPE appliances such as MSE can be used to cor-
tients rect transverse maxillary deficiency in adolescent or young adult
patients with minimal dentoalveolar side effects. A total expan-
sion of 5.4 mm can be achieved in which near 60% was contrib-
uted by skeletal expansion. More parallel expansion can be ex-
pected anteroposterioly and more expansion vertically at the pal-
atal compared to the nasal floor.

Author (s): Hideo Suzuki, Miniscrew-assisted Review 37 articles Rapid palatal expansion might be recommended for patients at
Won Moon, Luiz Hen- rapid palatal ex- the final pubertal growth stage, in addition to adult patients with
rique Previdente, pander (MARPE): maxillary constriction. It represents a treatment solution that can
Selly Sayuri Suzuki, the quest for pure potentially avoid surgical intervention. When performed in asso-
Aguinaldo Silva Garcez, orthopedic move- ciation with rapid palatal expanders, it might enhance the skele-
Alberto Consolaro ment tal effects of the latter.
Year: 2016
Results:
Stable maxillary expansion (both skeletal and dentoalveolar) was achieved without surgery when using MARPE. Whereby, RME was mostly den-
toalveolar in post pubertal patients.