S.A.R.P.E is an acronym for Surgically Assisted Rapid Palatal Expansion. This technique has the purpose to correct problems such as lateral crossbite and dental crowding of the upper arch and combines surgery with orthodontic treatment to achieve a widening of small palates.
The operation is mostly done because the upper jaw usually does not expand during development in order to accommodate all its teeth in the dental arch causing significant crowding, malpositioned and misaligned teeth.
In general, the maxillary arch has a very deep, constricted palate and orthodontic treatment by itself cannot correct this dentofacial growth discrepancy.
Who needs a SARPE surgery?
Two bones that join in the dome of the maxilla to form the palate. The union between these two bones is called palatine suture or maxillary suture.
Ideally, the palate expansion should be done at an early age, before the palatine suture has completely merged, a process that is completed during puberty. In these cases, surgical intervention is not necessary, but only an orthodontic treatment called RPE (Rapid Palatal Expansion).
SARPE (the palatal expansion by surgical route) is the only possible treatment for patients whose palatal suture has already merged.
Cases that may need orthognathic surgery:
- Complication chewing or biting food
- Pain swallowing
- Chronic jaw or jaw joint (TMJ) pain and headache
- Excessive wear on the teeth
- Open bite (space between the upper and lower teeth when the mouth is closed)
- Unbalanced facial appearance from the front or side
- Facial injury or birth defects
- Fading chin
- Distending jaw
- Inability to make one’s lips meet without straining
- Breathing Problems – Chronic mouth breathing and dry mouth
- Sleep apnea (breathing problems when sleeping, including snoring)
- Speech Problems
What entails the SARPE surgery?
Before the surgery, the patient will need a custom-made specialized orthopedic expanding appliance made to fit in the palate. This expander is cemented to the first molars and premolars and activated with a special key. The key turns a screw within the expander to allow for separation of the right and left side of the upper jaw. The expander also works like a retainer after the expansion took place. The actual SARPE surgery is performed under general anesthesia in hospital and usually takes less than one hour to complete. Most patients stay in the hospital overnight, but some patients may leave the same day if they are medically stable.
The usual recovery from this procedure is about one week. The surgeon will first use specialized instruments to perform multiple bone cuts in specific locations that will symmetrically expand the arch. No fixating devices are used other than the expander. Over the next several months, the patient will use the key every day to achieve incremental expansions, which commonly creates a space between the two front teeth. The expander will typically stay in the mouth after the expansion has been obtained for about three months, at which time it is removed. Orthodontic treatment to close the space between the two front teeth will then begin. Patients are followed very closely during the first two weeks to ensure no complications are encountered. After the procedure, the patient should consume soft foods.
How long does the treatment take?
It is important to know that SARPE surgery is not a complete treatment – it is done in combination with other treatments, including braces before and after the surgery.
Comprehensive treatment time depends on the type of treatment that may suit your clinical case and the severity of the problem. In cases that require jaw surgery, it may take 18-24 months to complete the whole treatment. In growing patients or adolescents where jaw growth modulation is planned it may take up to 24-36 months of treatment to achieve the desired correction.
Cost and Insurance
SARPE surgery is an expensive procedure without health insurance. Of course, this will depend on your dental provider. Beyond orthodontics, other factors that can increase the cost include severity of the jaw misalignment and what type of surgery is required. A difference could be done also by your location, the hospital treating you, and complications during recovery.
Without insurance, the typical costs of SARPE surgery can run from $20,000 to $40,000. Costs are usually lower if surgery is only needed on one jaw. Surgery involves an exam, X-rays, general anesthesia, bone cutting, bone reshaping, and jaw repositioning.
Above all, SARPE surgery is considered a medical procedure, not a cosmetic procedure, and is necessary to prevent more expensive medical and dental problems later in life. Because of this, some health insurance policies cover at least part of the cost of orthognathic surgery.
Further costs include:
Braces, which are often required before and after SARPE surgery, so treatment can take two to three years. It can cost:
- $1,500 – $10,000 or more for traditional metal braces;
- $2,000 – $8,500 for braces with tooth-colored ceramic or plastic brackets;
- $2,000 – $8,500 for self-ligating braces (which don’t need elastic bands);
- $5,000 – $13,000 for lingual braces (installed behind the teeth);
- $3,500 – $8,000 for the Invisalign tray system.
Other costs of the surgery consist of:
- $1900 for the expander plate that is put in the patient’s mouth before surgery. This fee is an orthodontic fee;
- $1700 represents the surgeon’s fee. This fee is due before the day of the surgery and is to be paid in full;
- $1200 is the hospital fee. This covers the hospital care/day stay on the day of your surgery. This is due on the day of the surgery and to be paid in full;
- $850 for the anesthetist fee. It is due a couple of days before surgery and to be paid in full.
The same as in any other surgical procedure, SARPE is not free of risks, and careful planning and execution of treatment are fundamental to ensure an adequate result. Nonetheless, there is scarce information on many issues related to SARPE. There are still no convincing ways to identify the optimal equilibrium between extensive surgeries for adequate mobilization versus a conservative procedure with minimal complications. Advances in imaging techniques have figured another perspective to the evaluation of bone density and surgical use. These can help in obtaining better precision and aid standardize surgical techniques and orthodontic treatment protocols.