{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T01:54:17Z","timestamp":1789437257974,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: This systematic review aimed to evaluate the effectiveness of currently available methods for the diagnosis and monitoring of skeletal, dental, and soft tissue changes, as well as the adequacy of follow-up protocols, in adolescents and adults treated with miniscrew-assisted rapid palatal expansion (MARPE). Materials and Methods: This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive electronic literature search was performed across five databases (PubMed, Scopus, Embase, Cochrane, and Web of Science) to identify prospective and retrospective clinical studies evaluating dental, periodontal, and alveolar bone outcomes associated with MARPE in late adolescent and adult patients. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies and the RoB 2 tool for randomized studies. The certainty of the evidence was evaluated using the GRADE approach. Owing to substantial methodological heterogeneity and limited follow-up duration, a structured qualitative (narrative) synthesis of the results was performed. Results: A total of 20 studies were included in the systematic review. The reported adverse events primarily involved hard and soft tissues and were identified using cone-beam computed tomography (CBCT), clinical and periodontal examination, panoramic and cephalometric radiography, and digital dental casts. Dental effects, including dental tipping, were frequently reported across the included studies. Alveolar bone loss was reported in 11 studies, buccal alveolar bone dehiscence in 3 studies, and failure of palatal suture opening in 6 studies. In most of the included studies, follow-up was either not reported or limited. Conclusions: The MARPE technique appears to be potentially effective in achieving transverse maxillary expansion in late adolescent and adult patients. However, the included studies report possible adverse events affecting periodontal and alveolar bone tissues, such as alveolar bone thinning and gingival hypertrophy, the assessment of which requires an integrated diagnostic approach combining CBCT imaging with clinical and periodontal examination. Overall, the certainty of the available evidence was low to very low, mainly due to a high risk of bias, methodological heterogeneity, and limited or absent follow-up in most studies. Therefore, the results should be interpreted with caution. Well-designed prospective controlled studies with standardized protocols and long-term follow-up are needed to conclusively evaluate the safety and long-term clinical stability of the MARPE technique.<\/jats:p>","DOI":"10.3390\/diagnostics16020352","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:31:46Z","timestamp":1769009506000},"page":"352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Assessment of Periodontal and Dentoalveolar Complications Following Mini-Screw-Assisted Rapid Palatal Expansion in Adults and Late Adolescents: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Barbara","family":"Frenna","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Orthodontics School, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Orthodontics School, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Fiandaca","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Orthodontics School, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renisa","family":"Basha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, School of Dentistry, Catholic University \u201cOur Lady of Good Counsel\u201d, 1000 Tirana, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Caprio","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Orthodontics School, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9335-6740","authenticated-orcid":false,"given":"Giacomo Emanuele Maria","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, La Maddalena Cancer Center, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3315-0112","authenticated-orcid":false,"given":"Alessio","family":"Verdecchia","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Orthodontics School, University of Cagliari, 09124 Cagliari, Italy"},{"name":"Orthodontics Division, Instituto Asturiano de Odontolog\u00eda, Universidad de Oviedo, 33006 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4563-9804","authenticated-orcid":false,"given":"Enrico","family":"Spinas","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Orthodontics School, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"432","DOI":"10.2319\/080919-522.1","article-title":"Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion","volume":"90","author":"Li","year":"2020","journal-title":"Angle Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"353","DOI":"10.4041\/kjod.2017.47.6.353","article-title":"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","volume":"47","author":"Hur","year":"2017","journal-title":"Korean J. Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Benetti, M., Montresor, L., Trevisiol, L., D\u2019Agostino, A., Zerman, N., Verdecchia, A., and Spinas, E. (2024). Health and TMJ Function in Adult Patients Treated for Dentoskeletal Open Bite with Orthognathic Surgery\u2014A Retrospective Cohort Study. Appl. Sci., 14.","DOI":"10.3390\/app14188559"},{"key":"ref_4","first-page":"150","article-title":"The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification","volume":"12","author":"Franzini","year":"2023","journal-title":"J. World Fed. Orthod."