6.5 MARPE Patient Disqualifiers

These types of patients should avoid MARPE

This is Chapter 6.5 of the JawHacks ebook. See the full Table of Contents here.

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Summary of How MARPE Can Go Wrong

In chapters 6.1 through 6.4, we discussed several ways in which MARPE can go wrong.

They were:

1. Failure to split

2. Molar tipping

3. Over-expansion

4. Asymmetries

5. Dropping the midface

6. Piezotome surgical assist complications

Understanding these potential problems gives insight into what puts a patient at high risk of experiencing complications with MARPE.

Below is a list of attributes which should raise red flags about proceeding with MARPE treatment.

These disqualifiers are not black and white. Of course, every case needs to be looked at individually.

I think an informed patient should have the right to proceed with MARPE if he is crystal clear about the inherent dangers involved therein, and how they may apply to a pre-disposing feature like pre-existing asymmetry and others that we will discuss below.

However, avoiding MARPE in patients who meet any of these criteria may avert problems for both patient and doctor.

MARPE Disqualifiers

Remote Patients Unwilling to See Their Orthodontist Regularly

We know that most MARPE problems can be nipped in the bud if the providing doctor keeps a close eye on the expansion process.

Doctors can catch asymmetries early and instruct the patient to either stop expanding or turn back.

They can also detect when an expansion is getting to the point that orthodontic correction of the bite will be dubious without the help of SFOT or some other surgery.

The worst MARPE asymmetries and over-expansions that I have seen were the result of remote patients going months without seeing their doctor, and not realizing that they were sailing into a hurricane.

I understand that many patients wish to travel out of state to work with the best MARPE providers. But be aware that doing so requires a willingness to sacrifice the time and money needed to visit your doctor regularly, even if that means flying several hours for a 10 minute checkup.

This is one reason why I encourage people to choose local orthodontists whenever possible.

True, many top doctors now are using apps like Grin that facilitate remote monitoring of patients. But many don’t, and ultimately there is nothing like an in-person checkup to ensure that expansion is headed in the right direction.

Delusional Patients Intending to Over-expand

There is nothing stopping a patient from running away forever after their MARPE is placed. All patients are given their own jackscrew wrench capable of expanding their device.

This means that it is possible for patients to duck their orthodontist and go off on their own, turning their appliance according to their own preference.

If you miss a checkup, your orthodontist will not go out looking for you. He will not send the police to stop you.

With hundreds of patients under his care at any one time, he will probably not even notice.

Some delusional patients have taken advantage of this freedom to determine their own expansion numbers.