Indications and Types of Palatal Expansion
- Maxillary expansion indicated when the width of upper jaw to lower jaw difference is 4 mm or greater
- Measurement done from width of outside first molars in upper jaw compared to lower jaw
- Rapid palatal expansion used in cleft palate repair
- Rapid palatal expansion used to gain room for teeth in patients with moderate crowding in upper jaw
- Types of expansion include rapid palatal expansion (RPE), slow expansion, implant-supported expansion, and surgically assisted rapid palatal expansion (SARPE)
Rapid Palatal Expansion (RPE)
- RPE achieved by turning a key in the expander
- RPE typically remains in patient's mouth for 3-6 months
- RPE can be tooth supported, bone supported, or both
- RPE relieves posterior crossbite by achieving daily expansion of 0.5mm to 1mm
- RPE results in a gap between the two top front teeth, which may require braces
- Adjustment to eating and speaking may take a week or two after receiving RPE
- Patients turn the expansion screw themselves to widen the expander
- Bionator appliance may be an alternative for lower jaw expansion not managed by the patient
Implant-Supported Expansion
- Mini-implant assisted rapid palatal expansion (MARPE) applies forces directly to the maxillary bone
- MARPE involves placing 2-4 mini-implants in the palatal vault area to anchor the RME appliance
- MARPE allows palatal expansion in young adults with fused palatal suture
- Surgical assist may be recommended in adults for consistent outcomes
- Expansion at the PNS and nasal aperture critical in treating Obstructive sleep apnea
Surgically Assisted Rapid Palatal Expansion (SARPE)
- SARPE used when patient's palate halves or intermaxillary suture fuses together
- Palatal expander surgically inserted onto mid-palatal suture by oral-maxillofacial surgeon
- Orthodontist connects palatal expanders band rings to maxillary molars
- SARPE allows expansion in patients with matured palate
- Surgical procedure required for SARPE
Definition, Purpose, and Effects of Palatal Expansion
- Palatal expansion is a dental procedure that aims to widen the upper jaw.
- It is commonly used to correct issues such as crossbite, overcrowding, and narrow arches.
- The procedure involves applying pressure to the midpalatal suture to stimulate bone growth.
- Palatal expansion can improve breathing, speech, and facial aesthetics.
- It is often performed during childhood or adolescence when the bones are still growing.
- Palatal expansion techniques include rapid maxillary expansion (RME), surgically assisted rapid maxillary expansion (SARME), distraction osteogenesis maxillary expansion (DOME), endoscopically-assisted surgical expansion (EASE), and implant-supported palatal expansion.
- Benefits of palatal expansion include improved breathing, corrected crossbite, improved dental occlusion, enhanced speech articulation, and improved facial aesthetics.
- Palatal expansion is most effective when performed during the growth phase, and the success and relapse rates of different techniques have been investigated.
- Notable figures in the field of palatal expansion include Charles J. Burstone, Thomas M. Graber, Robert M. Ricketts, David L. Turpin, and Charles H. Tweed.
A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. Although the use of an expander is most common in children and adolescents 8–18 years of age, it can also be used in adults, although expansion is slightly more uncomfortable and takes longer. A patient who would rather not wait several months for the end result by a palatal expander may be able to opt for a surgical separation of the maxilla. Use of a palatal expander is most often followed by braces to then straighten the teeth.
It is believed that expansion therapy should be started in patients either before or during their peak growth spurt. To obtain maximal skeletal changes, the therapy is typically initiated at a very early age. Expansion therapy performed after the peak growth spurt will lead to more dental changes than skeletal which leads to tipping of buccal teeth.
