Maxillary constriction is a common problem we face in orthodontics. In younger patients, rapid palatal expansion (RPE) works beautifully because the midpalatal suture is still immature and repairs predictably. But in adults, things get tricky. Conventional RPE is often insufficient, and that’s where miniscrew-assisted rapid palatal expansion (MARPE)comes in.
A recent study by Naveda et al. (2022) looked into how the midpalatal suture actually repairs in adults after MARPE. And the findings are important for how we plan retention and manage expectations in this age group.
🦴 Midpalatal Suture Repair (16 months post-MARPE)
- Incomplete repair common in adults
- Bone density ↓ (vs. pre-expansion):
- Anterior: –34%
- Median: –77%
- Posterior: –52%
- Anterior region always repaired (100%)
- Middle third = weakest (57% unrepaired)
- >50% repair in 81% of patients
📊 Repair Scoring (0–3 scale)
| Score | Description | Frequency |
|---|---|---|
| 0 | No repair | 0% |
| 1 | <50% repair | 19% |
| 2 | >50% repair | 38% |
| 3 | Complete repair | 43% |
🔑 Clinical Takeaways
✔ Expect slower & incomplete repair in adults
✔ Anterior + posterior heal better (vascular supply)
✔ Middle third caution → miniscrew zone, less vascularity
✔ Always reinforce retention
🔒 Retention Protocol
- Maintain expander in situ: 12 months
- After removal → place 0.8 mm stainless steel TPA
- Monitor with CBCT + visual scoring
- Inform patients: repair ≠ full ossification even after 16 months
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