MARPE结合数字化在临床实践中的创新应用

doi:10.13591/j.cnki.kqyx.2026.07.011

摘要/Abstract

摘要：

微种植钉辅助上颌快速扩弓(miniscrew-assisted rapid palatal expansion,MARPE)作为治疗成人上颌横向发育不足的创新技术,正逐步取代传统上颌扩弓技术。尽管MARPE技术在生物力学机制与临床疗效方面积累了丰富研究证据,但随着人工智能在医学领域应用愈加广泛,如何实现技术革新与数字化诊疗体系的有机融合仍待深入探索。本研究通过整合生物力学分析、临床疗效评估及新型装置设计三大研究方向,重点探索三维影像与人工智能技术的协同应用,致力于为成人上颌横向发育不足的精准矫治提供科学依据,推动正畸治疗向个性化、数字化方向发展。

关键词: 微种植钉辅助上颌快速扩弓, 上颌横向发育不足, 腭中缝分期

Abstract:

Miniscrew-assisted rapid palatal expansion(MARPE), a transformative approach for adult maxillary transverse deficiency, is increasingly superseding conventional palatal expansion. While MARPE boasts robust evidence in biomechanical efficacy and clinicaloutcomes, its seamless integration with AI-driven digital diagnostic systems remains under-explored. This study converges biomechanical analysis, clinical evaluation, and novel device design to pioneer synergistic applications of 3D imaging and AI technologies. By advancing data-driven protocols for customized force delivery and skeletal adaptation, this work aims to establish a scientific foundation for precision orthodontic correction, propelling the evolution of personalized and digitized treatment paradigms.

Key words: miniscrew-assisted rapid palatal expansion, transverse maxillary deficiency, palatal suture stage

中图分类号:

R783.5

王芯萌, 李依梅, 常新. MARPE结合数字化在临床实践中的创新应用[J]. 口腔医学, 2026, 46(7): 555-560.

WANG Xinmeng, LI Yimei, CHANG Xin. Innovative clinical applications of MARPE techniques integrated with digital technologies[J]. Stomatology, 2026, 46(7): 555-560.

