A Breakthrough for Breathing & Bite
Miniscrew-Assisted Rapid Palatal Expansion in Sacramento
MARPE — Miniscrew-Assisted Rapid Palatal Expansion — is an advanced orthodontic technique that gently widens the upper jaw using a custom appliance anchored by tiny titanium miniscrews. Unlike traditional palate expanders, MARPE works for teenagers and adults because the miniscrews engage bone directly, making expansion possible even after the mid-palatal suture has begun to fuse.
At Evrigenis Orthodontics, Dr. Gregory Evrigenis brings over 22 years of clinical experience — including a faculty position at Stanford's Craniofacial Anomalies Clinic — to help Sacramento patients breathe easier, sleep better, and achieve a healthier, beautifully aligned smile.
What Is MARPE?
The upper jaw (maxilla) is made of two halves joined at the mid-palatal suture. In children, this suture is soft and easy to expand. In older teens and adults, the suture becomes denser — making conventional expanders ineffective.
MARPE uses four ultra-small titanium miniscrews (about 1.5 mm wide) placed just beneath the gum surface to anchor a specialized palatal expander directly into the bone of the palate. Patients or parents turn the expander's key a small amount each day, gradually separating the two halves of the palate.
New bone fills in the gap — a process called sutural expansion — permanently widening the arch, creating more space for teeth, and significantly opening the nasal airway.
Key difference from traditional expanders: MARPE works in patients ages 14–45+ because the miniscrews provide the skeletal anchorage needed to expand bone — not just teeth — even when the suture is partially or fully fused.
A narrow upper jaw often means a narrow nasal passage. When the airway is constricted, the body compensates in ways that affect sleep, energy, focus, and overall health. Patients with a narrow palate frequently experience:
- Mouth breathing and chronic nasal congestion
- Snoring and sleep-disordered breathing (SDB)
- Obstructive sleep apnea (OSA) or upper airway resistance syndrome
- Crowded or impacted teeth
- Crossbite (upper teeth biting inside lower teeth)
- Daytime fatigue, difficulty concentrating, and behavioral changes in children and teens
MARPE is frequently recommended alongside Invisalign or braces as part of a comprehensive treatment plan, and may significantly reduce or eliminate the need for jaw surgery that was previously the only adult option.
Benefits of MARPE
Palatal expansion with MARPE addresses far more than just tooth alignment — it can be truly life-changing for breathing and overall wellness.
Improved Breathing
Widens the nasal floor, increasing nasal airway volume and reducing nasal resistance for easier, fuller breaths.
Better Sleep
By opening the airway, MARPE can reduce snoring and sleep-disordered breathing, leading to deeper, more restorative sleep.
Enhanced Smile
Creates space to align crowded teeth naturally, often reducing the need for tooth extractions and improving facial esthetics.
May Avoid Surgery
MARPE often achieves results in adults that previously required orthognathic (jaw) surgery — a less invasive, lower-risk path.
Works for Adults Too
The miniscrew design makes skeletal expansion achievable for teens and adults — no age limit that traditional expanders impose.
Lasting Results
Because new bone forms in the expanded space, MARPE results are permanent — not just tooth tipping that can relapse.
Are You a Candidate?
MARPE is an excellent option for a wide range of patients. Dr. Evrigenis will evaluate your individual anatomy — including 3D cone-beam CT imaging — to confirm whether MARPE is the right approach for you.
You may be a strong candidate for MARPE if you have:
A narrow upper jaw or palate (maxillary transverse deficiency)
A posterior or anterior crossbite
Crowded or impacted teeth related to a narrow arch
Chronic mouth breathing or nasal obstruction
Snoring or diagnosed obstructive sleep apnea
Sleep-disordered breathing or upper airway resistance syndrome
A history of failed or relapsed traditional palate expansion
Age 14 and older (including adults up to their 40s and beyond)
What to Expect
MARPE treatment at Evrigenis Orthodontics is carefully planned and closely monitored every step of the way.
1
Comprehensive Evaluation
3D CBCT scan and clinical exam to assess palatal suture maturity, airway volume, and bite. Dr. Evrigenis reviews all findings with you in plain language.
2
Appliance Placement
The custom MARPE expander is bonded to the upper molars. Four miniscrews are gently placed in the palate under local anesthesia — the procedure typically takes under an hour.
