Ortodonti

SARPE – Surgically Assisted Palatal Expansion

Name: SARPE – Surgically Assisted Palatal Expansion
Creator: Dore Medical Editorial Board
Published: 2026-05-11

Surgical loosening of the midpalatal suture followed by skeletal expansion with an expansion appliance. An effective solution for older adults when MARPE is insufficient.

Medically reviewed. Last updated: May 20, 2026.

Message Us Call Us

Pre-Assessment · 1 minute Is this treatment right for you? Find out about your eligibility, treatment duration and pricing. We'll send you the next steps.

Start Assessment

What Is SARPE?

SARPE stands for "Surgically Assisted Rapid Palatal Expansion," a treatment for widening the upper jaw. It's used in adult patients with a narrow upper jaw whose palatal suture has fully ossified (turned to bone). SARPE is preferred in advanced cases where the suture is too rigid to open with MARPE. During the procedure, a controlled surgical cut is made in the palatal suture to reduce bone resistance, allowing the expansion appliance to open the bone more easily.

SARPE is performed for severe narrow upper jaw and related crossbite cases. Patients are typically older adults who have not had orthodontic treatment before, or who have tried MARPE without achieving sufficient expansion. They often present with concerns like crowding, mouth breathing, a narrow smile line, and difficulty chewing. Surgical assistance makes the suture less resistant so the desired width can be achieved.

Before treatment, your jaw structure is evaluated in detail with 3D tomography. Surgical planning is done digitally. The operation is performed under general anesthesia by an oral surgeon. Controlled cuts are made at the midline and lateral walls of the upper jaw, and the palatal suture is separated when necessary. During the same session, a custom-made expansion appliance is placed. Hospital stay is typically one day. In the first few days after surgery, cold compresses, soft-food diet, and prescribed medications are important.

After the first week of healing, activation begins. You turn the appliance screw daily to achieve expansion. The active expansion phase lasts 2 to 4 weeks. Once expansion is complete, the appliance remains in place for 4 to 6 months to allow new bone formation and stabilization of the suture. After the appliance is removed, braces or clear aligner treatment is used to finalize tooth positioning. In some patients, orthognathic surgery may be planned simultaneously for more advanced jaw corrections. For cost information, visit our SARPE cost calculator page.

Treatment Process

Alternative Treatments

SARPE is one of the most reliable methods for upper jaw expansion in adults with advanced sutural maturation. However, surgically assisted approaches are not necessary for every narrow upper jaw case. The patient's age, sutural maturation level, degree of narrowness, and accompanying orthodontic problems directly determine treatment selection. At Doredent, no single method is imposed for upper jaw expansion treatment. The most appropriate approach for your case is honestly recommended. Below you can find the actual alternatives to SARPE and which situations favor each approach.

MARPE (Mini-screw Assisted Rapid Palatal Expansion)

This method can achieve skeletal expansion without surgical support in late adolescent and young adult cases where sutural maturation is not yet advanced. Mini-screws are placed into the palate under local anesthesia and the expansion appliance works through these screws. Because it does not require surgery, it is less invasive than SARPE. Advantages:

No surgery required, no general anesthesia risk.
Patient does not need a recovery period.
Cost is significantly more favorable compared to SARPE.
Outpatient treatment process.
Provides skeletal expansion in suitable cases.

Limitations:

Only effective in patients whose sutural maturation is in stage A, B, or C.
Age range is generally limited to 15-25 years.
May fail in cases where the suture is completely fused.
May not provide as reliable expansion as SARPE in advanced narrowness cases.

At Doredent, MARPE treatment is planned and performed by Uzm. Dt. Merve Özkan Akagündüz. Following assessment with CBCT, suitability is honestly explained. Unnecessary failed MARPE attempts are not made.

Traditional Rapid Palatal Expansion (RPE / Hyrax)

This is the classic expansion method applied directly in children and growing adolescents without surgical support because the midpalatal suture is still open. The appliance is fixed to the molars and expansion force is transmitted through the teeth. It is not an alternative to SARPE. Rather, it is the preferred traditional method for the age group where SARPE is not necessary. Advantages:

Does not require mini-screws or surgery.
Gives highly effective results in children and growing adolescents.
Cost is significantly more favorable than MARPE and SARPE.
A well-understood method clinically that has been applied for many years.

Limitations:

Effective only in growing patients (generally ages 7-14).
In adults, leads to dental tipping. True skeletal expansion cannot be achieved.
From late adolescence onward, MARPE or SARPE provides more reliable results.

At Doredent, the classic expansion method is successfully applied in cases detected early during pediatric dentistry check-ups. Waiting until later ages creates unnecessary risk for these patients.

Dental Expansion (Orthodontic Treatment Only)

In mild upper jaw narrowness cases, rather than expanding the jaw itself, the narrow appearance can be improved by changing tooth positions. This approach is called dental expansion or dental compensation. It is not an alternative to SARPE. It is an option for mild cases without true skeletal narrowness. Advantages:

Does not require mini-screws or surgery.
The least invasive, mildest approach.
Only the orthodontic treatment process is involved, no additional stage.
Provides appropriate functional results in mild cases.

Limitations:

The actual width of the jawbone does not change.
Effective only in mild narrowness cases.
Insufficient in moderate and advanced narrowness cases.
Does not resolve functional problems like nasal breathing difficulty.
Excessive compensation may affect long-term dental health.

At Doredent, dental compensation can be applied with Invisalign clear aligner treatment or traditional braces treatment. This approach is not recommended in advanced skeletal narrowness cases requiring SARPE.

Expansion Combined with Orthognathic Surgery

In some complex cases, upper jaw narrowness appears together with other skeletal anomalies. For example, in situations like upper jaw narrowness plus upper jaw deficiency, upper jaw narrowness plus Class III malocclusion, or upper jaw narrowness plus advanced open bite, isolated SARPE may be insufficient. In these cases, comprehensive orthognathic surgery is planned and expansion is performed as part of this surgery. Advantages:

Allows complex skeletal anomalies to be corrected in a single session.
Both expansion and positional change of the upper jaw can be achieved.
Offers comprehensive solutions in complex cases like bimaxillary surgery.

