What is a Palatal Expander?
A Palatal Expander is an orthodontic appliance that is used to widen the upper jaw (Maxilla). The expander applies gentle pressure to the midline boney suture or “zipper” that sits in the middle of the Maxilla. This gentle nudging of the suture induces a widening which creates increased space.
Why would someone benefit from widening their upper jaw?
Because the human upper jaw (Maxilla) is designed to “hold” the mobile, lower jaw (Mandible), these two parts best fit together when the Maxilla is slightly larger/wider than the Mandible. This allows all the teeth to couple with each other in harmonious occlusion, ensuring proper function in addition to achieving beautiful esthetics.
What are some examples of situations where a Palatal Expander can be helpful?
When the upper jaw is too narrow, a person has to shift to one side to get their teeth to touch. Alternatively, people may subconsciously start grinding their teeth to correct the coupling of the top and bottom teeth. A Palatal Expander can enlarge the upper jaw resolving this situation, which is called a “Crossbite”.
There are other benefits to improving the upper dental arch size and shape. Crowding and overlapping of teeth can be corrected and the overall shape of one’s smile can be broadened to maximize tooth display. Expanding the upper arch also creates a wider, more beautiful smile and erases the dark areas at the corner of a smile that are called “dark buccal corridors”
How does a Palatal Expander work?
Because the upper jaw, or Maxilla is a substantial bone that is formed in two halves connecting at the center/midline, we can encourage these halves to grow by applying gentle pressure on each side of the palate. This can be achieved by placing pressure on the teeth only (tooth borne orthodontic appliances) or on the teeth and the palatal tissues together (tooth and soft tissue borne orthodontic appliances).
What is the best time to consider a Palatal Expander for my child?
The perfect time to place a Palatal Expander for kids is during the Early Mixed Dentition phase of development. This means that your child has welcomed some of their adult incisors but still has plenty of primary molars present. For most children this is between the ages of 6 and 10 (but is variable).
At this stage, the midline “zipper” or suture connecting the two halves of the upper jaw are actively growing and are very amicable to gentle nudges. Kids at this stages are also typically comfortable with their dental experiences and tend to be excited about the idea of embarking on an orthodontic adventure. It also helps that many of their classmates may very well have similar appliances.
What about other ages? Are they candidates for a Palatal Expander?
Although we always evaluate occlusion and development in toddlers and younger children, we tend to observe or minimally address occlusal issues in this age group unless they are super comfortable in the dental setting and can really benefit from orthodontic care.
As for our teenagers, the midline suture starts to get very interlaced as kids grow into young adulthood, so the expansion plan needs to be altered. That said, the expansion process can happen during all ages thanks to bone-borne technologies like TADs (Temporary Anchorage Devices) that serve as additional support for the increased pressures needed to encourage the midline suture to open in older candidates.
It’s good to keep in mind that upper arch expansion is easier, faster and works best in a growing child. That’s why we are big fans of Early Orthodontics or Phase One Orthodontics. Who wouldn’t choose an easy option when it is possible?
What types of Palatal Expanders can I choose from for my child?
In a broad sense, there are two major categories that expanders fall into: 1- Fixed (Cemented onto the teeth with dental adhesives), 2- Removable (can be taken in and out of your child’s mouth). The choice of appliance depends on the goals that are mapped out during the orthodontic treatment planning stage. What we are aiming for is a solution that is the right match for the child, the family and the dental situation that is being addressed.
The AAO (American Association of Orthodontics), classifies expanders as Rapid, Bonded, and Removable. Rapid and Bonded expanders fall into the first category mentioned above of Fixed Expanders. Rapid refers to the speed of expansion and Bonded refers to the design of the appliance. The mechanism of both appliances is similar in terms of being fixed onto the dentition.
Removable expanders have recently undergone a new evolution. While this term used to refer to what is commonly called a “retainer”, it has now broadened to include the new Invisalign Palatal Expander. Traditional removable appliances create space by tipping the teeth outward than by truly inducing changes in the width of the upper jaw bones. The Invisalign Palatal Expander differs in that it can mimic the results of a Fixed Expander.
What is a Fixed Palatal Expander?
A fixed Palatal Expander is an orthodontic appliance that is designed specifically for your child’s mouth. Its framework is created from orthodontic metals and its design looks like a “butterfly” in shape. The appliance consists of two wings that attach along the center with an expansion screw. The screw is “expandable” and gets larger as it is turned or “activated”.
