Orthodontic expanders play a pivotal role in modern orthodontics, offering solutions for various dental and skeletal issues. These devices are designed to widen the upper jaw, improving dental alignment, airway function, and overall oral health. In this blog, we’ll dive deep into what orthodontic expansion entails, how it works, and why it’s a vital component of orthodontic treatment. Whether you’re considering treatment for yourself or a family member, this guide will provide valuable insights into the world of orthodontic expanders.
What Is Orthodontic Expansion?
Orthodontic expansion involves widening the upper jaw, medically known as the maxilla, to create more space in the dental arch. This procedure addresses issues such as crowding, crossbites, and even certain airway obstructions. The process is particularly effective in growing children and young teenagers, whose bones are more malleable due to the presence of open sutures.
Expansion can be achieved using various types of orthodontic expanders, each tailored to the specific needs of the patient. The procedure is most commonly performed in the upper jaw because its structure allows for skeletal expansion, unlike the lower jaw (mandible), where expansion is typically limited to dental movement.
How Orthodontic Expansion Works Biologically
The upper jaw consists of two halves joined by a mid-palatal suture, a flexible growth plate in younger patients. When an orthodontic expander is applied, gentle but consistent pressure is exerted on the palatal bones. Over time, this pressure encourages the suture to widen and new bone to form, a process called osteogenesis.
This biological response is unique to the upper jaw. The lower jaw lacks a suture along the midline, making skeletal expansion in this area impossible without surgical intervention. Instead, lower arch expansion relies on moving the teeth outward within their sockets, which can still improve alignment but does not alter the skeletal framework.
Optimal Timing for Orthodontic Expansion
The ideal time for orthodontic expansion is during childhood or early adolescence, typically between the ages of 7 and 10. At this stage, the sutures in the upper jaw remain flexible, allowing for effective skeletal expansion. Once these sutures fuse—usually in the mid-teens to early adulthood—skeletal expansion becomes more challenging and may require surgical assistance.
Adult patients may still benefit from orthodontic expansion, but the approach often involves a combination of surgical techniques, such as SARPE (Surgically Assisted Rapid Palatal Expansion) or MARPE (Miniscrew-Assisted Rapid Palatal Expansion).
Why Might Someone Need Orthodontic Expansion?
Orthodontic expansion addresses a variety of dental and health concerns, including:
- Dental Crowding: Expanding the upper jaw creates more space for teeth, reducing the need for extractions.
- Crossbites: A narrow upper jaw can lead to misalignment of the teeth and bite issues, which expansion can correct.
- Airway and Sleep Apnea: Narrow palates can restrict airflow, contributing to obstructive sleep apnea. Expansion can widen the airway, improving breathing and reducing apnea symptoms.
- Aesthetic Concerns: A narrow arch can affect facial symmetry. Expansion helps achieve a more balanced appearance.
- Orthodontic Stability: A well-aligned jaw provides a stable foundation for long-term dental health.
Types of Orthodontic Expanders
Orthodontic expanders come in various designs, each suited to different cases:
- Rapid Palatal Expander (Hyrax)
- A traditional and widely used device, the Hyrax features a screw mechanism that is turned periodically to widen the jaw. It’s effective for achieving significant skeletal expansion. This is the most common type of expander, and is a non-removable fixed appliance that sits in the roof of the mouth.
- Quad Helix Expander
- This device uses metal wires attached to the molars. It is less aggressive than the Hyrax and is often used for more gradual expansion. There is less true skeletal expansion with a quad helix, but this appliance can be useful for situations that don’t require skeletal expansion. This is also a non-removable fixed appliance that sits in the roof of the mouth, but it is less cumbersome when compared to the hyrax.
- Haas Expander
- Similar to the Hyrax, the Haas includes an acrylic plate that rests against the palate, offering additional stability. Comfort with this type of expander can vary from patient to patient.
- Removable Acrylic Expander
- This expander looks very similar to a Haas expander, but it is removeable. These expanders are less common because patient compliance with wearing the expander full time can often be an issue. In order to get true expansion similar to a Hyrax or Haas expander, the removable expander should ideally be in the mouth for 23 hours per day at a minimum.
- Invisalign Expanders
- Introduced in 2023, Invisalign Expanders can be a great option for younger patients provided they are committed to wearing it full time. Invisalign expanders are more comfortable that traditional expanders, and patients generally tolerate them better. Additionally, these expanders do not need to be activated by the parent or guardian. Patients simply move to a new tray every 1-2 days, and each tray slowly expands the palate. While they are an Invisalign product, these expanders do not look like the traditional Invisalign aligner with which you may be familiar. At Rise + Smile Orthodontics, Dr. Mathue Faulkner was actually one of the first orthodontists to use the Invisalign Expander in Austin, TX. He treated his oldest daughter with the appliance shortly after it was released.
SARPE and MARPE: Advanced Expansion Techniques
SARPE (Surgically Assisted Rapid Palatal Expansion)
SARPE is a technique used for adult patients whose sutures have fused. The procedure involves a surgical incision to separate the mid-palatal suture, followed by the use of a traditional expander. This method achieves significant skeletal changes even in mature patients.
MARPE (Miniscrew-Assisted Rapid Palatal Expansion)
MARPE uses temporary anchorage devices (TADs) or miniscrews embedded in the bone to provide additional support. This technique minimizes the movement of teeth and focuses the expansion forces on the skeletal structure. MARPE is particularly effective for adults and late teens seeking non-surgical options.
Pertinent Research and Studies
Recent studies have highlighted the broader benefits of orthodontic expansion:
- A 2020 study published in the Journal of Clinical Orthodontics found that maxillary expansion improves nasal airflow, benefiting patients with obstructive sleep apnea.
- Research in the American Journal of Orthodontics and Dentofacial Orthopedics underscores the long-term stability of skeletal changes achieved through rapid palatal expansion.
- Advances in imaging technologies, such as CBCT scans, allow orthodontists to visualize the effects of expansion in real-time, improving treatment outcomes.
Frequently Asked Questions
How does the Hyrax expander work? The Hyrax expander uses a central screw mechanism to gradually widen the upper jaw. Patients or caregivers turn the screw daily, applying gentle pressure that encourages the mid-palatal suture to expand.
Are Invisalign expanders as effective as traditional expanders? Invisalign expanders are relatively new, and as such, there isn’t as much non-biased research available yet. Early clinical cases, however, have shown all of the typical biological signs of effective expansion. This appears to be a great option for families provided the patient can commit to wearing the removable appliance full time.
Is expansion painful? Patients may experience mild discomfort during the initial adjustment period, but it typically subsides within a few days. Most patient describe the discomfort as “pressure” rather than “pain”.
How long does the expansion process take? Active expansion usually lasts 1-3 months, followed by a retention phase to stabilize the new bone growth.
Can adults benefit from orthodontic expansion? Yes, adults can benefit through techniques like MARPE or SARPE. These methods address the limitations posed by fused sutures in mature patients.
Orthodontic expanders are versatile tools that address a wide range of dental and skeletal issues. Whether you’re seeking treatment for crowding, bite correction, or improved airway function, expansion can offer transformative results. At Rise + Smile Orthodontics, Dr. Mathue Faulkner DDS MS combines expertise with state-of-the-art technology to deliver personalized care tailored to your needs. Schedule a consultation today to explore your orthodontic options!