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Inside Dentistry
January 2022
Volume 18, Issue 1

Maxillary Expansion for Jaw Alignment

Treatment indications and considerations

Satish Pai, DDS, MS, MPH

Having a misaligned upper jaw can be a real struggle for patients. This misalignment occurs when the upper jaw is either smaller than the lower jaw or set back, and it can be either hereditary or caused by improper development. Addressing the problem of a crooked jaw is essential because it not only affects patient's appearances but also their health.

A crooked or misaligned jaw can create many issues, including the following:

• The appearance of hollow looking cheeks and an inappropriately defined upper lip

• Speech disorders and malocclusion, such as underbite, overbite, and crossbite, which can cause difficulty when chewing

• Deterioration of general health

• A reduction of the resistance in the nasal airway that creates a poor respiratory pattern

• Breathing disorders such as obstructive sleep apnea

• Less available space to align crooked or crowded teeth, which can leave extraction as the only possible solution

• Deviation of the lower jaw

• Facial skeletal asymmetry that can lead to structural and functional disorders of the stomatognathic system

One solution to correct a misaligned upper jaw involves maxillary expansion using a palatal expander. But how does this treatment work and for whom is it indicated?

Maxillary Expansion

Maxillary expansion, which is sometimes referred to as rapid maxillary expansion, is a dental procedure that is performed to widen the upper jaw so that the balance between the widths of the jaws is reestablished. Harmonizing the widths of the jaws through maxillary expansion is performed as a part of phase 1 interceptive orthodontic treatment in children. Once completed, any dental malposition can be corrected during the second phase of the treatment.

A narrow upper jaw can affect patients' facial experiences and long-term health; therefore, maxillary expansion treatment is extremely important. However, many parents make the mistake of assuming that this problem will resolve itself as their children age when, in fact, the narrow maxilla deviates from the mandible over time. This can lead to tooth wear and serious problems such as temporomandibular joint disorder. Moreover, in some cases, correcting crooked teeth is impossible if maxillary expansion is not performed.

How Does a Palatal Expander Work?

A palatal expander is a custom-made device that is bonded to the insides of the upper teeth to widen the roof of the mouth. When correctly positioned, the device works by applying gradual pressure to the rear half of the jaw, which creates space for new bone to be generated and makes room for crowded teeth to grow.

First, the metal frame is bonded to the rear teeth in the upper jaw. A screw is integrated into the middle, which must be turned with a key by the patient or a parent 1 or 2 times every day (as indicated) to activate the appliance. The force generated separates the two palatal bones where they are united at the suture over a period of around 3 weeks, resulting in a widened jawbone. Once the bones are separated, the device is allowed to remain in place for approximately 3 months so that the new bone tissue in the middle of the palate can completely form.

Prescribing Palatal Expanders

Referral to an orthodontist for palate expansion should be considered in all circumstances involving upper jaw deficiencies, including the following:

· Malocclusion. When the upper set of teeth improperly aligns with the lower set of teeth, an orthodontist may suggest correction by expanding the upper jaw.

· Crowding. When the upper jaw does not have enough room to accommodate all of the teeth, it needs to be widened. Maxillary expansion through palatal expanders creates the necessary space for the teeth without the need for extraction.

· Impaction. When the growth of a tooth is blocked by other teeth, the jaw can be expanded to create space for it to grow. This most often occurs with canine teeth.

Regarding the appropriate age for treatment, a palatal expander will generally work up until the age at which the palatal bones become fused at the suture. And because the bone starts to fuse around the age of 15, the final recommended age for treatment is 12 to 13 years for girls and 13 to 14 years for boys. When the suture becomes fused, surgical orthodontics is an option that can be considered to facilitate the performance of rapid maxillary expansion.

Wearing a palatal expander for maxillary expansion can lead to certain side effects, many of which gradually disappear as the treatment progresses. These include the following:

• Slight pain and discomfort

• Headaches

• Difficulty speaking

• Extra saliva production

• Diastema or gaps between the teeth

• Sore tongue

• Extrusion of rear teeth

• Increased lingual bone thickness and decreased buccal bone thickness

• Accumulation of food debris between the roof of the mouth and the expander

Patients and their parents should be educated regarding what to expect during all phases of the treatment and the importance making the daily adjustments and performing appropriate at-home hygiene to maintain the device. When patient compliance with the instructions is achieved, maxillary expansion with a palate expander can provide excellent outcomes and help indicated patients avoid a lifetime of potential oral health problems.

About the Author

Satish Pai, DDS, MS, MPH, is the founder of Putnam Orthodontics in Carmel Hamlet and Briarcliff Manor, New York, and he is also a partner at Brite Orthodontics in St. Rome and New Harford, New York.

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