Review Article
Volume 21 Issue 5 - 2022
Sleep Apnea Treatment with Rapid Maxillary Expansion in Adults and Children - Review of Literature
Benoît Carrier DMD, M.Sc Dental*

Doctor in Dental Medicine, University of Montréal, and Master in Dental Sciences, McGill University, Montréal, Canada
*Corresponding Author: Benoît Carrier, Doctor in Dental Medicine, University of Montréal, and Master in Dental Sciences, McGill University, Montréal, Canada.
Received: March 15, 2022; Published: April 13, 2022


Sleep apnea treatment with rapid maxillary expansion in adults and children take different approaches to achieve positive outcomes. Obstructive sleep apnea (OSA) is one of the six sleep-related disorders classified in the ICSD-3 by the American Academy of Sleep Medicine (AASM). Its prevalence has been on a steady increase in the past decade, making it a key health concern in a global scale. China, the United States, and Brazil are among the countries with the highest number of people suffering from OSA. There are numerous treatment options for OSA, with CPAP being the preferred option. However, some patients have tolerability issues with CPAP, which reduces its efficacy in correcting OSA hence the need to use alternative treatment methods that use oral appliances, such as Mini-Implant Assisted Rapid Palatal Expansion (MARPE) and mandibular advancement device (MAD), which have gained widespread popularity. MARPE, facilitated with mid-palatal suture cardiopuncture, provides the most effective bone-anchored procedure for lateral osteotomy in the maxillary expansion, and the procedure effectual in adults than other RPE options, such as the toothborne in children. Because the narrow maxilla blocks facial development, promote nasal obstruction, nasopharyngeal airways collapse and leads to crowding of teeth because of limited space, MARPE is preferred in young adult with fused suture. The periodontal and oral nature of the treatment options makes the inclusion of dentists in the OSA treatment plans critical.

Keywords: Obstructive Sleep Apnea (OSA), Dental Sleep Medicine, Obstructive Apneas, Repetitive Hypopneas, Sleep-Disordered Breathing, MARPE, And CPAP


  1. Aarab Ghizlane and Frank Lobbezoo. "Dental changes in obstructive sleep apnea patients under oral appliance treatment are progressive in nature”. Journal of Dental Sleep Medicine2 (2015): 35-36.
  2. Addy Nancy., et al. “Policy Statement on a Dentist’s Role in Treating Sleep-Related Breathing Disorders”. Journal of Dental Sleep Medicine1 (2018): 25-26.
  3. Al Kawari and Huda M. "Alternate Rapid Maxillary Expansion and Constriction (alt-ramec) and Mini-screw Assisted Rapid Palatal Expansion (MARPE) Appliance. A Comprehensive Literature Review”. International Journal of Medical Dentistry3 (2021): 317-323.
  4. American Thoracic Society. "Positive Airway Pressure (CPAP and BPAP) for Adults with Obstructive Sleep Apnea”. ATS - American Thoracic Society (2015).
  5. Benjafield Adam V., et al. “Estimation of the Global Prevalence and Burden of Obstructive Sleep Apnea: A Literature-Based Analysis”. The Lancet. Respiratory Medicine8 (2019): 687-6398.
  6. Brunetto DP., et al. “Mini-implant Assisted Rapid Palatal Expansion (MARPE) Effects on Adult Obstructive Sleep Apnea (OSA) and Quality of Life: A Multi-Center Prospective Controlled Trial”. Progress in Orthodontics1 (2022).
  7. Brunetto DP., et al. “Non-Surgical Treatment of Transverse Deficiency in Adults Using Microimplant-Assisted Rapid Palatal Expansion (MARPE)”. Dentsal Press Journal of Orthodontics 22 (2021): 110-125.
  8. Bud Eugen Silviu., et al. “Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) With or Without the Use of Corticopuncture Therapy”. Biology3 (2021): 187.
