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

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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.

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.

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:

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!