Evidence-based evaluation of MARPE versus SARPE in cases of maxillary transverse deficiency: overview of reviews and GRADE assessment
Journal
Clinical and Investigative Orthodontics
ISSN
27705781
Date Issued
2026-06-04
Author(s)
Carvajal-Álvarez, Mishell
Echeverría-Carrera, Cynthia
Villareal-Ortega, Byron
Type
Article
Abstract
Purpose: To synthesize the comparative effects of mini-implant assisted rapid palatal expansion (MARPE) and surgically assisted rapid palatal expansion (SARPE) on upper airway, skeletal, and dentoalveolar dimensions in patients with maxillary transverse deficiency, and to assess certainty of evidence for each outcome using GRADE approach. Materials and methods: A hybrid evidence synthesis was undertaken, combining a FRISBEE-based overview of systematic reviews with a de novo random-effects meta-analysis of primary studies identified from those reviews. Analyses were done in RevMan Web, and certainty of evidence was assessed with GRADEpro. Prespecified outcomes were anterior nasal width, posterior nasal width, upper first molar inter-cusp distance, posterior maxillary basal width, and posterior nasal floor width. Results: Two systematic reviews comprising three primary studies (84 participants) were included. Certainty of evidence was very low for all outcomes according to GRADE. Although point estimates showed numerical differences between techniques, with trends favouring MARPE for posterior nasal width and posterior nasal floor width and SARPE for upper first molar inter-cusp distance, these findings were highly uncertain and did not support reliable comparative inferences. No definitive conclusions could be drawn from the available evidence. Conclusions: MARPE and SARPE seem to produce measurable skeletal and nasal dimensional changes, but the available evidence is of very low certainty and does not include functional respiratory outcomes. Current data are more consistent with possible clinical equivalence than with superiority of either technique. High-quality randomized trials incorporating functional respiratory outcomes and stratification by age and skeletal maturity are needed. © 2026 Japanese Orthodontic Society. Published by Informa UK Limited, trading as Taylor & Francis Group.