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Listen "MARPE - SARPE: Sense and NON-sense Björn Ludwig "
Episode Synopsis
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
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
In God we trust