Patient: Female, 16 years
Chief Complaint
Crowding and misalignment of teeth, with a history of pediatric OSA (status post adenoidectomy and tonsillectomy 1.5 years ago).
Clinical Findings (Pre-SARPE)
- Skeletal Class I base with straight profile and competent lips
- Severe upper and lower anterior crowding
- Bilateral molar Class I relationship
- Right canine relationship not established
- History of obstructive sleep apnea in childhood
- Erupting third molars (#38, #48)
Treatment Rationale
A Surgically Assisted Rapid Palatal Expansion (SARPE) was indicated to correct severe transverse maxillary deficiency and create space for orthodontic alignment without excessive dental tipping.
CBCT Evidence for Treatment Choice:
- CBCT was taken to assess midpalatal suture status.
- According to the sutural classification by Fernanda Angelieri et al., the patient’s suture maturation was Stage D.
- This stage indicates partial suture fusion, making conventional RME less predictable in adults — supporting the decision for SARPE to ensure effective skeletal expansion.
SARPE Surgical Phase
Date: 20 July 2025
Procedure:
- Under NETT with general anaesthesia
- Vestibular incision from #14 to #24 region
- Mucoperiosteal flap reflected
- Osteotomy cut from piriform aperture to zygomatic buttress bilaterally
- Palatal corticotomy performed
- Appliance fixed: Maxillary banded Hyrax (bands on 16, 14, 26, 24)
- Mandibular banded Hyrax placed on 36, 46 (for concurrent lower expansion)
- Surgical extraction of 38 and 48 performed
Activation Protocol & Progress
- Initial activation: 2 turns on day of surgery
- Post-op: 2 turns per day initially, adjusted per tissue response
- Regular reviews for irrigation and healing assessment
- By early August 2025:
- Intended skeletal expansion achieved
- Midline diastema present
- Transverse dimension corrected as planned
Current Status
- Healing satisfactory
- Appliance stable
- Skeletal expansion confirmed clinically and radiographically
- Transverse correction achieved, meeting surgical objectives
- Orthodontic phase to proceed for alignment and occlusal detailing
Discussion
In this patient with severe transverse maxillary deficiency and Stage D midpalatal suture maturation, SARPE was the treatment of choice. The CBCT findings provided clear justification, showing advanced suture interdigitation that would limit orthopedic expansion alone. SARPE allowed controlled skeletal expansion, creation of adequate arch space, and correction of transverse deficiency, establishing a stable foundation for comprehensive orthodontic treatment.