Limitations:

A much more comprehensive surgical procedure than SARPE.
Surgical duration, recovery period, and cost are significantly higher.
Appropriate only for cases where upper jaw narrowness is not an isolated problem.

At Doredent, in complex cases requiring orthognathic surgery, we work in coordination with Oral and Maxillofacial Surgery Specialist Uzm. Dt. Tayfun Cıvak. Pre-surgical orthodontic preparation and post-surgical completion are conducted at Doredent by Merve Hoca.

Postponing Treatment and Regular Monitoring

In some mild narrowness cases, if the patient is not experiencing significant functional or aesthetic complaints clinically, regular monitoring may be recommended instead of surgery. However, this approach is generally not appropriate if the upper jaw narrowness is at a level requiring SARPE, because narrowness at SARPE level already causes significant clinical effects. Advantages:

Patient is not burdened with unnecessary surgery.
Most favorable approach in terms of cost.
In very mild cases, the progression of the condition can be monitored over time.

Limitations:

Problems related to upper jaw narrowness continue during monitoring.
Crossbite, crowding, or breathing problems are not resolved.
Not clinically appropriate for narrowness at SARPE level.

Which Treatment Is Right for You?

Choosing the correct method for upper jaw narrowness treatment depends on these factors:

Age and sutural maturation level: RPE is preferred in children and adolescents, MARPE in late adolescence and young adults, SARPE in mature adults. The degree of sutural fusion (Angelieri classification) is evaluated with three-dimensional cone beam computed tomography (CBCT). This is the basis for the MARPE or SARPE decision.
Severity of narrowness: Dental compensation may be sufficient in mild cases, while skeletal expansion is necessary in moderate and advanced cases.
Accompanying orthodontic problems: Conditions like crossbite, crowding, or lower jaw anomalies shape the treatment plan. Orthognathic surgery may be considered in complex skeletal anomalies.
Patient preference: For patients who want to avoid a surgical approach and are in the appropriate age group, MARPE is evaluated first. However, in cases with a possibility of failure, direct SARPE may be recommended.
General health status: In surgical cases requiring general anesthesia, the patient's general health is taken into account.

Doredent's Approach: The Right Method at the Right Time At Doredent, no single method is imposed for upper jaw expansion treatment. Classic RPE is evaluated first in children and growing adolescents. MARPE is preferred in late adolescence and young adults. In adult cases with advanced sutural maturation, SARPE is planned in coordination with our contracted jaw surgeon Tayfun Hoca. During your initial examination, Merve Hoca thoroughly evaluates the degree of your upper jaw narrowness, your sutural maturation level, and your additional orthodontic needs. Following analysis with CBCT, which method is most appropriate for you is honestly explained. SARPE is a surgical procedure and is only recommended when clinically truly necessary. Unnecessary surgery is not performed in cases that can be resolved with milder methods.

Risks and Complications

SARPE is a long-established, clinically well-understood treatment method in modern maxillofacial surgery. Success rates are high with proper patient selection, an experienced team, and digital surgical planning. However, because SARPE is a comprehensive surgical procedure performed under general anesthesia, it carries a range of risks and complications you should be aware of. At Doredent, openly sharing all risks so our patients can make informed decisions is a fundamental principle. Below, you'll find a transparent overview of the risks that can occur with SARPE treatment. Most of these risks are rare and can be largely minimized with proper planning.

💊 General Anesthesia Risks

SARPE is performed under general anesthesia. General anesthesia itself carries rare risks: allergic reactions, cardiovascular problems, respiratory complications, and rarely serious anesthesia complications. Pre-surgical assessment by an anesthesiologist greatly minimizes this risk. Your overall health status, existing conditions, and medications you take are reviewed in detail.

🩸 Post-Surgical Bleeding

Bleeding occurs during SARPE due to blood vessels in the upper jaw bone. This is an expected outcome. In most cases, bleeding is controlled. Rarely, more bleeding than expected can occur. Before surgery, you're assessed for any bleeding disorders. If you take blood thinners, these are managed before surgery. Smoking is a significant factor that increases bleeding risk.

🦠 Infection Risk

As with any surgical procedure, SARPE carries infection risk. Modern protocols using prophylactic antibiotics, sterile hospital environments, and meticulous post-operative care greatly minimize this risk. Strict adherence to prescribed antibiotic treatment after surgery is important. Smoking, diabetes, and immune-suppressing conditions increase infection risk.

😷 Swelling, Bruising, and Pain

Visible facial swelling and bruising in the first few days after surgery is normal. This is an expected process, not a complication. Swelling usually peaks at 2 to 3 days, then gradually resolves. Significant swelling largely subsides within 2 to 3 weeks. Pain is controlled with prescribed pain medication.

⚡ Nerve Sensitivity and Numbness

During SARPE, the infraorbital nerve and greater palatine nerve run close to the surgical area in upper jaw surgery. These nerves can be affected during surgery. As a result, temporary numbness or sensitivity may occur in your upper lip, sides of your nose, and palate. This resolves completely within weeks to months for most patients. In rare cases, some permanent sensory change may occur.

↔️ Asymmetrical Expansion

In some cases, expansion does not occur equally on both sides. One side may expand more than the other. This can result from anatomical differences in the suture on each side, asymmetric effect from the surgical cut, or incomplete patient compliance with the activation protocol. If asymmetric expansion is detected, the activation protocol is adjusted. In advanced cases, additional orthodontic adjustments may be necessary.

👃 Nasal Shape Changes

Expansion of the upper jaw can result in widening at the base of the nose and the sides of the nostrils. This is not a side effect of SARPE but a natural result of the upper jaw position change. For many patients, this is mild. In some cases, it may be more noticeable. This change can also bring improvement in nasal breathing. This topic is discussed with you in detail before surgery, and expectations are shaped using digital simulation.