参考文献 46

[1]	张赟, 李小兵. 上颌扩弓疗效评价的临床意义及发展方向[J]. 口腔医学, 2022, 42(7): 659-663.
[2]	Shen J, Liu ZY, Shuai J, et al. Transverse dentoalveolar development in Chinese children and adolescents: A cross-sectional study using revised Andrews’ Element Ⅲ analysis[J]. Am J Orthod Dentofac Orthop, 2025, 167(2): 144-153. doi: 10.1016/j.ajodo.2024.08.015
[3]	Chaconas SJ, Caputo AA. Observation of orthopedic force distribution produced by maxillary orthodontic appliances[J]. Am J Orthod, 1982, 82(6): 492-501. doi: 10.1016/0002-9416(82)90318-9 pmid: 6760725
[4]	Cho AR, Park JH, Moon W, et al. Short-term effects of microimplant-assisted rapid palatal expansion on the circummaxillary sutures in skeletally mature patients: A cone-beam computed tomography study[J]. Am J Orthod Dentofac Orthop, 2022, 161(2): e187-e197. doi: 10.1016/j.ajodo.2021.01.023
[5]	史晓扬, 林雪芬, 马驰, 等. 上颌骨性扩弓器对成年女性眼眶容积的评价[J]. 华西口腔医学杂志, 2022, 40(3): 314-319.
[6]	Lázaro-Abdulkarim A, Hernández-Alfaro F, Puigdollers-Pérez A, et al. Is efficacy of miniscrew-assisted rapid palatal expansion in mid to late adolescents and young adults related to craniofacial sutures opening?A systematic review and meta-analysis[J]. Med Oral, 2025: e271-e281.
[7]	Chun JH, de Castro ACR, Oh S, et al. Skeletal and alveolar changes in conventional rapid palatal expansion(RPE)and miniscrew-assisted RPE(MARPE): A prospective randomized clinical trial using low-dose CBCT[J]. BMC Oral Health, 2022, 22(1): 114. doi: 10.1186/s12903-022-02138-w
[8]	Jia HC, Zhuang L, Zhang N, 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[J]. Angle Orthod, 2021, 91(1): 36-45. doi: 10.2319/041920-332.1 pmid: 33289835
[9]	Naveda R, Dos Santos AM, Miranda F, et al. Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs. middle-aged adults[J]. Am J Orthod Dentofac Orthop, 2023, 164(3): 416-422. doi: 10.1016/j.ajodo.2023.02.014
[10]	Pan SY, Gao X, Sun JC, et al. Effects of novel microimplant-assisted rapid palatal expanders manufactured by 3-dimensional printing technology: A finite element study[J]. Am J Orthod Dentofac Orthop, 2023, 164(5): 700-711. doi: 10.1016/j.ajodo.2023.04.020
[11]	Li QM, Tang HY, Liu XY, et al. Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion[J]. Angle Orthod, 2020, 90(3): 432-441. doi: 10.2319/080919-522.1
[12]	Kim SY, Park YC, Lee KJ, et al. Assessment of changes in the nasal airway after nonsurgical miniscrew-assisted rapid maxillary expansion in young adults[J]. Angle Orthod, 2018, 88(4): 435-441. doi: 10.2319/092917-656.1
[13]	Mehta P, Singh AK, Malhotra A, et al. Effect of customized 3D-printed MARPE appliance on hard tissues, soft tissues, and airway: A prospective CBCT study[J]. J World Fed Orthod, 2025, 14(3): 161-169.
[14]	Sin Ç, Akkaya N, Aksoy S, et al. A deep learning algorithm proposal to automatic pharyngeal airway detection and segmentation on CBCT images[J]. Orthod Craniofacial Res, 2021, 24(S2): 117-123. doi: 10.1111/ocr.v24.s2
[15]	Lee SR, Lee JW, Chung DH, et al. Short-term impact of microimplant-assisted rapid palatal expansion on the nasal soft tissues in adults: A three-dimensional stereophotogrammetry study[J]. Korean J Orthod, 2020, 50(2): 75. doi: 10.4041/kjod.2020.50.2.75
[16]	Mehta S, Vishwanath M, Patel A, et al. Long-term evaluation of soft-tissue changes after miniscrew-assisted and conventional rapid palatal expansion using voxel-based superimposition of cone-beam computed tomography scans[J]. Am J Orthod Dentofac Orthop, 2024, 165(3): 332-343. doi: 10.1016/j.ajodo.2023.09.017
[17]	Büyükçavuş MH, Findik Y, Baykul T. Evaluation of changes in nasal projection after surgically assisted rapid maxillary expansion with 3dMD face system[J]. J Craniofacial Surg, 2020, 31(5): e462-e465. doi: 10.1097/SCS.0000000000006436
[18]	Alkhayer A, Becsei R, Hegedüs L, et al. Evaluation of the soft tissue changes after rapid maxillary expansion using a handheld three-dimensional scanner: A prospective study[J]. Int J Environ Res Public Health, 2021, 18(7): 3379. doi: 10.3390/ijerph18073379
[19]	Seifert LB, Beyer M, Czok V, et al. Comparative accuracy of stationary and smartphone-based photogrammetry in oral and maxillofacial surgery: A clinical study[J]. J Clin Med, 2024, 13(22): 6678. doi: 10.3390/jcm13226678
[20]	Choi SH, Shi KK, Cha JY, et al. Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults[J]. Angle Orthod, 2016, 86(5): 713-720. doi: 10.2319/101415-689.1
[21]	Tang HY, Liu PP, Liu XY, et al. Skeletal width changes after mini-implant-assisted rapid maxillary expansion(MARME)in young adults[J]. Angle Orthod, 2021, 91(3): 301-306. doi: 10.2319/052920-491.1
[22]	Zeng WQ, Yan SY, Yi YT, et al. Long-term efficacy and stability of miniscrew-assisted rapid palatal expansion in mid to late adolescents and adults: A systematic review and meta-analysis[J]. BMC Oral Health, 2023, 23(1): 829. doi: 10.1186/s12903-023-03574-y pmid: 37924088
[23]	Park JJ, Park KH, Kim SH, et al. Critical issues concerning miniscrew-assisted rapid palatal expanders: A narrative review[J]. Semin Orthod, 2025, 31(2): 179-186. doi: 10.1053/j.sodo.2024.04.003
[24]	Tarraf NE, Küffer M, de Gabriele O, et al. Principals for placement and expansion protocol for the bone-first Quadexpander in adolescents and adults[J]. Semin Orthod, 2025, 31(2): 197-206. doi: 10.1053/j.sodo.2024.09.003
