The clinical applications and outcomes of digital MARPE in orthodontics: A scoping review

Abstract

Aim

This scoping review aims to assess the literature on the use of digital Miniscrew-Assisted Rapid Palatal Expander (MARPE) appliances, highlighting the technological advancements in the planning, design, and manufacturing process, the clinical outcomes, and potential advantages offered by integrating digital technology into the MARPE workflow.

Background

MARPE is a widely used technique to address maxillary skeletal deficiencies, particularly in adult and late adolescent patients. The core function of MARPE remains consistent regardless of whether conventional or digital approaches are used. However, digital technologies like CAD-CAM and CBCT have introduced new methods for improving precision and customization in MARPE treatments.

Methodology

The PRISMA-ScR guidelines were followed, conducting a comprehensive literature search across databases such as PubMed, Scopus, Web of Science, and Google Scholar. The search terms used included “digital MARPE,” “miniscrew-assisted rapid palatal expander,” and “digital orthodontic appliances.” Inclusion criteria focused on studies incorporating digital technologies in the design, planning, or manufacturing stages of MARPE. Studies only describing the conventional MARPE, or non-English articles were excluded.

Results

A total of 1,024 publications were identified and after applying the inclusion criteria and full-text screening,12 articles were included in the final analysis. It was observed that the integration of digital technologies, such as CAD-CAM, has dramatically enhanced the precision, customization, and predictability of MARPE treatments, as evidenced in the studies reviewed. Digital workflows enable orthodontists to precisely align MARPE devices with the patient's anatomy, minimizing complications and enhancing treatment efficiency. CAD-CAM-enabled MARPE devices were able to produce effective mid-palatal suture separation and skeletal expansion even in situations where the thickness of the palatal bone was less than optimum for conventional expansion methods. It was observed that 3D-printing combined with CBCT could help overcome the limitations of prefabricated MARPE designs, which may not always fit well in cases with high-arched palates, thus compromising anchorage.

Conclusion

The introduction of digital technologies in MARPE treatments has offered clear procedural advantages in terms of precision, customization, and workflow efficiency. However, the fundamental clinical efficacy of MARPE remains consistent, regardless of whether digital or conventional methods are used. Future research should focus on quantitatively assessing the long-term impact of digital workflows on treatment outcomes, patient comfort, and procedural efficiency.