  9. Byrne A. "How does auto-continuous positive airway pressure (CPAP) compare with fixed-pressure CPAP in time of machine use for adults with obstructive sleep apnea (OSA)?" Cochrane Clinical Answers (2020).
  10. Calik MW. "Treatments for Obstructive Sleep Apnea”. Research Gate (2016).
  11. Chen Weiting., et al. “Palatal Bone Thickness at the Implantation Area of Maxillary Skeletal Expander in Adult Patients with Skeletal Class III Malocclusion: A Cone-Beam Computed Tomography Study”. BMC Oral Health 21 (2021): 1-9.
  12. Cunha Amanda Carneiro da., et al. “Miniscrew-Assisted Rapid Palatal Expansion for Managing Arch Perimeter In An Adult Patient”. Dental Press Journal of Orthodontics1 (2017): 97-108.
  13. Da Cunha Amanda C., et al. “Miniscrew-Assisted Rapid Palatal Expansion for Managing Arch Perimeter in an Adult Patient”. Dental Press Journal of Orthodontics 3 (2017): 97-108.
  14. Loriato Lívia and Carlos E Ferreira. "Surgically-Assisted Rapid Maxillary Expansion (SARME): Indications, Planning and Treatment of Severe Maxillary Deficiency in an Adult Patient”. Dental Press Journal of Orthodontics 3 (2020): 73-84.
  15. De MeloQuintela Marcelo., et al. “Miniscrew-assisted Rapid Palatal Expansion (MARPE) Protocols Applied In Different Ages And Stages Of Maturation Of The Midpalatal Suture: Cases Report”. Research, Society and Development 11 (2021): e503101119480-e503101119480.
  16. De Oliveira Cibele Braga., et al. “Microimplant Assisted Rapid Palatal Expansion Vs Surgically Assisted Rapid Palatal Expansion for Maxillary Transverse Discrepancy Treatment”. American Journal of Orthodontics and Dentofacial Orthopedics 6 (2021): 733-742.
  17. Eckert Danny J and Atul Malhotra. “Pathophysiology of Adult Obstructive Sleep Apnea”. Proceedings of the American Thoracic Society 2 (2008): 144-153.
  18. Eugen-Silviu Bud., et al. “Retrospective Case Series regarding the Advantages of Cortico-Puncture (CP) Therapy in Association with Micro-Implant Assisted Rapid Palatal Expander (MARPE)”. Applied Sciences 3 (2021): 1306.
  19. Garib Daniela G., et al. “Rapid Maxillary Expansion-Tooth Tissue-Borne Versus Tooth-Borne Expanders: A Computed Tomography Evaluation of Dentoskeletal Effects”. The Angle Orthodontist4 (2005): 548-557.
  20. Hur Jae-Sik., et al. “Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis”. The Korean Journal of Orthodontics6 (2017): 353-364.
  21. Jeon Ji Yoon., et al. “The success and Effectiveness of Miniscrew-Assisted Rapid Palatal Expansion Are Age-And Sex-Dependent”. Clinical Oral Investigations (2021): 1-11.
  22. Jia Haichao., et al. “Comparison of Skeletal Maxillary Transverse Deficiency Treated By Microimplant-Assisted Rapid Palatal Expansion and Tooth-Borne Expansion During The Post-Pubertal Growth Spurt Stage: A Prospective Cone Beam Computed Tomography Study”. The Angle Orthodontist1 (2021): 36-45.
  23. Kandasamy Sanjivan. "Schwarz Expansion Appliance”. American Journal of Orthodontics and Dentofacialorthopaedics6 (2006): 697.
  24. Kapetanovic A., et al. “Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: A systematic review and meta-analysis”. The European Journal of Orthopaedic 43 (2021): 313-323.
  25. Karakuła Kaja Hanna., et al. “The Relationships between Obstructive Sleep Apnea and Psychiatric Disorders: A Narrative Review”. Current Problems of Psychiatry1 (2021): 46-53.
