Title Miniscrew-Assisted Rapid Palatal Expansion May Be an Effective Treatment Modality for Adult Patients with Obstructive Sleep Apnea and a Transverse Maxillary Deficiency
Clinical Question In adult patients with obstructive sleep apnea (OSA) and a transverse maxillary deficiency, is miniscrew-assisted rapid palatal expansion (MARPE) an effective treatment option compared to surgically assisted rapid palatal expansion (SARPE)?
Clinical Bottom Line For adult patients with obstructive sleep apnea and a transverse maxillary deficiency and who are seeking a non-surgical treatment option, miniscrew-assisted rapid palatal expansion may be an effective treatment modality to improve breathing. However, caution should be taken by the orthodontist and additional studies are needed, as there is only limited evidence evaluating the patient’s improvement in a supine position.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29561652Kim/201814 patients (mean age, 22.7 yrs)Retrospective Study
Key resultsThis study evaluated the effects of MARPE on the upper airway using CBCT imaging before expansion (T0), directly following expansion (T1), and 1 year after expansion (T2). The volume of the nasal cavity and nasopharynx showed a significant increase (P < 0.05) from T0 to T2 of 15.4% and 10.5% respectively. The cross-sectional area of the anterior and middle segments of the nasal airway increased significantly (P < 0.05) from T0 to T2: 31.3% and 9.5% respectively. Overall, palatal expansion in young adults increases the nasal airway dimensions and may be helpful in improving breathing.
26948172Abdullatif/20168 studies/39 patientsSystematic Review and Meta-Analysis of Case Series
Key resultsArticles up to January 8, 2016 were included. Six studies of 36 patients involved solely maxillary expansion. Three articles involved SARPE and reported apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) before and after expansion. The overall point estimate for the 33 SARPE patients favored an AHI reduction of -9.71 (95% CI, -15.41, -4.01). The overall effect Z score was 3.34 and I2 of 57% showed moderate inconsistency. Regarding all maxillary expansion studies included, AHI was reduced 59.3%. Expansion improved LSAT by 2.6 points but was not clinically significant. Overall, expansion can improve AHI and LSAT, but additional research on this topic is needed.
29090123Hur/20171 patient (18 yrs 7 months)Case report
Key resultsThe authors evaluated the upper airway following MARPE on a young adult male with OSA. CBCT imaging occurred before and 6 months after treatment. 3D models of the upper airway were fabricated, and airflow was analyzed using the fluid-structure interaction (FSI) method. The patient underwent a polysomnography study before (T0) and after MARPE (T1). There was a significant reduction in AHI (from 49.5 [T0] to 2.2 [T1] events/hour), and there was significant improvement in LSAT (from 85% [T0] to 95% [T1]). FSI simulation showed an improvement in the quality of respirations, likely the result of smoother airflow due to the increased cross-sectional area following MARPE.
Evidence Search Adult [All Fields] AND sleep apnea [All Fields] AND/OR sleep apnea [MeSH Terms] AND miniscrew [All Fields] AND/OR miniscrew [MeSH Terms] AND palatal expansion [MeSH Terms] AND/OR palatal [All Fields] AND expansion [All Fields]
Comments on
The Evidence
Validity: The study design used to research this topic consisted mostly of observational studies comparing before and after treatment. Although there is a lack of evidence on this topic, the published studies used different methods of analysis but reported similar findings. The systematic review commented on the lack of published evidence regarding this topic, but the articles included were of moderate to high quality. Perspective: The clinical question is becoming increasingly important as more individuals are seeking treatment to improve their current sleep condition. Regarding financials, MARPE would be a less costly treatment option compared to surgery. However, because MARPE is a newer technique, additional research is needed on the topic, but the consistency of the current published evidence appears promising.
Applicability The subjects in these studies were adults with transverse maxillary deficiencies and OSA. All studies showed that increasing the maxillary transverse dimension results in increased upper airway dimensions. When patients are seeking treatment for OSA, it is important to discuss all modalities that could aid in improvement of their condition. Additional studies need to be completed with larger sample sizes and in a supine position, but for the adult patient who dislikes a CPAP machine and refuses an intraoral appliance or surgical correction, MARPE appears to be another possible treatment modality.
Specialty (General Dentistry) (Oral Surgery) (Orthodontics)
Keywords Obstructive sleep apnea, miniscrew-assisted rapid palatal expansion, MARPE, adult palatal expansion, surgically assisted rapid palatal expansion, maxillary deficiency
ID# 3413
Date of submission 11/27/2019
E-mail greena1@livemail.uthscsa.edu
Author Austin Green, DDS
Co-author(s) Shelby Steffenhagen, DDS
Co-author(s) e-mail steffenhagen@livemail.uthscsa.edu
Faculty mentor Dr. Ravikumar Anthony, BDS, MDS, MS
Faculty mentor e-mail anthonyr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available