Miniscrew-Assisted Rapid Palatal Expansion for Obstructive Sleep Apnea

The Effectiveness of Miniscrew-Assisted Rapid Palatal Expansion in the Management of Obstructive Sleep Apnea: A Randomized Controlled Clinical Trial

The goal of this clinical trial is to learn whether miniscrew-assisted rapid palatal expansion (MARPE) can improve obstructive sleep apnea (OSA) in late adolescents and adults aged 16 to 60 years. The main questions it aims to answer are:

1. Does MARPE improve sleep apnea severity, as measured by Home Sleep Apnea Testing (HSAT), including respiratory event index (REI), oxygen desaturation index (ODI), mean oxygen saturation, nadir oxygen saturation, snoring events, and body position?
2. Does MARPE improve breathing and sleep-related symptoms, including upper airway dimensions, daytime sleepiness, quality of life, and peak nasal inspiratory flow (PNIF)?

Researchers will compare a MARPE group with a control group that receives standard care for obstructive sleep apnea for 3 months to see whether MARPE provides additional benefit.

Participants will:

1. Receive standard care for obstructive sleep apnea
2. Be randomly assigned to either MARPE plus standard care or standard care alone for 3 months
3. In the MARPE group, wear a miniscrew-assisted rapid palatal expander and activate it according to the study protocol
4. Visit the clinic for follow-up care and monitoring
5. Data will be collected at baseline (T0) and 3 months (T1). At both time points, participants in the MARPE group will be assessed using Home Sleep Apnea Testing (HSAT), cone beam computed tomography (CBCT), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire Short Version (FOSQ-10), and peak nasal inspiratory flow (PNIF). Participants in the control group will be assessed using HSAT, ESS, FOSQ-10, and PNIF.

Study Overview

• Status: Not yet recruiting
• Conditions: OSA - Obstructive Sleep Apnea; Palatal Expansion Technique
• Intervention / Treatment: Device: Miniscrew-Assisted Rapid Palatal Expansion; Other: Standard Care (in control arm)

Detailed Description

This is a single-blind, double-arm, parallel-group randomized controlled trial designed to evaluate the effectiveness of miniscrew-assisted rapid palatal expansion (MARPE) in late adolescents and adults with obstructive sleep apnea (OSA). A total of 24 participants aged 16 to 60 years will be enrolled if they meet the study criteria. Eligible participants must have OSA, as shown by an apnea-hypopnea index (AHI) of 5 or higher, and must also have maxillary transverse deficiency, such as posterior crossbite or reduced maxillary intermolar width. Participants with severe obesity, active periodontal problems, mobile teeth, major maxillary pathology, previous orthodontic treatment, or recent OSA treatment will not be included.

Participants will be assigned by gender-stratified block randomization in a 1:1 ratio to either the test group or the control group. The test group will receive MARPE with standard care for OSA. The control group will receive standard care for OSA for 3 months and will be offered MARPE after the 3-month assessment if they wish to undergo treatment.

The MARPE device used in this study is the Maxillary Skeletal Expander II. Expansion will begin according to the manufacturer's instructions until a median diastema appears, and then the screw will be activated two turns per day until overcorrection is reached. After expansion, the appliance will remain in place for 6 months as retention to allow bone formation.

Data will be collected at baseline before the start of treatment (T0) and three months after the completion of expansion (T1). At both T0 and T1 the test group will undergo assessment using Home Sleep Apnea Testing (HSAT), cone beam computed tomography (CBCT), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire Short Version (FOSQ-10), and peak nasal inspiratory flow (PNIF); the control group will undergo assessment using HSAT, ESS, FOSQ-10 and PNIF.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. AHI ≥ 5
2. Aged ≥ 16 and ≤ 60 years old
3. Presence of the upper first permanent molars
4. Presence of unilateral or bilateral posterior crossbite or maxillary transverse deficiency (considering intermolar width measurements, posterior teeth buccolingual incli- nation, and posterior crossbites) allowing meaningful maxillary expansion of at least 5mm
5. Willingness to undergo MARPE treatment under the standard fee structure of the Faculty of Dentistry, Universiti Malaya

Exclusion Criteria:

1. BMI ≥ 30 kg/m2
2. Basic Periodontal Examination (BPE) ≥ 3 or BPE markers* (root bifurcation lesions)
3. Mobile teeth (Mobility grade ≥ 1)
4. Pathology in the maxilla, such as substantial maxillary bone defects, or maxillary bone defects due to space-occupying cysts, tumors, etc.
5. Significant true skeletal asymmetry
6. Presence of significant root resorption of upper first permanent molars due to previous orthodontic treatments
7. Concurrent on-going treatment for OSA such CPAP
8. Previous treatment for OSA such as soft tissue or hard tissue surgery within the past 4 months
9. Significant mandibular retrognathic (SNB less than normal value cephalometrically)
10. General chronic medical illnesses like cardiac failure, kidney failure, stroke etc.
11. Medication
12. Syndromic
13. Presence of neuropsychiatric illnesses such insomnia, narcolepsy, parasomnia etc.

