Fig. 10c1 - Coronal
Fig. 10c2 - Sag
Fig. 10c3 - Axial
Case 3: 43-year, 6-month-old man,
custom MARPE expansion appliance
+ full braces
This patient presented with concerns
of spacing, open bite, tooth
wear and wanting a dental implant
to replace his missing maxillary
left lateral incisor (Figs. 11a–c). Our
treatment plan included a custom
MARPE appliance with eight TADS
(Fig. 12a–d), designed by Partners
Dental Lab using the patient’s initial
CBCT to identify the areas with the
most adequate bone for TAD placement,
with piezotome palatal midline
osteotomy and braces on all the
teeth (Figs. 13a–13d).
The patient was instructed to turn
the expander two times per day for
the first five days, then once per day
for 10 days. CBCT images were made
before and at his three-week recall
visit (the latter to rule out complications,
but later used for analysis).
At three weeks, the patient’s expansion
was not yet complete.
Our intent is to show the skeletal
changes in all three dimensions following
sutural expansion in an adult
male at this earlier time point.
The results of these superimpositions
(Figs. 14a and 14b) show a
transverse skeletal change of 2.1 mm
(1 mm per side) with a transverse
dental change at the molars of 5.7 mm
(more than 2.5 mm per side). Skeletal
AP changes were minimal at this time,
however, because the maxilla expands
on an arc; it translates downward and
forward as skeletal expansion occurs.
This resulted in anterior displacement
of the maxillary central incisors more
than 1 mm and inferior displacement
of approximately 0.7 mm, which was
enough to correct his anterior edge-to-
[Superimposition videos (Figs. 14c1-3) demonstrate how quickly skeletal
changes occur with successful split
of the maxilla.]
Fig. 14c1 - Axial
Fig. 14c2 - Coronal
Fig. 14c3 - Sag
The field of orthodontics has witnessed
significant advancements in
recent years, with expansion techniques
taking center stage in the
treatment of skeletal Class III malocclusions.
However, it is important to
acknowledge that these innovative
approaches have not come without
skepticism and scrutiny. It is crucial
for the orthodontic community to
remain open-minded and receptive to
new ideas. As we continue to invest in
research and evidence-based practice,
we can better understand the potential
of expansion techniques and their
impact on treatment outcomes.
As evidence continues to emerge,
we can look forward to more refined
and predictable expansion techniques
and indications, leading to improved
results and enhanced patient care.
By embracing new possibilities
and staying committed to learning
and growing, we pave the way for a
brighter future in orthodontics.
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Dr. Jeremy Manuele earned his
DMD from the University of Nevada,
Las Vegas School of Dental Medicine
and his orthodontics certificate from
Louisiana State University in New
Orleans. He teaches early interventional
orthodontics part time at UNLV SDM
while maintaining a partner practice with
Dr. R. Cree Hamilton in Las Vegas.
Manuele is a key opinion leader and
on the clinical advisory board for uLab
Systems, provides orthodontic coaching
services through Your Ortho Coach,
and teaches an online CE course about
MARPE 360 for Innovator Ortho. He
retired from the Army National Guard
after 21 years of service, including an
18-month deployment to Ramadi, Iraq,
in 2005–2006. In his free time, he enjoys
travel, pickleball and all things outdoors
with his wife and their four children.