Skeletally Anchored Maxillary Expansion—A Current Consensus

Maxillary transverse deficiency (MTD) is a common affliction among orthodontic patients, affecting 8%-17% of the population. Historically, MTDs have been treated using rapid palatal expanders (RPEs), typically anchored on molar and premolar teeth; however, their efficacy in achieving true skeletal expansion decreases dramatically during adolescence. For patients with mature sutures, a surgically assisted rapid palatal expansion (SARPE) was the only choice until the advent of miniscrew-assisted rapid palatal expansion (MARPE). In MARPE, the expansion screw is anchored on the basal bone through miniscrews. This provides a minimally invasive alternative to SARPE, while facilitating transverse maxillary expansion in older patients. There are many designs of MARPE in use. MARPE causes an increase in the width of the maxilla, with a more parallel separation of the midpalatal suture (MPS), with expansion effects reaching almost till the midfacial regions, minimal dentoalveolar effects, an increase in the airway, and effects are seen on the concomitant soft tissues. While the effects of MARPE have been well documented, the factors affecting its success are less understood. This position article on MARPE highlights the factors affecting the success and failure of MARPE. Procedures like corticopunctures and minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) are being used to supplement MARPE and improve its success rate. Overall, MARPE is a highly successful procedure, well-accepted by patients and practitioners, and should be used when indicated, following the proper diagnosis of a true skeletal transverse deficiency of the maxilla.