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Maxillary Distraction

Bone support: SARPE vs MARPE, which strategy for which patient?

Correcting transverse maxillary deficiencies remains a major challenge in orthodontics, both for functional and aesthetic reasons. When growth has ended or skeletal resistance is high, traditional rapid palatal expansion (RPE) techniques show their limitations.

In this context, bone-supported approaches such as SARPE (Surgically Assisted Rapid Palatal Expansion) and more recently MARPE (Miniscrew-Assisted Rapid Palatal Expansion) have emerged as innovative and effective solutions for adult patients or those with missing teeth.

 

SARPE: A Reliable and Proven Surgical Approach

SARPE combines surgical osteotomy of the maxilla with a palatal expansion device. It is indicated for adult patients whose palatal suture is too ossified for non-surgical expansion. The procedure reduces bone resistance, allowing for safer and more predictable skeletal expansion.

Advantages:

  • Proven effectiveness in adults.
  • Significant skeletal expansion.
  • Long-term stability.

Disadvantages:

  • Requires surgery under general anesthesia.
  • Higher cost and invasiveness.
  • Surgical risks and patient reluctance.

MARPE: A Minimally Invasive and Effective Alternative (Under Anatomical Conditions)

MARPE uses miniscrews anchored in the palate to provide direct bone support without surgery. It is especially suitable for adolescents and young adults whose palatal suture is not fully ossified.

This bone anchorage allows for transverse maxillary expansion in a purely orthopedic manner. Since the expansion forces are applied directly to the bone base, the usual dentoalveolar compensations seen with dental anchorage are significantly reduced or even eliminated.

 

 

The maxillary expansion achieved after palatal disjunction (Fig. 6) is never purely orthopedic:
According to a study conducted by the University of Bordeaux and published in the Revue d’Orthopédie Dento-Faciale (August 2017), based on Garrett’s findings, the expansion consists of approximately:

  • 38% skeletal expansion through the action on the midpalatal suture,
  • 13% alveolar expansion due to buccal apposition and palatal resorption,
  • and 49% undesired buccal tipping of the teeth.

 

Advantages:

  • Non-surgical technique (less expensive and faster).
  • Less invasive and better accepted by patients.
  • Good skeletal response in young adults (depending on suture ossification).

Disadvantages:

  • Less effective or even impossible in older patients.
  • Risk of device sinking during activation.
  • Possible side effects if suture condition is borderline.

Clinical Comparison and Indications

 

Criteria SARPE MARPE
Age and suture ossification Over 18 years 13–25 years (depending on suture ossification)
Invasiveness Moderate surgical Non-surgical (local anesthesia)
Anchorage Bone via osteotomy Bone via miniscrews
Stability High Good, depends on anchorage and suture condition
Complications Surgical Technical (screws, inflammation)

Conclusion: Toward Personalized and Safe Maxillary Distraction

Bone-supported maxillary distraction is evolving rapidly thanks to digital technologies and diversified protocols. MARPE, with its minimally invasive approach and direct bone anchorage via miniscrews, offers an effective and well-tolerated option for young adults, while limiting dentoalveolar side effects.

SARPE remains essential for older patients, ensuring stable skeletal expansion through surgical osteotomy.

Solutions like those offered by Global D, combining 3D digital planning, custom devices, and secure positioning guides, help optimize treatment precision, safety, and comfort. This personalization paves the way for more predictive orthodontics, better adapted to patient anatomy and more integrated into the care pathway.

Article in Revue d’Orthopédie Dento-Faciale · August 2017, Effect of maxillary disjunction according to GARRETT, in a study conducted by the University of Bordeaux: neuro-muscular environment and stability of transverse maxillary expansion.

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