Non-Surgical Palatal Expansion in Adults

[ruca2]

Hi everyone! So, I know this is a controversial subject on this forum and for orthodontists in general. I thought I would shed some light on my own experience thus far and on some research I've done. I don't have specific measurements for my own case but I have some progress pictures that might help shed some light on the subject. I know many people are very confused on whether or not palatal expansion in adults is even possible. And if so, what are the most effective methods for achieving this. I'm definitely not an orthodontist or expert on the aforementioned subject. From information I have gathered it is generally agreed upon that the palantine sutures fuse at or after puberty making if very difficult for expansion without surgery thereafter. Some orthodontists still insist on placing RPE's or RME's (rapid maxillary expanders) in adults and I'm sure some get adequate expansion but it is very difficult to retain after the RPE and braces are removed. I'm sure there are cases where retention is maintained but it seems as if this percentage would be relatively low. My ortho had discussed another type of expansion available in adults. This is termed the SPE or SME (slow maxillary expander). There are various kinds available that function in slightly different ways. I have a specific device called the NiTi expander. It is a viable treatment option for any kind of posterior crossbite and constricted maxilla. "This appliance expands both posterior as well as anterior teeth. It helps to correct rotations and open bite, provides space for the teeth in the arch and requires minimal patient cooperation. This particular one is a combination of Nickel and Titanium and is activated by body temperature. It places a uniform slow and constant force of relatively 350–400g against the palatine suture. SME appliances produce light force and opens the suture at a rate that is close to the maximum speed of bone formation. Slow expansion produces suture separation at a rate that maintains the integrity of maxillary sutures by allowing for bone remodelling." I have provided a link to a very informative case study that I've quoted here chronicling this particular subject. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736147/
I have also attached my 6 month pictures and you can tell I've gotten some expansion from the device. Note: I obviously had pre-molar extraction as well. I hope this was a somewhat informative post.

IMG_3095 (2).gif

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[sirwired]

If the appliance claims to be good for "any" posterior crossbite, color me skeptical. And I don't see how this addresses the long term stability issues seen in many, if not all, non-surgical expansion cases. ( The case report you linked to was a pre-surgical, not non-surgical case. ) I also found it odd that the report felt compelled to explain what NiTi was, given that it's been the standard material for early-stage arch wires for a couple decades now.

[dbala]

Hi ruca2! Thank you so much for sharing your journey here. I'm a 23 yo female with very similar issues. I have a narrow upper arch, posterior crossbite, open bite, and some tongue thrust (basically a sort of milder version of the case you linked in your post). I had braces when I was 12-14ish but for some reason an expander was never brought up then. Now i have more crowding and a constricted jaw and am looking to start treatment soon once I find orthodontist I can trust. Every orthodontist I've been to insists surgery is the only way to correct my bite. I really find that hard to believe, especially when my own research keeps turning up study after study with successful SME treatment. For some reason I'm not being allowed to see the photos you posted in your 6 month progression. Do you have a flicker or a public blog I could see them on? It's so incredibly difficult to find others looking into SME for similar issues- progress photos are my biggest source of confidence in non-surgical treatment success. Hope to hear back- it would be so helpful. Thanks!

[quote="ruca2"]Hi everyone! So, I know this is a controversial subject on this forum and for orthodontists in general. I thought I would shed some light on my own experience thus far and on some research I've done. I don't have specific measurements for my own case but I have some progress pictures that might help shed some light on the subject. I know many people are very confused on whether or not palatal expansion in adults is even possible. And if so, what are the most effective methods for achieving this. I'm definitely not an orthodontist or expert on the aforementioned subject. From information I have gathered it is generally agreed upon that the palantine sutures fuse at or after puberty making if very difficult for expansion without surgery thereafter. Some orthodontists still insist on placing RPE's or RME's (rapid maxillary expanders) in adults and I'm sure some get adequate expansion but it is very difficult to retain after the RPE and braces are removed. I'm sure there are cases where retention is maintained but it seems as if this percentage would be relatively low. My ortho had discussed another type of expansion available in adults. This is termed the SPE or SME (slow maxillary expander). There are various kinds available that function in slightly different ways. I have a specific device called the NiTi expander. It is a viable treatment option for any kind of posterior crossbite and constricted maxilla. "This appliance expands both posterior as well as anterior teeth. It helps to correct rotations and open bite, provides space for the teeth in the arch and requires minimal patient cooperation. This particular one is a combination of Nickel and Titanium and is activated by body temperature. It places a uniform slow and constant force of relatively 350–400g against the palatine suture. SME appliances produce light force and opens the suture at a rate that is close to the maximum speed of bone formation. Slow expansion produces suture separation at a rate that maintains the integrity of maxillary sutures by allowing for bone remodelling." I have provided a link to a very informative case study that I've quoted here chronicling this particular subject. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736147/
I have also attached my 6 month pictures and you can tell I've gotten some expansion from the device. Note: I obviously had pre-molar extraction as well. I hope this was a somewhat informative post. [attachment=1]IMG_3095 (2).gif[/attachment][attachment=0]021 (2).gif[/attachment][/quote]