  26. Kawaiah Abdal Hadi., et al. “MARPE for the Treatment and Cure of OSAS: Aruba Experience”. Asian Journal of Medical Sciences5 (2020): 103-107.
  27. Kulshrestha Rohit. "Advanced Light Wire Functionals (ALF) in Orthodontics”. Archives of Dentistry and Oral Health1 (2019): 18-19.
  28. Kumar Nishaevitha., et al. “Miniscrew Assisted Rapid Palatal Expansion (Marpe)–Expanding Horizons To Achieve An Optimum In Transverse Dimension: A Review”. European Journal of Molecular and Clinical Medicine 2 (2021): 389-403.
  29. Lee Keun-Ha., et al. “Maxillomandibular Advancement Surgery After Long-Term Use of a Mandibular Advancement Device in a Post-Adolescent Patient With Obstructive Sleep Apnea”. The Korean Journal of Orthodontics 4 (2019): 265-276.
  30. Lee Woo-Jin., et al. “Effect of Obstructive Sleep Apnea on Cerebrovascular Compliance and Cerebral Small Vessel Disease”. PLoS ONE11 (2021): 1-14.
  31. Levine Michelle. “Dental Sleep Medicine Standards for Screening, Treating, and Managing Adults with Sleep-Related Breathing Disorders”. Journal of Dental Sleep Medicine3 (2018): 64-69.
  32. Li W., et al. “The comparison of CPAP and oral appliances in treatment of patients with OSA: A systematic review and meta-analysis”. Respiratory Care7 (2013): 1184-1195.
  33. Lim Zhu Wei., et al. “Obstructive Sleep Apnea Increases Risk of Female Infertility: A 14-Year Nationwide Population-Based Study”. PLoS ONE12 (2021): 1-12.
  34. Lione R., et al. “Palatal Surface and Volume in Mouth-Breathing Subjects Evaluatedwith Three-Dimensional Analysis of Digital Dental Cast-A Controlled Study”. European Journal of Orthodontics 37 (2015): 101-104.
  35. Lione R., et al. “Treatment and postreatment skeletal effects of rapid maxillary expansions studied with low-dose computed tomography in growing subjects”. American Journal of Orthodontics and Dentofacial Orthopedics 134 (2008): 389-392.
  36. Mcmanara JA. “Maxillary transverse deficiency”. American Journal of Orthodontic and Dentofacial Orthopeadics 117 (2000): 567-570.
  37. McNamara JAJr., et al. “The role of maxillary expansion in the promotion of oral and general health”. Progress in Orthodontics 16 (2015): 33.
  38. Nojima Lincoln I., et al. “Mini-Implant Selection Protocol Applied to MARPE”. Dental Press Journal of Orthodontics5 (2018): 93-115.
  39. Oliveira CB., et al. “Evaluation of factors related to the success of miniscrew-assisted rapid palatal expansion”. The Angle Orthodontist 91 (2021): 187-194.
  40. Park Jung Jin., et al. “Skeletal and Dentoalveolar Changes After Miniscrew-Assisted Rapid Palatal Expansion in Young Adults: A Cone-Beam Computed Tomography Study”. The Korean Journal of Orthodontics 2 (2017): 77-86.
  41. Peppard Paul E., et al. “Increased Prevalence of Sleep-Disordered Breathing in Adults”. American Journal of Epidemiology 9 (2013): 1006-1014.
  42. Pirelli Paola., et al. “Rapid Maxillary Expansion In Children With Obstructive Sleep Apnea Syndrome”. Sleep 4 (2004): 761-766.
  43. Quinzi Vincenzo., et al. “Comparison of Mandibular Arch Expansion by the Schwartz Appliance Using Two Activation Protocols: A Preliminary Retrospective Clinical Study”. Journal of Functional Morphology and Kinesiology 3 (2020): 61.
