Surgical Digitally Guided Planning for the Mini-Screw Assisted Rapid Palatal Expansion (MARPE) and Suture Perforation: MARPE Guide

Abstract

The surgical planning digitally guided for the mini-screw assisted rapid palatal expansion (MARPE) technique consists of a three-dimensional positioning of MARPE and its mini-implants by a nasomaxillary anatomic evaluation. This technique also includes the simulation of the perforation areas on the midpalatal and transpalatal sutures. This type of planning is performed by superimposing the patients’ files (STL and DICOM). Correct positioning without colliding with the lateral tissues of the palate and the bicortical positioning of each mini-implant are important components of the case study. The MARPE device permits individualization of the height of the mini-implant rings in each region. To avoid incorrect insertion of the drill, the location of the midpalatal and transpalatal sutures was determined using digital planning. A positioning that avoids contact with important structures, such as the nasopalatine canal, while permitting bicortical drilling of the sutures is recommended. Then, a guide that reproduces MARPE positioning and another guide that reproduces the perforations are fabricated, providing exact reproducibility as performed virtually.