What is right for me: MARPE, MSE, DOME, MASPE, RPE, SARPE, ... ?

There are many different names for one and the same treatment: MARPE, MSE, DOME, MASPE. This can be quite confusing - and not only for patients, but also for colleagues. The reason for this is that every practitioner has their own philosophy for expanding the upper jaw.

Here is a brief explanation of the acronyms:

MARPE: Mini-Implant Assisted Rapid Palatal Expansion
MASPE: Mini-Implant Assisted Slow Palatal Expansion
MSE: Maxillary Skeletal Expansion
DOME: Distraction Osteogenesis Maxillary Expansion

What they all have in common is the aim of widening the upper jaw skeletally and not just widening the dental arch.

Skeletal expansion of the upper jaw with an expander on mini-implants

In the past, bony expansion of the upper jaw was only possible in children, as their sutures had not yet ossified.

Since the invention of mini-implants, this orthopaedic expansion of the maxilla has also been possible in adolescents and adults - without any jaw surgery.

It takes more force and more time to open the palatal suture in adults. An expander on mini-implants makes exactly that possible. Instead of using the teeth as anchors, the force is transferred directly to the upper jaw bone using the mini screws. According to experts, activation should take place slowly - i.e. away from Rapid Palatal Expansion (RPE, MARPE) towards Slow Palatal Expansion (MASPE) in order to avoid complications as much as possible.

Custom-made expander on 4 mini implants.

The teeth can be included in the appliance as additional anchors (e.g. MSE), but this does not only have advantages. The teeth can move out of the bone and cause discomfort - especially if the skeletal expansion does not work as planned.

Teeth can be included in the appliance as additional anchors, but this does not only bring advantages.

What do you do if skeletal expansion of the upper jaw with mini implants does not work?

If the resistance to expansion is too great, bone cuts can be helpful. Here, too, there are various approaches (SARPE, SABAME, DOME, MISMARPE, Le-Fort-I osteotomies ...).

What they have in common: All techniques refer to bone incisions in the maxilla to reduce resistance and allow skeletal expansion.
What they differ in: the extent of the incisions.

The dotted lines mark the osteotomies (bone cuts) that facilitate the expansion of the upper jaw.

Basically, the more extensive the incisions, the higher the probability of success - but at the same time the more invasive the procedure.

It is not yet possible to predict with certainty who will benefit from bone incisions and for whom the enlargement will work without them. However, experts agree that it works better in women than in men without surgical incisions and that it works better in younger people than in older people.

To summarize, MARPE, MASPE, MSE, SARPE, etc. all refer to techniques that extend the maxilla skeletally.

I am convinced that treatment should be tailored to the individual needs and circumstances of the patient. That's why I like to use the term DOME. According to the author of this concept, Dr. Stanley LiuDOME focuses on the result for the patient - not the technique. It means transforming a high, narrow palate into a functional, dome-shaped palate that provides enough room for the tongue and allows for improved nasal breathing.

The latest development of this concept is DOMExD: While the upper jaw is slowly extended, the teeth are moved towards each other at the same time so that there is no disruptive gap between the teeth. The credit for this ingenious idea goes to Dr. Christian Leonhardt.

DOMExD: Maxillary expansion for improved nasal breathing and more tongue space without a gap between the teeth.