  44. Rossi Andrea., et al. “Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review”. International Journal of Dentistry (2021).
  45. Sateia Michael J. "International classification of sleep disorders”. Chest 5 (2014): 1387-1394.
  46. Shin Hyerin., et al. “Predictors of Midpalatal Suture Expansion by Miniscrew-Assisted Rapid Palatal Expansion In Young Adults: A Preliminary Study”. The Korean Journal of Orthodontics6 (2019): 360-371.
  47. , et al. “A Comparative Study of Three Types of Rapid Maxillary Expansion Devices in Surgically Assisted Maxillary Expansion: A Finite Element Study”. Journal of Int Oral Health 7.9 (2015): 40-46.
  48. Sutherland Kate., et al. “Efficacy Versus Effectiveness in the Treatment of Obstructive Sleep Apnea: CPAP and Oral Appliances”. Journal of Dental Sleep Medicine4 (2015): 175-181.
  49. Suzuki Hideo., et al. “Miniscrew-Assisted Rapid Palatal expander (MARPE): The Quest for Pure Orthopedic Movement”. Dental Press Journal of Orthodontics 4 (2016): 17-23.
  50. Suzuki Hideo., et al. “Miniscrew-Assisted Rapid Palatal expander (MARPE): The Quest for Pure Orthopedic Movement”. Dental Press Journal of Orthodontics 4 (2016): 17-23.
  51. Suzuki Selly S., et al. “Corticopuncture Facilitated Microimplant-Assisted Rapid Palatal Expansion”. Case Reports in Dentistry (2018): 1-12.
  52. Suzuki SS., et al. “Corticopuncture Facilicitated Microimplant -Assisted Rapid Palatal Expansion”. Case Reports in Dentistry (2018): 1-12.
  53. Tomar Arvind., et al. “Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients: A Cross-Sectional Analysis of Record-Based”. Journal of Family Medicine and Primary Care8 (2021): 3105-3110.
  54. Tsai Huei-Rou., et al. “Evaluation of Patients’ Experiences after Microimplant-Assisted Rapid Palatal Expansion (MARPE) Treatment”. Taiwanese Journal of Orthodontics1 (2021): 2-34.
  55. Tsuda Hiroko., et al. “Practical Considerations for Effective Oral Appliance use in the Treatment of Obstructive Sleep Apnea: A Clinical Review”. Sleep Science and Practice 1 (2017): 1-11.
  56. Vanderveken Olivier M. "Combination Therapy for Obstructive Sleep Apnea In Order to Achieve Complete Disease Alleviation: From Taboo to New Standard of Care”. Journal of Dental Sleep Medicine1 (2015): 7-8.
  57. Varadharajan Natarajan and Sandeep Grover. “Prevalence of Risk for Obstructive Sleep Apnea in Patients with Bipolar Disorder”. Industrial Psychiatry Journal2 (2021): 285-290.
  58. Vidalón José A., et al. “Periodontal Effects of Maxillary Expansion in Adults using Non-Surgical Expanders with Skeletal Anchorage Vs. Surgically Assisted Maxillary Expansion: A Systematic Review”. Head and Face Medicine 17 (2021): 1-12.
  59. Winsauer Heinz., et al. “Success and Complication Rate of Miniscrew Assisted Non-Surgical Palatal Expansion in Adults - a Consecutive Study using a Novel Force-Controlled Polycyclic Activation Protocol”. Head and Face Medicine 17 (2021): 1-9.
  60. Yanagihara M., et al. “Treatment of Obstructive Sleep Apnea With a Tongue-Stabilizing Device at a Single Multidisciplinary Sleep Center”. The Journal of Dental Sleep Medicine 2 (2016): 43-47.
Citation: Benoît Carrier. “Sleep Apnea Treatment with Rapid Maxillary Expansion in Adults and Children - Review of Literature”. EC Dental Science 21.5 (2022): 03-24.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before July 19, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.