Skeletal, Dentoalveolar, Dental, and Soft-Tissue Effects Following MARPE Treatment: A Review — Table 3

Study

N

Average Age

Treatment

CBCT/Software

Measurements

Cantarella, et al¹⁹

15 (6 men, 9 women)

17.2 ± 42 y.o.

MSE + 4 MT

NewTom 5G/
OnDemand 3D

Linear bone measurements:

• Anterior intermaxillary distance (AIMD)
• Posterior interzygomatic distance (PIZD)
• Posterior intertemporal distance (PITD)

Angular bone measurements:

• Right zygomaticotemporal angle (Rt ZTA)
• Left zygomaticotemporal angle (Lt ZTA)
• Angle of the right zygomatic process of the temporal bone (Rt ZPA)
• Angle of the left zygomatic process of the temporal bone (Lt ZPA)

Conclusions: In the horizontal plane, the maxillary and zygomatic bones, as well as the entire zygomatic arch, underwent significant lateral displacement following expansion using MSE. The center of rotation for the zygomatic–maxillary complex was located near the proximal portion of the zygomatic process of the temporal bone, more posterior and more lateral than described in the literature for toothborne expanders. A significant bending of the bone in the zygomatic process of the temporal bone occurs during miniscrew-supported maxillary expansion.

Park, et al²⁵

14 (9 men, 5 women)

20.1 ± 2.4 y.o.

Disyuntor Hyrax + 4 MT

Alphard Vega/
Invivo5

Dental: IPM width, IM width, interdental angle

Skeletal: Distance in Z-Z, N-N, J-J, MA-MA, C6-C6, AG-AG; nasal cavity width; basal bone width; buccal bone thickness; buccal alveolar width

Conclusions: MARPE can be an effective treatment modality for correcting maxillary transverse deficiency in young adults by separating the MPS. The maxillary expansion achieved with MARPE exhibits a pyramidal pattern; in this study, the degrees of skeletal, alveolar, and dental expansion were 37.0%, 22.2%, and 40.7%, respectively. The buccal inclination of the maxillary teeth with MARPE leads to a decrease in buccal alveolar bone thickness and crest height. Orthodontists should pay attention to these changes.

Lim, et al²⁶

24 (8 men, 16 women)

21.6 ± 3.1 y.o.

Disyuntor Hyrax + 4 MT

Alphard Vega/
Invivo5

Dental: Amount of expansion; intercusp width and interapex width of I, C, 1PM, 2PM, 1M; molar inclination

Skeletal: Alveolar width; width of nasal cavity/nasal floor; dentoalveolar inclination; interproximal alveolar crest level; buccal alveolar crest level 1PM, 2PM, 1M; buccal/palatal bone thickness 1PM, 2PM, 1M

Conclusions: The null hypothesis was rejected: there were significant increases in dentoalveolar and skeletal measurements 1 year after MARPE, while the buccal alveolar bone thickness and height at the first premolar decreased 1 year after MARPE. Within the limitations of this study, the results suggest that MARPE can be used as an effective tool to correct maxillomandibular transverse discrepancies in young adults, showing stable results after 1 year of expansion. However, in patients whose buccal alveolar bone in the area of the first premolar is thin and the alveolar crest is low prior to expansion, the possibility of alveolar dehiscence should be carefully monitored.

Shin, et al²⁷

31

22.52 ± 5.11 y.o.

Disyuntor Hyrax + 4 MT

Alphard Vega/
Invivo5

Skeletal: Suture opening width, suture opening ratio, palatal length, palatal depth at the level of the first premolar and first molar

Vertical pattern

A/P classification

Suture maturation stage

Suture density ratio

Conclusions: For MARPE in young adults, age, palatal length, and MSE (midpalatal suture expansion), but not the MSE ratio (MPSD), showed significant negative correlations with the proportion of MPS opening. Although the vertical skeletal pattern and the anteroposterior skeletal classification did not show statistically significant correlations, these findings should be verified in a future study with a larger sample size. Based on the results of the regression analysis, the authors propose that age, palatal length, and MSE should be considered simultaneously as predictors of the success or failure of MARPE in young adults.