3
Daily Activation at Home
You (or a parent) turns the key one or two clicks per day as instructed. The expansion phase typically lasts 4–8 weeks, with appointments every 2–3 weeks.
4
Retention Phase
After expansion is complete, the appliance stays in place for several months to allow new bone to consolidate. Braces or Invisalign can often begin during or right after this phase.
5
Smile Completion
With the arch widened and airway improved, comprehensive orthodontic treatment finishes aligning your teeth into a beautiful, healthy smile.
MARPE & Airway Health
The connection between a narrow palate and airway problems is well-established in the medical and dental literature. When the roof of the mouth is narrow, the floor of the nasal cavity is also narrow — leaving less space for air to pass through.
MARPE directly addresses this by expanding the nasal floor as the palate widens. Multiple studies have documented significant increases in nasal airway volume and reductions in nasal resistance following MARPE — with many patients reporting they can breathe through their nose comfortably for the first time in years.
For patients with sleep-disordered breathing or mild-to-moderate obstructive sleep apnea, MARPE may substantially improve or resolve symptoms, sometimes reducing dependence on CPAP therapy. We coordinate closely with sleep physicians and ENT specialists when appropriate to ensure a complete, team-based approach to your care.
Airway Improvements Patients Report
Easier nasal breathing
Many patients who were chronic mouth breathers find nasal breathing becomes natural and effortless after expansion.
Reduced snoring & sleep apnea
An expanded airway means less obstruction during sleep — partners and patients alike notice the difference.
More energy and better focus
Better sleep and improved oxygenation during the day can translate to noticeably higher energy and concentration.
Improved facial development in teens
Addressing airway restriction early in teens supports healthier jaw growth and may reduce the severity of future orthodontic issues.
Frequently Asked Questions
Have more questions? We're always happy to talk through your options at a free consultation.
Is MARPE painful?
Miniscrew placement is done under local anesthesia, so you won't feel the procedure. Patients often notice mild pressure or soreness for a day or two after placement — easily managed with over-the-counter pain relievers. The daily key activations may produce slight pressure or a tingling sensation in the nose, which is completely normal and indicates the expansion is working.
Am I too old for MARPE?
Age is rarely a barrier. MARPE has been successfully performed in patients in their 40s and beyond. The CBCT scan helps Dr. Evrigenis assess suture maturity and predict outcomes. Most adults with a narrow palate and intact suture are excellent candidates.
Will there be a gap between my front teeth?
Yes — as the palate expands, a temporary space often opens between the two upper central incisors. This is a normal and expected sign that expansion is occurring. The gap typically closes on its own within a few weeks once activation stops, and any remaining spacing is corrected during subsequent orthodontic treatment.
How does MARPE compare to orthognathic (jaw) surgery?
Jaw surgery (surgically assisted rapid palatal expansion, or SARPE) was historically the only reliable option for adults with a fused suture. MARPE is a non-surgical alternative that, for many patients, achieves comparable skeletal expansion with far less risk, recovery time, and cost. Dr. Evrigenis will discuss which approach is most appropriate based on your individual anatomy.
Can MARPE help my child or teen?
Absolutely. MARPE is an excellent option for teenagers whose suture may be partially fusing. For younger children, a conventional removable or fixed expander is often sufficient and equally effective. Dr. Evrigenis evaluates each patient individually and recommends the most appropriate appliance for their age and anatomy.
Is MARPE painful?
Miniscrew placement is done under local anesthesia, so you won't feel the procedure. Patients often notice mild pressure or soreness for a day or two after placement — easily managed with over-the-counter pain relievers. The daily key activations may produce slight pressure or a tingling sensation in the nose, which is completely normal and indicates the expansion is working.
Will insurance cover MARPE?
Coverage varies by plan. Our team will work with you to submit the necessary documentation and help you understand your benefits. We also offer flexible payment plans to make treatment accessible for every family.
How long does MARPE treatment take?
The active expansion phase typically takes 4–8 weeks. The appliance remains in place for an additional 4–6 months during the bone consolidation (retention) phase. Comprehensive orthodontic treatment — braces or Invisalign — often begins during or after this retention period and continues until your smile is complete.