Complex Case: Skeletal Asymmetry

This session focused on one of the most difficult scenarios clinicians encounter with MARPE: Asymmetric expansion that alters the occlusal plane, shifts the mandible and triggers new or worsening TMJ symptoms. The discussion centered on a complex patient who developed a significant cant, yaw, and mandibular deviation after a second round of expansion performed without supervision. When the patient arrived for help, she was experiencing pain, swelling, facial asymmetry and functional instability.

See how Dr. Yoon stabilized the patient, re-established a functional bite and carefully intruded and repositioned the maxillary segment to rebalance the occlusion. Strategies such as using temporary splinting, occlusal blocks and TAD-supported intrusion were discussed as ways to help the joint “find home” while correcting the cant. The case also raised questions about how joints adapt to vertical changes, when disc compression or decompression contributes to symptoms, and why some patients experience meaningful TMD relief after expansion while others relapse over time.

A second case highlighted an even more dramatic example: An unsupervised expansion that resulted in a severe one-sided drop of the maxillary complex. The session explored how slow expansion protocols, coordinated lower-arch movement and joint-friendly sequencing reduce the risk of these complications. Watch the full session to get updated protocols, including one-turn-per-week activation and simultaneous Invisalign movement to maintain occlusal stability throughout treatment.

Throughout the discussion, participants examined the interplay between sutural resistance, vertical changes, joint space, soft-tissue adaptation and airway-related symptoms—and why many patients report feeling more comfortable as the mandible naturally finds a more physiologic position during expansion.

To watch the full walk-through—including visuals, biomechanics, troubleshooting steps and the complete slow-expansion protocol—access the full recording inside the Advanced Implementation Course.

Live meeting sessions are held on the last Monday of every month at 6PM PT. All sessions are recording and available for replay.