[jodyxlee]

dbala You can't see photos until your username is green, have a look for the new members info

[dbala]

jodyxlee thanks for the tip! I'll get to posting :)

[quote="jodyxlee"]dbala You can't see photos until your username is green, have a look for the new members info :)[/quote]

[Rubyg]

Hi ruca2, thanks for sharing, you can really see some expansion from those photos!! How are you finding the device so far? I have an Alf for the last 2 months, I have a lisp with it and sometimes find it very sore against the roof of my mouth. My ortho strongly recommended proper tongue posture and nose breathing at all times to really help with the expansion too. It's early days but I'm def getting better at it and really hopeful that ill start seeing some positive changes soon. I'm a bit impatient so have to keep reminding myself that the ortho is taking a very slow and gentle approach..fingers crossed it will all be worth it in the end.
Ive researched a lot on tongue posture and nose breathing etc and just wondering could this be why people's results relapse after treatment stops..the tongue in correct posture supports the maxilla and helps maintain the newly acquired arch expansion amongst loads of other benefits...hopefully I'll be able to report back with some positive changes soon!!

Keep us posted n your progress too

[ruca2]

dbala, I haven't posted the pictures anywhere else other than this site. You just need to keep posting until you've reached you're able to activate the picture viewing capability of your account. The expander is difficult to live with but the end goal will hopefully be worth the dismay. My ortho is keeping mine in for a few more months to serve as an anchor to bring my central incisors back to correct my overjet. As for retention, who knows. We just have to see what happens when I and brace free.

[mynewmouth]

Hi!!

I'm 22 and just about to start non surgical expansion to correct a crossbite! Orthodontist says expander in for 2mths then getting Invisalign to straighten everything out.

Got my lil blue spacers in yesterday and teeth are feeling very tender..

I'm so hoping it works.

[februaryrichard]

Hi ruca2!

Any updates on your situation?

[ruca2]

Yes, I posted some progress pictures a few weeks ago. I think it's something titled 11 months. Just search through my posts. I have had the expander out for 3 months now. I have lost a little bit of width that I had when the expander was in but nothing too significant. Everything seems to be on track. Thanks

[dbala]

Hi! I started a new thread, but thought I'd post here as well since it's relevant :)

My name is DIvya, I'm a 23 yo female with skeletal open bite and a posterior crossbite. I just started my orthodontic journey with various devices and braces. I had Phase 1 braces as an early teen and was told that jaw surgery was the only way to correct my open bite and narrow arch fully. I never intended to do the surgery as it's just not a comfortable option for me. Over the last year I decided to revisit orthodontics as my jaw has started to feel a bit strained. I went on 20+ orthodontic consults and everyone told me the same thing- I had to have surgery to correct both issues. I wasn't ready to accept that so I did my own thorough research for 3-4 months until I found two relatively new technologies (there's not too many studies published on either) that should eliminate the need for jaw surgery in my case altogether, if they work as anticipated. I found a special palate expander called MARPE that is able to "unlock" and widen a mature adult's maxillary bone to correct crossbite. I then saw that a combination of TAD mini-implants and elastics can facilitate the closure of an open bite by intruding/extruding teeth to fix the occlusal angle. Then I found a research university close to me that actually uses MARPE (most orthodontic practices haven't even heard of it yet), and after a consult have started my orthodontic treatment with them. Disclaimer: I am not an orthodontist and do not claim to be an authority on any orthodontic issues. Everything I share is from my own personal research (I'm pretty good at it, if I say so myself!) and my own experience.

I've started a blog to track share my progress along the way including photos, appointment summaries etc!

Hope you'll follow along at http://smileofsteel.weebly.com

[awkwardbraceface8]

Whilst it's definitely a controversial topic, I've found that non-surgical palatal expansion has really worked for me, and has given me a much wider jaw/smile without extractions.

[Blingythings]

I'm interested in this subject. I've been looking at photos on the Internet and not seeing any teeth like mine. I'm also dealing with some gum recession issues even though I've always taken great care of my teeth. I'm wondering how this might work with periodontal issues?