Pacific Coast Society of Orthodontists Bulletin Summer 2019 - 55

Angle Pearls

Customizing Microimplant-Assisted
Rapid Palatal Expander (MARPE) to
Maximize Efficacy of Treatment

Dr. Thomas Roblee
San Francisco, CA

Incorporating adjunct mechanics into a patient's
microimplant-assisted rapid palatal expander
(MARPE) design gives the practitioner the ability
to address problems in all three planes of space at
the beginning of treatment. It can also decrease
chair time and eliminate the need for additional
appliances. By capitalizing on the biomechanical
advantage of skeletal anchorage provided by the
MARPE along with the favorable biological conditions following expansion, treatment efficiency
can be maximized with these customized appliances. The following MARPE intrusion technique
is an excellent treatment option for simultaneous
transverse and vertical correction.

intrusion hooks were added to the MARPE and
molar bands were used (Figure 3).
2.	 Following expansion, simply cut the support
arms anchoring the molars and add power
chains or NiTi springs to activate intrusion
(Figure 4). If palatal tipping is a concern, adding a buccal microimplant or transpalatal arch
can help achieve more pure bodily intrusion
by maintaining molar angulation.
3.	 During the 6-month retention period following
expansion, MARPE anchorage is used to stabilize the newly established vertical position of

1.	 The patient presented here had both skeletal
and dental transverse discrepancy (Figures 1
and 2). Design the appliance so that minimal
chair time is needed to activate the adjunct
mechanics following expansion. In this design,

Figure 3. Postexpansion: MARPE design includes
hooks (green arrows) for easy transition to intrusion mechanics

Figure 1. Pretreatment: maxillary occlusal view

Figure 2. Pretreatment: front intraoral view

Summer 2019    PCSO Bulletin	

Figure 4. Cut support arms and add an elastic
chain or NiTi springs to begin intrusion mechanics

55



Pacific Coast Society of Orthodontists Bulletin Summer 2019

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