🌫️ Sinus Problems

The surgical incision lines in SARPE run close to the maxillary sinus wall. For this reason, temporary sinusitis, sinus pressure, or bleeding into the sinus can occur after surgery. In most cases, this resolves on its own or with short-term antibiotic treatment. Patients with existing chronic sinus problems may be recommended for additional assessment and ENT consultation.

🦷 Damage to Teeth and Tooth Roots

There is a risk of damage or impaired blood circulation to tooth roots near the surgical incision lines. This is very rare, but if it occurs, it can lead to the tooth losing vitality. Root canal treatment may be needed. Modern digital planning and surgical guides greatly minimize this risk. All tooth root positions are examined radiologically in detail before surgery.

📐 Temporary Diastema (Gap Between Front Teeth)

During the active expansion phase of SARPE, separation of the upper jaw at the midline creates a visible gap between the two front teeth. This is called diastema and is not actually a complication. It's a positive clinical sign that the suture has opened. Diastema is an expected and desired finding. After activation is complete, the gap is closed with orthodontic treatment. Knowing about this beforehand prevents surprise and anxiety.

😣 Pressure and Pain During Activation

When you begin turning the activation screws at home 5 to 7 days after surgery, temporary pressure may be felt in your teeth, palate, and nose/face area. This usually passes within a few hours and is a natural part of the treatment process. If you experience severe, persistent pain, you should contact the clinic immediately.

🗣️ Temporary Speech Changes

Because the SARPE appliance takes up space on your palate, tongue position may change in the first few days and pronunciation of some sounds may become difficult. Sounds like "s," "t," and "k" are particularly affected. This is temporary. Most patients' tongues adapt to the appliance within 1 to 2 weeks and speech returns to normal.

🍽️ Eating Difficulties

In the first week after surgery, you'll eat liquid and pureed foods. In the following weeks, you gradually transition to soft and normal foods. While the appliance is in place, hard, fibrous, and sticky foods (gum, caramel, raw carrots, etc.) can damage the appliance or make cleaning difficult. This requires temporary adaptation during the treatment process.

🧼 Hygiene Difficulty and Local Infection

If the appliance and surgical site are not thoroughly cleaned, local infection can develop. Regular oral hygiene, a water flosser, antiseptic mouth rinses, and regular clinical follow-up greatly minimize this risk. Gentle, meticulous hygiene practices in the initial post-surgical period are critically important.

🔄 Post-Treatment Relapse

Skeletal expansion achieved with SARPE can partially revert over time if proper retention is not maintained. This is called relapse. After active expansion is complete, leaving the appliance in the palate for at least 4 to 6 months for retention, followed by adherence to an appropriate retention protocol, greatly minimizes this risk.

🦴 Insufficient Expansion or Bone Healing Problems

Very rarely, despite surgical incisions, the suture may not open sufficiently or newly formed bone tissue may not heal as expected. In this case, additional surgical intervention or a different treatment approach may be necessary. Modern surgical techniques and proper patient selection greatly minimize this risk.

⚙️ Appliance Breakage or Malfunction

Very rarely, the activation screw may malfunction or the appliance may break. These situations typically result from incorrect activation, hard food consumption, or trauma. If the appliance malfunctions, it's important to contact the clinic quickly and have the necessary repair done.

🩺 Other Rare Complications

Very rare additional complications include: avascular necrosis (impaired blood circulation in bone tissue), airway problems (in the early post-surgical period), need for reoperation, and worsening of nasal septum deviation. These complications are extremely rare, but modern surgical ethics requires they be disclosed to you.

Risk-Increasing Factors

Certain conditions can increase the risk of complications in SARPE treatment. These factors don't mean treatment can't be done. However, they do mean additional assessment, special planning, or prior resolution of certain conditions is necessary.

Smoking and tobacco use: One of the most negative factors affecting healing. It increases bleeding risk, infection risk, and impairs bone healing. Smoking must be stopped completely at least 2 to 4 weeks before surgery and at least 4 to 6 weeks after surgery.
Uncontrolled systemic diseases: Diabetes, heart disease, high blood pressure, kidney diseases, and immune-suppressing treatments require additional evaluation, especially for SARPE. Coordinated planning is done with relevant specialists.
Bleeding disorders and blood-thinning medications: In these patients, hematology consultation and medication management before surgery is essential.
Bisphosphonate and biologic agent use: Osteoporosis medications and some cancer drugs can seriously affect jaw bone healing. History of use of these medications must be reviewed.
Chronic sinus problems: For patients with existing chronic sinusitis or sinus anomalies, ENT consultation before surgery is recommended.
Active gum disease or cavities: All active oral health problems must be resolved before surgery. Dental scaling, cavity treatments, and if needed curettage are completed.
Inadequate oral hygiene: Plaque accumulation around the appliance increases infection risk. Improving hygiene habits before treatment is important.
Non-compliance with activation protocol: If you don't turn the activation screws at home as your dentist instructs, expansion won't be at the desired level. Treatment duration extends and results fall short of expectations.
Advanced age: As age increases, general anesthesia risk and healing time increase. However, age alone is not a barrier to surgery. Overall health status is more determinative.
Unrealistic expectations: Having realistic expectations about surgical outcomes is critical for treatment satisfaction. Side effects like nasal shape changes are discussed clearly in advance.
Non-compliance with retention protocol: Removing the appliance early after active expansion seriously increases relapse risk. Strict adherence to the retention protocol is essential.
Missed follow-up appointments: Regular clinical follow-up during treatment makes the active expansion period safe and effective. Missed appointments increase complication risk.

How Are These Risks Managed at Doredent?

