Can You Be Too Old for a Palate Expander? MARPE Explained

Many patients who didn’t get the opportunity to fix their teeth during childhood decide to get braces as adults. If this is you, it’s a great act of self-care and I salute you. Braces can work in almost the same way on kids and adults, but there are some exceptions.

One of those exceptions is palate expansion. We normally can’t achieve palatal expansion in children older than 13 (or even younger in some cases). So if you’re wondering if you can be too old for a palate expander, the short answer is YES – however, we can work around this.

Science has come a long way, and there’s a way to open the adult maxillary suture in a minimally invasive, non-surgical manner. It’s a procedure called MARPE (miniscrew-assisted rapid palatal expansion), and it’s what we’re going to cover today.

Does rapid palatal expansion work for Older patients?

If you’re an adult, palate expansion is a more complex procedure, so your orthodontist should be the one to decide whether you actually need it. But with the right approach, palate expansion can work even in mature patients. Here’s how to know if it will help you.

You’re a good candidate for palate expansion if you have:

  • Unilateral or bilateral crossbite
  • Severe narrowing of the upper arch
  • Severe narrowing combined with overbite (class II) or underbite (class III)
  • Mouth breathing or sleep apnea combined with a narrow upper arch

Contraindications for adult palate expansion include:

  • Soft tissue or skeletal issues at the site of insertion of the miniscrews
  • Normal occlusion (that doesn’t require expansion)
  • Single teeth in crossbite (that can be resolved with braces)
  • Open bite or vertical skeletal discrepancies (expanders can worsen open bite)

In other words, if you think your palate is exceptionally narrow, your orthodontist could confirm that rapid palate expansion is something that might help you, even if you’re an older patient. Crossbites, where your top teeth bite inside your bottom teeth, are a good example of what can be fixed with MARPE.

However, if you’re an adult, your bite is acceptable and the narrowing of the maxilla isn’t severe, most orthodontists will just put braces on and achieve moderate expansion by simply moving and tipping your teeth. Dental tipping isn’t always a good thing, so it’s best to discuss with your orthodontist whether this is an option for you.

Another thing to consider is sleep apnea in adults. There are several studies that correlate sleep apnea with narrow arches and claim that expanding the maxilla will lead to bigger airways and better nasal airflow.

How do palate expanders work in adults?

Miniscrew-assisted rapid palatal expansion (MARPE) is a relatively new technique used in orthodontics to correct skeletal transverse maxillary deficiencies in adults. It involves the temporary insertion of small screws (known as miniscrews) into the palatal bone and the application of forces through the screw to expand the upper jaw.

Miniscrews, also known as TADs (temporary anchorage devices)

Traditionally, palatal expansion was achieved using a device called a rapid palatal expander (or RPE), which is a fixed appliance that attaches to the upper teeth and applies outward force to the palatal bone.

However, this technique is less effective in adults because the palatal bone is less flexible and more resistant to movement. Most importantly, after puberty, the suture that separates the two plates of the maxilla is closed. This is why conventional palate expanders are only recommended for children under 12 years old. Read this article on the best age to get a palate expander.

Do expanders break the maxilla bone?

Fortunately, the suture that separates the two maxillary halves is not completely fused although it may appear permanently closed. This suture is a place for minimal resistance. So no, expanders won’t ever cause the bone to break, they will simply cause separation.

Think of the palate suture as tightly interlocked fingers. If your hands are forced apart, you’ll eventually let go. The same goes for palatal expanders in adults. We need a higher amount of force, and we can’t achieve that by using the molars, like in a traditional expander (or we’ll hurt the molars). So we use miniscrews instead.

The miniscrews used in MARPE are placed directly into the palatal bone, and are more stable and provide more direct forces for expansion. The forces applied are also more controlled and precise, allowing for greater predictability in the results. This type of miniscrews don’t become osteointegrated as implants do, so they can easily be removed at any time.

Together with the miniscrews, you’ll also receive your expander, which is a device that contains a screw and can rest either exclusively on the miniscrews, or on both miniscrews and your first molars. Once everything is in place, you’ll start turning the screw every day, typically two turns per day.

MARPE Expander before it goes in the mouth. Source: Uniortholab

One advantage of MARPE over traditional palatal expansion is that it can be completed in a shorter amount of time, typically around 3-6 months. It also allows for greater expansion of the skeletal structure, rather than just the dental arch. The greatest indicator of this true expansion is the sizeable gap that appears between the incisors – read more about why this gap develops in this article.

Since it’s still a relatively new method of treatment, MARPE does require greater expertise and skill on the part of the orthodontist, and there is a higher risk of complications if the miniscrews are not placed correctly.

What are the risks of maxillary expansion in adults?

When considering maxillary expansion in adults using the MARPE technique, it’s important to understand the potential risks involved. After all, we are talking about adjusting the bones inside your facial structure.

