MARPE / MSE as a non-Invasive alternative to SARPE in Houston

Doing MARPE / MSE  since 2015

Now we offer custom-made MSE / MARPE with 8 holes for extreme cases, see below.

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 a deficiency of 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 (REF). He suggested splitting 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 the 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's mouth.  A cone-beam computed tomography might need to measure the exact width of the maxilla.  

When is Mini-implant Assisted Rapid Palatal Expander MARPE / MSE 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 (REF)
• 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.

Does MARPE really help to increase the size of my nasal airway?

Research has shown that MARPE – IF DONE CORRECTLY - can successfully expand the nose up to 80% of the actual expansion of the MARPE expansion.

Here's the case Dr. Kanaan treated in his office with a patient who gained significant expansion in her nose and she got rid of her mouth breathing.

What are the benefits of using MSE / 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 MSE?  

• Initial discomfort/pressure is the most common side effect of the MSE
• 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 the 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 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.  

However, MARPE / MSE can be successful at any age, but the ideal age for treatment is typically during adolescence when the upper jaw suture is growing and developing. Studies have shown that MARPE can be more effective in Female adults when compared to male adults.  

In one study with 215 patients, the success rate for female patients was 94% compared to 61% for male patients (REF). This difference was more obvious in male patients older than 25.  However, male patients younger than 20 have almost the same success rate as female patients.

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 / MSE 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 of 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 one time every night. When enough expansion is achieved, Dr. Kanaan might ask you to turn the expander once or twice a week as needed.  

References: 

Brunetto DP, Moschik CE, Dominguez-Mompell R, Jaria E, Sant'Anna EF, Moon W. Mini-implant assisted rapid palatal expansion (MARPE) effects on adult obstructive sleep apnea (OSA) and quality of life: a multi-center prospective controlled trial. Prog Orthod. 2022 Feb 1;23(1):3. doi: 10.1186/s40510-021-00397-x. PMID: 35102477; PMCID: PMC8804045.

Turatti G, Bruni A, Savoini M, Giordano M, Gerbino G. Maxillomandibular Transverse Osteodistraction: A Multidisciplinary Case Report with 30-Month Follow-Up. Case Rep Dent. 2020 Jan 31;2020:3856412. doi: 10.1155/2020/3856412. PMID: 32082642; PMCID: PMC7016482.