How to Minimize MARPE Failures: What We Have Learned After Two Decades of Traveling Uncharted Territory

The success of MSE/MARPE was not always predictable, especially for mature male patients. Over the last two decades, enormous efforts have taken place in attempts to further understand determining factors. During the two decades of journeying through the uncharted territory of non-surgical midfacial expansion in mature patients, not only have traditional paradigms been defied, but many initial MARPE concepts have also required adjustment. In this presentation, various ways to accommodate patients with extremely thick or thin palatal bones, narrow palatal vault, massive zygoma, palatal torus, skeletal asymmetry, etc. will be discussed. Application of digital workflow in MSE fabrication and MSE modification could also enhance the success of MSE treatment in difficult cases. Furthermore, for extremely difficult cases, various minor surgical procedures that could aid MSE will be discussed. Through clinical studies, computer simulations, and innovative treatment modifications, many of those challenging cases now can be safely treated without significant complications, and the traditional SARPE can be largely eliminated.