Miniscrew assisted rapid palatal expansion (MARPE) in an adult with cleft lip and palate

Vol. 13 – Number 51 – 2020 Case report Page 54-64 Miniscrew assisted rapid palatal expansion (MARPE) in an adult with cleft lip and palate Rodrigo Almeida Nunes Teixeira1 Rodrigo Naveda2 José Carlos da Cunha Bastos Júnior3 Lourival de Castro Garcia4 Daniela Gamba Garib5 Abstract Rapid maxillary expansion (RME) is a therapeutic procedure often required in patients with complete cleft lip and palate for correction of the upper dental arch constriction, posterior crossbite and maxillary segments misalignments. When the orthopedic therapeutic window is lost and late rehabilitation procedures are performed with advanced bone maturation stage, surgically assisted maxillary expansion may be indicated. However, with the advent of Miniscrew Assisted Rapid Palatal Expansion (MARPE), orthopedic RME has become an option in adult patients without cleft lip and palate. The aim of this study was to develop an expander device with skeletal anchor for patients with cleft lip and palate. Secondarily, it also aimed to describe a case report of an adult patient with complete unilateral cleft lip and palate not treated orthodontically previously. The female, 24 years old patient, presented severe Class III malocclusion with posterior and anterior crossbite. RME skeletally anchored was performed using a Hyrax expander anchored in 2 bands on the first molars and 4 mini-implants on the palatine bone distant from the cleft palate. As there was not enough skeletal anchorage, the results obtained were predominantly dentoalveolar. The singular morphology of the patient with cleft lip and palate caused by palate bone deficiencies and the presence of thicker palatal mucosa requires a unique assessment for each patient. More studies are needed to detect soft and bone tissue singularities, finding sites with sufficient support for orthopedic effect and minor side effects. Descriptors: Cleft palate, cleft lip, Angle Class III malocclusion, palatal expansion technique. 1 Master’s student in Orthodontics – FOB-USP, Specialist in Orthodontics – HRAC-USP. 2 PhD student in Orthodontics – FOB USP. 3 Oral and Maxillofacial Surgeon – HRAC-USP. 4 Orthodontic Laboratory Technician – HRAC-USP. 5 Associate Professor of Orthodontics – HRAC USP and – FOB-USP.