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Maxillary Distraction

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

Correcting maxillary transverse deficiencies remains a major challenge in orthodontics, for both functional and aesthetic reasons. Traditional rapid palatal expansion (RPE) techniques show their limitations when faced with finished growth or increased skeletal resistance.

 

It is in this context that 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 with missing teeth or fragile periodontal tissues.

SARPE: the safe and proven surgical approach

SARPE combines a surgical maxillary osteotomy with a palatal expansion device. It is indicated for adult patients with a palatal suture that is too ossified to allow for non-surgical expansion. The procedure helps to reduce bone resistance, thus facilitating safer and more predictable skeletal expansion.

 

Advantages:

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

 

Disadvantages:

  • Requires surgery under general anaesthesia.
  • More costly and invasive.
  • Surgical risks and patient may become more refractory.

MARPE: an effective minimally invasive alternative, under certain anatomical conditions

MARPE relies on the use of mini-screws anchored in the palate, allowing for direct bone support without surgery. It is particularly suitable for adolescents and young adults, in whom the palatal suture is not yet fully ossified.

 

Bone support also optimises transverse maxillary expansion in a purely orthopaedic way.
Since the expansion forces are applied directly to the bone base, the dentoalveolar compensations generally observed with dental support are significantly reduced, or even eliminated.

 

 

 

The maxillary expansion obtained after disjunction (Fig 6) is never purely orthopaedic: 38% of skeletal expansion is observed through action on the median palatal suture, 13% alveolar expansion through vestibular apposition and palatal resorption, and 49% parasitic vestibuloversion of the teeth.

 

Advantages:

  • Non-surgical technique (less expensive and faster).
  • Less invasive and therefore better tolerated by patients.
  • Good skeletal response in young adults (subject to verification of the maxillary suture).

 

Disadvantages:

  • Less effective, or even impossible, in older patients.
  • Risk of device displacement during activation.
  • Possible side effect if the suture is in poor condition.

 

Clinical Comparison and Indications

 

Criteria SARPE MARPE
Age and ossification status of the palatal suture Over 18 years 13 – 25 years old (depending on the ossification stage of the palatal suture)
Invasiveness Moderate surgical procedure Non-surgical procedure (local anaesthesia)
Anchorage Bone support via osteotomy Bone support via mini-screws
Stability High Good, depends on anchorage and the ossification statuts of the palatal suture
Complications Surgical Technical (screws, inflammation)

Conclusion: moving towards personalised and safe maxillary distraction

Bone-supported maxillary distraction is undergoing major development with the integration of digital technologies and the diversification of protocols. MARPE, with its minimally invasive approach and direct bone support via mini-screws, offers an effective and well-tolerated alternative for young adults, while limiting dentoalveolar effects. SARPE, for its part, remains essential for older patients, guaranteeing stable skeletal expansion through surgical osteotomy.

 

The contribution of solutions like the one offered by Global D, combining 3D digital planning, custom-made devices and safe positioning guides, optimises the precision, safety and comfort of treatment. This customisation paves the way for more predictive orthodontics that is better suited to the patient’s anatomy, and better integrated into the care pathway.

*Article in Revue d’Orthopédie Dento-Faciale [Journal of Dentofacial Orthopaedics]·August 2017, Effect of maxillary disjunction according to GARRETT, in a study conducted by the University of Bordeaux: neuromuscular environment and stability of transverse maxillary expansion.

Pratice