SARPE: Surgical-assisted rapid palate expansion

In the Region of MurciaAs in other areas of western society, transverse problems of the upper jaw, which can be excessively narrow in relation to the mandible, affect about 10% of the general population, often diagnosed by a experienced orthodontist based on measurements of the arch in a clinical and radiological examination.

In the case of child patients, who are still growing, maxillary disjunction is a well-known treatment with proven efficacy up to approximately 15 years of age, and with problems of a lack of between 4 and 7 millimetres of maxillary width.

However, in the case of adult patients, jaw disjunction using a fixed appliance often leads to complications such as compression of the periodontal membrane, tooth extrusions and, in many cases, a loss of the expansion achieved at the end of the treatment.

This is why in these cases, the orthodontist will offer his patients a rapid expansion of the jaw using a combined technique of orthodontics and surgery, known as SARPE, Surgically Assisted Rapid Palatal Expansion).

When is an EWRS necessary?

1. When the upper jaw is narrower than the lower jaw, from 5 millimetres difference between the upper and lower jaw.
2. When the jaw is excessively wide, and the jaw, with normal proportions, fails to be positioned correctly in relation to the jaw.
3. When orthodontic disjunction has been attempted but the patient's growth has stopped.
4. When the adult patient is at risk of gingival recession that may increase with orthodontic expansion

What does it consist of?

This is a combined technique between orthodontist and oral surgeon, which usually requires a first phase of surgery:

1. The placement of a small disjunctor, invisible from the outside of the patient's mouth, prior to surgery, at the level of the premolars and the first molar.
2. Local or general anaesthesia, depending on the patient's and surgeon's preference
3. Two small cuts at the level of the gum with an electric scalpel, on the inside of the upper lip, at the level of the canine and the first molar on each side.
4. One incision at bone level on both sides, parallel to the occlusal plane of the patient, and a third at the level of the mid palatal raphe.
5. Check for proper functioning of the circuit breaker, and suture the incisions with absorbable stitches.

Once the surgery has been performed, which is usually ambulatory and does not require hospitalisation, the patient can return to normal life the same day, with minimal discomfort and easily controlled with oral medication, and late complications are not frequent.

The patient will return to the dental clinic 4 to 5 days later to get instructions from the orthodontist handling the case:

1. Number of turns of the circuit breaker each day (usually one in the morning and one in the evening)
2. Number of days to turn the circuit breaker, and when to return to the practice to fix it.
3. Metal ligature fixation of the disjunctor, for a period of about 6 months, until bone stability is achieved.

With this, the adult patient achieves rapid expansion, similar to that of a growing child patient, in a simple and painless way, guaranteeing that orthodontic treatment with fixed multibracket appliances, Invisalign, lingual orthodontics, or any other technique, will guarantee stable and predictable results, as the patient's bone bases will be suitable to allow the ideal placement of the teeth.

Can a narrow jaw be solved without SARPE?

It depends on the case.

That is why it is important to go to a experienced orthodontistThe orthodontist, who will advise you on the particularities of your case and, if it can be treated with orthodontics alone, explain the limitations of the case, which will generally be as follows:

- Increased recession at tooth level, due to tooth displacement in the upper arch on an insufficient bone base.

- Reduced stability of treatment, and the possibility of worsening results over the years.

- Possible worsening of the patient's profile, depending on the movements and compensations required in the individual case.

At this point, it is important to remember that, in the event of such advice being given by your trusted professionalIt is important to consider that, when starting treatment, it is important to take into account the long-term perspectives and to try to opt for the alternative that will bring the most benefits not only in the short term, but also in the long term.