Adult Non-Surgical Palatal Expansion

[VA5]

i read somewhere here.. that the bite is in some ways more important than straight teeth. and i believe it. you have to think about the health of your roots and how it might relate to your gums and also you should realize that the way the teeth are lined up can cause undue stress to the roots/gum if the bite isn't good.

yeah, i agree. i may not be able to afford to get my bite fixed though if insurance doesn't cover the surgery. which is why i'm still considering nonsurgical expansion still as well, but i'm really weary of it.

i personally do not have a cross bite, but have a friend who does. she didn't need surgery to correct it. all that is needed is elastics.

[owlsonbikes]

yeah, i agree. i may not be able to afford to get my bite fixed though if insurance doesn't cover the surgery. which is why i'm still considering nonsurgical expansion still as well, but i'm really weary of it.

i personally do not have a cross bite, but have a friend who does. she didn't need surgery to correct it. all that is needed is elastics.[/quote]

ah, yeah, i was told by everyone that i'd need either the surgery or the expander. my bite is too narrow to correct with elastics.

i called one of the orthos who wants to use an expander without the surgery & he said he felt that i didn't need surgery to correct it... but he did admit you aren't moving the palate or jaw... you are just pushing/tipping the teeth. he claimed he's seen no bad side effects to nonsurgical expansion in adults, but he said they only started doing more of it a couple years ago. he explained they started experimenting with nonsurgical expansion when he had adults who couldn't afford the surgery.

i got a really thorough email response from another ortho i saw (pro-surgery) stating that you can ruin the gums/roots with nonsurgical expansion in adults. there's the exception of a small percentage of cases where the teeth are actually tilted in toward the tongue, but the jaw is still wide enough & an expander can be used correctly on adults.

he explained: "If a palatal expander is used without the surgery- then all the appliance is doing is pushing the roots and crowns of the teeth off their foundation. There are plenty of documented cases where the teeth get pushed off the bone and actually cause the gum on the outer surface of the teeth to recede and cause some periodontal issues.

There are a very small group of patients who have a wide upper jaw and the teeth are inclined or tilted towards the tongue and a using a palatal expander may work. ( you aren't that small percentage, and the small patient population that this may work- I'd say why mess with an expander when regular braces and wires can expand the upper teeth and achieve the same result.)

In your case, you are not going to be able to fully expand the teeth on the arch with braces alone because the teeth with be tipped out and that's not a stable position for the teeth. Also if you don't get the teeth completely out of crossbite- you will put the occlusion or bite in a situation where it will be bad for your gums down the road.

In my younger days, I've stretched the envelope and have followed these patients long enough to see that the orthodontics contributes to gum issues down the road. So experience is the best teacher.. either do the surgical option or do the ortho to straighten the teeth but not the crossbite."

[DrJasonKTam]

ah, yeah, i was told by everyone that i'd need either the surgery or the expander. my bite is too narrow to correct with elastics.

i called one of the orthos who wants to use an expander without the surgery & he said he felt that i didn't need surgery to correct it... but he did admit you aren't moving the palate or jaw... you are just pushing/tipping the teeth. he claimed he's seen no bad side effects to nonsurgical expansion in adults, but he said they only started doing more of it a couple years ago. he explained they started experimenting with nonsurgical expansion when he had adults who couldn't afford the surgery.

i got a really thorough email response from another ortho i saw (pro-surgery) stating that you can ruin the gums/roots with nonsurgical expansion in adults. there's the exception of a small percentage of cases where the teeth are actually tilted in toward the tongue, but the jaw is still wide enough & an expander can be used correctly on adults.

he explained: "If a palatal expander is used without the surgery- then all the appliance is doing is pushing the roots and crowns of the teeth off their foundation. There are plenty of documented cases where the teeth get pushed off the bone and actually cause the gum on the outer surface of the teeth to recede and cause some periodontal issues.

There are a very small group of patients who have a wide upper jaw and the teeth are inclined or tilted towards the tongue and a using a palatal expander may work. ( you aren't that small percentage, and the small patient population that this may work- I'd say why mess with an expander when regular braces and wires can expand the upper teeth and achieve the same result.)

