Abstract

The Importance of Digital Planning and CAD-CAM Technology in the Treatment of Maxillary Transverse Deficiency with MARPE Appliance

by Cantarella Daniele

Miniscrew-assisted rapid palatal expansion (MARPE) has become a widespread technique for adolescents and young adults and the use of CBCT imaging has improved the accuracy of treatment planning. However, the increased rigidity of midface structures in patients above the age of 25 – 30 years makes the non-surgical midface expansion more challenging to achieve. The presentation covers the method of digitally planning the position of Maxillary Skeletal Expander (MSE) and miniscrews in the patient CBCT and the digital workflow for appliance fabrication. Prediction models for success of non-surgical MARPE in adults will be presented, discussing the most critical factors (midpalatal suture maturation, patient age, gender, palatal bone thickness, skull asymmetry). For more mature patients, a mini-invasive surgical technique has been developed. Localized osteotomies are performed with local anesthesia and sedation. The rationale, clinical applications and surgical technique will be analyzed in detail.

Learning Objectives

After this lecture, you will be able to plan the position of MARPE device on patient CBCT for optimal biomechanical effect on midface skeletal structures and adequate miniscrews stability
After this lecture, you will be able to recognize the main prediction factors for success of non-surgical maxillary expansion in adults, particularly with respect to midpalatal suture maturation, patient age, gender, palatal bone thickness, skull asymmetry
After this lecture, you will be able to know the mini-invasive surgical technique that involves MARPE and localized maxillary osteotomies performed with a piezoelectric instrument, local anesthesia and sedation, in an outpatient setting.