The vast majority of possible risks in SARPE can be minimized with proper patient selection, comprehensive planning, an experienced team, and regular follow-up. The key components of the approach at Doredent are:

Detailed clinical and radiological evaluation: Before surgery, panoramic X-ray, cephalometric analysis, and especially three-dimensional cone-beam computed tomography (CBCT) are used to perform detailed evaluation of suture maturation level (Angelieri classification), palate anatomy, nerve and vascular structures, and all measurements needed for surgical planning.
Proper patient selection: Treatment is planned only for patients who are clinically appropriate for SARPE. Unnecessary surgery is not performed in cases that can be resolved with less invasive methods (MARPE or RPE).
Multidisciplinary team approach: The long-standing partnership between orthodontist Uzm. Dt. Merve Özkan Akagündüz and Oral, Dental, and Maxillofacial Surgery Specialist Uzm. Dt. Tayfun Cıvak ensures a coordinated, seamless treatment process.
Pre-anesthesia evaluation: Before surgery, a detailed evaluation is performed by an anesthesiologist. Your overall health status, existing conditions, and medications you take are reviewed.
Surgery in a hospital setting: SARPE is performed under general anesthesia in a contracted hospital. Modern surgical protocols, sterile standards, and post-operative follow-up facilities are available.
Pre-treatment preparation: Before surgery, all active oral health problems, nutritional status, and control of systemic diseases are ensured.
Patient education: All options, expected outcomes, risks, and limitations are explained clearly. You're empowered to make an informed decision. No decision is imposed.
Detailed post-operative follow-up: The healing process is closely monitored with frequent follow-up appointments in the initial post-surgical period. The activation process and retention period are managed at Doredent.
Emergency protocol: You're informed in detail about possible emergencies in the post-surgical period. Communication channels remain open.

SARPE, when combined with proper patient selection, an experienced team, and patient compliance, is a treatment method that produces highly successful results. Possible risks and their likelihood in your specific case are assessed in detail by our orthodontist at your initial exam. In cases requiring surgery, a patient meeting with Tayfun Hoca is arranged, and all your questions are answered.

Who Is It Suitable For?

SARPE is not a suitable treatment option for every case of narrow upper jaw. This surgery is a permanent and reliable solution for adult patients whose palatal suture has advanced maturity and for whom less invasive methods (MARPE, conventional expansion) would be insufficient. Below you can find the patient profiles for whom SARPE is most commonly applied and situations requiring additional evaluation for this surgery.

An Important Prerequisite: Suture Maturity Level

The basic clinical requirement for SARPE: The junction at the midline of the upper palate (midpalatal suture) must be completely or almost completely closed. In this case, since the suture cannot be opened despite mini-screw support, surgical release is the only reliable method.Suture maturity level is assessed with three-dimensional cone beam computed tomography (CBCT). In this method, known as Angelieri classification, the suture is divided into 5 different stages (A, B, C, D, E). MARPE is generally successful in stages A, B, and C. In stages D and E, SARPE provides more reliable results. The age range is typically over 25 years old. However, in some cases, the suture may have closed early even in individuals under 25 years old. In this case, SARPE becomes prominent. Conversely, some patients over 30 may still have a chance with MARPE. Therefore, age alone is not a sufficient criterion. CBCT evaluation is mandatory in every case.

🧑 Adults with Completely Closed Suture

For adult patients whose suture maturity level is stage D or E on CBCT and who require narrow upper jaw treatment, SARPE is the most reliable method. In these cases, MARPE fails or provides limited results.

Generally patients over 25 years old.
Reliable expansion is achieved with surgical cuts.
Treatment takes 6-12 months including retention.
Carried out with a multidisciplinary team.

↩️ Cases Where MARPE Has Failed

In cases where MARPE has been tried but sufficient skeletal expansion could not be achieved, SARPE is considered as a rescue treatment. This is usually due to the suture being more mature than expected.

Cases with dental tipping after MARPE.
Cases where skeletal expansion could not be achieved.
Detailed evaluation is performed again with CBCT.
Surgical planning is prepared case by case.

📐 Adults with Severe Maxillary Constriction

In adult cases with severe maxillary constriction of 8 mm or more, SARPE is the most appropriate solution. This level of constriction cannot be adequately resolved with MARPE or dental compensation.

Cases with pronounced structural constriction.
Provides greater skeletal expansion.
Airway support can also be provided.
Requires complex orthodontic planning.

↔️ Adults with Severe Crossbite

In cases of bilateral or unilateral severe crossbite due to pronounced maxillary constriction, SARPE permanently resolves the bite disorder by truly expanding the upper jaw.

Chewing balance is restored.
Effective results in asymmetric bite cases.
TMJ relief can be achieved.
Orthodontic completion is required after SARPE.

🦷 Preparation Before Complex Orthodontic Treatment

In adult cases where comprehensive orthodontic treatment (Invisalign, braces) is planned but expansion is preferred instead of tooth extraction, space can be gained with SARPE and treatment can be carried out more efficiently.

Extraction of healthy teeth is avoided.
Orthodontic treatment duration is optimized.
Jaw dimensions become compatible with orthodontic goals.
Applied as the first stage of comprehensive treatment plan.

🏥 Part of Orthognathic Surgery Planning

In some complex cases, maxillary constriction appears together with other skeletal anomalies. In these cases, comprehensive orthognathic surgery is planned and SARPE can be applied as the first stage of this process.

As preparation before bimaxillary surgery.
Cases accompanied by maxillary deficiency.
In treatment of complex skeletal anomalies.
Surgical planning is done case by case.

😴 Sleep Apnea Cases Due to Maxillary Constriction

In adult patients experiencing obstructive sleep apnea due to maxillary constriction and narrow nasal cavity, SARPE can relieve the airway by expanding the upper jaw and nasal cavity. Requires a multidisciplinary approach.

Orthognathic surgery may be required in severe sleep apnea cases.
Coordinated planning with sleep medicine and ENT specialists.
Polysomnography evaluation is recommended.
May not be sufficient alone; additional treatments may be needed.

😊 Those with Pronounced Narrow Smile Aesthetics Complaint

For adults complaining of pronounced "black triangles" on the sides when smiling and narrow smile aesthetics, SARPE brings fullness to the smile by truly increasing upper jaw width.

A wider and fuller smile is achieved.
Balance of facial proportions improves.
Dark areas on the sides are reduced.
Prominent in cases with high aesthetic expectations.

Which Patients Require Additional Evaluation?