In your case, you are not going to be able to fully expand the teeth on the arch with braces alone because the teeth with be tipped out and that's not a stable position for the teeth. Also if you don't get the teeth completely out of crossbite- you will put the occlusion or bite in a situation where it will be bad for your gums down the road.

In my younger days, I've stretched the envelope and have followed these patients long enough to see that the orthodontics contributes to gum issues down the road. So experience is the best teacher.. either do the surgical option or do the ortho to straighten the teeth but not the crossbite."

This is it spot on. The confusion with expansion is over whether expansion is dental or skeletal and also depends on the initial positions of the teeth relative to the jaws.

If your teeth are tipped in lingually with a wide enough skeletal base, then you do not need an expander. Wires and brackets are sufficient because you are only moving the teeth. Even if expansion occurs with an expansion appliance in place, it is not "palatal expansion", it is simply dental expansion.

On the other hand, if the teeth lined up over the base of the bone and "expanded" it is simply tipping the teeth outwards. This can compromise the future stability of the teeth and bite..

Really, there shouldn't be a debate :).

[Jrorb]

Sorry for digging up an old thread, but I would just like to report that I have had success with non surgical palate expansion. My ortho wasn't sure that it would work since I'm 24 but we tried anyways and it did. I heard a small cracking noise and noticed my two front teeth separating at about turn #15, the gap got larger every turn thereafter. I heard and felt the bone really break with a loud pop at turn #22 It didn't hurt but it was a strange feeling. I had braces with the archwire attached the entire time and it didn't stop the gap from forming or the palate from separating. I hope you had a similar experience! I can't say this happens for all adults, I might just be lucky.

[Chicagogal]

My ortho is one of the foremost researchers on non-surgical palate expansion. He is pro using it in several cases, HOWEVER he really doesn't dispute that true skeletal expansion doesn't happen after puberty without surgery. I am one of his non-surgical expansion cases. I just needed a few milimeters between a couple front teeth so that he could properly line up the bone plates being installed in my zygoma (cheek bones) with all of my brackets. So far so good. My dentist and periodontist were on the same page as far as bone/gum health of using only a palatal expander in my case. That was enough buy-in for me, otherwise I would've been very skeptical of non-surgical expansion.

[Angie831]

Hey everyone. I am 27 now. I got expanders placed in July 2010. i had severe crowding and needed significant expansion. the entire right side of my mouth was overlapping eachother with the front tooth very crooked. I had a bad case of TMJ. my breaking point was the day i woke up and like many other times, my jaw was locked. Now, typically it would last a couple hours, TOPS!! but, this time it lasted almst 2 weeks. it was un-bearable.. after 3 consultations and alot of planning we started the process.

i didnt have a key or anything like that.. it was a helix expander. they were on the top and the bottom. well, in the first week i felt the difference. i didn't see much of a difference but, i felt it in my jaw. i was told 6 months with the expanders... but, reality was that it took 9 months.. it was the LOOOONGGGGESSSTT 9 months of my life. and my jaw was "fractured" twice in the process. but, the end result of the expanders was that my TMJ is gone and now i have only the braces and 13 months to go. i am VERY pleased with the results so far and the pain is very much worth it!!!

[LadyJennifer]

^you beat me to it...non-surgical doesn't work with adults, unless you want to push your teeth out the side of your jaw.

Actually that is not exactly true. Many adults have had great success with palatal expansion. Here is a study about it:
http://www.semortho.com/article/S1073-8 ... 5/abstract

The bones don't fuse when you're an adult.

[LadyJennifer]

And here's another:
http://iadr.confex.com/iadr/2006Orld/te ... _76180.htm

" Conclusion: Our results defy the current paradigm regarding expansion in adults. The results indicate that non-surgical maxillary and mandibular expansion in adults is a clinically successful and safe method for correcting bimaxillary transverse arch deficiency."

[LadyJennifer]

The mid palatal suture is the line you feel running down the middle of your palate. This denotes the location of an opening between two bones and becomes fused during puberty. The goal of expansion is to move these two bones apart. After fusion, the upper jaws are not able to be separated from each other without surgery. As such, only dental tipping is possible.

