The non-surgical Micro-Implant Assisted Rapid Palatal Expander (MARPE) has evolved significantly since its introduction in the early 2000s, and its use continues to expand worldwide. With the increasing number of MARPE-related publications, strong evidence now supports its clinical impact.

This seminar will briefly compare maxillary skeletal expander with traditional expansion devices and other MARPE systems before focusing on the latest research findings—both published and unpublished—and their influence on clinical protocols. Clinical cases from both adolescents and adults will illustrate these advancements.

While MARPE has transformed treatment possibilities, its success has not always been predictable, particularly in mature male patients. Through clinical studies, computer simulations, and innovative treatment modifications, many of these challenges can now be overcome safely and effectively. Updates will include strategies for addressing difficult scenarios such as extremely thick or thin palatal bone, narrow palatal vaults, massive zygomas, palatal tori, and skeletal asymmetries.

The integration of digital workflows in MARPE fabrication and modification has further improved outcomes. A new cloud-based digital platform designed for easy clinical adoption will be introduced for the first time, along with its clinical applications.

For extremely difficult cases, minimally invasive surgical adjuncts will be presented as alternatives to traditional SARPE. Evidence illustrating significant nasal airway enlargement, functional breathing improvements, and the impact of MARPE on obstructive sleep apnea syndrome (OSAS) will also be discussed. Finally, the role of MARPE in growth modification for younger patients, as well as distraction-like maxillary protraction in adults, will be examined—opening new possibilities for Class III treatment.

• Apply correct MARPE fabrication and positioning techniques using radiographic information and digital workflows.
• Utilize the latest digital software for MARPE planning and modification.
• Implement updated activation protocols informed by both mechanical and biological considerations.
• Adapt appliance designs for difficult clinical scenarios.
• Apply new MARPE protocols for narrow palates and for patients requiring multiple expanders.
• Manage extremely challenging cases, including those with skeletal asymmetry.
• Incorporate corticopuncture and minor surgical procedures to avoid invasive SARPE.
• Understand and manage asymmetric expansion.
• Evaluate airway changes and breathing improvements following MARPE.
• Apply MARPE in maxillary protraction for both young and mature patients.
• Troubleshoot complications and refine clinical protocols for greater predictability.

• Log-in and account creation
• Patient information entry
• Uploading CBCT and STL files
• Ordering digital preparation
• Navigating the AI-driven digital software and finalizing optimal positioning
• Downloading or forwarding the STL file of the positioner

• Examining the digitally produced typodont with MSE positioning
• Proper placement on the typodont and contouring of supporting arms

• Initial expansion
• Adding the auxiliary
• Securing the auxiliary
• Further expansion

• Placing the prefabricated MARPE onto the typodont
• Inserting micro-implants into synthetic bone using both the mini hand-driver and ratchet wrench
• Activation
• Removing micro-implants with the mini hand-driver
• Clinical tips: managing patients with thick or thin palatal bone, corticopuncture, piezo-surgery, troubleshooting, and more

• Master digital workflow for positioning and fabrication
• Perform manual fabrication techniques
• Gain hands-on experience in clinical insertion, activation, removal, and troubleshooting