Comparative evaluation of Er:YAG laser assisted corticotomy vs. MARPE using the Keles Keyless Expander: A case report

The aim of this comparative case report is to evaluate the skeletal, dental, and airway effects of two CAD-CAM-designed maxillary expansion protocols using the Keles Keyless Expander (KKE): a Hyrax-type expander with Er:YAG laser-assisted corticotomy(LAC), and a MARPE appliance stabilized with four palatal miniscrews. To our knowledge, this is the first report describing the use of LAC techniques in SARPE, underscoring its novelty and clinical significance.

Two female patients, both 18 years of age, were included. In the first case, a Hyrax-type expander with a 12-mm keyless screw was used, and LAC was performed with an Er:YAG laser. In the second case, a MARPE appliance with four mini-screws and an 8-mm keyless screw was applied. Pre-post-expansion cone-beam computed tomography(CBCT) scans were obtained for both patients, measurements were analyzed and compared.

The KKE with corticotomy produced marked more dental effects, while the MARPE appliance showed a distinct skeletal expansion pattern. Molar inclination increased buccally by 7.8° in the laser case but decreased lingually by 1.8° in the MARPE case. The midpalatal suture opening was more parallel in the MARPE group.

Both expansion protocols demonstrated measurable skeletal, dental, and airway changes, yet with different patterns of response. LAC provided pronounced skeletal and dental effects, whereas the MARPE appliance achieved a more parallel midpalatal suture opening without buccal tipping of molars. These differences highlight the importance of appliance selection and adjunctive techniques in treatment planning. Larger prospective studies are needed to confirm long-term stability and clinical applicability.