TOWARDS AN EVIDENCE-BASED PROTOCOL FOR MAXILLARY EXPANSION: THE CRITICAL IMPORTANCE OF MIDPALATAL SUTURE MATURATION

This study analyzed factors influencing the choice between Rapid Palatal Expansion (RPE), Miniscrew-Assisted RPE (MARPE), and Surgically Assisted RPE (SARPE) for treating maxillary transverse deficiency. Through a systematic review of literature from 2015-2025, key selection criteria were identified. The maturation stage of the midpalatal suture (Angelieri classification) was found to be the most critical factor, superseding chronological age, with non-surgical expansion becoming less predictable in advanced fusion stages (D and E). Additional factors include bone density, patient sex, and device positioning. The findings underscore the necessity for CBCT-based, personalized treatment protocols to ensure successful skeletal expansion, optimize clinical outcomes, and improve long-term stability.