The appliance also has bands that are placed on selected molars (we prefer using the primary molars) and extensions that typically rest on the canines. If the design is tissue-born in addition to being tooth-borne support, the appliance will also include resin pads that rest on the palate. The pads can be custom-colored and are a highlight in the orthodontic journey. Kids love to choose colors for these pad (sparkles are also available!).
To create the appliance, the fabricating entity (orthodontic lab) needs to get a copy of your child’s mouth. Long gone are the days of “analogue” impressions. In the era of Digital Dentistry and dental arch scanning, an oral scanner (a very sophisticated dental camera) can easily and comfortably capture a digital impression.
Once the lab has the digital scan, the technician will create the design according to the specifics that we requested. Labs also have options of analogue or digital creations. We prefer 3D printed, digital technology and support its ease and accuracy. A skilled technician is behind the design, but the artistic process is enhanced by software tools that are extremely valuable, precise and time efficient. Once the design is approved, the appliance is fabricated from a metal alloy (and colorful resin components), polished, checked for high-quality outcome/fit and sent over (think delicate jewelry making).
How is the Fixed Palatal Expander Delivered in my child’s mouth?
Here are the steps for the “Delivery Visit” of a fixed 3D printed metal fixed Palatal Expander:
- Excite your child about this new adventure, it will be smooth sailing! Please bring them in with clean, brushed/flossed teeth. We will explain/practice and talk things over at the beginning of the visit. During the visit, movie choices are ready! Safe/light sedation options are always available for those who choose.
- We will check your child’s teeth carefully, reclean, show them the appliance and fit it on the printed model of their mouth, then place it gently in their mouth so that they can get used to it. We will show you and your child how to activate the appliance outside of the mouth.
- The appliance is then removed, cleaned again and prepared for cementation with dental adhesives.
- Cheek retractors/cotton rolls are placed in your child’s mouth to keep the field isolated.
- Dental adhesive is place on the 3D printed bands and the appliance is placed in your child’s mouth.
- The dental adhesive used is a dual-cure material. It is first cured with a blue dental curing light in a matter of seconds. The full setting will take a few minutes to occur after the initial light exposure.
- Gentle cleaning of margins of the appliance is next.
- Instructions on how to activate the appliance in your child’s mouth are fully explained and demonstrated (we will ask you to use your phone and take a video for home reference).
- Cleaning instructions/supplies and an expansion schedule will be provided.
What should I expect after placement of the fixed Palatal Expander?
The fixed Palatal Expander is a new adventure for your child and for you! Like all new adventures, some adaptation time is expected.
- A feeling of something “new” is normal. Most kids adapt to the appliance very quickly. They may speak/articulate a little differently at first but are expected to adjust within a few weeks.
- With the expansion turns, comes a sensation of slight pressure which your child will feel. This is not super intense and is a good confirmation that you are properly achieving a full turn on the appliance. The reason for this sensation is due to the pressure applied by the device to the teeth and palatal structures. This gentle, yet consistent pressure is what allows for the promotion of growth in the palatal suture.
- Cold foods such as ice cream and smoothies are encouraged in the early days of appliance placement. These offer a cooling feeling that helps to keep kids happy. Soft foods are also encouraged in the early stages. Pasta, softer breads, easy-to-chew proteins like soft meats, fish, tofu, and beans are great. In rare instances of sensitivity, Tylenol or Motrin can be offered.
- “Not the best idea” (please steer clear from!) foods: Nuts, Popcorn and super crunchy foods. This get stuck in the appliance and irritate the soft tissues. Also to be avoided are sticky foods like taffy, caramel and candy that can pull on the appliance and dislodge it.
How do we keep a fixed Palatal Expander clean?
- Brush 2-3 times a day or after every meal if possible!
- Use a Waterpik system to clean around and under appliance twice a day.
- Swish with 1 teaspoon of Peroxyl rinse two times a day, for one minute. Rinse out with water afterwards.
- Schedule routine pediatric dental cleanings every 3-4 months.
How is the fixed Palatal Expander activated?
Expansion activations: Instructions on how to activate the expander in terms of process and timing will be clearly provided. We prefer to tailor this plan to each child’s needs. Some kids may move quickly through daily activations. Others may be a better match to slower activation or turns on every other day. All of these timetables is still considered Rapid Expansion as it is completed within a matter of months.
