MARPE - SARPE: Sense and NON-sense Björn Ludwig

orthodontics In summary

Join me for a summary of Björn Ludwig’s lecture exploring Miniscrew Assisted Rapid Palatal Expansion (MARPE) and Surgically Assisted Rapid Palatal Expansion (SARPE). Björn described how MARPE works, aspects of design and his clinical process.

Effects of MARPE

• Parallel opening of suture 2mm greater at 6 region than RME (S/R Krusi 2019)
• Facial changes
  • Widens Zygoma
  • Nasal base expands
  • Changes to the orbit – no significant but beware Brutally evasive!
• No periodontal side effects with MARPE (limited evidence) S/R Vidalon 2021
• RME Vs bone borne, hybrid = bone borne no dental side effects: Canan 2017

Age

MARPE Vs RME

• Age up to 11, no difference in outcomes Bazargani 2021

Retention after MARPE

At 7 months: suture has not fully remodelled

• Retention is needed for 1 year to allow full remodelling
• Type of retainer
  • TPA does not maintain bony changes Prado 2014
  • TPA with TADs = prevent bony relapse

Expansion rate of MARPE

• Fast Vs slow bone borne
  • Fast (2-3 x activation per day) Vs slow (2 activations per week)
    • Slow expansion MARPE: Sutural opening still occurs Pulver 2016 (Rabbit study)
    • No diastema

Activation process: Force controlled polycyclic activation

• Activation occurs if the force is 500g, key indicates activation Winsauer 2021

Airflow

• Increase in airflow with MARPE
• White paper from AJODO on OSA – limited evidence
  • Our job is to get rid of crossbites NOT to resolve OSA
• MARPE effective at resolving crossbite S/R: Kapetanović 2019
  • MSE reduce OSA: Brunetto and Moon 2022
    • Björn considered a good side effect, not the main cause

Class 3

• RME most effective in class 3 cases
• Alt-Ramec Eric Liou 2005
• 3 x day = maxilla moves downwards and forwards due to position of buttress
• Facemask
  • Facemask in the night, and class 3 elastics in the day
    • A point advance 3mm: MARPE + facemask study: Maino 2018
    • Realistic ½ unit correction – borderline correction

SARPE Vs MARPE

• SARPE mainly changes maxilla, maintains aspects of midface
• MARPE changes to midface

Take home messages

• Hi tech is good but low tech is key
• No body said it was easy, and orthodontics is not easy

For more information see Benedict Wilmes guest blog on Kevin O’Brien’s Orthodontic Blog