Upper Airway and 3D Skeletal Changes with 3D Guided Midpalatal
Piezocorticotomy Assisted Midfacial Skeletal Expansion in Adults
by Svitlana Koval
DMD, MSc, BDS
Abstract
Mini-screw Assisted Rapid Palatal Expansion (MARPE) appliances are
commonly used to achieve maxillary skeletal expansion in adolescents and non-growingindividuals with fused midpalatal sutures. In adult patients, auxiliary techniques have been proposed to enhance midpalatal suture separation. Measurements of the nasal cavity following MARPE are typically focused on the ANS and PNS regions, nasal
septum deviation angle, and pharyngeal volumes.
Most studies assessing MARPE outcomes rely on cephalometric analyses derived from
lateral and frontal views. Accordingly, nasal cavity width, molar inclination, and
intermolar width are the most frequently evaluated parameters in the frontal plane,
whereas sagittal alterations are examined to assess MARPE’s effectiveness in
correcting skeletal Class III discrepancies. To date, however, no studies have
investigated three-dimensional skeletal changes following MARPE expansion.
Our studies involve 3D analysis of skeletal alterations after 3D-guided midpalatal
piezocorticotomy-assisted MARPE expansion, a technique previously shown to
maintain nasal septum position while eliminating its restrictive influence on midpalatal
disarticulation. Standardized head orientation is critical for assessing the effects of
MARPE, as cervical curvature and postural adaptations accompany midpalatal
disarticulation.
In our observations, increased nasopharyngeal airway volume appears to reverse
cervical kyphotic changes—an effect corroborated by previous long-term studies on
MARPE. The 3D-guided midpalatal piezocorticotomy-assisted MARPE expansion has
demonstrated midfacial modifications across all three spatial planes in 3D
cephalometric assessments. Comprehensive longitudinal studies are needed to further
evaluate these changes and their implications across different skeletal classifications.
Learning objectives:
- Understand the difference between unassisted and 3D guided midpalatal
piezocorticotomy assisted (MPA) MARPE expansion in adults. - Evaluate common effects of 3D guided MPA MARPE expansion including 3D
cephalometric skeletal changes, upper airway changes, and 3D skin changes. - Draw conclusions on the effectiveness of the method and its indications.