MARPE vs Custom MARPE vs MSE vs FME

[brielarsonbf]

Can someone explain the differences between these expanders and how youd rank them for adult skeletal expansion?

Here's my understanding so far:

• MARPE = General category of miniscrew-assisted expanders. Results seem to depend a lot on the appliance design and the orthodontist. Usually has more dentoalveolar effects than the newer designs.
• Custom MARPE = Individually designed from CBCT(cone bean computed tomography) + intraoral scans. Better fit, more optimized TAD placement, and supposedly less dental tipping.
• MSE = A specific MARPE design developed by Won Moon. Uses 4 long bicortical TADs and seems to have one of the best track records for achieving skeletal expansion in adults.
• FME = Newer custom skeletal expander that's designed to maximize parallel skeletal expansion while minimizing dentoalveolar effects. Looks promising, but I havent seen as much long-term data compared to MSE.

A few questions:

• Which one actually gives the highest skeletal-to-dental expansion ratio?
• Is FME genuinely an improvement over MSE, or is the hype ahead of the evidence?
• Can a well-designed Custom MARPE achieve results close to MSE or FME?
• For someone in their early 20s, what would you consider the current gold standard?

My current ranking (based on what I've read):

1. FME
2. MSE
3. Custom MARPE
4. Standard MARPE

Curious to hear from people whove actually gone through treatment or orthodontists who have experience with multiple systems.