Abstract

Expansion in Non-Growing Patients: How Far Can We Go, Indications and Limits

by Contardo Luca

Maxillary transverse deficiency is a common finding even beyond the pubertal growth period, but its correction becomes progressively more challenging as skeletal maturation advances, owing to the increasing interdigitation and eventual fusion of the midpalatal suture. While conventional tooth-borne rapid palatal expansion (RPE/RME) remains the well-established gold standard in the growing patient, treatment selection in the patient at the end of growth requires a more nuanced assessment. Available therapeutic options range from non-surgical miniscrew-assisted rapid palatal expansion (MARPE) to surgically assisted rapid palatal expansion (SARPE), with minimally invasive intermediate procedures—such as corticotomies and corticopuncture—proposed to overcome the limitations of MARPE in patients with advanced skeletal maturation. MARPE frequently achieves skeletal expansion values comparable to those obtained with SARPE, with lower morbidity and biological cost; however, the scientific evidence regarding its actual efficacy and long-term outcomes remains limited, and reliable clinical and radiographic predictors of success or failure have yet to be established. SARPE, although associated with the inherent risks, costs, and morbidity of a surgical procedure, remains the more predictable option in more severe deficiencies or in fully mature patients. The aim of this lecture is to provide a practical decision-making framework—diagnostic, biomechanical, and prognostic—to address the question "how far can we go": to what extent stable skeletal expansion can be achieved without surgery, what the real limits of MARPE are across different stages of suture maturation, and when SARPE remains the treatment of choice.