MISMARPE / DOME what is it?
Join me for a look at maxillary expansion combining both surgery with miniscrews. Seemingly opposite ideas have been brought together to offer potentially greater versatility in expansion, with less surgical complexity andcomplications.
MISMARPE – minimally invasive surgery miniscrew assistedrapid palatal expansion Haas 2021
Or
DOME Distraction Osteogenesis Maxillary Expansion Liu2017
Protocol
· Osteotomy
o Anterior vertical incision interdental toperiform fossa
o Lateral incisions to the base of zygomaticprocess of maxilla
o Without releasing the pterygomaxillary suture
o Activate in surgery up to 20x ensure diastema
o Duration 24 minutes (14.4-32) Junior 2021
o Less pain – Mild on VAS
· Expansion
o 7 days no expansion
o Expansion of rate 0.25 - 0.50 mm,
§ Some until diastema and slow to 0.25 per day
Advantages
· Less osteotomies required
· Under sedation or local anaesthetic
· Greater anchorage for force delivery throughminiscrews
· Less intra-operative haemorrhage – due to a lackof pterygopalatine disjunction
· Parallel expansion – Lin 2015 Vs V shapeexpansion
Age
Limitation of MARPE was age, with 20-30 years females 94% 20-30years males 80%, MARPE success 30-37 = 20% Olivera 2021, MISMARPE 96% successage 20-59, 24 patients majority over 30 years old Piccoli 2023.
Expansion amount
· Direct comparison show no significant differenceda Silva 3mm, and no difference in molar angulation 2023
Indicated for:
· Failed MAPRE
· Age- greater 30 females and 25 for males
Could MISMARPE / DOME replaceSARPE?
