Clinical Application of Surgical Guides in MARPE: Observational Research

Background/Objectives: Miniscrew-assisted rapid palatal expansion (MARPE) is an effective treatment for maxillary transverse deficiency in skeletally mature patients. However, resistance of the midpalatal suture may limit treatment success. Surgical corticopunctures have been proposed to facilitate suture opening, while digital planning and 3D-printed surgical guides may improve procedural accuracy and safety. This study aims to evaluate the clinical effectiveness and safety of MARPE combined with surgically guided midpalatal corticopunctures in adult patients. Methods: A retrospective observational study was conducted on 15 adult patients (at least 20 years old) presenting with maxillary transverse deficiency and midpalatal suture maturation stages D or E. All patients underwent corticopuncture-assisted MARPE using patient-specific 3D-printed surgical guides designed through CBCT-based virtual planning. Treatment success was assessed by postoperative cone-beam computed tomography (CBCT), which evaluated midpalatal suture opening and transverse expansion. Clinical records were reviewed for complications, mini-implant stability, and postoperative outcomes. Results: Successful opening of the midpalatal suture was achieved in 13 of 15 patients, corresponding to a success rate of 86.7%. Among successful cases, the mean suture expansion measured on CBCT was 3.6 ± 0.9 mm. The customized surgical guides demonstrated adequate intraoral fit and enabled accurate execution of the planned corticopunctures in all cases. No intraoperative guide-related complications were reported. Postoperative healing was uneventful, with only mild and transient discomfort observed. No infections, excessive bleeding, significant soft-tissue injuries, damage to adjacent anatomical structures, or adverse events related to the corticopuncture procedure were recorded. Mini-implant stability was maintained in the majority of patients throughout the expansion phase. Conclusions: Within the limitations of this retrospective single-arm study, corticopuncture-assisted MARPE performed using customized 3D-printed surgical guides was feasible and associated with a high rate of successful midpalatal suture opening and few complications. The technique demonstrated a high rate of suture opening, clinically significant skeletal expansion, and a low incidence of complications. Digital planning and guided execution may enhance treatment precision and improve clinical outcomes in MARPE procedures.