In some cases, additional evaluation, preparation, or different planning is required before SARPE. This does not mean that surgery cannot be performed. Most often, it means that an additional stage needs to be added to treatment or certain conditions must be met first.

Patients suitable for MARPE: In cases where suture maturity level is stage A, B, or C, MARPE is tried first. SARPE comes into consideration only when less invasive methods are insufficient or have failed.
Children and adolescents in growth period: In children between 7-14 years old, conventional rapid palatal expander (RPE) is generally sufficient because the suture is still open. SARPE is definitely not recommended for this age group.
Mild constriction cases: In mild constriction cases that can be resolved only with dental compensation, SARPE remains unnecessarily invasive.
Active smokers and tobacco users: Smoking seriously negatively affects healing. Smoking must be completely stopped at least 2-4 weeks before surgery and at least 4-6 weeks after surgery.
Uncontrolled systemic diseases: Diabetes, heart disease, hypertension, kidney or liver diseases, and immunosuppressive treatments require additional evaluation. Coordinated planning is done with relevant specialists.
Patients with bleeding disorders: Requires hematology consultation and special surgical planning.
Those taking blood thinners: Medication management before surgery must be coordinated with cardiology or internal medicine specialists.
Bisphosphonate and biological agent use: These medications can affect jawbone healing. Usage history is always questioned.
Chronic sinus problems: ENT consultation is recommended for patients with existing chronic sinusitis or sinus anomaly.
Active gum disease or cavities: All active oral health problems must be resolved before surgery. Tartar cleaning, cavity treatments, and curettage if necessary are completed.
Pregnancy period: SARPE is not planned during pregnancy and is postponed until after birth. Pregnancy test is performed before surgery.
Patients not psychologically ready: The SARPE process is long and challenging. It is important that the patient is psychologically able to cope with the process.
Patients with unrealistic aesthetic expectations: Side effects such as changes in nose shape after surgery are clearly discussed beforehand. Unrealistic expectations can lead to dissatisfaction.
Elderly patients: Age alone is not an obstacle to SARPE. However, general health condition, anesthesia tolerance, and healing capacity are evaluated in detail.
Patients unable to comply with activation protocol: In SARPE, the patient performs active activation at home after surgery. An alternative approach may be evaluated for patients unable to comply with the disciplined activation protocol.

What Does Being Ready for Treatment Mean?

SARPE means not only being clinically suitable but also the patient being ready for this process. The treatment journey, including surgery, active activation period, retention, and orthodontic completion, can take 6-12 months. The patient's practical and psychological readiness for this process directly affects treatment success.

Time commitment: Allocating time to attend regular checkup appointments, comply with the activation protocol, and go through the post-surgical healing period during treatment.
Work and social life planning: Since work and social life need to be restricted for at least 1-2 weeks after surgery, this period should be planned in advance.
Family support: Family or close circle support is important in the early period after surgery.
Psychological preparation: Coping with situations such as the appliance presence in the palate, temporary feeding difficulties, and diastema appearance during the activation period requires psychological strength.
Financial planning: Since SARPE is a surgical procedure, it is recommended to make financial planning in advance.

What Steps Are Taken in the Initial Examination?

Whether SARPE is suitable for you is determined after the comprehensive evaluation performed at the initial examination. The basic steps of this evaluation are:

Clinical examination: Our orthodontist Uzm. Dt. Merve Özkan Akagündüz examines the degree of maxillary constriction, bite relationship, tooth position, and general orthodontic condition.
Three-dimensional cone beam computed tomography (CBCT): Suture maturity level (Angelieri classification) is evaluated. This is the basis for MARPE or SARPE decision. Palatal anatomy, sinus structures, and anatomical structures critical for surgery are examined in detail.
Cephalometric analysis: Jaw-face relationship and tooth positions are evaluated in terms of orthodontic goals.
Multidisciplinary planning: When SARPE is determined to be necessary, coordinated planning begins with our contracted oral surgeon Uzm. Dt. Tayfun Cıvak. Surgical technique, cut lines, and activation protocol are determined together.
Anesthesia consultation: General health evaluation is performed by the anesthesiologist before surgery.
Patient information: Treatment duration, surgical process, activation protocol, expected outcome, risks, and cost are clearly explained. The decision is made together with the patient.

All these conditions are evaluated at the initial examination. At Doredent, SARPE is only planned when clinically truly appropriate. In cases that can be resolved with less invasive methods, this option is honestly recommended. Merve Hoca honestly explains the most suitable approach for you at the initial examination. In cases requiring SARPE, coordinated planning is done with Tayfun Hoca.

After Treatment

SARPE treatment does not end when the surgery is complete. The post-surgical period is one of the most critical phases that determines the long-term success of the treatment. Even if the surgery is successful, the care applied in the following weeks and months, the healing process, active expansion period, retention, and orthodontic completion directly affect the treatment outcome. Below you will find the post-SARPE period step by step, with all its stages. Patient compliance and clinical follow-up at each stage are fundamental for the success of the process.

First 24 Hours: Hospital Period

The first 24 hours after SARPE are spent in hospital admission. During this period, the patient is under continuous monitoring and observed for early post-surgical complications.

Ward monitoring: The first few hours after surgery are closely monitored for post-anesthesia recovery, airway safety, and general condition.
Swelling and bruising: Significant swelling in the face begins within the first few hours; this is an expected process. Cold compress application and head elevation help reduce swelling.
Pain management: Pain control is provided with intravenous pain medications. Once the patient can tolerate the pain, oral pain relievers are introduced.
Nutrition: Liquid nutrition begins within the first 24 hours. Water, freshly squeezed fruit juices, soup, and dairy products are preferred.
Antibiotic therapy: Prophylactic antibiotic therapy is initiated and continues for a certain period after surgery.
Oral hygiene: Special hygiene protocols are initiated for cleaning the surgical area. Warm salt water gargle or special mouth rinse solutions recommended by your doctor are used.

Latency Period: 5-7 Days

The first 5-7 days after surgery is an important waiting period. During this process, no expansion is performed; the initial healing of the surgical area and the start of new bone formation (callus formation) is awaited.

