Surgical expansion of the upper arch is typically done for three reasons.
- Help with severe dental crowding when the maxilla is narrow
- Treat a posterior cross bite
- Improve nasal breathing and reduce sleep apnea
SARPE - Surgically Assisted Rapid Palatal Expansion
This is maxillary expansion to help an orthodontist correct the way your teeth fit. This is done in skeletally mature adults with a narrow maxilla to gain arch length. This procedure is done at the beginning of orthodontics and can be done with braces or aligners.
SARPE is an outpatient surgery very similar to a lefort I osteotomy. There is an incision in your mouth under the upper lip. Incisions are made in the bone between the front teeth and above all the upper teeth. There is a device that goes in the roof of your mouth to facilitate expansion of the bone.
After surgery, you turn the device twice daily for a number of weeks creating a gap in the front teeth. The device in the roof of your mouth will stay for another 3-4 months to help stabilize the bone. This process is known as distraction osteogenesis.
What are the risks?
The most typical risks are asymmetric expansion, injury to teeth, nasal bleeding, nonunion/malunion, face change and need for further surgery. These risks are very similar to a lefort osteotomy.
MARPE
This is the same as a SARPE but with the usage of skeletal anchors. Skeletal anchors are also known as TADS (temporary anchorage devices) or mini implants. The M in MARPE is for miniscrew. There are too many acronyms in the world of maxillary expansion!
Adding screws to anchor the device that is on the roof of your mouth has many advantages and it is our general preference to use miniscrews to help assist a SARPE. This is because the TADS can apply pressure to the bone itself and not just the teeth. Many designs exist, but commonly we see 4-6 TADs in expander devices.
The usage of miniscrews alone to expand the maxilla (without any surgery) is known as MSE (miniscrew skeletal expansion or sometimes just maxillary skeletal expansion.) This is useful in young adults but many times MSE is tried in adults whose bones are unlikely to move. We typically see failed MSE for surgical consults as the identification of who can and who cannot benefit from MSE is being still being researched. If you had troubles with your MSE, we are here to help!
DOME/EASE
DOME – Distraction Osteogenesis Maxillary Expansion
When maxillary expansion is being done to help with breathing, it is referred to as DOME. This is really a SARPE/MARPE in people whose teeth fit but have sleep apnea. An analogy is MMA vs orthognathic surgery – it is the same surgery but different indications. Good data exists that DOME is helpful to treat mild to moderate sleep apnea in adults.
DOME is often done with orthodontic assistance but not always. DOME is used to improve nasal breathing and increase tongue space at the roof of the mouth. The process and risks are very similar to SARPE/MARPE but
EASE is endoscopically assisted skeletal expansion