Hidden Risks of Miniscrew-Assisted Rapid Palatal Expansion (MARPE): A Retrospective Analysis of Treated Cases With Preventive Strategies

INTRODUCTION: Miniscrew-assisted rapid palatal expansion (MARPE) is an effective non-surgical alternative for managing transverse maxillary deficiency in late adolescents and young adults. While its skeletal effects are well documented, reports of clinical complications remain limited. This retrospective study presents a comprehensive case-based analysis of MARPE-related complications within a cohort, highlighting both management outcomes and preventive strategies. MATERIALS AND METHODS: A retrospective review was conducted of 24 consecutive MARPE cases (mean age 17.4 ± 1.3 years; 11 males, 13 females) treated between January and December 2024. Appliance designs included a two-screw hybrid MARPE (n = 16) and a four-screw maxillary skeletal expander (MSE) (n = 8), with miniscrews measuring 1.8-2.0 mm in diameter and 9-11 mm in length. Data were collected on demographics, appliance type, screw size, fabrication method (custom vs. prefabricated), complications, management, and treatment interruptions. In addition to summary statistics, six representative case studies of complications were described in detail. RESULTS: Of the 24 patients, eight (33.3%) developed true complications, two (8.3%) experienced procedural delays due to screw-locking defects, and 14 (58.3%) had no adverse events. Mechanical complications (n = 6) included screw fracture, appliance arm breakage, and acrylic failure, while biological complications (n = 2) involved tongue irritation and peri-implant mucositis. When the complication and no-complication groups were compared, an independent t-test revealed no significant age difference (17.8 vs. 17.1 years, p = 0.21). Chi-square analysis revealed no significant gender effect, although males experienced more complications (54.5% vs. 30.8%, OR = 2.7, p = 0.064). Fisher's exact test demonstrated that complications were confined to screws ≤10 mm, while none occurred with 11 mm or 2.0 × 10 mm screws (p = 0.03). Activation was interrupted for at least two weeks until the issue was resolved. Six detailed case reports illustrate the causes, management, and clinical precautions for these events. CONCLUSIONS: MARPE is an effective and minimally invasive alternative to surgically assisted rapid palatal expansion, but complications occur in nearly one-third of cases. These may arise with any appliance type and are often related to human or technical errors. Early recognition, implementation of preventive strategies, and adherence to standardized protocols are crucial for ensuring safe and predictable outcomes.