Timing of day: We advise to activate at nighttime after the kids have cleaned their mouths well and are getting ready to sleep for the night. An additional benefit is that your child will be lying in bed. This position allows for ease for both the child and parent.
The process: The activations involve inserting a tiny key (which we will provide) in the expansion screw and turning it to gradually widen the device. Leaning your child’s head back against a pillow, using good lighting (Siri has a great flashlight at hand!) and asking your child to open wide are all great ways to ensure smooth activations.
How long will the fixed Palatal Expander need to stay in my child’s mouth?
A fixed Rapid Maxillary Expander or Rapid Palatal Expander is surprisingly fast! Each turn of the expansion screw equals an expansion distance of 0.25 millimeters. The average goal for expansion is about 8-10 mm. If the orthodontic plan is set for daily activations, it would take four days of activations (at a rate of one turn per day) to achieve 1 mm of expansion. For a goal of 9 mm, this will calculate to 36 days (or activation turns). That’s a little over one month! The rate can be further accelerated or slowed down depending on each child’s needs.
It is important to keep in mind that the appliance will need to stay in place for several weeks to months post completion of the expansion goal. This is to ensure stability of the results. Once removed, (the timing will be case-dependent) a removable appliance will follow to hold and/or further enhance the upgrades.
What are the pros and cons of a Fixed Palatal Expander?
Successful orthodontics is based on consistent, gentle pressure. The word “consistent” is key! With a fixed appliance, consistency is “built-in” because the appliance cannot really be taken out of the mouth at home (providing it is well delivered in the dental setting and well-cared for at home). Keeping the appliance clean is the biggest task at hand here.
A collaborative, child/parent team approach will be needed. Cleaning morning and night is necessary to keep the teeth and the oral tissues in tip-top shape and to avoid the need for early removal. With a goal of smooth success, this appliance is a good match for kids and parents who would like to focus on oral hygiene rather than reminders of keeping the appliance in the mouth.
What is a Removable Invisalign Palatal Expander?
As a team that promotes leading-edge technologies, we will be referring to the new approach to Removable Palatal Expanders that was recently launched by Invisalign, a global entity providing clear aligner orthodontic therapy. The difference between this appliance and the “retainer” that what one might recall from their own childhood, is that its fabrication technology relies on simulating changes in the midline palatal suture not on just tipping teeth.
This Removable Expander innovation includes a series of appliances rather than just one device. The system is similar to Invisalign Clear Aligners in that the appliances are sequenced in numbers and are progressively switched out. The timeframe of switching the expansion trays is only one to three days versus the weekly timeframe used for clear aligners. Also, the expansion appliances differ in appearance from the clear aligner trays. These are opaque, white trays that are 3D printed from a Nylon-like filament and are only seated on the back teeth.
This approach has been shown to create a wider upper dental arch by expanding the palatal suture in a similar way that a Fixed Expander does. Each tray is worn for 24-72 hours simulating one expansion activation on a fixed appliance. Instead of turning the key to apply gentle pressure, the child simply “clips” on the next tray in the sequence of numbered trays. By clipping, we are referring to a little audible “click” that is noted when the child snaps the tray over small, tooth-colored attachments that are temporarily bonded onto the surfaces of the molars during the phase of active expansion.
Creating the trays requires a digital impression of your child’s mouth, This is captured using a digital oral scanner. The data is shared to facilitate custom fabrication according to the proposed orthodontic goals. Once the trays are received in the office, we will bond the small buttons onto your child’s molars to allow the appliance to seat well. You will receive all the trays in the sequence of the treatment during the delivery session along with detailed instructions. As an example: For a goal of 9 mm of expansion, you will receive around 36 trays.
How long will the Removable Palatal Expander need to stay in my child’s mouth?
Early palatal expansion is surprisingly fast and occurs within a few weeks to a few months. Every new expansion tray equals an expansion distance of 0.25 millimeters. The average goal for expansion is about 9 mm. For a goal of 9 mm, this will calculate to 36 trays each worn for a day or up to 3 days each. The rate can be accelerated or slowed down depending on each child’s needs.
It is important to keep in mind that the achieved expansion will need to be stabilized in the weeks that follow the active phase. This goal is usually achieved with a removable retainer which can be followed by clear aligner trays to start finetuning tooth alignment (the timing of this will be case-dependent).
How is the Removable Palatal Expander Delivered in my child’s mouth?
