SARPE vs. SAPE: How Surgical Palatal Expansion Has Changed and Why It Matters for Your Airway
Dr. Lucas W. Shapiro, DDS·
Published
What Is SARPE, and Is It Still the Same Procedure?
SARPE stands for Surgically Assisted Rapid Palatal Expansion, a procedure used to widen the upper jaw in adults whose palate has fully matured. Traditionally, SARPE meant a surgical release of the palate combined with a tooth-borne expander, an appliance anchored to the teeth. Today the field increasingly uses the broader term SAPE (surgically assisted palatal expansion), which includes surgical expansion with or without bone-borne anchorage, and that change affects planning and results.
Wall Street Orthodontics explained this shift in a recent TikTok, where Dr. Lucas Shapiro walked through how the terminology and techniques have evolved and why he no longer recommends the traditional approach. You can watch the video here:
Why Do Some Adults Need Surgery to Expand the Upper Jaw?
In children and teens, the suture running through the middle of the palate is still open, so a palatal expander can widen the jaw gradually as it grows. In adults, that suture has matured and fused, which makes expansion harder. Depending on the patient's skeletal maturity and the amount of width needed, adults may be candidates for non-surgical, bone-anchored options such as MARPE or MSE, or for a surgically assisted approach when more resistance has to be overcome.
A narrow upper jaw can contribute to crossbites, crowding, and restricted nasal airway space, which is why expansion is often part of an airway-focused plan. You can read more on our Expansion page.
What Is the Traditional Tooth-Borne SARPE Approach?
In traditional SARPE, the surgeon releases the palate and the orthodontist places an expander that is anchored to the teeth. Because the appliance relies on the teeth for anchorage, the palate is expanded rapidly. As the two halves of the palate separate, a large gap (diastema) opens between the front teeth.
Our orthodontist points out two drawbacks of this method:
✓Less nasal airway benefit. With a tooth-borne expander, the expansion may not deliver as much nasal airway improvement as other approaches.
✓Less control of the maxilla. Anchoring to the teeth gives the orthodontist less control over how the upper jaw moves and forces rapid expansion, which creates a large diastema that can be difficult to close afterward.
What Is SAPE, and How Is It Different?
SAPE refers to surgically assisted palatal expansion in a broader sense. It can be performed with a tooth-borne appliance, as in traditional SARPE, or with bone-borne anchorage, where the expander is anchored to the bone using mini-implants instead of relying only on the teeth.
There are also different surgical techniques. Some are performed in a hospital, and others can be done in an office under local anesthesia. According to him, the technique used can make the nasal airway benefits larger or smaller, so the surgical approach matters as much as the appliance.
Why Is SAPE With a Tooth-Borne Appliance No Longer Recommended Here?
In his view, the tooth-borne version gives up too much control. With less control of the maxilla and a need to expand rapidly, the patient ends up with a large diastema that can be hard to close, and the airway benefit may be smaller than it could be. For that reason, he personally would not recommend SAPE with a tooth-borne appliance anymore, and instead favors approaches that use bone-borne anchorage where surgical assistance is needed.
This is one clinician's professional recommendation, and the right plan for any patient depends on their anatomy, skeletal maturity, and goals.
How Does SAPE Compare to MARPE and MSE?
MARPE and MSE are bone-borne, non-surgical expanders that can widen the palate in many adults without a surgical release. SAPE with bone-borne anchorage adds a surgical step for patients who need more help, such as those with greater skeletal maturity or a larger amount of expansion needed. The right choice is determined by the diagnosis, often with imaging such as 3D CT Scanning, and when surgery is involved, the orthodontist and surgeon plan the case together through Interdisciplinary Treatment.
For growing patients, the picture is different. The Facegenics Midface Expander (FME) and Early Intervention can guide the jaw while growth is still possible, which can reduce the chance that surgery is needed later. MARPE in New York City is also a common non-surgical starting point for adults being evaluated for airway concerns, including Upper Airway Resistance Syndrome (UARS). For a wider look at this approach, see our post on airway-focused orthodontics in NYC, and for more on surgical cases see our Surgical Orthodontics page.
Frequently Asked Questions
What does SARPE stand for?
SARPE stands for Surgically Assisted Rapid Palatal Expansion. It is a procedure that combines a surgical release of the palate with an expander to widen the upper jaw in adults.
What is the difference between SARPE and SAPE?
SARPE traditionally refers to surgical expansion with a tooth-borne expander. SAPE is a broader term that includes surgical expansion with or without bone-borne anchorage, and with different surgical techniques.
Does SARPE improve nasal breathing?
It can, but the amount of nasal airway benefit depends on the surgical technique and the type of expander. According to our orthodontist, tooth-borne SARPE tends to offer fewer nasal airway benefits.
Is SAPE done in a hospital?
Some techniques are performed in a hospital, while others can be done in an office under local anesthesia. The right setting depends on the technique and the patient's case.
Why does the diastema matter?
Rapid expansion with a tooth-borne appliance opens a large gap between the front teeth that can be difficult to close, which is one reason the approach has fallen out of favor with some clinicians.
Do I need surgery to expand my upper jaw as an adult?
Not always. Many adults are candidates for non-surgical bone-anchored options such as MARPE or MSE. A full evaluation determines whether surgical assistance is needed.
Schedule a Consultation at Wall Street Orthodontics
If you have been told you need surgical expansion, or you want a second opinion on adult expansion options, we can evaluate your jaws and airway and walk you through your choices in Lower Manhattan.