Jesus, et al²⁸

36

15–39 y.o.

Disyuntor Hyrax + 4 MT

iCat/Dolphin 3D

Skeletal: Maxillary width in the molar region, width of the nasal base in the molar region, width of the nasal base in the premolar region, width of the nasal cavity at the canine level, width of the nasal base in the canine region

Dental: Intermolar width at the groove, intercuspid intermolar width, width of nasal soft tissue

Conclusions: Overall, the findings of this study show that MARPE uniformly increased the width of the anterior and posterior nasal cavity. SARPE expanded the nasal cavity in a “V” shape (greater expansion in the anterior region than in the posterior). However, the expansion of the anterior region was the same with both techniques. The percentage change in the nasal cavity and choanal opening relative to the amount of dental arch expansion was greater for the MARPE technique than for SARPE. MARPE, SARPE with a strap, and SARPE without a strap increased the width of the nasal soft tissue, although the strap limited this increase.

Metha, et al²⁹

31

11–15 y.o.

MARPE: Hyrax + 2 MT
RPE: Hyrax

iCat/Dolphin 3D

Airways: Outline of the nasal cavity, nasopharyngeal contour, oropharyngeal contour, laryngopharyngeal contour, volume and area of the nasal cavity, volume and area of the nasopharynx, oropharyngeal volume and area, laryngopharyngeal volume and area, total airway volume, total airway area

Dental: Maxillary intermolar width, palatal width

Osseous: maxillary external width

Conclusions: Both MARPE and RPE significantly increased the volume of the nasal cavity, oropharynx, and nasopharynx, the area of the nasopharynx, total airway volume, maxillary intermolar width, external maxillary width, and the palatal width compared to the controls in the short term. In the long term, MARPE resulted in a significant increase in the volume of the nasopharynx and palatal width compared to the RPE and control groups. Both the MARPE and RPE groups showed a greater external maxillary width compared to the controls in the long term. There was no significant difference in airway parameters, except for the volume of the nasopharynx, between the MARPE, RPE, and control groups in the long term. Therefore, the age and growth of the patient may be predominant factors. The amount of expansion, the external maxillary width, and the palatal width were not correlated with the airway volume.

Kapetonović, et al³⁰

34 (8 men, 26 women)

21 ± 9.4 y.o.

D-MED + 4 MT

KaVo 3d eXam/IPS CaseDesigner®

Dental: Intermolar width, interpremolar width, intercanine width, dental inclination in M1 or P1 (TI), clinical crown height in M1 or P1 (CCH)

Skeletal: Width of the MPS at M1 or P1 (MSW), palatal alveolar width at M1 or P1 (PAW), nasal cavity width (NCW), buccal bone thickness at M1 or P1 (BBT)

Conclusions: This prospective clinical cohort study provides a higher level of evidence regarding the efficacy of MARPE, which achieved significant maximum transverse expansion in a large and diverse group of late adolescents and adults. The Dutch Maxillary Expansion Device proved to be an effective MARPE appliance with a success rate of 94.1%. Furthermore, the skeletal component of the expansion was very high at both the molar and premolar levels—60.4% and 92.2%, respectively. Buccal dental tipping, an increase in clinical crown height, and thinning of the buccal bone were observed, but these may be considered clinically insignificant in patients with a healthy periodontium. Therefore, MARPE is an effective and safe nonsurgical treatment for maxillary transverse deficiency in late adolescents and adults.

Salmoria, et al³¹

20 (8 men, 12 women)

24.9 ± 1.8 y.o.

MSE + 4 MT

iCat/OsiriX

Skeletal: Expansion screw activation, anterior opening of the intermaxillary suture, posterior opening of the intermaxillary suture

Dental: Interpremolar distance, intermolar distance, buccolingual inclination of the first premolars, buccolingual inclination of the first molars

Conclusions: The use of MARPE promoted changes in the variables studied, demonstrating the effectiveness of this treatment in the correction of transverse discrepancies. The group at stage D of suture fusion showed a greater opening of both the diastema and the suture (anterior and posterior) than the group at stage E, demonstrating better outcomes of the technique in less fused sutures. The increase in interpremolar and intermolar distances was similar in both groups. There was a direct relationship between the opening of the diastema and the opening of the MPS, which enabled the assessment of skeletal transverse gain based on a clinically measurable parameter.