[25]	Ponna P, Tarraf NE, Dalci K, et al. Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: A single-centre retrospective study[J]. Eur J Orthod, 2024, 46(2): cjad080.
[26]	Zhong XH, Wang HX. Dentoperiodontal and skeletal changes induced by miniscrew-assisted rapid maxillary expansion(C-expander)treatment in adults: A retrospective clinical trial[J]. Am J Orthod Dentofac Orthop, 2024, 165(3): 303-313. doi: 10.1016/j.ajodo.2023.09.013
[27]	Bai J, Choi JY, Kim SH. The design of bone-borne maxillary expander affects the different dentoalveolar inclination and expansion pattern: A CBCT study[J]. Semin Orthod, 2025, 31(2): 258-270. doi: 10.1053/j.sodo.2024.05.002
[28]	Ceschi M, Riatti R, Di Leonardo B, et al. Skeletal expansion using a miniscrew-assisted rapid palatal expansion in a 50-year-old patient[J]. Am J Orthod Dentofac Orthop, 2022, 162(4): 568-579. doi: 10.1016/j.ajodo.2021.03.030
[29]	Winsauer H, Walter A, Katsaros C, 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[J]. Head Face Med, 2021, 17(1): 50. doi: 10.1186/s13005-021-00301-2 pmid: 34895287
[30]	Meirelles CM, Ferreira RM, Suzuki H, et al. Analysis of factors associated with the success of microimplant-assisted rapid palatal expansion[J]. Am J Orthod Dentofac Orthop, 2023, 164(1): 67-77. doi: 10.1016/j.ajodo.2022.10.029
[31]	罗卫红, 徐晓南, 王壬, 等. 超声骨刀劈开腭中缝辅助MSE对上颌宽度不足扩弓效果的研究[J]. 实用口腔医学杂志, 2022, 38(2): 234-238.
[32]	Angelieri F, Cevidanes LHS, Franchi L, et al. Midpalatal suture maturation: Classification method for individual assessment before rapid maxillary expansion[J]. Am J Orthod Dentofac Orthop, 2013, 144(5): 759-769. doi: 10.1016/j.ajodo.2013.04.022
[33]	Barbosa NMV, de Castro AC, Conti F, et al. Reliability and reproducibility of the method of assessment of midpalatal suture maturation: A tomographic study[J]. Angle Orthod, 2019, 89(1): 71-77. doi: 10.2319/121317-859.1 pmid: 30230376
[34]	Georgi GM, Knauth S, Hirsch E, et al. Age-related changes in the midpalatal suture: Comparison between CBCT staging and bone micromorphology[J]. Bone, 2024, 179: 116984. doi: 10.1016/j.bone.2023.116984
[35]	Grünheid T, Larson CE, Larson BE. Midpalatal suture density ratio: A novel predictor of skeletal response to rapid maxillary expansion[J]. Am J Orthod Dentofac Orthop, 2017, 151(2): 267-276. doi: 10.1016/j.ajodo.2016.06.043
[36]	Eguren M, Liñán-Duran C, Quezada M, et al. Midpalatal suture density ratio after rapid maxillary expansion evaluated by cone-beam computed tomography[J]. Am J Orthod Dentofac Orthop, 2022, 161(2): 238-247. doi: 10.1016/j.ajodo.2020.07.040
[37]	Gao L, Chen ZY, Zang L, et al. Midpalatal suture CBCT image quantitive characteristics analysis based on machine learning algorithm construction and optimization[J]. Bioengineering, 2022, 9(7): 316. doi: 10.3390/bioengineering9070316
[38]	Chung M, Zhang WY, Zhu YF, et al. A novel system for classification for midpalatal suture ossification based on pseudocolored and multilayer reconstructed coronal slices: Indication for selection of maxillary expansion methods[J]. Am J Orthod Dentofac Orthop, 2025, 167(4): 409-424. doi: 10.1016/j.ajodo.2024.10.019
[39]	Wilmes B, De Gabriele R, Dallatana G, et al. “Bone first”principle with CAD/CAM insertion guides for mini-implant-assisted rapid palatal expansion[J]. J Clin Orthod, 2022, 56(3): 158-166.
[40]	Al-Gazzawi AMQ, Knode V, Ludwig B, et al. Midpalatal miniscrew insertion: The accuracy of digital planning and surgical placement[J]. Am J Orthod Dentofac Orthop, 2024, 166(1): 69-75. doi: 10.1016/j.ajodo.2024.02.014
[41]	Choi EA, Lee KJ, Choi SH, et al. Skeletal and dentoalveolar effects of miniscrew-assisted rapid palatal expansion based on the length of the miniscrew: A randomized clinical trial[J]. Angle Orthod, 2023, 93(4): 390-397. doi: 10.2319/072322-512.1
[42]	de Medeiros Alves AC, de Carvalho NO, de Paiva Cunha ÂCP, et al. Do the miniscrews of the prefabricated systems for the“appliance first”protocol of miniscrew-assisted rapid palatal expansion have lengths that meet the palatal thickness of patients?[J]. Am J Orthod Dentofac Orthop, 2023, 163(6): e152-e161. doi: 10.1016/j.ajodo.2023.03.012
[43]	Kapetanović A, Odrosslij BMMJ, Baan F, et al. Efficacy of miniscrew-assisted rapid palatal expansion(MARPE) in late adolescents and adults with the Dutch maxillary expansion device: A prospective clinical cohort study[J]. Clin Oral Investig, 2022, 26(10): 6253-6263. doi: 10.1007/s00784-022-04577-9
[44]	Williams BJD, Currimbhoy S, Silva A, et al. Complications following surgically assisted rapid palatal expansion: A retrospective cohort study[J]. J Oral Maxillofac Surg, 2012, 70(10): 2394-2402. doi: 10.1016/j.joms.2011.09.050
[45]	Loriato L, Ferreira CE. Surgically-assisted rapid maxillary expansion(SARME): Indications, planning and treatment of severe maxillary deficiency in an adult patient[J]. Dent Press J Orthod, 2020, 25(3): 73-84. doi: 10.1590/2177-6709.25.3.073-084.bbo
[46]	Herber V, Okutan B, Antonoglou G, et al. Bioresorbable magnesium-based alloys as novel biomaterials in oral bone regeneration: General review and clinical perspectives[J]. J Clin Med, 2021, 10(9): 1842. doi: 10.3390/jcm10091842