14. Presence of neuromuscular diseases such multiple schlerosis, epilepsy, Parkinson's disease.

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: MARPE; Participants in the test group will receive standard care for obstructive sleep apnea (OSA), including lifestyle and conservative measures, medical management if indicated, and treatment of nasal obstruction as appropriate. In addition, participants will undergo maxillary skeletal expansion using a Mini-screw Assisted Rapid Palatal Expansion (MARPE) device (Maxillary Skeletal Expander II, MSE; Biomaterials Korea, Seoul, South Korea). The device will be custom-fabricated and anchored with mini-screws under local anaesthesia. Expansion will follow manufacturer instructions and continue with two turns per day until overcorrection is achieved. The device will then be retained in situ for approximately six months without further activation. Participants will be reviewed one week after placement and then 1-4 times per month depending on clinical need. During follow-up visits, pain, discomfort, oral hygiene, and compliance will be monitored.	Device: Miniscrew-Assisted Rapid Palatal Expansion; This intervention uses a standardized miniscrew-assisted rapid palatal expansion (MARPE) protocol to achieve maxillary expansion in skeletally mature patients with obstructive sleep apnea. Unlike conventional tooth-borne rapid maxillary expansion (RME), MARPE is designed to achieve more skeletal expansion and reduce unwanted dental effects. Compared with surgically assisted expansion techniques such as SARPE and DOME, this intervention is non-surgical and focuses on correcting transverse maxillary deficiency as a contributing anatomical factor in upper airway narrowing.; Other Names: MARPE; palatal expansion technique; maxillary skeletal expansion; Maxillary skeletal expander; miniscrew-assisted rapid maxillary expansion
Other: Wait-list Control; This control group is a 3-month wait-list standard care arm for obstructive sleep apnea (OSA). During the trial period, participants will receive conservative and physician-directed management only, including lifestyle advice (e.g., weight management, sleep hygiene, positional therapy, and avoidance of alcohol or sedatives before sleep), medical management if indicated, and treatment of nasal obstruction as appropriate (e.g., topical nasal steroids or antihistamines). Participants will be monitored every 4 weeks and may receive rescue CPAP if clinically indicated. Unlike the experimental arm, no active maxillary expansion will be provided during the waiting period; MARPE will be offered after the 3-month assessment if they wish to undergo treatment.	Other: Standard Care (in control arm); This control group is a 3-month wait-list standard care arm for obstructive sleep apnea (OSA). During the trial period, participants will receive conservative and physician-directed management only, including lifestyle advice (e.g., weight management, sleep hygiene, positional therapy, and avoidance of alcohol or sedatives before sleep), medical management if indicated, and treatment of nasal obstruction as appropriate (e.g., topical nasal steroids or antihistamines). Participants will be monitored every 4 weeks and may receive rescue CPAP if clinically indicated. Unlike the experimental arm, no active maxillary expansion will be provided during the waiting period; MARPE will be offered after the 3-month assessment if they wish to undergo treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Apnea Hyponea Index(AHI)	"From treatment begin/recruited to the end of treatment/recruited at 3 months"

Secondary Outcome Measures

Outcome Measure	Time Frame
Cone Beam Computed Tomography	"From treatment begin/ recruited to the end of treatment/recruited at 3 months"
Epworth Sleepiness Scale	"From treatment begin/ recruited to the end of treatment/recruited at 3 months"
Functional Outcomes of Sleep Questionnaire Short Version	"From treatment begin/ recruited to the end of treatment/recruited at 3 months"
Peak Nasal Inspiratory Flow	"From treatment begin/recruited to the end of treatment/recruited at 3 months"

Collaborators and Investigators

• Sponsor: University of Malaya

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): February 20, 2027
• Study Completion (Estimated): February 20, 2027

Study Registration Dates

• First Submitted: July 20, 2026
• First Submitted That Met QC Criteria: July 23, 2026
• First Posted (Actual): July 29, 2026

Study Record Updates

• Last Update Posted (Actual): July 29, 2026
• Last Update Submitted That Met QC Criteria: July 23, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: adult; obstructive sleep apnea; palatal expansion technique; MARPE; miniscrew-assisted rapid palatal expansion
• Additional Relevant MeSH Terms: Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Sleep Wake Disorders; Apnea; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Dentistry; Orthodontics; Orthodontics, Corrective; Standard of Care; Palatal Expansion Technique
• Other Study ID Numbers: DF CD2605/0015 (P)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No