Hey everyone,
I wanted to bring attention to an issue that has been developing over the last 7–8 years involving MARPE/MASPE, MSE, FME, and other skeletal expanders commonly promoted by so-called “airway orthodontists.” Many of these providers are not telling patients the full story about what these appliances can—and more importantly, cannot—do.
Before going further, I want to be clear about one thing:
Skeletal expanders are objectively better than tooth-borne appliances like the DNA appliance, AGGA, ALF, or similar devices that rely primarily on dental force. Those appliances largely cause tooth flaring, and in some cases can lead to permanent damage from overexpansion. They do not provide true skeletal change.
With skeletal expanders, you can achieve true transverse maxillary expansion, with a very limited degree of anterior projection in some cases. But this distinction is critical—and often misunderstood.
What does this actually mean?
If your issue is a narrow maxilla, or an upper arch that is skeletally smaller than the lower arch, then yes—you may be a candidate for skeletal expansion. In some cases, you may even see mild aesthetic improvements, such as slightly more prominent cheekbones due to lateral expansion.
However—and this is the part no one wants to hear—
these devices do NOT meaningfully advance the maxilla forward.
If you are hoping to fix a recessed maxilla in the anteroposterior (forward) direction, that is not going to happen with MARPE, MSE, or FME alone. Even when combined with a facemask, forward movement is severely limited, especially in adults.
If someone is skeletally Class III with a deficient maxilla, expansion may help transversely and could potentially improve nasal airflow or airway to some extent. In those scenarios, some clinicians might argue that FME combined with facemask therapy gives the best possible non-surgical outcome.
But let’s be honest:
If you truly want to correct a recessed maxilla in forward projection, the definitive treatment is a Le Fort osteotomy. That is the cold, uncomfortable truth that many providers either avoid or actively downplay.
Now let’s talk about Class II patients.
If you are skeletally Class II—with a recessed lower third, recessed chin, or weak jawline—let me save you $10,000 to $40,000 right now:
Don’t do it.
Yes, if your dental arches are narrow, expansion may help fill out your smile. But guess what?
The upper jaw can be surgically segmented and expanded if needed during orthognathic surgery.
And the real question no one seems to answer is:
What are you going to do with the lower jaw?
In a Class II patient, MARPE/MSE/FME does absolutely nothing to fix a recessed mandible or chin. Nothing.
Sure, an orthodontist can expand the maxilla and then camouflage the bite dentally. But then ask yourself:
Why are you paying $15k–$40k to an “airway orthodontist” when any competent orthodontist can perform camouflage treatment for ~$5k?
At best, what most Class II patients get from MARPE/MSE/FME—if expansion even succeeds—is mandibular repositioning, not mandibular advancement. And that means your recessed chin and lower jaw stay exactly the same.
So what’s the end result?
- 2–3 years of your life
- $15k–$40k spent
- And the same core skeletal problem you started with
To put it bluntly:
Class II patients can cope all they want and praise MARPE/MSE/FME, but these skeletal expanders are not going to fix a recessed mandible or chin. Period
Class II patients often have a narrow maxilla. You can do both expansion and jaw surgery—it’s not an either/or. Skeletal expansion is superior to a segmental LeFort in terms of breathing benefits (though it can be inferior to a segmental Lefort in a lot of other ways). I definitely know of people who did large lower jaw movements who were not cured of their sleep disordered breathing and still can’t breathe through their nose and wish they did expansion too. Expansion is expensive and time consuming but it’s an individual decision whether it’s worth it. I wouldn’t say class II patients should never do it, and I think everyone knows it’s not going to fix a recessed mandible.
On that we agree. As I said in the post nasomaxillary expansion has the possibility of improving nasal breathing and increase upper arch width. So as to say if your goal is to improve nasal breathing then sure, go ahead and try to expand. However I’m just putting out there that if your goal however is to correct retrognathia then skeletal maxillary expanders are not going to do anything. I’m just telling clients/patients to be honest as to what their goals are as far as advancement or expansion and for them to be aware of what the expanders can and cannot do. In your example of a class 2 that wants improved nasal breathing, do they understand that after MARPE+ ortho the skeletal discrepancy remains?
I’m class II, did FME, and am planning to do jaw surgery within the next year or two. My orthodontist was hoping FME would be enough for me because he thinks I look good and have a respectable (but still small) airway, but I know my body and because I had such severe childhood orthodontic retraction (both headgear and premolar and wisdom extractions), I feel I need advancement, even just for tongue space and comfort in my body. My ortho fully supports me getting surgery and I never felt oversold on what FME could do by my ortho. I’m happy with my FME results and can breathe better. Maybe expansion is a bit overhyped these days, but I don’t think it’s so overhyped that orthos are making ridiculous claims about fixing recessed lower jaws.
How much did you expand and did you get any forward growth?
I expanded ~5mm and got ~1mm forward movement
I guarantee than this person didn’t even get 1/2 mm of forward growth. His mandible may have gotten a very minor degree of mandibular repositioning which may have pushed his mandible 1 mm of so forward, also may not have.