Dental tipping in a buccal direction, as mentioned, is not true jaw expansion, but can be considered dental expansion. Keep in mind that the teeth can only be tipped out so far before the supporting structures, such as the gums and bone, are compromised. Long term stability is also of great concern.

This is as sure as night and day .

But there are so many case reports and reports from patients and studies. All you need to do is search this forum.

Here's an example of a study:

http://www.ncbi.nlm.nih.gov/pubmed/3310 ... t=Abstract

And another:

http://www.angle.org/doi/pdf/10.1043/00 ... 2.0.CO%3B2

This study says:

Rapid maxillary expansion in adults flared the
molars buccally only 3 degrees per side. The mandibular plane and lower facial height were unchanged. The
adults achieved 18% of their transmolar expansion at the height of the palate and the remainder with buccal
displacement of the alveolus. /quote

18% is not that great, but the point is, bone expansion was achieved.

My suspicion, based on what I've read, is that the amount of tipping and the type of expansion (dental or skeletal) depends on what was used to achieve the expansion.

There is one thread where a person reported on using a kind of expander that fits against the roof of the mouth and, IIRC, they didn't need to turn any key. The fact that it fit against the roof ensured that there'd be no tipping.

The person said that they were told by the dr that expansion is achieved by growing new bone. The bone stretches out, holes appear, and new bone grows (I'm not 100% on the explanation, I've read so many stuff recently it's all jumbled up).

There are really so many reports from patients, and case reports from doctors and studies (and it's not folks who confuse it with tipping of teeth). You can just search this forum and find reports of faces getting wider and cheekbones more pronounced.

I think the reason some people write off adult non surgical expansion is that they see one that isn't done well and results in just tipping and they assume it's all just tipping.

I think you're right. If you look, there is a good bit of evidence supporting that adults do grow bone with proper expansion pressure.

[JumpTheDitch]

I know this is an older thread, but as it's been reactivated I wanted to post my thoughts.

This is such a hotly debated topic, but I wonder how expansion following previous extraction-and-retraction ortho work fits into this debate?

Also how do the varying methods of non-surgical expansion stack up? My NM dentist is very keen on ALF-type expansion as it apparently uses gentle, constant forces. As opposed to RPE, does one type of expansion have a higher success rate in terms of long-term retention, or reduced ill-effects such as bone loss, gum recession, etc? Is this the kind of expander that other posters were referring to in creating 'holes' in the bone which your body replaces, 'growing in' more bone to keep pace with the gentle expansion?

Is expansion more likely to be successful in these cases as there was originally bone in the more promient postition to support the expansion? Is the bone still there or would it have deteriorated? Any orthos out there able to comment? Has this area been researched? I know Dr Hang in the US is quite active in this area, as are an increasing number of orthos and NM dentists worldwide.

I had upper bicuspid extraction and front teeth retracted about 6 years ago, following which I developed TMJD which deteriorated to such a point I am now trying to reverse the ortho work. My NM dentist says I should have had my arches expanded rather than treated as if I had an overjet (I was already 26yo when I first consulted an ortho). Pulling the lower jaw even further back into the jaw joint socket in order to achieve dental occlusion with the newly retracted upper arch, pushed my TMJ disc out of it's space, and a whole host of physical issues followed. I've been in Phase I of TMJ Split Therapy for just over 2 months with huge success. I'm looking forward to (hopefully!) regaining a healthy bite that I can live with, without the need for 24hr splinting. I desperately hope it can be achieved.

At my last appointment she said she thought I would need two different types of expander; one to push the upper teeth forward again, and a second to push the upper teeth out, as she says my narrow upper palate was trapping my lower jaw in the first place, creating the appearance of an overjet. I also have minor crowding with just two teeth in my lower arch. I'm not sure if lower expansion is part of the plan also.

Since I have already had so much trouble following traditional ortho work (which was undertaken by a highly trained, very experienced prominent orthodontist), I am hesitant in trusting my dental, and therefore overall health to anyone! While I trust my NM dentist as she comes highly recommended by a craniofacial chiro who works extensively in this precise field, I understand that this area is evolving, and my dentist herself says she's constantly attending conferences and learning new practices and techniques. I know that there are no guarantees, but having said that I want one!

