Adult Palatal expansion

[thorin]

I'm 38 and looking into palatal expansion. I did some searching in the forums and most of the answers that I saw talked about aligning teeth as an adult. I'm specifically interested in the actual expansion of the palate. I have an extraordinarily narrow upper palate (my thumb can't touch the roof of my mouth) and although I'm very thin and sleep on my side I snore and have been told this is most likely caused by my narrow palate. I have seen the website for the homeoblock and some other sites that talk about epigenetic orthodontics but am having a hard time finding anything from people who corrected a very narrow palate.
I've asked two dentists, one recommended a regular palatal expander and said that it's would be slower than for a kid but it will work. The other said It'll just push out my teeth but will not actually change the palate itself.

Can anyone clarify or testify as to the validity of expanding the palate (and affecting things like the sinus passage) as an adult? And further help point me to the type of device that indeed achieved this?

Thank you so much!

-Thorin

[sirwired]

The Homeoblock and "epigenetic orthodontics" both set off my B.S. Detector. (Read the sticky I wrote about spotting quackery...) The first red flag is that neither appliance was developed by an ACTUAL board-certified orthodontist. You'd think that even if they aren't orthodontists themselves, they'd at least find an orthodontist to sign off on their appliance as something new, different, and useful. Neither has.

On appearance, the "Homeoblock" appears to be nothing more than a standard palatal expander, but with a fancy name attached so you pay more. (Take careful note on the website that none of the professional articles about it appear in decent orthodontic journals, just a few glossy trade magazines on cosmetic dentistry, placement in which may very well have been paid for.)

And "Epigenetic Orthodontics" (and the associated "DNA Appliance") sure sounds like woo also (and also has the looks of a gussied-up palatal expander.) If you look carefully at it's list of articles, it's certainly longer than Homeoblock's, but many of them are in chiropractic journals (anything with the word "subluxation" in the title is a red flag), journals specifically geared towards general dentists practicing orthodontics, and other marginal publications. The provider search helpfully provides links to chiropractors and "orofacial myologists" (I have no idea what that is, but it also smells strongly of woo.)

For both appliances, a bunch of the providers (almost all of which are general dentists) proudly advertise themselves as "Holistic Dentists". While ordinarily I'd say it's not an appliance's fault that there are quacks that would like to use it, the number of such dentists signing up for these appliances seems to be well out of proportion with how many there are.

Now, to answer your actual question: The long-term stability of expansion in adults is a very controversial topic. There are multiple studies that have reached the exact opposite conclusions on that question. Personally I suspect that it IS possible in some people, but NOT possible in others, and nobody has yet figured out how to tell the difference between the two ahead of time. I wish I had a more conclusive answer for you.

Did either orthodontist suggest surgery? (Either a LeFort I or SARPE/SARME?) If neither did, does either of them ever refer adult patients for such surgeries? ("No" is the wrong answer there... I'm not saying you need surgery, just that you want to be consulting with orthodontists that are familiar with it as an option.

If I were in your place, given how dramatically narrow you describe your palate as being, if offered surgery I'd take it. SARPE/SARME is not nearly as traumatic (or expensive) as a LeFort I or BSSO.

[thorin]

Sirwired,

Yeah, both the homeoblock and the epigenetic stuff also hit my BS sensors (albeit lightly cause I wanted them to be real.)
I like your assessment of it either working for SOME people or at least KINDA working for some people. I was really hoping to avoid surgery obviously as most normal humans would do I think.
Both of my dentists (and an ENT doctor) mentioned surgery but it always seemed to be mentioned with a shaking of the head and a slight shudder. Maybe just my imagination. I'll look into the surgery a bit more, it doesn't seem all too common and I'm hoping that's not because the procedure is medieval in terms of torture. :)
Thanks for your response. You have gave another voice to the rational voice in my head telling me "probably too good to be true!"

[sirwired]

Well, as far as pain goes, neither LeFort I nor SARPE/SARME is particularly painful. I had a LeFort 1 myself to correct a crossbite (also caused by a too-narrow palate, although much of the narrowness was fixed as a child by an expander) and while it was not a fun experience that I'd do for kicks, recovery was more annoying than painful.

(Word of warning: If you are of the queasy of stomach, DO NOT look at YouTube videos of a LeFort I or BSSO! Like many bone surgeries, it certainly LOOKS medieval (one step in the LeFort I involves a mallet and chisel), and certainly makes any patient very glad they are stone-cold out during the operation. But it's less painful than it looks and sounds! Honest!)

Jaw surgery isn't as common as, say, wisdom tooth removal, but all Oral Surgeons learn how to do them during their training; it's not particularly rare. An orthodontist experienced with treating adults should have one or more he/she regularly works with for surgical cases. The real trick is finding one that takes medical insurance, as jaw surgery is considered Medical instead of Dental.

If surgery has been offered as an option, and you have coverage to pay for it, that's the route I'd go down if it were my mouth to have the best chance at long-term stability.

