{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:37:46Z","timestamp":1787971066174,"version":"build-2784847793"},"reference-count":22,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Midpalatal suture expansion is effective in both growing and adult patients, and Miniscrew-Assisted Rapid Palatal Expansion (MARPE) provides greater skeletal effects and fewer dentoalveolar side effects than traditional expanders. However, asymmetric expansion remains a challenge, often influenced by pre-existing craniofacial asymmetries, appliance design, and suture morphology. In this case report, we describe asymmetric expansion with 3D-guided piezocorticotomy-assisted MARPE and its management with directly printed aligners (DPAs). Methods: A patient with facial asymmetry, a narrow maxillary arch, and multiple dentoalveolar deformities underwent pre-treatment evaluation, including root inclination analysis and CBCT imaging. A MARPE appliance with 3D-guided piezocorticotomy assistance was applied; post-expansion orthodontic treatment was digitally planned and performed with directly printed aligners. Results: During MARPE activation, asymmetric midpalatal suture disarticulation was observed, with greater displacement on the left side due to jackscrew orientation and root proximity. Post-expansion orthodontic correction with DPAs allowed precise root positioning, spatial redistribution, and improved occlusal symmetry. Over 20 months, significant improvements were achieved in midline orientation, axial root inclination, and transverse arch coordination. Conclusions: The reported case underscores the importance of pre-treatment evaluation for asymmetries and careful appliance design in MARPE protocols; in addition, it demonstrates that directly printed aligners, supported by digital planning, can provide accurate and efficient dentoalveolar correction following asymmetric expansion.<\/jats:p>","DOI":"10.3390\/jcm14217773","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:30:27Z","timestamp":1762198227000},"page":"7773","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Asymmetry Management During 3D-Guided Piezocorticotomy-Assisted MARPE Treatment with Direct Printed Aligners: Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2325-4316","authenticated-orcid":false,"given":"Svitlana","family":"Koval","sequence":"first","affiliation":[{"name":"DrKoval Orthodontics, Boca Raton, FL 33431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3164-1690","authenticated-orcid":false,"given":"Viktoriia","family":"Kolesnyk","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria","family":"Chepanova","sequence":"additional","affiliation":[{"name":"DrKoval Orthodontics, Boca Raton, FL 33431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40510-021-00397-x","article-title":"Mini-implant assisted rapid palatal expansion (MARPE) effects on adult obstructive sleep apnea (OSA) and quality of life: A multi-center prospective controlled trial","volume":"23","author":"Brunetto","year":"2022","journal-title":"Prog. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40510-018-0240-2","article-title":"Zygomaticomaxillary modifications in the horizontal plane induced by micro-implant-supported skeletal expander, analyzed with CBCT images","volume":"19","author":"Cantarella","year":"2018","journal-title":"Prog. Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.2147\/MDER.S331127","article-title":"Digital Planning and Manufacturing of Maxillary Skeletal Expander for Patients with Thin Palatal Bone","volume":"14","author":"Cantarella","year":"2021","journal-title":"Med. Devices"},{"key":"ref_4","first-page":"e243","article-title":"[Structural changes in the craniofacial complex induced by microimplant-supported skeletal expander\u2013MSE. A review]","volume":"13","year":"2025","journal-title":"Rev. Cient. Odontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.ajodo.2024.10.018","article-title":"Long-term assessment of skeletal and dental asymmetry after conventional and mini-implant-assisted rapid palatal expansion","volume":"167","author":"Barton","year":"2025","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e9216","DOI":"10.1002\/ccr3.9216","article-title":"Successful treatment for an adult with bilateral posterior teeth crossbite by miniscrew-assisted rapid palatal expansion: A case report","volume":"12","author":"Fan","year":"2024","journal-title":"Clin. Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1097\/SCS.0000000000010758","article-title":"Miniscrew-assisted Rapid Palatal Expansion Before Orthognathic Surgery for a Patient with Laterognathia","volume":"36","author":"Albayrak","year":"2025","journal-title":"J. Craniofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101443","DOI":"10.1016\/j.jormas.2023.101443","article-title":"An adult case of unilateral posterior crossbite caused by maxillary transverse deficiency treated with miniscrew-assisted rapid palatal expansion","volume":"124","author":"Takagi","year":"2023","journal-title":"J. Stomatol. Oral. Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1111\/ocr.12531","article-title":"Three-dimensional assessment of asymmetric mid-palatal suture expansion assisted by a customized microimplant-supported rapid palatal expander in non-growing patients: Uncontrolled Clinical Trial","volume":"25","author":"Almaqrami","year":"2022","journal-title":"Orthod. Craniofac Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/ocr.12320","article-title":"Asymmetric nasomaxillary expansion induced by tooth-bone-borne expander producing differential craniofacial changes","volume":"22","author":"Kim","year":"2019","journal-title":"Orthod. Craniofac Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Koval, S., Kolesnyk, V., and Chepanova, D. (2025). Applications of the Novel Midpalatal Piezocorticotomy Guide for MARPE Midfacial Skeletal Expansion. J. Clin. Med., 14.","DOI":"10.20944\/preprints202506.1325.v1"},{"key":"ref_12","first-page":"1","article-title":"Orbito-Condylion and Orbito-Basion Lines as Alternatives to Frankfurt and Sella- Nasion Lines in Cephalometry","volume":"17","author":"Vedavathi","year":"2022","journal-title":"Iran. J. Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0889-5406(93)70010-L","article-title":"Facial keys to orthodontic diagnosis and treatment planning. Part I","volume":"103","author":"Arnett","year":"1993","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0889-5406(99)70234-9","article-title":"Soft tissue cephalometric analysis: Diagnosis and treatment planning of dentofacial deformity","volume":"116","author":"Arnett","year":"1999","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chun, J.-H., de Castro, A.C.R., Oh, S., Kim, K.-H., Choi, S.-H., Nojima, L.I., and Lee, K.-J. (2022). Skeletal and alveolar changes in conventional rapid palatal expansion (RPE) and miniscrew-assisted RPE (MARPE): A prospective randomized clinical trial using low-dose CBCT. BMC Oral. Health, 22.","DOI":"10.1186\/s12903-022-02138-w"},{"key":"ref_16","first-page":"105","article-title":"Biomechanics of conventional and miniscrew-assisted rapid palatal expansion","volume":"13","author":"Mehta","year":"2024","journal-title":"J. World Fed. Orthod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.ajodo.2015.04.043","article-title":"Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult","volume":"149","author":"Carlson","year":"2016","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/ocr.12452","article-title":"Clinical applications of miniscrews that broaden the scope of non-surgical orthodontic treatment","volume":"24","author":"Choi","year":"2021","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"105616","DOI":"10.1016\/j.jdent.2025.105616","article-title":"3D-printed clear aligners: An emerging alternative to the conventional thermoformed aligners?\u2014A systematic review","volume":"155","author":"Torkomian","year":"2025","journal-title":"J. Dent."},{"key":"ref_21","first-page":"658","article-title":"Direct-printed aligners: A clinical status report","volume":"58","author":"Ludwig","year":"2024","journal-title":"J. Clin. Orthod."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, S.Y., Kim, H., Kim, H.-J., Chung, C.J., Choi, Y.J., Kim, S.-J., and Cha, J.-Y. (2022). Thermo-mechanical properties of 3D printed photocurable shape memory resin for clear aligners. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-09831-4"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7773\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:52:27Z","timestamp":1762199547000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,1]]},"references-count":22,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217773"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217773","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,1]]}}}