},{"key":"ref_5","first-page":"161","article-title":"Effect of customized 3D-printed MARPE appliance on hard tissues, soft tissues, and airway: A prospective CBCT study","volume":"14","author":"Mehta","year":"2025","journal-title":"J. World Fed. Orthod."},{"key":"ref_6","first-page":"S54","article-title":"Miniscrew-assisted rapid palatal expansion: A review of recent reports","volume":"9","author":"Baik","year":"2020","journal-title":"J. World Fed. Orthod."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1615\/JLongTermEffMedImplants.2021038874","article-title":"Evaluation of Soft Tissue and Airway Changes in Individuals Treated with Mini-Implant Assisted Rapid Palatal Expansion (MARPE)","volume":"32","author":"Shetty","year":"2022","journal-title":"J. Long-Term Eff. Med. Implant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/ejo\/cjab005","article-title":"Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: A systematic review and meta-analysis","volume":"43","author":"Theodorou","year":"2021","journal-title":"Eur. J. Orthod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"546","DOI":"10.4103\/njcp.njcp_105_17","article-title":"Evaluation of the success and complication rates of self-drilling orthodontic mini-implants","volume":"21","author":"Gurdan","year":"2018","journal-title":"Niger. J. Clin. Pr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2993","DOI":"10.1007\/s00784-021-04281-0","article-title":"The success and effectiveness of miniscrew-assisted rapid palatal expansion are age- and sex-dependent","volume":"26","author":"Jeon","year":"2022","journal-title":"Clin. Oral Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5343","DOI":"10.1007\/s00784-023-05154-4","article-title":"What is the impact of miniscrew-assisted rapid palatal expansion on the midfacial soft tissues? A prospective three-dimensional stereophotogrammetry study","volume":"27","author":"Krijt","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Labunet, A., Iosif, C., Kui, A., Vigu, A., and Sava, S. (2024). Miniscrew-Assisted Rapid Palatal Expansion: A Scoping Review of Influencing Factors, Side Effects, and Soft Tissue Alterations. Biomedicines, 12.","DOI":"10.3390\/biomedicines12112438"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2319\/051420-436.1","article-title":"Evaluation of factors related to the success of miniscrew-assisted rapid palatal expansion","volume":"91","author":"Oliveira","year":"2021","journal-title":"Angle Orthod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1007\/s00784-021-04284-x","article-title":"Dentoskeletal changes and their correlations after micro-implant-assisted palatal expansion (MARPE) in adults with advanced midpalatal suture ossification","volume":"26","author":"Salmoria","year":"2022","journal-title":"Clin. Oral Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Sterne, J.A.C., Hern\u00e1n, M.A., Reeves, B.C., Savovi\u0107, J., Berkman, N.D., Viswanathan, M., Henry, D., Altman, D.G., Ansari, M.T., and Boutron, I. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355.","DOI":"10.1136\/bmj.i4919"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.jclinepi.2011.01.012","article-title":"GRADE guidelines 6. Rating the quality of evidence\u2014Imprecision","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"713","DOI":"10.2319\/101415-689.1","article-title":"Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults","volume":"86","author":"Choi","year":"2016","journal-title":"Angle Orthod."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4041\/kjod.2017.47.5.313","article-title":"Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion","volume":"47","author":"Lim","year":"2017","journal-title":"Korean J. Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Bud, E.S., Bic\u0103, C.I., P\u0103curar, M., Vaida, P., Vlasa, A., Martha, K., and Bud, A. (2021). Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy. Biology, 10.","DOI":"10.3390\/biology10030187"},{"key":"ref_22","first-page":"66","article-title":"Evaluation of Dental Changes After Mini-Implant Assisted Rapid Maxillary Expansion in Young Adults: CBCT Study","volume":"342","author":"Madeeh","year":"2023","journal-title":"Georgian Med. News"},{"key":"ref_23","first-page":"e269","article-title":"Correlation of age and skeletal effects after miniscrew assisted rapid palatal expansion","volume":"15","author":"Benitez","year":"2023","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4041\/kjod.2017.47.2.77","article-title":"Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: A cone-beam computed tomography study","volume":"47","author":"Park","year":"2017","journal-title":"Korean J. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/2321-1407.207220","article-title":"Skeletal and Dentoalveolar Changes after Skeletal Anchorage-assisted Rapid Palatal Expansion in Young Adults: A Cone Beam Computed Tomography Study","volume":"7","author":"Clement","year":"2017","journal-title":"APOS Trends Orthod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4103\/apos.apos_27_18","article-title":"Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study","volume":"8","author":"Ngan","year":"2018","journal-title":"APOS Trends Orthod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"360","DOI":"10.4041\/kjod.2019.49.6.360","article-title":"Predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion in young adults: A preliminary study","volume":"49","author":"Shin","year":"2019","journal-title":"Korean J. Orthod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e363","DOI":"10.1016\/j.ajodo.2020.11.031","article-title":"Skeletal and dental changes after maxillary expansion with a bone-borne appliance in young and late adolescent patients","volume":"159","author":"Annarumma","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4041\/kjod.2020.50.2.75","article-title":"Short-term impact of microimplant-assisted rapid palatal expansion on the nasal soft tissues in adults: A three-dimensional stereophotogrammetry study","volume":"50","author":"Lee","year":"2020","journal-title":"Korean J. Orthod."