Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy

Eugen Silviu Bud, Cristina Ioana Bică, Mariana Păcurar, Petru Vaida, Alexandru Vlasa, Krisztina Martha, Anamaria Bud, Eugen Silviu Bud, Cristina Ioana Bică, Mariana Păcurar, Petru Vaida, Alexandru Vlasa, Krisztina Martha, Anamaria Bud

Abstract

The use of maxillary expanders has the effect of distancing the maxillary bones at the level of the median palatal suture. During maxillary expansion, the main resistance forces occur at the zygomatico-maxillary sutures, and not in the median palatal suture, which is the basic principle on which this method is based. In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. The mid-palatal suture was separated in 88.88% of cases, buccal bone height of the alveolar crest had decreased at first molar both at oral and palatal level by approximately 2.07 mm in 40.7% of cases whilst the remaining 59.3% showed insignificant bone loss, with canines exhibiting buccal tipping of 4.10° in 62.5% of cases. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.

Keywords: CBCT; MARPE; MSE; orthodontic miniscrew; palatal expansion.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Axial view of the palatal suture. Stage E sutural fusion.
Figure 2
Figure 2
Axial view of the palatal suture. Stage D sutural fusion.
Figure 3
Figure 3
Miniscrew-assisted rapid palatal expander (MARPE) device in position without corticopuncture (CP) therapy.
Figure 4
Figure 4
MARPE device associated with CP.
Figure 5
Figure 5
Axial view of the palatal suture showing MARPE and perforations of the palatal suture during CP.
Figure 6
Figure 6
Antero-posterior view of the perforations of the palatal suture.
Figure 7
Figure 7
Initial situation vs after palatal suture split with MARPE.
Figure 8
Figure 8
Different measurements in relation to the infraorbital foramen before and after palatal suture split with MARPE associated with CP therapy.
Figure 9
Figure 9
Cross sectional CBCT images before and after palatal split with MARPE device.
Figure 10
Figure 10
Measurements of the bone level in relation to cement-enamel junction before (left) and after (right) palatal suture split with MARPE.
Figure 11
Figure 11
Measurements of the canine position before (left) and after (right) palatal split with MARPE.
Figure 12
Figure 12
Occlusal relations before split and after.
Figure 13
Figure 13
Occlusal relations before and after palatal suture split.
Figure 14
Figure 14
Gingival hypertrophy of the palatal mucosa associated with the MARPE device.
Figure 15
Figure 15
Canine tipping after split (°).
Figure 16
Figure 16
Canine tipping before and after split (°).
Figure 17
Figure 17
Comparative bone level before and after split (mm).
Figure 18
Figure 18
Inter-side differences in vertical distances from tip of the cusp of the canine and infraorbital foramen (mm).

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