The Smile That Started It All by Michele Jerrell, Publisher

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The Smile That Started It All   

How a seventh-grade orthodontic patient grew into “the MARPE guy”—and why he’s betting on curiosity over division

by Michele Jerrell, publisher

For Dr. Jeremy Manuele, the journey into orthodontics began with his own treatment in seventh grade. He was self-conscious about his smile, and what fixing it did for his confidence stayed with him long after the braces came off.

“My own smile changed my world when I was a self-conscious seventh grader,” he recalls. “It taught me that confidence can shape the trajectory of a person’s life.”

That lesson is the foundation of nearly everything he’s built since. Today, Manuele is a partner at Hamilton & Manuele Orthodontics, a 4,500-square-foot practice with a team of 16. He’s also widely known online as “the MARPE guy,” a nickname earned through years of teaching colleagues about miniscrew-assisted rapid palatal expansion and the broader implications of skeletal-focused, airway-aware orthodontics. The path that got him there has been less about following a plan and more about being willing to throw out his own assumptions when the evidence pointed somewhere new.

The scan that changed everything
The turning point arrived in 2017, when the practice bought its first cone beam CT scanner.

“Almost overnight, it changed the way we saw orthodontics,” he explains. “Instead of looking at teeth in two dimensions, we could suddenly evaluate the entire craniofacial system in 3D, teeth, jaws, airway, and surrounding skeletal structures. Once you have that level of information, it’s very difficult to go back to practicing the way you did before.”

As the team began studying CBCT data, superimpositions, and long-term case outcomes, a conclusion took shape that has reshaped the practice ever since: Orthodontic mechanics don’t just move teeth. They influence the entire skeletal framework of the face.

Seeing how treatment affected jaw position, nasal airway space, and facial balance was, by Manuele’s account, transformative. The more they learned, the more they realized how much remained unknown. That curiosity pushed them deeper into airway-focused orthodontics and skeletal expansion techniques like MARPE.

Today, treatment planning at Hamilton & Manuele starts with jaw size, skeletal balance, and airway health. Straight teeth are still important, but Manuele frames them as something else now.

“They are the natural byproduct of creating the right structural environment for the face and airway to function optimally,” he says.

Diagnosis in 3D
In practice, the philosophy means a more comprehensive diagnostic workup than most orthodontic offices run. Beyond standard records, Manuele’s team uses CBCT imaging to evaluate jaw width relationships, airway dimensions, TMJ anatomy, and skeletal symmetry through cross-sectional slices and 3D measurements.

When something looks off, like a maxilla that’s too narrow relative to the mandible, the questions go beyond alignment. The team asks about breathing, function, and overall craniofacial balance, and whether skeletal correction may be necessary to achieve a healthier and more stable outcome. It’s also how they catch potential airway or sleep-related risk factors early enough to coordinate with medical colleagues when appropriate.

But identifying a discrepancy doesn’t automatically mean treating it, and Manuele is deliberate on that point. Every complex case starts with the patient’s chief concern, and the team works backward from there.

“Just because we identify a discrepancy, whether skeletal, airway-related, or dental, doesn’t necessarily mean it must be treated, or that the patient wants to pursue it,” he explains. “Our role is to educate patients about what we’re seeing, explain the available options, and help them understand how different treatment paths might affect their health, function, and long-term stability. From there, we work within the parameters of the patient’s goals to design a treatment plan that aligns with their priorities.”

What’s encouraging, Manuele notes, is that the goals tend to reinforce each other rather than compete. Improving the underlying skeletal anatomy usually enhances the aesthetic outcome too. Priorities like airway health, functional bite, and facial aesthetics, in his view, are not competing goals but synergistic ones.

The most misunderstood tool in the toolkit
If there’s a single technique Manuele wishes more orthodontists understood, it’s MARPE.

“MARPE is probably the most misunderstood and underutilized tool in modern orthodontics, particularly in how it relates to airway health,” Manuele says. “Interest in airway-focused treatment has grown tremendously among patients, but the reality is that most orthodontic residency programs still provide very limited training in this area.”

The result is that practitioners who want to practice in a data-driven way end up logging thousands of continuing education hours to fill the gap, often well outside orthodontics itself. Sleep medicine, ENT, and craniofacial biology all become part of the curriculum, because the underlying problems are multifactorial and don’t respect specialty boundaries.

“Airway and sleep-disordered breathing are multifactorial problems, and if we want to help patients in the most meaningful way, we have to be willing to pursue that deeper education,” he notes.

That conviction is part of why teaching has become so central to his career. He wants to bridge the gap by sharing what he’s learned, particularly through online education that simplifies complex concepts and integrates them into the general orthodontic knowledge base. The more practitioners who understand when MARPE belongs in a treatment plan, he says, the more patients can be helped.

Building a practice that doesn’t need a second doctor
Manuele’s adoption of digital workflows wasn’t about chasing technology for its own sake. As his business partner Dr. Cree Hamilton approached retirement, Manuele wanted to maintain the output of a two-doctor practice without adding another orthodontist, while continuing to take on complex cases.

That meant rebuilding the workflow. Digital indirect bonding eliminated most of the inefficient bracket placement and inactive wire adjustments that used to eat up chair time. An in-house digital lab producing direct-printed aligners has saved hundreds of hours of treatment planning. Remote monitoring keeps clear aligner and MARPE patients on track without unnecessary office visits, which alone shaves two clinical days a month off the schedule.

“These digital systems allow us to do something that can otherwise be very difficult in healthcare: marry clinical excellence with operational efficiency,” Manuele explains.

The single workflow change that saved him the most personal time, though, isn’t something he can point to on an invoice. It’s a self-guided clear aligner setup process he built out of frustration. Clear aligners account for only about 25% of his practice, but with his previous system, setup and refinement had grown into a part-time job that spilled into evenings, non-clinical days, and vacations.

