A recent airway webinar featured information on MARPE and showed cases that achieved 4 mm of maxillary expansion as if this was a groundbreaking accomplishment. Four millimeters of expansion is a nice start, but it is less than half of what is needed in most cases to create a maxilla wide enough for the tongue to comfortably fit in the palate at rest.
The Stanford University Sleep Clinic Director, the late Dr. Christian Guilleminault, routinely stated that the end goal of all airway treatment was the establishment of proper rest oral posture involving 100 percent nasal breathing. Achieving that goal is impossible when the tongue cannot fit into the palate at rest.
My orthodontic training taught me that the sutures close and the adult maxilla cannot be expanded because the midline suture is closed. That thinking began to change in the early 1980s with articles suggesting that the suture might still be opened orthodontically, but that resistance in the adult was due to buttressing of the zygoma. Surgically assisted techniques were developed and popularized to address this supposed problem.
I remember the emotionally charged arguments surrounding maxillary expansion discussed at a joint meeting of the American Association of Orthodontists and the American Academy of Periodontics in February of 1995 in New Orleans. That was 30 years ago. One orthodontic academic suggested that surgically assisting maxillary expansion was needed for expansion of even 12 year old children to avoid periodontal damage.
On the other hand, a non-academic orthodontist showed cases of dramatic expansion of the adult maxilla with no surgical assist whatsoever and no periodontal damage.
I have been expanding the adult maxilla 10 mm or more since the 1980s without using any surgical assist. My record for non-surgical, non-TAD assisted expansion with no periodontal damage in a young, growing child is 17 mm of maxillary expansion.
This is not to say that MARPE, SARPE, DOME, SFOT, and other surgical approaches are not useful in certain cases. However, it is my belief that they are the currently fashionable hammer looking for a nail.
Why put the patient through a surgical procedure and added expense when simple upper and lower expanders can achieve expansion approaching 10 mm in most cases? Save the surgically assisted approaches for cases that are extremely narrow, have existing periodontal concerns, and outwardly tipped bicuspids and molars.
Just because we have a hammer in our toolbox doesn’t mean everything has to be a nail.
