Transforming an Underbite and Breathing: A Case Study with Dr. Koval’s MARPEFACE Protocol
One of our recent patients came to us with a common concern: a fuller face and an underbite. What made this case unique is that it wasn’t just a dental problem — it was a true skeletal Class III malocclusion, meaning the bones of the face and jaw were misaligned, not just the teeth.
Traditionally, these cases can be very challenging. But with Dr. Koval’s MARPEFACE protocol, we achieved life-changing results.
What is the MARPEFACE Protocol?
Dr. Koval’s method combines advanced imaging and surgical precision to guide treatment. It involves:
- 3D-guided midpalatal piezocorticotomy – a minimally invasive way of loosening the midfacial bones.
- Mini-screw assisted palatal expansion (MARPE) – a custom device that gently expands and repositions the upper jaw.
The goal is to separate the midface from surrounding bones so it can move forward and outward, correcting both the bite and the facial profile.
Dr. Koval’s recent studies even confirmed that this technique works in both men and women, helping the maxilla (upper jaw) shift into a healthier, more natural position.
The Patient’s Starting Point
- Underbite confirmed by scans: ANB angle of -1.89° (showing true skeletal Class III).
- Flattened midface with the upper jaw positioned at 87°.
- Neck posture issues: many Class III patients develop a forward-leaning, “L-shaped” airway curve as the body compensates for reduced breathing space. This narrowing often happens in the nasal and throat region.
Treatment Journey
Using a custom MARPE appliance, activated over 10 weeks, we guided the midface into a healthier position.
Results included:
- Full skeletal correction: ANB improved from -1.89° to +2.78°.
- Forward jaw movement: SNA angle increased by 2°, showing a more natural upper jaw position.
- Better neck alignment: the airway shape improved from a curved “L” to a more open, vertical pathway.
- Patient`s expansion concluded 10.5 mm of midpalatal suture disarticulation.
The Takeaway
This case highlights how the MARPEFACE protocol not only corrects underbites in adults but also improves:
- Facial balance and profile
- Airway size (making nasal breathing easier)
- Posture and neck curvature
For patients struggling with skeletal Class III malocclusions, this approach is proving to be a powerful, non-compromising solution — restoring both function and confidence.