[thorin]

Thank you very much for your posts sirwired. I really appreciate it. I'll be sure to post my findings/updates here for others that might be going through the same!

[dantocanada]

I also had a very narrow palate, and so I just had my palate expanded using Wilckodontics surgery and a palate expander. Can't say it was the most pleasurable experience, but it has been fast. Wllckodontics not only allows the reshaping of your jaw and palate, but it also significantly speeds up tooth movement. My treatment has been very fast and taken place in several phases:
1) Lower braces July 2014
2) Upper brackets placed December 2014
3) Wilckodontics surgery December 2014 followed by 10 days of recovery (you can read about my experience in more detail here http://www.archwired.com/phpbb2/viewtop ... 15&t=48021)
4) RPE placed January 2015.
5) RPE turned daily ( .25mm each day for 28 days = 7mm of expansion)
6) Upper arch wire and elastics added February 2015

I am now 10 weeks into upper wire / elastics, and according to my Ortho, my crossbite has been completely fixed and they are beginning to fine tune my teeth. She thinks I'll be all done by late summer - a total of 14 months. So, while it has been challenging, I think the fact that I only have 4 months to go makes it all worth it because the thought of wearing these things for another year is definitely not appealing. Anyways, if you read my story, you'll find out some other details that might help you in your research.

[thorin]

Thank you Dantocanada,

I'll check out your story soon!

[freysmiles]

Surgical expansion, whether it is a SARPE or with PAOO (wilckodontics), is a more predictable procedure when significant orthopedic expansion needs to be done, but palates can be expanded in adults and they have been doing this since the 50s. The Homeoblock people like to pretend like this is some sort of magic, but it is not.

Whether orthopedic expansion can be successful without surgery depends on the maturation of the suture (this can be assessed on a CBCT radiograph), but expanders in adults are much more uncomfortable and less predictable than in adolescence.

[thorin]

Hi Freysmiles,

Thank you for your post. I'll definitely ask about the possibility of checking the maturation of my suture via CBCT.

[freysmiles]

Just as an FYI, the need for surgery also depends on the amount of orthopedic expansion required since the suture is only one of the resistant structures (though it is the primary one). In surgery, all of the sites of resistance are addressed to get the expansion to happen predictably. Even with favorable information on the CBCT, it is still a case by case decision.

[Tellmemore]

Anyone heard anything about the possibility of lingual braces with SARPE? My ortho says they'd use a TAD-based (bone-borne) expander but they wouldn't do the orthodontic correction after surgery with linguals. I'm having a hard time telling if THEY don't do it, or if it can't be done, or can't be done reliably.

[Dalicia]

Well I'm just wearing an Schwartz expander and have done so for a few months and it indeed it has expanded my palate and not just tilted the teeth outwards. I have photos that clearly show the palate being wider, can send them to you if you like. I figured I had to turn slow "by feel" so to speak, if I turn to fast, which I have done at the start I could feel it on my teeth, I've gone slow after and just turn again once the expander sits nicely on my palate for a few days and nearly feels like it feels off, then its time to do one turn again. :)

[LittleSern]

Have you looked into Damon Braces?

[sirwired]

Have you looked into Damon Braces?

Damons (specifically their archwire form) widen smiles, not palates. And I'm pretty sure most brands of braces offer a similar archform. Just as the company that sells Damons also sells narrower archforms under other brands. Damon braces are a particular brand of self-ligating bracket and archform; they are heavily marketed, but in the end not fundamentally different (much less better) than any other similar (and less expensive!) product from another supplier.

[Ed1020]

[quote="dantocanada"]I also had a very narrow palate, and so I just had [b]my palate expanded using Wilckodontics surgery and a palate expander. [/b] Can't say it was the most pleasurable experience, but it has been fast. Wllckodontics not only allows the reshaping of your jaw and palate, but it also significantly speeds up tooth movement. My treatment has been very fast and taken place in several phases:
1) Lower braces July 2014
2) Upper brackets placed December 2014
3) Wilckodontics surgery December 2014 followed by 10 days of recovery (you can read about my experience in more detail here http://www.archwired.com/phpbb2/viewtop ... 15&t=48021)
4) RPE placed January 2015.
5) RPE turned daily ( .25mm each day for 28 days = 7mm of expansion)
6) Upper arch wire and elastics added February 2015

I am now 10 weeks into upper wire / elastics, and according to my Ortho, my crossbite has been completely fixed and they are beginning to fine tune my teeth. She thinks I'll be all done by late summer - a total of 14 months. So, while it has been challenging, I think the fact that I only have 4 months to go makes it all worth it because the thought of wearing these things for another year is definitely not appealing. Anyways, if you read my story, you'll find out some other details that might help you in your research.[/quote]

How can be palate expanded via Wilckodontics(AOO) ?As far as I am aware, wilkodontics is a surgical procedure in dental domain and has nothing to do with opening sutures?