Orthodontic appliance for palatal expansion MARPE
Correction of jaw narrowing
Treatment period — from 8 monthsWe are accustomed to the fact that to correct the bite usually put braces or eliners. But modern orthodontics — is much more interesting and diverse than it seems at first glance. Doctors use new high-tech apparatuses to solve problems that used to be either solved only by maxillofacial surgery, or on braces, but much longer. Anna Stanislavovna Reznichenko, dentist-orthodontist, leader of pediatric orthodontics, will talk about one of these devices.
To better understand how the palatal expansion appliance works, let's first talk about the forms of malocclusion: dentoalveolar and skeletal (gnathic) malocclusion.
- A dentoalveolar overbite — is a crowding formed by misaligned teeth. To correct this form of bite, it is usually sufficient to put the teeth in the correct position. Orthodontists use braces or eliners to correct this problem.
- A skeletal or gnathic bite — is a closure formed by the size or position of the bones of the jaw, i.e. at the level of the skeleton. This shape can be compensated with braces or eliners — the teeth are placed in a position where the correct alignment can be achieved, but the size and shape of the jaws are not changed. To change them, a surgical procedure is performed to reduce, enlarge or move the jaw.т.
In some cases, skeletal pathology can be corrected with less invasive techniques, without surgery. The MARPE device is designed for just such situations.
What is MARPE?
MARPE (Minisrew-Assisted Rapid Palatal Expansion) — apparatus for rapid palatal expansion on miniscrews.
The device is a metal base with a screw in the center, which is fixed to the sky on orthodontic mini screws.
The design of the device can be of two configurations:
- with support to the sky: metal base with screw and mini magnets, Teeth-supported: metal base with screw, teeth rings and mini screws.
Additionally, the device may include hooks for elastic rods. The choice of MARPE design depends on the stage of maturation of the palatine suture, clinical indications and treatment plan.
Operating principle of the apparatus
MARPE is fixed in the palatal suture by means of a miniscrew. The screw at the base is activated (twisted) and this causes a smooth stretching of the palatal suture. In this way, the jaw gradually expands — creating space for the alignment of the teeth and the conditions for bite correction.
Indications for treatment
The main objective of MARPE — is the expansion of the maxilla, therefore the main clinical indication — is a skeletal narrowing of the maxilla that cannot be corrected or compensated for by alternative methods. Constriction can be suspected by the following external signs:
- Crossbite, in which individual teeth or groups of teeth on the lower dentition overlap the antagonists;
- Severe crowding, in which some teeth have no place, and they protrude forward or vice versa are located behind the main dentition.
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At what age is MARPE placed?
The placement of a palatal expansion appliance is most effective for children from 9-10 years of age. At this age, the tooth-supported expansion appliance — Marco Rosa will no longer be effective because the palatal suture has begun to ossify. But MARPE, due to the miniscrew support, will be able to stretch the suture and give a good result in a relatively short period of time.
MARPE is also used to treat adult patients, depending on the degree of maturation of the palatal suture. The orthodontist can assess the stage of suture formation from the CBCT image.
In our practice at the moment the maximum age of a patient with the device — 26 years old.
Advantages and disadvantages of the MARPE apparatus
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The device is non-removable, so the result of treatment does not depend on cooperation with the patient.
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Rapid expansion from a few weeks.
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It can be combined with other devices.
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Depending on your body, the miniscrews may lose stability and will need to be reinstalled.
The installation and treatment process with MARPE
Preparation
Before deciding to use the appliance, the orthodontist will perform a diagnosis and create a treatment plan. If MARPE is indicated, the patient is digitally scanned to take a virtual impression of the teeth.
Based on the scans, the appliance is modeled and fabricated individually in the laboratory.
Installation
Fixation of the appliance involves a surgeon and an orthodontist. The dental surgeon installs the miniscrews into the palate. The dentist fixes the appliance to the teeth or to the palate depending on the design, activates the screw and teaches the patient how to activate the appliance.
The installation process takes 40 minutes to 1 hour.
Treatment
After installing the device, the orthodontist gives the patient a screw for activation and instructions. The patient independently tightens the screws every day before going to bed.
A week after fixation, the patient is recommended to come for a follow-up examination by an orthodontist. The doctor evaluates the dynamics and calculates the duration of wearing the device until the result is achieved. Depending on the degree of maturation of the seam, the device must be activated within 4-12 weeks.
After the device has completed the main task of jaw expansion, the activating screw is filled with a composite material, and the device is left in the mouth to hold the result while the bite is corrected with braces or aligners.
In addition to braces, MARPE is combined with a facial mask to improve facial parameters and more harmonious jaw development.
The average wearing time of the device is — 1 year. The device is removed when optimal and stable results are obtained.
Orthodontists recommend
MARPE appliance analogs
Orthodontics uses appliances with a similar principle of action, but for other stages of development of the dentoalveolar system.
- Marco Rosa — appliance for tooth-supported maxillary expansion. It is used at the age of 5-7 years, when the palatal suture has not yet formed and is more amenable to treatment.
- SARPE (Surgically assisted rapid palatal expansion) — palatal expansion apparatus with pre-surgical preparation. The oral surgeon makes an incision in the palatal suture under anesthesia. The patient then activates the device himself in a similar way to MARPE. This method is suitable for an already fully formed palatal suture.
Doctor's Review
With the MARPE appliance, I can achieve a cooler result in a shorter period of time when correcting jaw narrowing.
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