Aim: This paper presents a prototyped surgical guide for placement of MARPE—mini-implant-assisted rapid palatal expander.
Background: Investigations conducted in the last decades have increased the technological resources used in orthodontics. This scientific advance applies to several clinical procedures, including the planning of devices used in guided surgeries, using computed tomography images and intraoral scanning.
Case description: This case report presents maxillary expansion in an adult patient (18 years and 5 months), using the MARPE technique, by virtual planning and fabrication of a surgical guide (laser-printed on a 3D printer MoonRay D225—SprintRay, 2014), after merging of 3 files: digital file of the expander (.stl), computed tomography of the suture, and intraoral scanning of the patient, using the planning software NemoStudio (version 20122, 188.8.131.52).
Conclusion: Fabrication of a surgical guide for the MARPE technique provides an accurate transfer of the virtual planning to the surgical procedure. It allows three-dimensional orientation of the expander position and perforations of mini-implants, which are necessary to establish anchorage in areas with sufficient bone, assuring the system stability and a successful procedure.
Clinical significance: The mini-implant assisted rapid palatal expansion (MARPE) has been investigated as a promising option for correction of malocclusion related with maxillary atresia in adult patients and is an option to orthognathic surgery. Digital treatment planning is fundamental to establish individual, reproducible, and accurate parameters, as in the present case, which evidenced significant benefits in both occlusal and respiratory aspects.
Dietrich CA, Ender A, et al. A validation study of reconstructed rapid prototyping models produced by two technologies. Angle Orthod 2017;87(5):782–787. DOI: 10.2319/01091-727.1.
Chakraborthy P, Krishnamurthy K. Digital Era of Orthodontics: A Review. J Dent Oral Disord Open 2016;2(1):1–3.
Ras F, Habets LLMH, et al. Quantification of facial morphology using stereophotogrammetry — demonstration of a new concept. J Dent 1996 Sep;24(5):369–374. DOI: 10.1016/0300-5712(95) 00081-X.
Motohashi N, Kuroda T. A 3D computer-aided design system applied to diagnosis and treatment planning in orthodontics and orthognathic surgery. Eur J Orthod 1999;21(3):263–274. DOI: 10.1093/ejo/21.3.263.
Kau CH, Olim S, et al. The Future of Orthodontic Diagnostic Records. Semin Orthod 2011;17(1):39–45.
Rheude B, Sadowsky PL, et al. An evaluation of the use of digital study models in orthodontic diagnosis and treatment planning. Angle Orthod 2005;75:300–304.
MacGinnis M, Chu H, et al. The effects of micro-implant assisted rapid palatal expansion (MARPE) on the nasomaxillary complex - a finite element method (FEM) analysis. Prog Orthod 2014;15:1–15. DOI: 10.1186/s40510-014-0052-y.
Brunetto DP, Sant'Anna EF, et al. Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE). Dental Press J Orthod 2017;22(1):110–125. DOI: 10.1590/2177-6709.22.1.110-125.sar.
Vandersea BA, Ruvo AT, et al. Maxillary Transverse Deficiency - Surgical Alternatives to Management. Oral Maxillofac Surg Clin North Am 2007;19(3):351–368. DOI: 10.1016/j.coms.2007.04.007.
Handelman CS, Wang L, et al. Nonsurgical Rapid Maxillary Expansion in Adults: Report on 47 Cases Using the Haas Expander. Angle Orthod 2000;70(2):129–144.
Suri L, Taneja P. Surgically assisted rapid palatal expansion: A literature review. Am J Orthod Dentofac Orthop 2008;133(2):290–302. DOI: 10.1016/j.ajodo.2007.01.021.
Carlson C, Sung J, et al. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult. Am J Orthod Dentofac Orthop 2016;149(5):716–728. DOI: 10.1016/j.ajodo.2015.04.043.
Lee K-J, Park Y-C, et al. Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism. Am J Orthod Dentofacial Orthop 2010;137(6):830–839. DOI: 10.1016/j.ajodo.2007.10.065.
Barriviera M, Duarte WR, et al. A new method to assess and measure palatal masticatory mucosa by cone-beam computerized tomography. J Clin Periodontol 2009;36(7):564–568. DOI: 10.1111/j.1600-051X.2009.01422.x.
Barriviera M, Minervino BL, et al. Tomografia computadorizada volumétrica: um novo protocolo para avaliar a maturação e ossificação da sutura intermaxilar de forma tridimensional e subjetiva. Ortodontia SPO 2017;50(5):424–430.
de Oliveira IRM, Guimarães MAC, et al. Marpe – relato de caso e passo a passo da técnica. Ortodontia SPO 2018;51(3):306–313.
Moralis A, Zitzmann K, et al. The effects of surgical expansion of the maxillary arch and its consequences for the incisor axis. J Craniomaxillofac Surg 2016;44(5):569–573. DOI: 10.1016/j.jcms.2016.02.002.
Nojima LI, Nojima MDCG, et al. Mini-implant selection protocol applied to MARPE. Dental Press J Orthod 2018;23(5):93–101. DOI: 10.1590/2177-6709.23.5.093-101.sar.
D'haese J, Van De Velde T, et al. Accuracy and Complications Using Computer-Designed Stereolithographic Surgical Guides for Oral Rehabilitation by Means of Dental Implants: A Review of the Literature. Clin Implant Dent Relat Res 2012;14(3):321–335. DOI: 10.1111/j.1708-8208.2010.00275.x.
Zehnder MS, Connert T, et al. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J 2016;49(10):966–972. DOI: 10.1111/iej.12544.
Chen Y-F, Yoon A, et al. Biomechanical and stress distribution effects of maxillary expansion methods (sarpe, marpe, dome) using finite element model. Sleep Med 2017;1:e57. DOI: 10.1016/j.sleep.2017.11.159.
Wilmes B, Nienkemper M, et al. Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid hyrax. World J Orthod 2010;11(4):323–330.
Suzuki H, Moon W, et al. Miniscrew-assisted rapid palatal expander (MARPE): the quest for pure orthopedic movement. Dent Press J Orthod 2016;21(4):17–23. DOI: 10.1590/2177-6709.21.4.017-023.oin.
Angelieri F, Cevidanes LHS, et al. Midpalatal suture maturation: Classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofac Orthop 2013;144(5): 759–769. DOI: 10.1016/j.ajodo.2013.04.022.