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Maxillary skeletal expansion using MARPE. Akram Alhuwaizi. Episode 146. March 16th 2022

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Farooq Ahmed

Maxillary skeletal expansion using MARPE: Akram Alhuwaizi

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Join me for a summary of  Akram Alhuwaizi’s lecture on MARPE – Miniscrew assisted rapid palatal expansion. This summary explores MARPE from a clinical aspect, assessing the advantages and disadvantages, followed by a case discussion of success and failure, a discussion of MSE and lessons learned for designing MARPE.

The full lecture is available on Akram’s youtube channel:

Maxillary Skeletal Expansion using MARPE from A to Z (Updated) – YouTube

Introduction

Purpose of expansion

·       Correction of crossbite

·       Creating space

·       Pre myofunctional treatment

·       Widening smiles

Methods available

·       Removable appliance

·       Quad Helix

·       Rapid Maxillary Expander RME

·       Surgically assisted Rapid Palatal Expansion SARPE

Expansion methods

Ideal features of expansion appliances are to achieve bodily movement, minimal compliance required from the patient, applicable to a range of ages and straightforward for patients

 

MARPE experience

Case 1

·       Attended Peter Ngan lecture Arab conference

·       Surgical case requiring expansion – 2019

·       4 palatal TADs

·       FAILIURE – TADs moved, one got embedded into the palatal tissue, no significant expansion occurred

Cause of failure

Hyrax position: 

·       Too posterior = near to Pterygo palatine suture and the zygomatic buttress which causes more resistance to the expansion

·       No guiding arms, greatert risk of dental movements but they help in seating of the appliance

·       Lack of guiding arm allowed rotation of the device by failure of only one TAD.

TADs

·       Length: Short: Ideally bi-cortical engagement to avoid bending and increase retention

Appliance design

·       There was a play between the TAD and the device

·       Lab fabricated loops, not precision fit

 

Case 2

Design

·       Used 2 TADs 2mm D/12mm L

·       Guiding arms to the 1st molars

·       Hyrax more anterior

·       Good fit abutment / screw and expander

·       Longer screws – bicortical engagement

·       Younger patient and female

o   Successful palatal expansion

 

MARPE Vs MSE

Prof Moon Maxillary Skeletal expander (MSE)

·       Difference in posterior expansion

o   MSE:

§  Posterior position of expander

§  Expand at the pterygo palatine suture = more horizontal expansion

§  Requires more force to overcome resistance

§  Precision fit required between TAD and the MSE.

§  Longer TADs.

§  TADS are in the vault of the palate not on the lateral walls

·       Outcome with MSE

·       Less pyramidal expansion in the anterior region

·       Anterior and posterior Maxillary expansion

 MSE design Shwan Elias

·       8,10,12mm / most commonly used is the 8mm one

·       MSE 1

o   Same hyrax screw

o   Issue = key bends under higher forces

o   Activation:

§  Late teens: 0.2mm/ day = 1 turn

§  Older: 0.4-0.6mm/day = 2-3 turns

§  After diastema 0.2mm/day = 1 turn

·       MSE 2 (Biomaterial Korea)

o   Uses wrench / it is hexagonal screw =  6 turns for 1mm

o   Advantage = expansion is slower than MSE1

o   Flexible arms – instead of the rigid arms

§  Decrease the dental effect and increase the skeletal effect

o   Activation:

§  Late teens: 0.27mm/day = 2 turns

§  Older: 0.5-0.8mm/day = 4-6 turns

§  After diastema 0.27mm/day = 2 turns

Issues with MSE

·       Large force application can cause TADs to fail

·       Narrow and high palate =  difficult to place the TADs for  bicortical engagement.

Method of production

·       Procedure

o   Wire soldering with close contact to vault of palate, and 2 mm clearance of arms ofr the palatal mucasa for hygiene

o   TAD insertion: screw half way for efficiency, followed by ratchet / screw driver for second half of insertion – to have tactile feedback to ensure cortical engagment

o   End point: patient feel tingling sensation through nasal mucosa

Conventional RME / MSE 1 – 0.25mm per activation

·       2-3 x activation = 0.5-0.75mm

Hexagonal RME / MSE2 – 0.13mm per activation

·       4-6 activations = 0.5-0.8mm

·       MSE 1

o   Same hyrax screw

o   Issue = key bends under higher forces

o   Activation:

§  Late teens: 0.2mm/ day = 1 turn

§  Older: 0.4-0.6mm/day = 2-3 turns

§  After diastema 0.2mm/day = 1 turn

·       MSE 2 (Biomaterial Korea)

o   Uses wrench / it is hexagonal screw =  6 turns for 1mm

o   Advantage = expansion is slower than MSE1

o   Flexible arms – instead of the rigid arms

§  Decrease the dental effect and increase the skeletal effect

o   Activation:

§  Late teens: 0.27mm/day = 2 turns

§  Older: 0.5-0.8mm/day = 4-6 turns

§  After diastema 0.27mm/day = 2 turns

Contributions

Content: Abdallah Sharafeldin

Edited and produced: Farooq Ahmed

 

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