Solano Mendoza, et al³²

15

17 ± 4 y.o.

MSE + 4 MT

iCat/Invivo5

Skeletal: Nasal width, maxillary width, opening of the palatal suture, buccal maxillary width, palatal maxillary width, buccal and palatal bone thickness, level of the buccal alveolar bone crest, opening of the nasal floor, opening of the palatal floor, sutural expansion

Dental: Interpolar width, dental inclination

Conclusions: MARPE with tooth- and bone-borne expanders is an effective method for treating maxillary deficiency in adolescent patients with incomplete ossification of the MPS, resulting in significant maxillary expansion. Although some periodontal or dentoalveolar changes were observed, such as a radiographic reduction in buccal bone thickness after treatment, none of these effects was clinically detectable. Correction of maxillary deficiency with MARPE resulted in broader skeletal expansion, with reduced dentoalveolar and dental effects, and the buccal alveolar crest remained virtually unchanged. A tendency toward a parallel opening pattern of the MPS was observed after treatment in both coronal and axial views. Apart from the use of dental support for maxillary expansion, no significant dental tipping effect was observed after treatment.

Chun, et al³³

RPE: 20 (6 men, 14 women); MARPE: 20 (8 men, 12 women)

RPE: 14 ± 4.5 y.o.

MARPE: 14.1 ± 4.2 y.o.

RPE: Hyrax

MARPE: MSE + 4 MT

Alphard 3030/
Invivo5

Skeletal measurements: FZS (frontozygomatic suture), ZMS (zygomaticomaxillary suture), NW (nasal width), NPF (nasopalatine foramen), GPF (greater palatine foramen), MPS (midpalatal suture gap)

Dentoalveolar measurements: MW (maxillary width), IDW (interdental width), DI (dental inclination)

Periodontal measurements: BBPT (buccal bone plate thickness), PBPT (palatal bone plate thickness)

Conclusions: Separation of the MPS was observed in 90% (18/20) and 95% (19/20) of participants in the RPE and MARPE groups, respectively. Both groups exhibited significant triangular basal bone expansion (T1-T0) and skeletal relapse during consolidation (T2-T1). A greater overall increase in PM-NW, M-NW, and GPF was observed in the MARPE group during the expansion and consolidation periods. Under identical amounts of expansion, the MARPE group showed a smaller decrease in BBPT in the premolar and molar regions after consolidation, indicating that reinforcement with miniscrews may enhance consolidation, maintaining the anchor teeth within the basal bone.

Naveda, et al³⁴

Young adult: 14 (3 men, 11 women); Middle adult: 14 (6 men, 8 women)

Young adult: 22.87 ± 3.52 y.o.

Middle adult: 36.85 ± 5.55 y.o.

MARPE: Expander

CBCT: not identified/
Invivo5

Skeletal transverse variables: Width of the nasal cavity between the most lateral walls of the nasal cavity; MW tangent to the inferior level of the nasal floor; alveolar width measured 10 mm below the nasal floor

Dental variables measured in coronal sections passing through the maxillary first molars and premolars: Interradicular width between the palatal roots; maxillary arch width between the distolingual cusp of the first maxillary molars and the lingual cusps of the first maxillary premolars; dental inclination defined as an angle between the right and left dental axes, determined by connecting the palatal cusp and the apex of the palatal root, in relation to the nasal floor

Periodontal variables measured in sections passing through the palatal and distobuccal roots of the maxillary first molar and the center of the maxillary first premolar: The first molar and first premolar were divided into thirds based on the lengths from the palatal cusp to the apex of the palatal root and from the cusp to the apex of the root, respectively. Buccal bone plate thickness (BBT) and lingual bone plate thickness (LBT) parallel to the nasal floor between the middle third and the apical third

Conclusions: The null hypothesis was confirmed. After MARPE, middle-aged adults showed similar dentoskeletal and periodontal changes compared to young adults.