09/05/2026
A 19-year-old female presented with a skeletal Class III pattern, posterior crossbites, transverse maxillary deficiency, and mandibular asymmetry. She had previously undergone orthodontic treatment with braces by another provider, but her underlying skeletal transverse deficiency had not been addressed.
At this age, the midpalatal and circummaxillary sutures are significantly more mature, making conventional tooth-borne approaches less predictable and increasing the risk of dental compensation rather than true skeletal correction.
Because her previous treatment involved braces only — without skeletal expansion — the transverse deficiency remained unresolved. Over time, this can contribute to persistent posterior crossbites, instability, and orthodontic relapse.
We chose MARPE — Miniscrew-Assisted Rapid Palatal Expansion — to deliver expansion forces directly to the maxillary skeletal complex.
Just 7 weeks after MARPE, we achieved a clear skeletal split and substantial transverse correction, with the posterior crossbites already corrected.
This case highlights an important principle: when the problem is skeletal, the treatment must address the skeletal foundation — not just dental alignment. Braces alone can align teeth, but they cannot always correct an underlying maxillary transverse deficiency in a mature patient.
The diastema seen during active expansion is expected and is actually an important clinical sign that the maxilla has separated. Orthodontic treatment will then coordinate the arches, close the space, and refine the occlusion.
Expand the foundation first. Then align the teeth.
Dr. Delia Tuttle, DDS
Canyon Lake Dental Crossbite Orthodontics AirwayDentistry MiniscrewExpansion TransverseDeficiency DentalCBCT CanyonLakeDental DrDeliaTuttle