No expansion is performed: During this period, the patient does not turn the expansion screw. Early expansion can negatively affect new bone formation.
Healing process: The beginning of new bone tissue (callus) forms during this period at the incision lines created during surgery.
Swelling begins to decrease: Swelling gradually begins to decrease 2-3 days after surgery. Cold compress application continues.
Nutrition: Soft and liquid foods are consumed. Soft options such as soup, yogurt, smoothies, puree, and eggs are preferred.
Oral hygiene: The surgical area must be cleaned gently. Strict adherence to the special hygiene protocols recommended by your doctor minimizes infection risk.
Medication use: Antibiotics and pain relievers prescribed by our contracted jaw surgeon Uzm. Dt. Tayfun Cıvak are used regularly.
Smoking and alcohol: Complete abstinence from smoking and alcohol for at least 4-6 weeks after surgery is strongly recommended.
Activity restriction: During this period, intense physical activity, heavy lifting, and exercise are prohibited. Light activities such as walking are safe.

Why Is the Latency Period Important? Skipping the latency period and starting early expansion can negatively affect new bone formation in the surgical area. This situation can increase relapse risk and weaken long-term stability. Therefore, strict adherence to the waiting period determined by Tayfun Hoca is essential. During this period, patience is required, not haste.

Active Expansion Period (2-4 Weeks)

After the latency period, the decision to start expansion is made during a check-up by Uzm. Dt. Merve Özkan Akagündüz. The patient begins turning the expansion screw daily at home.

Daily expansion: The patient turns the expansion screw at home according to the determined protocol. The expansion rate (usually 0.25-0.5 mm per day) is planned for the patient.
Expansion duration: This period typically lasts 2-4 weeks. Expansion is terminated when the targeted expansion amount is reached.
Diastema observation: During active expansion, a noticeable gap forms between the front two teeth as the midline junction opens. This is a positive indicator that SARPE is working successfully; it is not a cause for concern.
Pressure sensation during expansion: After turning the screw, temporary pressure sensation may be experienced in the teeth, palate, and nose-face area. This usually passes within a few hours.
Nutrition: Soft and careful eating is recommended during this period. Hard, sticky foods and foods that could damage the appliance are avoided.
Oral hygiene: Meticulous oral hygiene is applied to prevent plaque buildup around the appliance. Soft toothbrush, water flosser, and antiseptic mouth rinse are used.
Clinical check-ups: Frequent check-up appointments are scheduled by Merve Hoca during this period. The progress of expansion and the condition of the teeth are evaluated.

Retention Period (4-6 Months)

After active expansion is completed, the SARPE appliance is not immediately removed. The appliance remains in the palate for at least 4-6 months for retention purposes. This period is a critical stage for the long-term success of SARPE.

New bone maturation: New bone formation (callus) begins between the two bone segments when the suture opens during active expansion. The full maturation and hardening of this new bone takes 4-6 months. During this process, the appliance remains fixed in the palate, protecting the new bone tissue.
No active expansion is performed: During the retention period, the patient no longer turns the screw. The appliance only serves a retention function.
Periodic check-ups: Regular check-up appointments are made by Merve Hoca during this period. Appliance control and oral hygiene are evaluated.
Continued oral hygiene: Attention to hygiene must continue meticulously during the retention period.
Diastema management: During the retention period, the gap between the front teeth may begin to partially close naturally. Complete closure is achieved with subsequent orthodontic treatment.

Is It Possible to Skip the Retention Process? No. The retention period is an integral part of SARPE and cannot be skipped. Early removal of the appliance after active expansion seriously increases relapse risk. Since the newly formed bone tissue has not yet hardened sufficiently, the two bone segments can move back together and the skeletal expansion achieved can be largely lost. While the difficulty of the retention process is tolerable, repeating a failed surgery is much more difficult and costly. Therefore, strict adherence to the retention period determined by Merve Hoca is essential.

SARPE Appliance Removal

After the retention period is completed and it is clinically confirmed that the new bone tissue has matured sufficiently, the SARPE appliance is removed. This procedure is usually painless and completed quickly in clinical conditions.

Appliance removal: The appliance is removed from the palate; it does not leave any permanent marks on the teeth.
Palate adaptation: After the appliance is removed, the tongue's re-adaptation to the palate may take a few days. This process is brief and easy.
Overall evaluation: After the appliance is removed, the expansion achieved, bite relationship, and tooth positions are re-evaluated.
Next phase planning: After the appliance is removed, the orthodontic completion period begins.

Next Phase: Orthodontic Completion

SARPE is not a standalone treatment; it is the upper jaw expansion phase. After the appliance is removed, orthodontic treatment begins to bring the teeth to their final position and correct the bite relationship. This phase is conducted by Merve Hoca at Doredent.

Treatment option: Depending on the patient's preference and clinical situation, Invisalign clear aligner treatment or traditional braces treatment can be applied. With Diamond Provider experience, Invisalign treatment is offered as a prominent option.
Diastema closure: The gap between the front teeth formed after active expansion is gradually closed with orthodontic treatment. This process usually takes a few months.
Crossbite correction: If the patient has a crossbite accompanying upper jaw narrowness, this is also corrected with orthodontic treatment.
Final tooth alignment: Teeth are brought to ideal positions in the expanded upper jaw.
Comprehensive treatment duration: Orthodontic completion after SARPE can take 12-24 months. This duration depends on the clinical requirements of the case.

Retention Treatment

After all orthodontic completion is finished, orthodontic retention treatment begins. This is an integral phase that ensures long-term preservation of treatment results.

Fixed lingual retainer: Tooth positions are permanently maintained with a thin wire bonded to the back surface of the front teeth. This is the standard retention method for adult orthodontic treatment.
Night guard: In addition to the fixed retainer, night guard use is recommended. Every night for the first year, a few nights per week in subsequent years may be sufficient.
Vivera (optional): Vivera can be preferred as a high-quality clear retainer system. Its three-set package ensures long-term durability.
Width retention: To prevent relapse after SARPE, an additional palatal retention appliance may be recommended in some cases. This is important for preserving the skeletal expansion achieved.
Annual check-ups: During the retention period, orthodontic check-ups are performed at least once a year. The condition of the retainer and tooth positions are evaluated.

