Miniscrew-Assisted Rapid Palatal Expander (MARPE)

What is a MARPE?

A miniscrew-assisted rapid palatal expander (MARPE) is an orthodontic appliance used to widen the upper jaw (maxilla). It is often recommended for older adolescents and adults when a traditional tooth-supported expander will not provide enough skeletal expansion.

MARPE uses small temporary orthodontic screws, also called miniscrews or temporary anchorage devices (TADs), to help anchor the expander to the roof of the mouth. This allows the expansion forces to be directed more toward the upper jaw and less toward the teeth, reducing the risk of periodontal problems such as gum and bone loss.

Why is expansion needed?

Your orthodontist may recommend MARPE to:

Correct a narrow upper jaw
Correct a crossbite
Improve the way the upper and lower teeth fit together
Create additional space for crowded teeth
Improve the width and shape of the upper dental arch
Provide skeletal expansion when conventional tooth-supported expansion is less predictable and/or appropriate

What are other benefits of a MARPE?

Reduce or eliminate need for future jaw surgery
Reduce or eliminate need for tooth extractions to reduce crowding
Increase nasal airway dimensions to potentially improve nasal breathing
May improve airflow during sleep and reduce symptoms associated with Sleep-Disordered Breathing or Obstructive Sleep Apnea
Improve space available for the tongue and promote better tongue posture

What should I expect?

Fabrication Sequence

Consultation with a general denstist or oral surgeon to discuss miniscrew placement
When your orthodontist confirms you are ready for your MARPE (sometimes this is done at the beginning of treatment and sometimes it is after some other appliances having been placed), our office will do an iTero scan of your teeth
CBCT scan (done with the dentist or oral surgeon)
Pre-MARPE appointment at our office to prepare the teeth

Placement

* NOTE that either our office OR the surgeon’s office will be placing the expander on the teeth

The MARPE is glued to select teeth on the upper arch. Small miniscrews are placed through openings in the appliance and into the bone of the palate to provide additional support. The number of miniscrews needed is determined by an individual patient’s anatomy and physiology.

Local anesthetic is typically used during miniscrew placement. You may feel pressure during the procedure, but the area should be numb.

Depending on who places the miniscrews, you may request sedation for the procedure

Sometimes the surgeon will “prime” the suture area for expansion by doing piezosurgery (micro-vibrations) or micro-perforations. This increases the likelihood of success

Activating the expander

You will be given a special expander key/wrench and specific instructions for turning the appliance

1 “swing” of the key/wrench = 1 expander turn = .017 mm of expansion

We use a Tiger Power Screw with a hexagonal design. There are 6 sides to the Tiger Screw and each turn will reveal a new side. It takes 6 turns with the wrench to achieve 1 mm of expansion.

Follow your orthodontist’s activation schedule exactly. Do not perform additional turns or change the schedule unless instructed to do so.

Each turn gradually widens the expander and applies pressure to the upper jaw

What will it feel like?

During the first several days, it is normal to experience:

Pressure or tightness in the palate, teeth, nose, or cheek area
Mild tenderness around the miniscrews
Temporary difficulty speaking
Increased saliva
Difficulty chewing certain foods
The sensation that the appliance feels large or bulky

Most patients adjust to the appliance as their tongue and mouth become accustomed to it.

Expansion should feel like pressure—not severe or persistent pain. Please contact our office if you experience significant pain or have concerns about your appliance: 614-363-2525 or info@sciotobraces.com

Gap Teeth

The “gap” between the front teeth

Don’t be surprised if a space or “diastema” develops between your two upper front teeth during expansion. Typically patients feel increasing pressure until the diastema forms

This is a positive sign that the upper jaw is expanding and sutural separation has occurred. The space may appear suddenly and can become noticeable during the active expansion phase

After expansion is complete, the front teeth often begin moving back toward one another naturally. Orthodontic treatment will ultimately position the teeth appropriately.

Eating with your expander

For the first few days, softer foods may be more comfortable.

Good choices include yogurt, eggs, pasta, soup, rice, soft vegetables, smoothies, and other foods that require minimal chewing.

Avoid foods that are:

Hard or very crunchy
Sticky or chewy
Difficult to clean from around the appliance

Cut firmer foods into smaller pieces rather than biting directly into them.

Keeping your MARPE clean

Excellent oral hygiene is especially important while wearing your expander.

Brush your teeth and the appliance thoroughly after meals.
Carefully clean around the miniscrews and underneath the expander.
Use a water flosser or other cleaning aids if recommended by our office.
Rinse your mouth after eating when brushing is not possible.
Check the appliance regularly for trapped food.

Keeping the area clean helps maintain healthy gum tissue around the appliance and miniscrews.

If you have trouble turning the expander

If you cannot complete a turn, or are unsure whether the turn was completed, stop and contact our office. Do not force the appliance or perform an extra turn to “make up” for an uncertain activation.

Please let us know if you need a new key/wrench and we will provide one.

When should I call the orthodontic office?

Please contact us if:

You experience severe or increasing pain.
A miniscrew appears loose or moves.
The expander becomes loose, broken, or distorted.
You are unable to activate the expander as instructed.
You develop significant swelling, bleeding, or irritation.
You are unsure whether an activation was completed correctly.
Something about the appliance simply does not seem right.

What happens after expansion?

Once the desired expansion has been achieved, you will stop turning the appliance when instructed by your orthodontist.

The MARPE usually remains in place for a period of time afterward. This retention period allows new bone to form and helps stabilize the expanded upper jaw. The parts of the MARPE connected to the teeth are typically removed before the Tiger Screw and miniscrews

Our office will remove the arms attached to the teeth and the surgeon’s office will remove the miniscrews

Your orthodontist will continue to monitor the expansion and coordinate it with the remainder of your orthodontic treatment.

Remember

Turn only as instructed
Keep the appliance clean
Don’t worry about the temporary front-tooth gap
Call us if something doesn’t seem right

Your MARPE is an important part of your orthodontic treatment. Following the activation and cleaning instructions carefully will help your treatment progress as planned.

This handout provides general information and does not replace the individualized instructions provided by your orthodontist.

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