Here are the steps for the “Delivery Visit” of a Removable, Invisalign Palatal Expander:
- Excite your child about this new adventure, it will be smooth sailing! Please bring them in with clean, brushed/flossed teeth. We will explain/practice and talk things over at the beginning of the visit. During the visit, movie choices are ready! Safe/light sedation options are always available for those who choose.
- We will check your child’s teeth carefully, reclean, show them the appliance then place it gently in their mouth so that they can get used to it.
- Cheek retractors/cotton rolls are placed in your child’s mouth to keep the field isolated.
- We will use a clear template to bond a total of four tooth-colored buttons onto the outside surface of your child’s molars using a dental adhesive material (two on each side).
- The dental material is cured with a blue dental during light in a matter of seconds.
- Gentle polishing of the margins of the buttons.
- Instructions on how to seat the appliance in your child’s mouth (we will ask you to use your phone and take a video for home reference).
- You will be supplied with the full sequence of trays or at least enough until our next touch point with your family, depending on the plan.
- Cleaning instructions and an expansion schedule will be provided.
What should I expect after placement of the Removable Palatal Expander?
For this approach to be successful, it is necessary to wear the trays for 22 out of 24 hours every day. Consistency is key! We encourage kids to learn how to eat while the appliance is in their mouths with the caveat that they must remove the tray and brush/floss their teeth morning and night. The appliance can be brushed with a toothbrush as well. With the switching of trays being frequent, maintenance on the appliances is low. If the tray is taken out to eat, it must be placed in the provided box and worn again after eating is completed and the mouth is cleaned or at least rinsed with water.
The removable Palatal Expander is a new adventure for your child and for you! Like all new adventures, some adaptation time is expected.
- A feeling of something “new” is normal. Most kids adapt to the appliance very quickly. They may speak/articulate a little differently at first but are expected to adjust within a few weeks.
- With each new tray, comes a sensation of slight pressure which your child will feel. This is not super intense and is a good confirmation that the appliance is working. The reason for this sensation is due to the device applying pressure to the teeth and palatal structures. This gentle yet consistent pressure is what allows for the excitement and growth promotion of the palatal suture.
- Cold foods such as ice cream and smoothies are encouraged in the early days of appliance placement. These offer a cooling feeling that helps to keep kids happy. Soft foods are also encouraged to start out. Pasta, softer breads, easy-to-chew proteins such as soft meats, fish, tofu, beans are great. In rare instances of sensitivity, Tylenol or Motrin can be offered.
How do we keep a Removable Palatal Expander clean?
- Brush/floss 2-3 times a day.
- Brush the appliance with a toothbrush once or twice a day.
- Swish with 1 teaspoon of Peroxyl rinse at nighttime for one minute. Rinse out with water afterwards.
- Schedule routine pediatric dental cleanings every 3-4 months.
How is the Removable Palatal Expander activated?
The Removable Palatal Expander system is a progressive expansion system based on a sequence of trays that represent stages. Each stage is a quarter of a millimeter wider than the one before it. The increase in width is simulated by digitally enlarging the midline of the palate and designing a new tray with each increase in width. The stages are meant to mimic the turns of an expansion screw. Rather than activate the expansion by turning a screw with a key, the child simply switches to the next stage of expansion trays.
What are the pros and cons of a removable Palatal Expander?
The convenience of achieving true expansion with a removable appliance is great. A child can take out the tray and clean their mouth easily. Food restrictions are minimal, and kids can be super satisfied as they move through the stages and note the positive results. However, orthodontics is based on consistent, gentle pressure.
The word “consistent” is key! With a fixed appliance, consistency is “built-in” because the appliance cannot really be taken out. With a removable appliance comes the responsibility of wearing it to achieve the desired results. A collaborative, child/parent team approach will be needed.
With a goal of smooth success, this appliance is a good match for kids and parents who enjoy tracking results with a team approach and know can commit to wearing the trays. As a bonus, kids get to enjoy all of their favorite foods as long as they clean their mouths and place the trays in immediately afterwards.
In conclusion, a Palatal Expander is an orthodontic aid used to expand the upper jaw, improve tooth alignment, and create a more stable bite. It is most effective if used during a child’s early years of dental life, but can be used for teenagers as well if properly done.
There are different types of expanders, including fixed and removable ones, each with pros and cons. While consistency and focus are the formulas for success of oral health. Fixed or removable, these appliances can make an indelible mark on your child’s smile and oral health.
Schedule your child’s first dental visit today! Contact us here.
