How We Treat a "Narrow Palate"

M.A.R.P.E (The Mini-Screw Assisted Rapid Palatal Expander): Revolutionizing Maxillary Expansion

In the field of orthodontics, achieving optimal alignment and bite often involves not just straightening the teeth, but also addressing skeletal issues that may affect a patient’s jaw structure. One of the most common concerns is maxillary constriction, where the upper jaw is too narrow, leading to problems like crossbite, crowding, and even breathing difficulties.

Traditionally, the rapid palatal expander (RPE) has been used to widen the upper jaw, but a newer, more efficient method is quickly gaining popularity among orthodontists: the Mini-Screw Assisted Rapid Palatal Expander, or M.A.R.P.E.. This innovative device has changed the way orthodontists approach maxillary expansion.

In this blog post, we’ll dive into how the M.A.R.P.E. works, its advantages, and its increasing success in orthodontic treatment.

What is M.A.R.P.E.?

The Mini-Screw Assisted Rapid Palatal Expander (M.A.R.P.E.) is a modern variation of the traditional palatal expander. The key difference is the inclusion of mini-screws (also referred to as temporary anchorage devices, or TADs) to anchor the appliance more securely to the patient’s palate. These screws are placed in the bones of the upper jaw and act as stable anchors to allow for more effective and precise expansion.

M.A.R.P.E. combines the benefits of traditional Rapid Palatal Expander (RPE) mechanics with the added stability and control provided by mini-screws. This ensures that expansion is more directed towards the palate and less likely to cause unwanted side effects, such as tipping of the teeth or unwanted tooth movement.

How Does M.A.R.P.E. Work?

The M.A.R.P.E. device operates by applying gentle, controlled forces to widen the maxilla (the upper jaw). The appliance consists of two primary components:

1. Mini-Screws: Small screws are surgically placed in the palatal bone requiring only local anesthetic to anchor the appliance securely. These screws help to provide the necessary anchorage for the expansion process, allowing for more controlled and predictable results.

2. Expander Appliance: This is the part of the M.A.R.P.E. that applies force to the palate. The expander is usually connected to the mini-screws, and the force needed to widen the upper jaw is applied gradually over time.

The device is typically activated using a key that turns a screw mechanism in the appliance. This action gradually widens the palate by pushing apart the two halves of the maxilla, which are naturally connected by a suture (a soft tissue joint) in the middle of the upper jaw. The force causes the suture to open, allowing for the expansion of the palate.

Advantages of M.A.R.P.E.

1. Increased Precision and Control: One of the biggest advantages of M.A.R.P.E. is the precision it offers in directing the expansion to the palate. The mini-screws provide stable anchorage, reducing the chance of unwanted tooth movement or side effects commonly seen with traditional expanders. This means more predictable results, especially in complex cases.

2. Reduced Risk of Tooth Movement: In traditional expanders, the force can sometimes cause unintended movement of the teeth, which can complicate the treatment. With M.A.R.P.E., because the mini-screws anchor the appliance to the bone, the force is more focused on the palatal suture and less on the teeth themselves, leading to more stable results.

3. Faster Treatment: Because of the more efficient anchorage provided by the mini-screws, the expansion process can often be faster compared to conventional methods. This is especially beneficial for patients who are looking for quicker results or who require significant expansion in a short amount of time.

4. Versatility for Complex Cases: M.A.R.P.E. is particularly useful for patients with severe maxillary constriction (narrow palate), those who are skeletally mature, or patients who may have limited space in the upper arch. In these cases, traditional expanders may not be as effective, but the mini-screw design allows for more tailored and focused expansion, many times being an alternative to extracting teeth.

5. Aesthetic and Functional Benefits: Widening the upper jaw has significant aesthetic and functional benefits, including improved bite alignment and facial aesthetics. It can also reduce crowding and crossbite, leading to better overall oral health and improved chewing function. The roof of the mouth is also the floor of the nose, therefore increasing the volume for improved nasal breathing. Some can even experience a "facelift effect." The widening of the upper jaw can lift the cheeks and fill a skeletal deficiency. See this patient below. She appreaed to have an underbite but once M.A.R.P.E. treaement was complet it filled out the upper jaw and she no longer appears to have the "underbite."

The Clinical Success of M.A.R.P.E.

Numerous clinical studies and case reports have highlighted the success of M.A.R.P.E. in achieving effective maxillary expansion. Some of the key findings include:

• High Success Rates: Research indicates that M.A.R.P.E. offers high success rates in achieving effective and stable maxillary expansion, especially in the younger population.

• Minimal Side Effects: Studies have shown that M.A.R.P.E. has a low incidence of unwanted side effects such as tooth tipping or discomfort, compared to traditional palatal expanders.

• Improved Aesthetic Outcomes: As M.A.R.P.E. can provide more controlled expansion, patients tend to experience improved facial aesthetics and bite alignment. The anterior segment of the maxilla is also less likely to be over-expanded, leading to more natural results.

Who is a Candidate for M.A.R.P.E.?

M.A.R.P.E. is particularly effective for patients with the following conditions:

• Maxillary Constriction: When the upper jaw is too narrow, leading to issues like crossbite, crowding, or a collapsed bite.

• Skeletal Discrepancies: Patients with significant skeletal issues such as underdeveloped maxillas.

• Older Adolescents and Adults: While traditional expanders work best during growth, M.A.R.P.E. can still be effective for skeletally mature patients who may not have growing bones. It provides a non-surgical way to achieve maxillary expansion without the need for complex procedures.

• Crossbites: Crossbite correction is one of the primary indications for M.A.R.P.E., helping to restore functional and aesthetic alignment.

A thorough evaluation by an orthodontist will help determine if M.A.R.P.E. is the right solution for an individual’s specific needs.

The Mini-Screw Assisted Rapid Palatal Expander (M.A.R.P.E.) represents a significant advancement in orthodontic treatment. Offering more precise, stable and faster results, it has become a go-to option for treating a narrow palate and related skeletal discrepancies. By combining the reliability of mini-screw anchorage with the effectiveness of palatal expansion, M.A.R.P.E. has proven to be a game-changer for both orthodontists and their patients.

If you or your child is dealing with maxillary constriction or other skeletal issues, consulting an orthodontist skilled in M.A.R.P.E. could open up a range of treatment options that may provide lasting and aesthetically pleasing results.