Using treatment-planning software, he stripped planning down to only the steps that genuinely require a doctor and delegated the rest to his team. All of his aligner setups now happen during normal clinic hours. Roughly 90% of refinements are handled chairside, so patients rarely need a new scan or weeks of waiting for additional trays.

“The reality is that many doctors aren’t benefiting from these efficiencies yet because the learning curve of adopting new software and workflows can be steep,” he acknowledges. “But once implemented, the time savings and clinical control are enormous.”

Teaching as a feedback loop
Teaching has shaped Manuele as much as it’s shaped his audience.

“I’ve always tried to be an open book,” he explains. “My philosophy is simple: If I’m truly doing something the best way possible, I want others to be able to do it that way as well. And if someone else is doing it better, I want to learn from them and improve our workflows.”

That mindset has built a culture of constant learning inside the practice, though it has its moments. His team has been known to give him a hard time for ordering a new appliance before they’d completed full training on it. Manuele takes that ribbing in stride. The team understands that experimentation, when it’s genuinely in service of better patient outcomes, is part of how they operate.

“Every patient who walks through our doors could become a case that changes how we think about treatment planning,” he reflects. “When you teach, you’re constantly reminded that the standard you demonstrate to others has to start in your own practice.”

One principle he returns to repeatedly when teaching is to start from the ideal outcome and work backward. “As specialists, our primary responsibility is to provide patients with informed consent,” Manuele says. Not every patient will choose, or even be able, to pursue the ideal treatment plan, and he says that’s fine. “But if we don’t educate them about the full range of possibilities, we’re essentially removing their autonomy from the decision-making process.”

For many years, the perceived options in orthodontics were braces or orthognathic surgery. Tools like MARPE, TADs, and other modern techniques have opened up a spectrum of possibilities in between. If clinicians don’t stay educated enough to share those options, Manuele says, patients can miss treatments that could meaningfully change their function and overall health.

Changing smiles, and the world
Hamilton & Manuele’s tagline reads: “We change your smile… you change the world.” For Manuele, it isn’t a marketing slogan. It’s a throughline back to his own seventh-grade self.

For years, the practice produced an annual calendar featuring drawings submitted by kids in the community. During a team meeting one day, they had what Manuele calls an “aha!” moment. If the mission was about changing the world through smiles, why not spotlight people already doing exactly that?

That conversation became the World Changer Scholarship. Each year, the practice selects 12 recipients, one for each calendar month, who are making a meaningful difference in the community. One of those 12 is then chosen as the grand prize scholarship winner. The program, Manuele says, “reminds us constantly that orthodontics is about more than smiles. It’s about empowering people who will go on to impact the world around them.”

One recipient who captures what the program is about is Nijel Murray, who founded a nonprofit called Klothes 4 Kids when he was 14. The idea came from watching a foster brother arrive at his family’s home with clothing that didn’t fit, and seeing how stressful and embarrassing that moment was. Determined to spare other foster children the same experience, Nijel launched Klothes 4 Kids to collect and distribute new clothing and basic necessities to foster youth. Through the scholarship, Manuele’s practice has collaborated with him on clothing drives and a YouTube video to raise awareness.

“Seeing young people step up and make that kind of impact is exactly what the World Changer Scholarship is all about,” Manuele says.

The partner who set the bar
When Manuele finished residency, his plan was straightforward. Find the best practice he could purchase and grow it. Meeting Dr. Cree Hamilton rewrote that plan.

“I knew that as an orthodontist I would eventually find professional and financial success,” he recalls. “What Dr. Hamilton had, though, was something far more meaningful. A reputation not only as an exceptional orthodontist, but as a person of integrity and character the likes of which I had never seen matched. In that moment, I knew that whatever short-term financial sacrifices might be required, partnering with and learning from him and his team would be worth it.”

Years in, Manuele is clearer than ever about why that decision mattered. The value of the partnership, he says, has gone well beyond clinical mentorship.

“There’s a saying that you become like the five people you spend the most time around, and that makes me incredibly grateful to work alongside people with such integrity and heart,” he reflects. “They challenge me, help reveal my blind spots, and push me to grow. They make me a better orthodontist and more importantly, a better person. That’s something money simply can’t buy.”

That perspective has also shaped how he advises younger orthodontists. His core message is to resist the urge to copy other people’s practices: Learn from mentors, adopt what they do well, but stay true to your own vision.

“You bring something unique to your team, your community, and to the profession itself,” he notes. Early in a career, he advises identifying both strengths and genuine sources of energy, then building the practice in a way that leverages both as much as possible. “When your work aligns with what you’re naturally good at and what energizes you, it stops feeling like work and starts feeling like purpose.”

Staying curious, staying together
If there’s a closing thought Manuele wants to leave with the Orthotown community, it’s about how the profession talks to itself.

“One of the things I’ve come to appreciate most about orthodontics is that we’re all ultimately chasing the same thing: the truth,” he reflects. “We’re all trying to better understand how the craniofacial system works and how we can help our patients live healthier, better lives.”

What makes the field exciting, he adds, is how much remains unknown despite everything that’s been learned. Every doctor contributes in their own way: some push the science, some refine clinical workflows, some challenge existing paradigms, some excel in patient care or mentorship. All of those contributions, in his view, matter.

“My hope is that as a community we continue to lean into curiosity rather than division,” he says. “It’s easy for professions to fragment into camps or echo chambers of like-minded thinking, but the reality is that progress usually happens at the intersections where different perspectives meet and challenge each other in constructive ways.”

“If we can remember that we’re all on the same team, working toward deeper understanding and better patient outcomes,” he adds, “we’ll be much stronger as a profession.” 
Orthotown Magazine
June 2026
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