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"629","DOI":"10.4103\/jdmimsu.jdmimsu_443_23","article-title":"Comparative Evaluation of Skeletal and Dental Effects of Mini-Implant Assisted and Corticopuncture-Facilitated Rapid Palatal Expansion in Adults: A Randomized Clinical Study","volume":"18","author":"Basu","year":"2023","journal-title":"J. Datta Meghe Inst. Med. Sci. Univ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"390","DOI":"10.2319\/072322-512.1","article-title":"Skeletal and dentoalveolar effects of miniscrew-assisted rapid palatal expansion based on the length of the miniscrew: A randomized clinical trial","volume":"93","author":"Choi","year":"2023","journal-title":"Angle Orthod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.ajodo.2023.05.033","article-title":"Skeletal and dentoalveolar modifications in adults with different sagittal facial patterns after personalized miniscrew-assisted rapid palatal expansion: A prospective cone-beam computed tomography study","volume":"164","author":"Wang","year":"2023","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00056-022-00401-x","article-title":"Comparison of the short-term effects of tooth\u2013bone-borne and tooth-borne rapid maxillary expansion in older adolescents","volume":"85","author":"Gokturk","year":"2024","journal-title":"J. Orofac. Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"6253","DOI":"10.1007\/s00784-022-04577-9","article-title":"Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults with the Dutch Maxillary Expansion Device: A prospective clinical cohort study","volume":"26","author":"Odrosslij","year":"2022","journal-title":"Clin. Oral Investig."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1016\/j.ajodo.2020.09.011","article-title":"Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion","volume":"159","author":"Calil","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.ajodo.2023.02.014","article-title":"Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults","volume":"164","author":"Naveda","year":"2023","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.ajodo.2023.02.022","article-title":"Treatment effects after maxillary expansion using tooth-borne vs tissue-borne miniscrew-assisted rapid palatal expansion appliance","volume":"164","author":"Ning","year":"2023","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.xaor.2022.08.001","article-title":"A retrospective analysis of the complications associated with miniscrew-assisted rapid palatal expansion","volume":"2","author":"Yoon","year":"2022","journal-title":"AJO-DO Clin. Companion"},{"key":"ref_39","first-page":"35","article-title":"Skeletal and dentoalveolar changes in the maxillary bone morphology using two-arm maxillary expander","volume":"53","author":"Bratu","year":"2012","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_40","first-page":"e271","article-title":"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","volume":"30","author":"Elnayef","year":"2025","journal-title":"Med. Oral"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"161","DOI":"10.2500\/ajra.2010.24.3440","article-title":"Long-term effects of rapid maxillary expansion on nasal area and nasal airway resistance","volume":"24","author":"Matsumoto","year":"2010","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Ventura, V., Botelho, J., Machado, V., Mascarenhas, P., Pereira, F.D., Mendes, J.J., Delgado, A.S., and Pereira, P.M. (2022). Miniscrew-Assisted Rapid Palatal Expansion (MARPE): An Umbrella Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051287"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ejo\/25.4.353","article-title":"Dental tipping and rotation immediately after surgically assisted rapid palatal expansion","volume":"25","author":"Chung","year":"2003","journal-title":"Eur. J. Orthod."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1093\/ejo\/26.4.403","article-title":"Skeletal and dental changes following surgically assisted rapid palatal expansion","volume":"26","author":"Byloff","year":"2004","journal-title":"Eur. J. Orthod."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Sicca, N., Benedetti, G., Nieri, A., Vitale, S., Lopponi, G., Mura, S., Verdecchia, A., and Spinas, E. (2025). Comparison of Side Effects Between Miniscrew-Assisted Rapid Palatal Expansion (MARPE) and Surgically Assisted Rapid Palatal Expansion (SARPE) in Adult Patients: A Scoping Review. Dent. J., 13.","DOI":"10.3390\/dj13020047"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1164\/rccm.2008167","article-title":"Mandibular advancement devices: Rate of contraindications in 100 consecutive obstructive sleep apnea patients","volume":"166","author":"Petit","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/352\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:39:28Z","timestamp":1769009968000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16020352"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16020352","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]}}}