5.5 MARPE Failure to Split, Molar Tipping and Over-Expansion Problems
This is Chapter 5.5 of the JawHacks ebook. See the full Table of Contents here.
MARPE is Nuclear
All MARPEs are powerful devices that have the potential to permanently deform one’s facial structure to such a degree that only reconstructive jaw surgery can bail you out.
I do not want to understate this. Please, realize that MARPE treatment gone wrong can seriously derail your life.
Think of it like a nuclear reaction. If controlled and harnessed, it can be used for great good. But without skill, oversight and wisdom, it is capable of wreaking havoc. It is a potential energy that needs to be channeled carefully.
With great power comes great responsibility, and major MARPE pitfalls will be the subject of the next few chapters.
Failure to Split
The first major complication that can occur with MARPE is failure to split. This is a relatively benign problem as, worst case, you end up where you started, although only after some wasted time and heartache.
Failure to split occurs per our discussion in previous chapters. Devices that are too weak placed in skulls that are too strong results in a victory of the skull over the appliance.
This especially happens in adult males 25 or older who use off-the-shelf 4 TAD appliances such as MSE Type II without any kind of surgical assist to pre-release the palate.
In particular, failure to split manifests in the form of TADs dragging right through the bone like a finger through chocolate cream pie.
In other words, the strength of the forces in the skull resisting expansion are greater than the hardness of the palatal bone which the screws are meant to fix in.
Mitigating Failure to Split
This complication is mitigated by the use of more rigid appliances, with more TADs, strategically placed in denser palatal bone, and assisted by surgical release of the mid-palatal suture, anterior nasal spine, pterygomaxillary sutures, and sometimes the lateral buttresses.
See previous chapter for reference:
Teenagers with softer sutures and women of all ages tend to split more readily, but it never hurts to optimize appliance strength and surgical assist as discussed in prior chapters.
Molar tipping
Before I said that failure to split was a benign complication, since you often end up right where you started. No harm, no foul.
But this is not always the case.