Long-Term Care and Follow-Up

Certain habits are important for long-term preservation of SARPE results. These habits support the lifelong health of treatment outcomes.

Adherence to retention protocol: The night guard and retainer use protocol recommended by the doctor must be strictly followed. Skipping retention is the main cause of relapse.
Regular oral hygiene: Brushing twice daily, flossing, and regular oral care are the foundation of long-term oral health.
Routine dental check-ups every 6 months: Standard 6-month check-ups are sufficient for monitoring both orthodontic status and general oral health.
Annual orthodontic check-up: At least one orthodontic check-up per year during the retention period is important for retainer condition and width stability.
Professional dental scaling: Professional cleaning is applied when deemed necessary during regular check-ups.
Bruxism management: If there is a nighttime teeth grinding habit, the night guard recommended by the doctor should be used regularly. Bruxism can be an important cause of post-treatment relapse.
Avoiding smoking and alcohol: Reducing smoking and alcohol is recommended to support general oral and dental health.

Expected Improvements After SARPE

After successful SARPE treatment, patients typically experience these improvements:

True increase in upper jaw width: True skeletal expansion is achieved even in cases with advanced sutural maturation.
Permanent crossbite correction: Bite relationship normalizes in advanced crossbite cases.
Reduction in crowding: Space is gained in the upper jaw, so crowded teeth are orthodontically treated; extraction of healthy teeth is avoided.
Wider, fuller smile: Dark areas on the sides when smiling are reduced, smile aesthetics improve.
Improved nasal breathing: As nasal cavity volume increases, nasal breathing quality can improve; quality of life increases significantly in these patients.
Improvement in mild sleep apnea: The airway is supported; improvement can be seen in mild and moderate sleep apnea cases.
Foundation for complex orthodontic planning: A foundation is laid for successful execution of other orthodontic treatments.

Rare Problems and Their Management

Rare problems may be encountered after SARPE. Early detection of these problems and rapid intervention is important for treatment success.

Partial relapse: Partial relapse can occur when compliance with the retention protocol is not maintained. If detected early, it can be managed with additional retention.
Permanent nerve sensitivity: In most cases, temporary nerve sensitivity completely resolves. Rarely, some permanent sensory change may occur; this condition can be adapted to.
Asymmetric expansion result: If asymmetric expansion is detected after surgery, the expansion protocol is adjusted; additional orthodontic adjustments may be needed in advanced cases.
Worsening of sinus problems: In patients with existing chronic sinus problems, this condition can rarely worsen after surgery; it is managed with ENT consultation.
Second surgery need: Very rarely, the expected result may not be fully achieved; in this case, additional surgical correction may be planned.
Aesthetic expectation mismatch: If the change in nose shape after surgery differs from the patient's expectation, additional aesthetic treatments can be considered.

If any of these situations occur, it is important to contact Doredent and the Tayfun Hoca team. Early intervention can resolve most problems with simple methods.

An Important Message to the Patient

SARPE treatment is a long and comprehensive journey. The first weeks after surgery can be physically and psychologically challenging. During the expansion period, the diastema appearance, feeding difficulties, and the presence of the appliance in the palate require a certain adaptation process. However, the improvements achieved at the end of this process significantly change quality of life. At Doredent, post-SARPE follow-up is conducted in coordination by our orthodontist Merve Hoca and our contracted jaw surgeon Tayfun Hoca. Adherence to the latency period protocol, strict commitment to the retention period, participation in regular check-up appointments, and daily oral hygiene habits are the most important factors for long-term preservation of treatment success. Do not hesitate to contact the clinic for any questions or concerns you have during the post-surgical period. The Doredent and Tayfun Hoca team is with you at every stage of your treatment journey.

Frequently Asked Questions

What is SARPE and how is it performed?

SARPE stands for "Surgically Assisted Rapid Palatal Expansion." This method involves surgically loosening the midpalatal suture, followed by active expansion using a special expansion appliance. The procedure is performed as follows: The patient undergoes surgery under general anesthesia in a contracted hospital, operated by Uzm. Dt. Tayfun Cıvak. During surgery, the lateral maxillary walls and midline suture are loosened with controlled cuts; in advanced cases, the pterygomaxillary region may also be separated. The surgery takes 1-2 hours, and the patient typically stays in the hospital for one day. After a 5-7 day latency period following surgery, the patient begins daily activation by turning the screw at home. The active activation period typically lasts 2-4 weeks; afterward, the appliance remains in the palate for 4-6 months for retention. Throughout the entire process, orthodontic coordination is managed at Doredent by Uzm. Dt. Merve Özkan Akagündüz.

Who is SARPE performed on?

SARPE is performed on adult patients whose midpalatal suture is highly matured and for whom less invasive methods (MARPE, conventional expansion) would be insufficient. The age range is typically above 25 years, but age alone is not a sufficient criterion. The most common indications include: adults with suture maturation stage D or E, cases where MARPE has failed, advanced upper jaw narrowness of 8 mm or more, severe crossbite, need for space creation before comprehensive orthodontic treatment, as part of orthognathic surgery planning, sleep apnea cases related to upper jaw narrowness, and significant narrow smile aesthetic concerns. The decision is based on evaluating the suture maturation level using cone beam computed tomography (CBCT). In the system known as Angelieri classification, the suture is divided into five stages (A, B, C, D, E). MARPE is usually successful in stages A, B, and C; in stages D and E, SARPE provides more reliable results. At Doredent, suitability is honestly evaluated by Merve Hoca during the initial examination.

What is the difference between SARPE and MARPE?