I just want to regain my health, the last thing I want is bone loss or gum recession following my second round of ortho work...

Any thoughts?

[LadyJennifer]

From what I understand, JumpTheDitch, slow expansion allows for soft tissues to grow with the bone. There are several prominent orthodontists who have researched this and published their work. Kent Lausen is one of the first I read about. My ortho, Michael Williams has also published research on it. Maybe try googling keywords and you'll turn up something?

[LadyJennifer]

After a quick google, I found this article/study about rapid maxillary expansion.
http://www.ncbi.nlm.nih.gov/m/pubmed/10833001/

Gum recession and root resorption wasn't a problem here. It stands to reason it would be even less of a problem with slow expansion.
That's all I could find so far. I'll have to keep looking later.

[jonathon003]

i have a few questions, but i'm not really sure if it necessary relates to this discussion in particular.

so i had 4 premolars removed a few years ago, and then orthognathic surgery to widen, shorten, and move my upper jaw forward; my lower jaw was also moved forward. but even after all this, while my bite looks great, my face has clearly suffered the consequences of the sunken-in look (no cheeks, sort of look gaunt/sick even at high weights, my lips are noticably thinner, and my mouth/face just looks lifeless). so am i correct in thinking that most orthodontists would believe that since my extractions have been done (and i assume my jaw bones have shrunk) it is impossible, even with dental implants (assuming gaps could be re-opened) to correct this? i know there are certain orthodontists doing this (google dr. william hang in california) so is it just that some ortho's believe that there WILL be relapse or something? why can he do it and not others?

also lets pretend that i can expand my teeth outward, but as the doubters say, the bone remains the same, does that mean facial asthetics won't really improve much (ie. face will still look very narrow since jaw bone hasn't expanded itself, just the teeth)? also what about the BOTTOM arch? seems like everyone is talking about the maxilla arch, but how would the bottom expand to meet the top? *confused*

[katsface]

Hmm, I can't address most of your questions, but I think I can at least partially address some.

I lot of orthos don't reverse extractions because it's difficult to do. It's like lingual braces. They work. They can (for the most part) do the same thing as regular braces. But most orthodontists don't use them because they require different technique which may be seen as more difficult. I think reversing extractions seems to be in the same category. Orthodontists don't do it because they don't want to provide treatment which may fail because they are not experienced in the techniques required.

As for the lower jaw needing expansion, it seems like it often doesn't really need any.

Here's how my ortho explained it. The lower teeth follow the position of the upper teeth. Your teeth are trying their best to find the best bite that they can given the structure of your jaws.

So, in my case for example, my palate is very narrow, but my lower jaw is actually normal, width wise. My lower teeth followed the position of my upper teeth, so they tilt really far inward to meet the upper teeth. They're basically like this:

¯¯|¯¯¯¯¯¯|¯¯ Upper Arch
_/_______\_ Lower Arch

instead of like this:

¯|¯¯¯¯¯¯¯¯¯¯|¯ Upper Arch
_|__________|_ Lower Arch

Making the lower teeth more upright will help them match the upper jaw once it's expanded.

My ortho said this is pretty common. While it is possible to do a lower jaw surgery to expand it, in cases like mine, only dental expansion is necessary.

[jonathon003]

hmm makes sense. thank you very much for the help.

i remember hearing the same from my surgeon when i asked him about the bottom expanding to meet the top (since my top jaw was expanding via surgery) and he also echoed those sentiments, that the lower jaw didn't need widening b/c the top arch and your bite will keep everything in alignment.

that being said, i think it's a whole different ball game when you need to reverse extractions. i don't have much knowledge on it, b/c well there's not many people that have gone through it or can shed much info on it on the internet it seems, but if you open the extraction gaps on the bottom, i assume your arch also needs to be expanded on the bottom to allow the new implants to come in. maybe there are expanders for the bottom too. no idea.

it's so deflating that i just needed to do more research and perhaps consult more orthodontists a few years ago, and all this depression would have been avoided, and the potential of throwing away another 2-3 years of my life, and likely 20+ thousand dollars (including implants, and surely thats a very minimal forecast) would never even be a thought. sighhh