Which is best for anterior palatal expansion: SARPE or Multi-Segment LeForte I?

[David_D]

My goal is to get more lateral tooth show and expand my upper palate.  I want the canines and adjoining premolars to be a bit less hidden and laterally-facing.  And I definitely want smaller buccal corridors.

I have a choice to make: I can have SARPE or I can have a multi-segment LeForte I.  The surgeon that I saw yesterday seemed to me to recommend the LeForte, as he thought it is possible that with the SARPE, my bite would get thrown off, thus necessitating LeForte anyway.  He also acknowledged that I could get more anterior expansion with the SARPE.

Right now, I'm leaning toward going with the SARPE, knowing that a LeForte may be required.  I don't want to make a mistake, as I've already had two two-jaw surgeries!

Does anyone have an opinion on which procedure might be better for the cosmetic purpose of creating a wide smile?

[diculo]

I would say SARPE if the primary objective is to get more tooth show. There are before and after pictures of patients who have had SARPE having a wider smile.

[David_D]

I would say SARPE if the primary objective is to get more tooth show. There are before and after pictures of patients who have had SARPE having a wider smile.

Thanks.  That's my thought as well.  I haven't really seen before and after pictures that seem to corroborate this.  I have seen YouTube video of someone who had both SARPE and LeForte who had a pretty amazing outcome that I don't imagine would have been possible with LeForte alone.  SARPE it is...

[marcus3415]

they both do the same thing. sarpe is outdated. i would say segmented lefort, but as i told you earlier--are you really sure you want to go through this again? i have similar type of deal

[Lazlo]

yeah you can get more expansion from SARPE --go for it and show us your progress as you go.

[Lestat]

Can you also get a wider face through sarpe?

[Lazlo]

Can you also get a wider face through sarpe?

no

[thinkingme]

no

alittle yes

[David_D]

they both do the same thing. sarpe is outdated. i would say segmented lefort, but as i told you earlier--are you really sure you want to go through this again? i have similar type of deal

I'm pretty sure.  I'm not pleased with my results and the buccal corridors and narrowness of the anterior upper palate is a part of that.

Based on the information I got, they do not do the same thing.  With the multi-segment LeFort, the widening would occur posteriorly and superiorly.  I understand there would still be some anterior expansion in this scenario, just not to the extent as with SARPE.  SARPE, by simply widening along the middle of the palate/jaw, will definitely cause significant anterior expansion.

I understand that between the two options, LeFort is superior when there is forward/backward (sagittal) or upward/downward (vertical) movement needed, and SARPE is superior when there these things are not needed.

That said, I can see other potential benefit from redoing the upper jaw surgery, including fixing the cant of the teeth, possibly moving the maxilla forward a bit to give more support to the midface.  Perhaps the solution is to do both procedures.

This is interesting: http://www.ncbi.nlm.nih.gov/pubmed/19062299.  This study claims somewhat more stable results for maxillary expansion via LeFort, as compared with via SARPE.

I see this also: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411735/

This article states: "...most studies reported that SARME is more stable and has lower morbidity in complications than segmental osteotomy."  Here "SARME" being the thing as SARPE.  So, different sources have a different viewpoint - this is unsurprising to me.

This second article also states: "In our case, the surgical wafer was maintained for 6 weeks and transverse relapse occurred almost immediately after wafer removal. This relapse can be explained by the short retention period, and could have been prevented by a longer retention period. The retention period after transverse gain in adult patients should be at least 3 months, and lengthening of the retention period is recommended when it is critical to maintain arch width. Phillips et al. suggested that overexpansion of 2 to 3 mm should be performed to prevent relapse."

[Lazlo]

I'm pretty sure.  I'm not pleased with my results and the buccal corridors and narrowness of the anterior upper palate is a part of that.

Based on the information I got, they do not do the same thing.  With the multi-segment LeFort, the widening would occur posteriorly and superiorly.  I understand there would still be some anterior expansion in this scenario, just not to the extent as with SARPE.  SARPE, by simply widening along the middle of the palate/jaw, will definitely cause significant anterior expansion.

I understand that between the two options, LeFort is superior when there is forward/backward (sagittal) or upward/downward (vertical) movement needed, and SARPE is superior when there these things are not needed.

That said, I can see other potential benefit from redoing the upper jaw surgery, including fixing the cant of the teeth, possibly moving the maxilla forward a bit to give more support to the midface.  Perhaps the solution is to do both procedures.

This is interesting: http://www.ncbi.nlm.nih.gov/pubmed/19062299.  This study claims somewhat more stable results for maxillary expansion via LeFort, as compared with via SARPE.

I see this also: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411735/

This article states: "...most studies reported that SARME is more stable and has lower morbidity in complications than segmental osteotomy."  Here "SARME" being the thing as SARPE.  So, different sources have a different viewpoint - this is unsurprising to me.

This second article also states: "In our case, the surgical wafer was maintained for 6 weeks and transverse relapse occurred almost immediately after wafer removal. This relapse can be explained by the short retention period, and could have been prevented by a longer retention period. The retention period after transverse gain in adult patients should be at least 3 months, and lengthening of the retention period is recommended when it is critical to maintain arch width. Phillips et al. suggested that overexpansion of 2 to 3 mm should be performed to prevent relapse."

right that's the issue with sarpe, you need to keep the distraction device in there for like 8 months minimum to keep the expansion. otherwise sarpe is way better.

[marcus3415]

I saw your bite. I would again say lefort. That way, you can create more of an overbite as it allows for forward movement as well. Sarpe doesn't.

[David_D]

I saw your bite. I would again say lefort. That way, you can create more of an overbite as it allows for forward movement as well. Sarpe doesn't.

I don't think I need more of an overbite.  Right now, my incisors are out further than the lower teeth.  I don't have an edge-to-edge bite anteriorly.  That said, one possibility the maxillofacial surgeon did mention was to bring the maxilla forward so as to make the canines more prominent, then orthodontically move the incisors backward, to reduce the curvature of the positioning of the anterior teeth.

I see my orthodontist on Tuesday.  I'm hopeful that he can assist me in making more sense of it.

Another goal of mine, if possible, is to address my somewhat downturned mouth corners.  Cosmetic surgery I've had hasn't really addressed that issue.  It seems to me that widening the upper palate might help with that issue.