Both SARPE and MARPE are methods aimed at upper jaw expansion, but they are designed for different clinical situations. MARPE (Mini-implant Assisted Rapid Palatal Expansion): Works by placing mini-screws into the palate under local anesthesia. Does not require surgery. Effective in patients typically aged 15-25 with suture maturation at stage A, B, or C. Since it is non-surgical, there is no recovery period and it is more affordable than SARPE. SARPE (Surgically Assisted Rapid Palatal Expansion): Works by surgically loosening the midpalatal suture. Performed in a hospital setting under general anesthesia. Effective in adults typically over 25 years old with suture maturation at stage D or E. As a surgical procedure, it has a recovery period and higher cost; however, it provides a permanent solution in cases of advanced maturation where MARPE would fail. Which method is suitable for you is determined after evaluation with CBCT. At Doredent, MARPE is evaluated first in cases where there is a chance for this method; unnecessary surgery is not performed.

How long does the SARPE treatment process take?

The SARPE treatment process takes an average of 18-30 months, including not just the surgical day, but also the latency period, active activation, retention, and orthodontic completion. The stages of the process are as follows: Surgery (1 day) performed by Tayfun Hoca under general anesthesia in a contracted hospital; surgery takes 1-2 hours, patient stays in hospital for 1 day. Latency period (5-7 days) is the waiting time for post-surgical healing and initiation of new bone formation; no activation is performed during this period. Active activation period (2-4 weeks) occurs through the patient turning the screw daily at home. Retention period (4-6 months) where the appliance remains in the palate while the newly formed bone tissue matures. Subsequent orthodontic completion with Invisalign or braces can take 12-24 months. SARPE is not a standalone treatment but a stage in a comprehensive orthodontic plan. Factors affecting duration include: severity of upper jaw narrowness, accompanying orthodontic problems, patient compliance (with activation protocol and hygiene), healing rate, and general health status.

Is SARPE a painful treatment?

Since SARPE is performed under general anesthesia, no pain is felt during surgery. Some level of discomfort and mild pain is normal in the first days after surgery; this is effectively managed with prescribed pain medication. As many patients report, less pain is experienced than expected. The most intense discomfort after surgery is typically experienced due to swelling, limited jaw movements, and eating difficulties rather than pain; this is what challenges patients most. Swelling gradually decreases within the first week and daily life begins to return to normal. During the active activation period, when the patient turns the activation screws at home, temporary pressure sensations may be experienced in the teeth, palate, and nose-face area. This typically passes within a few hours and is a natural part of the treatment process. In case of severe and persistent pain, you should definitely contact the clinic.

Will a gap form between my front teeth during active expansion?

Yes, during the active expansion period of SARPE, a noticeable gap forms between the upper two front teeth because the midline junction point opens. This condition is called diastema. What is important to understand is this: This gap is not a complication or problem; on the contrary, it is a positive clinical sign that SARPE is working successfully and that the suture has opened. Many patients may panic when they see this; however, it is an expected and desired finding. The diastema is gradually closed during subsequent orthodontic treatment (with Invisalign or braces). During the retention period, the gap may also begin to naturally close partially; however, complete closure is achieved with orthodontic treatment. When the appliance is removed, there will be no gap between the teeth.

Will my nose shape change after SARPE?

After SARPE, widening of the nasal base and nasal wings may be seen. This is not a side effect of SARPE but a natural consequence of the positional change of the upper jaw. In many patients, it is mild; in some cases, it can be noticeable. This change can bring a positive side effect: improvement in nasal breathing may be seen with increased nasal cavity volume. In patients experiencing breathing difficulties due to upper jaw narrowness, this side effect actually becomes an advantage. This issue is discussed in detail with the patient by Tayfun Hoca before surgery. Expected side effects are shown in advance with digital surgical planning; realistic management of expectations is the foundation of treatment satisfaction. Special suturing techniques applied in surgical technique (such as alar cinch suture) can minimize changes in the nasal wings in some cases.

Is orthodontic treatment mandatory after SARPE?

Yes, orthodontic treatment after SARPE is necessary in almost all cases. SARPE is not a standalone treatment but the upper jaw expansion stage; afterward, orthodontic treatment is essential to bring teeth to their final positions and regulate the bite relationship. The reasons for orthodontic treatment are: closing the diastema formed as a result of active expansion, aligning teeth appropriately for the new jaw dimensions, correcting accompanying crowding and bite disorders, regulating upper-lower tooth relationships. At Doredent, Invisalign clear aligners or traditional braces are offered as orthodontic treatment options. Our orthodontist Merve Hoca, who holds the Diamond Provider title, explains in detail which method is suitable for you. It is not realistic to think of SARPE as a standalone treatment; it should be considered as an important stage of comprehensive orthodontic planning.

When can I return to work after SARPE?

The time to return to work after SARPE varies depending on the clinical requirements of the case, the patient's healing rate, and their profession. Generally, most patients can return to work 1-2 weeks after surgery. Patients who do not do intensive physical work and work in an office environment can keep this period shorter. In communication-intensive professions (teaching, sales, management, etc.), a few extra days may be needed due to speech adaptation; in the first days, pronunciation of some sounds may be difficult because the appliance takes up space in the palate. For those doing strenuous physical work (construction, transportation, jobs requiring heavy work), waiting 2-3 weeks is recommended. For intense sports and physical activity, waiting at least 4 weeks is necessary. The return-to-work time is determined by Tayfun Hoca for each patient; the period can be extended or shortened depending on how healing progresses. After the active activation period begins, the patient can continue their normal life; they only need to pay attention to the appliance and hygiene rules.

Treatment Pricing

Pricing

Surgically Assisted Maxillary Expansion (SARPE) Pricing

At Doredent, we offer transparent pricing for our international patients. As every case is different, the final treatment cost depends on your individual evaluation.

The cost of Surgically Assisted Maxillary Expansion (SARPE) varies based on factors such as the scope of the surgery, appliances used, hospital costs, and the orthodontic follow-up duration after treatment. For an accurate quote, a personalized assessment is recommended.

For pricing details, reach out via WhatsApp or book your initial consultation.

WhatsApp Get Pricing Information

→

Book Online Schedule Initial Consultation

→