MARPE / SME as a non-Invasive alternative to SARPE in Houston
In this article, you will learn how Dr. Kanaan is correcting severe narrow maxilla utilizing his invented expander with mini implants TADs.
To make crooked teeth straight and correct crossbites, an expansion might be needed during orthodontic treatment to create enough space and accommodate the crooked teeth. This is usually carried with a traditional orthodontic expander called the Rapid Palatal Expander RPE.
However, in extremely narrow cases with deficiency more than 5 mm "like Fig. 1” or in older patients, the traditional RPE might not work for the upper jaw, and a more aggressive approach might be needed to open the mid palatal suture.
What are the other treatment options if the traditional RPE is not indicated?
Surgically Assisted Rapid Palatal Expansion SARPE was introduced by Dr. Brown in 1938. He suggested to split the center of the palatal bone surgically and following the surgery with the use of the traditional RPE to expand the maxilla. This split will minimize the resistance of expansion from the bone especially in adult cases or cases with more than 5 mm of deficiency.
Although SARPE has higher stability than traditional RPE, its use is not widely considered due to the surgical cost and the recovery time. In Houston, SARPE will cost between $8000 and $12000.
In 2014, Dr. Moon modified the traditional palatal expansion appliance to support 4 mini implants. This modification allowed the RPE to be attached directly to the bone thus transferring the expansion forces directly to the skeletal bone. He named his device Surgical Maxillary Expander SME. Sometimes, this concept is also referred to as Miniscrew-Assisted Rapid Palatal Expansion technique (MARPE) or Maxillary Skeletal Expander MSE.
Dr. Kanaan redesigned the SME to fit narrower palates with a safety release mechanism. He filed his invention with the United States Patent Office on Oct 10th, 2016 under Application US15/333,531 “Safety release orthodontic skeletal expander using mini-implants” (REF).
His expander comes in two sizes: 7 mm and 9 mm. However, in extremely narrow cases, Dr. Kanaan will custom make a surgical expander to fit the patient mouth. A cone-beam computed tomography might need to measure the exact width of the maxilla.
When is implant-assisted rapid palatal expander indicated?
- Severe narrow maxilla
- Severe crowding when the extraction is not indicated
- Mouth breathing as the result of a narrow nose space
- Obstructive sleep apnea
- Crossbite correction in adult non-growing patients
- Severe underbite cases are caused by midfacial deficiency. This will require the use of a facemask to protract the maxilla forward
- Patients with front teeth that have short roots “ see case #3 below”
- Congenital problems such as CLP
If you have any of the above problems, or if you were told that SARPE is the only option to correct your case, please call the office of Dr. Kanaan at 281-249-9999 for a FREE consult.
What are the benefits of using SME / MARPE over SARPE?
- No need for an expensive invasive surgery when compared to SARPE
- Minimal recovery time after the procedure
- Start the expansion immediately after placing the expander
- The ability to place two expanders in severe narrow cases
What are the risks of SME?
- Initial discomfort/pressure is the most common side effect of the SME
- Initial sneezing if the maxilla has a thin bone
- Mini Screw breakage. Although this is a rare consequence, it might happen. Based on the location and size of the broken screw, Dr. Kanaan will either remove the broken part surgically or leave it for your body to expel broken part.
- Soft tissue irritation. This usually happens if the expander is pushing against the gum.
What are the benefits of using mini-implants with the expander?
- The mini implants will transfer the force to the bone directly, resulting in a better skeletal expansion.
- Less force is transferred to supporting teeth. This is important in cases with weak teeth.
- The 4 implants will support the expander in place. This is beneficial in Invisalign cases or cases where posterior teeth are missing.
At what age is the MARPE appliance recommended?
Research has shown that the maxillary suture will respond less to expansion forces from the RPE after the age of 13 (REF). As the suture gets tighter in young adults, it becomes harder to achieve bone expansion and most of the expansion coming from the traditional RPE is dental expansion.
The addition of 4 mini implants will add great support to the RPE allowing more skeletal effect and better expansion of the Maxilla.
There is no age limit when SME is contraindicated. We need to try and sometimes, a Corticotomy might be indicated. Dr. Kanaan has successfully corrected a severe narrow maxilla in a patient at the age of 36 utilizing two sets of SME expanders.
Can MARPE be used with Invisalign?
Yes, this will require an incredibly careful combination of the MARPE expander with the progressing Invisalign trays. The MARPE expander will help with widening the maxilla, while the Invisalign trays will help with the teeth movement at the same time. Here is a case that Dr. Kanaan treated with Invisalign and utilizing the MARPE.
How often do I need to turn the expander with the MARPE?
This depends on the case and the age of the patient. But usually, Dr. Kanaan will ask you to turn the expander every other night. When enough expansion is achieved, Dr. Kanaan might ask you to turn the expander once or twice a week as needed.