I didn’t make any claims about my mandible. I got 1mm maxillary forward movement with FME. I have superimpositions and measurements from top surgeons. I don’t know why you keep digging yourself into a hole. Your whole post is based on the promise that airway orthodontists are claiming expansion can fix severely retrognathic lower jaws which no one is claiming.
I’m not digging myself into any hole. I’m purely putting the information out there on what these expanders can and cannot do. If a skeletal class 2 patient went to an airway ortho and had no issues with nasal breathing, do you think this ortho would hesitate to recommend FME or MARPE?
I think everyone understands that. Some slight forward maxillary movement can happen with expansion (happened to me—1mm) and can allow a trapped lower jaw to come forward a bit, but I don’t know which orthos or patients you’re talking about that think expansion can advance a retrognathic lower jaw. I think for someone who is not severely recessed and has breathing issues, an airway orthodontist may say expansion can help you and you might be able to avoid surgery, but no one is saying what you’re arguing in this post. So it’s just a strange post and some sentences “if you’re skeletally class II don’t do it” are incorrect. Maybe some class II patients are better off just doing MMA but that’s not true across the board. You could easily say the same for someone is severely class III but not super narrow. Doesn’t really matter the whether you’re class I, II or III—what matters is where the problem is. You could be mildly class II and not very recessed with a narrow aperture in which case you’re giving a very bad recommendation here.
Sure you can spend 30 to 40 K on FME to try and fix your nasal breathing. But then you have to ask as a recessed class 2 patient with mandibular retrognathia is FME going to drive to needle as to whether your breathing will improve. A class 2 is that is truly retrognathic needs to get their lower jaw off of their throat and airway. Thats going to yield the results that you need for the airway. Just because you open the passage way at the beginning it doesn’t mean that the airway will be wide enough to past the pharynx and to the lungs🤣
you're just stating the obvious. Palatal expansion is made to expand the palate width. It's like complaining that nose surgery won't make you ears look better.
Palate expansion won't directly give you forward growth but you'll never get forward growth without a wide palate.
What if your recess lower chin is not really recessed, but it’s recessed because it’s stuck behind the maxilla?
As I said in the post, if you expand the maxilla via a skeletal maxillary expander you may to get a minor degree of mandibular repositioning in the forward direction. However if your skeletally recessed, let’s say your lower jaw is recessed, the expander is not helping you gain a single mm of lower jaw advancement. So sure from the repositioning you may get 1-2 mm of possible improvement projection of the mandible but if your truly 10-12 mm recessed that’s not going to make any difference
just mew
This is exactly what I mean. After 18 years old or even before that you could mew for the next million years and your palate won’t grow 0.01 mm. When you realize that you will go to MARPE or FME. Then after wasting 30K on MARPE and FME you will realize that what you really needed was advancement. Good luck wasting the next half decade and 40 k🤣
if you need advancement you most likely need expansion first
I didn’t say that patients who need expansion also don’t require advancement or vice versa. I’m simply telling people that “ air way” dentist may say that it is the fix for both. Does everyone realize that expansion is not the fix for everything? Does everyone understand that getting a wider palate doesn’t just magically fix everything???!
you're confusing bone growth with bone remodeling. Mewing can remodel your face forward but guess what ? you need enough width for it, which is only obtainable with skeletal expansion. Nobody is arguing that palatal expansion is going to make your maxilla grow in lenght, lmao.
Anyone who is an adult who still believes that mewing causes “bone remodeling” needs to seriously consider the words coming out of their mouth. If you need any proof as to evidence for this FACT you simply need to look at the literature. In addition what tells me you have no right to speak or any knowledge on the subject is the thought that bone growth and bone remodeling are two distinct biological processes
it's not a thing of belief, the science is there
The person that is recommending mewing in place of skeletal expanders/ surgery is talking about “science”. Good luck
I literally said skeletal expanders are needed for width. Then mewing will slowly remodel your face forward overtime. It's self-evident if you don't want to look at the science.
Good luck with surgery, which doesn't give you much functional and aesthetic benefits and come with tons of complications
“The greatest blindness is not the inability to see, but the refusal to recognize what’s obvious.”
Does everyone know that if they are pursing both expansion and advancement, this is not a one time + one provider treatment journey. You will first need an orthodontist that is experienced in both MARPE and/or FME who also understands pre surgical orthodontics and surgical planning. Then you will need a surgeon to approve doing the operation and perhaps numerous other care providers to get you to the finish line. This is not a walk down the street and just getting braces bud
My face changed a lot from marpe u can also see forward growth
First of all you got MSE installed 13 days ago 🤣.Show proof of your face changing and forward growth. I guarantee you there isn’t any
Can i dm u?
If you have sleep issues, nasal obstruction or need a large expansion (6mm+) get MARPE/MSE/FME/EASE 100% with MMA after if needed. Segmental can relapse more and it won't give you more nasal volume to fix problems regarding that. Appearance of zygomas/cheekbones are also not affected with segmental, unless you're doing lefort II/III, which is very unlikely.