What Is MSE?
Maxillary Surgical Expansion is an orthodontic procedure that helps eliminate crossbites, reduces crowding and broadens the overall arch. This procedure is most commonly done in children and teens, but can also be done in adults through palate expanders.
MSE is classified into two categories: dental and skeletal. Dental expansion is when the bone does not shift but the teeth do. When just the tops (crowns) of the teeth move, this is called tipping. When the crowns and the root move together, this is called bodily movement. If the teeth move without supporting tissue, loss of teeth can occur. Skeletal expansion is when both halves of the palate are separated by an expander. The position of the teeth is not affected and just the bone moves. A physical identifier for skeletal expansion is a gap in the front teeth, which happens as a result of the expansion.
The mid-palatal suture is the part of the mouth that helps determine which kind of movement is occurring. When the suture is not fused, the palatal expander will separate the two sides of the palate as the arch widens. The suture fuses at around age 15-17 and once the suture is fused and an expander is used, the arch will widen but this will cause tipping and the space between the front teeth won’t occur. For adults with crossbites, crowding and narrow arches, using the MARPE device is a surgical-free way to expand the maxillary. Before the use of the MARPE, there was the SARPE which stands for Surgically Assisted Rapid Palate Expander. The difference is the way in which the split is done. In the SARPE, a cut is made under the lip (to prevent exterior scarring) and into the bone right above the teeth roots and down the middle of the palate. The expander will need to be slowly activated until the desired width and once the split occurs, the expander will need to continue to be worn in order to allow the bone to heal.
MARPE: Mini-screw/Mini-implant Assisted Rapid Palatal Expansion
Developed by Dr. Won Moon, the MARPE is a device attached to the palate with mini-implant/mini-screws, temporary anchorage devices and it is attached to two molars with the use of four legs to stabilize and this device will create a drastic maxillary skeletal expansion, non-surgically. The amount of TADs depends on age of patient and size of the bone. It takes about 20-30 minutes to place, with the use of local anesthesia. Afterwards, there may be minor pain that can be maintained with over-the-counter remedies for one-two days.
To activate, the screw has to be turned every day using a wrench to split the suture, the split will cause a gap between the two front teeth and afterwards, orthodontic treatment is given to close the gap and stabilize the bite. The expander will stay in until new bone has formed at the mid-palatal suture which takes 4-6 months. Some side effects with the MARPE include tongue sores, minor discomfort and difficulty pronouncing some words.
MARPE to Treat Obstructive Sleep Apnea
Snoring, excessive daytime sleepiness and mouth breathing are among a few of the symptoms associated with sleep disordered breathing, the most common disorder being Obstructive Sleep Apnea. While there are machines and oral appliances to treat sleep apnea, MARPE is used to treat obstructive sleep apnea in cases that oral appliances and CPAP are unsuccessful. The MARPE will expand the palate and in turn open the airways and maximize airflow through the nose.
After the MARPE
Once the expansion is complete and the bone is healed, the patient will proceed with orthodontics to adjust the bite and close the gap between the two front teeth. This treatment includes braces or Invisalign.