While MARPE is generally considered to be a safe and effective treatment option, there are still some risks that patients should be aware of. Here are some of the potential risks associated with MARPE:

  • Inflammation: The area where the miniscrews are inserted can become inflamed, which can be difficult to prevent even with good hygiene. Using a water flosser on a low setting and a soft brush in the area will help. This inflammation will resolve once the expander is removed.
  • Pain: Expansion can cause moderate pain, but this can be managed with over-the-counter medication like acetaminophen.
  • Loosening of the miniscrews: In some cases, the miniscrews can become loose and require repositioning.
  • Asymmetrical expansion: Some patients may experience asymmetrical expansion, which can be addressed with adjustments to the treatment plan.
  • Failure to open the suture: In a small number of cases, the suture is so tightly fused that it will not open. This is impossible to know in advance and is quite rare.
  • Tinnitus: A small number of patients have reported experiencing tinnitus (ringing in the ears) after undergoing MARPE.
  • Unknown long-term effects: More research is needed to fully understand the long-term effects of MARPE on the bones of the face and skull, but the studies that we currently have don’t indicate any negative effects.

It’s worth noting that while these risks do exist, MARPE is generally considered to be a safe and extremely effective treatment option for maxillary expansion in adults, and the greatest thing about it is that patients can avoid costly and painful jaw surgery.

It’s important to discuss any concerns you may have with your orthodontist and follow their recommendations for minimizing these risks.

Conclusion

MARPE is what makes adult expansion possible, and as an orthodontist, I’m beyond thrilled that such a treatment option exists now. TADs are a bit of a learning curve and can be a little scary at first, for both practitioner and patient.

But there are so many resources and experts teaching these new developments, that there’s simply no reason to avoid MARPE and other miniscrew supported dental movements. So if you need maxillary expansion as an adult, and you’ve found a confident professional that offers this kind of treatment, look no further!

Whether you’re new to braces or a braces veteran, taking care of your teeth and gums during orthodontic treatment is crucial. That’s why I’ve put together a list of orthodontist-recommended tools that will make caring for your braces a breeze:

  • An awesome mid-range electric toothbrush. Rotating electric brushes are much more effective, in my opinion, than sonic ones. You can keep your teeth white by using whitening replacement heads.
  • A countertop water flosser to blast out food debris between teeth. I know handheld models are tempting, but you’ll need a lot of water. You can almost replace flossing with this and your gums will be healthier.
  • Braces accessories to get into all the nooks and crannies: straight or angled interdental brushes, floss threaders, orthodontic wax or silicone. For pain management, have gel ice packs handy, Orajel, and Mouth Magic (a cool soothing solution for mouth sores).
  • For clear aligner patients, a tool like PUL helps both remove and seat your aligner or retainer. Don’t forget to use a cleaning product like crystals to keep your trays fresh and hygienic.

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7 Comments

  1. Jenny Holliday says:

    I am sixty-eight, had a facial trauma as a child (car accident, thrown into the dash) where my orbital bone was broken and the right side of my face pushed medially and backwards. In 2003 an oral surgeon did a LeFort1, supposedly to bring forward my maxilla and rotate it, but he went the wrong direction. I am now very deficient in the lateral alveolar ridge and a unilateral high vault in Quadrant 1. I thought just an augmentation of that ridge would be the answer but I’d rather widen my palate. If the accident forced the sutures together enough to deform that palate would it be hard to open them with the MARPE, after so long a time and compounded trauma? Any ideas?

    1. Adriana Sim, DMD Orthodontist says:

      Hi Jenny, that’s a lot. I’m not qualified to answer that question considering all the trauma and surgery, but I know this: MARPE doesn’t work in all patients but it does work in most patients. The suture isn’t fused all the way, and at least in theory, it can be opened at any age. That being said, when you widen the palate, it puts pressure on all the other sutures and facial structures, and I personally wouldn’t risk it and just stick to bone augmentation. Best to ask a surgeon about this.

      1. I would highly recommend Dr Reza Movahed. He is an extremely talented OMFS with all these procedures.

  2. I’m 35 and have a palate expander. Do they stop turning when you get to around 40 turns? Will it stop turning or will it come apart if it’s turned to many times

    1. Adriana Sim, DMD Orthodontist says:

      Hi Stephen, the screw is designed to stop at 40 turns and has a built-in mechanism to help with accidental excess activation. So that means that once it’s turned all the way, it may keep turning if the patient tries, but it doesn’t cause any more expansion. Typically, once the screw is close to 30-ish turns, your orthodontist should see you to make sure you’ve completed all your activations. Some orthos prefer to then block the inside of the screw with composite so it doesn’t “unwind”, but not all doctors do this (I don’t).

  3. Thank you for publishing this really clear explanation of why and how this treatment works! I am 27 and just got a MARPE placed yesterday and have been feeling really nervous about it, but this article helped me feel confident that this treatment is effective and worthwhile. The visual aids showing the mini-screws and how the midpalatal suture is interlocked were especially informative! Your article about eating with an expander in is also very helpful 🙂

    1. Adriana Sim, DMD Orthodontist says:

      Hi Quinn, thanks so much for your comment. Feedback like yours is what keeps me going with these articles. Best of luck with your treatment!

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