Are palatal expanders really necessary?
Many patients will need a palatal expander to fix crossbites, asymmetries, create space and increase the width of the smile or buccal corridors if they have a narrow palate. Teeth can be moved within the bone with either regular or clear braces, but the width of the arch itself cannnot be changed much unless it is done via expanders. Typically the width of the opposing mandibular arch will dictate how much widening of the upper arch is necessary. Orthodontists are highly trained to detect skeletal imbalances and dental camouflage that accompanies these problems and can tell you if your treatment plan should include a rapid palatal maxillary expander. Statistically, about 66% of patients will need expanders, done at the right time, before maturation of their midpalatal suture. Therefore it is necessary to see orthodontic patients as early as age 7, as strongly advised by the American Association of Orthodontists.
There are some proponents of certain philosophies’ that use self-ligating brackets in an attempt to treat without extractions every single patient. They will slowly overexpand with very wide archwires developing the width of the arches without expanders, however from my personal experience, in many cases that creates dehiscence, fenestrations of thin periodontal labial bone with potential severe problems later in life. In addition there is a certain unnatural look like excessive flaring of anterior and posterior teeth. Some of these cases may need retreatment later in life since they relapse the minute the patients “divorce” their retainers.
Proper archwidth coordination is one of the 6 keys of occlusion developed by Drs, Larry and Will Andrews, who studied, researched and educated our orthodontic community about proper diagnosis, alignment and jaw relationships within the context of facial balance, harmony and stability.
Properly done, maxillary expansion had been shown to create a lot of benefits from broader smile arches, spacing to align crowded teeth without the need to do interproximal reduction or extractions, to increased airway and better sleep quality, preventing potential obstructive sleep apnea.’ As a side note, all my three children had traditional expanders around age 8, and many of my orthodontic colleagues, knwoing what we know, are doing the same thing for their own children. Proper diagnoses and treatment timing are essential.
The palatal expander “expands” (or widens) your upper jaw by putting gentle pressure on your upper molars each time an adjustment is made.
When you achieve the desired expansion, you will wear the appliance for several months to solidify the expansion and to prevent regression.
Adjusting the palatal expander
Step 1: In a well-lit area, tip the patient’s head back.
Step 2: Place the key in the hole until it is firmly in place.
Step 3: Push the key toward the back of the mouth. You will notice the fender will rotate and the new hole will appear. The rotation stops when the key meets the back of the expander.
Step 4: Press back and down toward the tongue to remove the key. The next hole for insertion of the key should now be visible.
More details about palatal expanders at Premier Orthodontics & Dental Specialists in Elmhurst and Downers Grove IL
What are the steps to get a custom made expander?
Once the decision is made that an expander is needed, there are a few critical steps to get a proper custom made comfortable appliance. Typically it starts with separators or spacers placed between the molars for a few days, to separate the teeth. A few days later, a 3D intraoral scan for a 3D printed expander or a traditional alginate impression is taken and bands fitted. A few weeks later the expander is bonded or cemented in and instructions given to patients and parents regarding activation protocol
How long will I have to wear my expander?
It depends, each patient and each malocclusion is different. Usually anywhere from 3-6 months, depending on the rate of activation and what the overall treatment plan is. Some patients will have a skinny design, so the epander can stay in place after the desired witdth is achieved, some are removed and replaced with a transpalatal bar across the roof of the mouth or the width of teh arches is maintained via clear aligners or braces with heavier wider more rigid archwires. Traditionally a more rigid retainer such a Hawley with aplatla acrylic coverage or a thick nighguard is reccomended if a lot of epxansion was done, to prevent arch collapse and the narowness coming back.
How about SARPE - Surgical Assisted Rapid Palatal Expanision?
For those nongrowing patients struggling to breath, with very narrow “V” shaped arches, lots of crowding, thin periodontal tissue , crossbites and open bites, SARPE is he answer. It is safe to plan a LeFort I surgical procedure done by oral surgeons in a hospital setting with general anesthesia. It is also very predictable and not taxing the limits of periodontal support. At Premier Orthodontics & Dental Specialists, we’re thrilled to work with experienced specialists that have the expertise to help our more challenging cases with these kind of procedures. Usually the medical insurance will cover for it and recovery is about 1-2 weeks. It is not uncommon for these patients to need additional surgical procedures or a second round of jaw surgery to correct other skeletal imbalances such as anterior/posterior or vertical discrepancies, in lay terms large overbites or underbites or deep bites or open bites. Very predictable and done in a hospital setting, these procedures will change the look of teh patients for teh better and help increase teh airways and quality of sleeep and life reducing many times the risk of OSA Obstructive Sleep Apnea.
