Does palate expansion work for adults and, if so, does the appliance require braces? (photo)

Question

I've had braces twice, in addition to jaw surgery to correct a jaw that grew longer on one side. Recently, I was told by a dentist that my upper palate remains narrow. I'm not super eager to do braces again, and I've heard mixed responses regarding the effectiveness of palate expansion in adults. Is it possible? If so, does it require full braces again? And how long does it typically take?

Brad Lockhart, DDS · Answer

With all due respect to Dr. Buren, and the thousands of other dentists and orthodontists who believe that adult arch development is not possible, I (and thousands of other dentists and orthodontists who perform adult arch development) believe (and have actually proven time after time) adult arch development is very much possible. I was taught in dental school exactly what Dr. Buren states below, i.e. that adult arch development is not possible. However, I subsequently was taught, and have verified through 25 years of experience, that indeed adult arch development is possible. I personally achieve remarkable levels of adult arch development with ZERO tipping of the teeth, no tissue recession and no pain. I have NEVER had teeth moved off the dental bony ridge (verified with CBCT scans). I have had exactly two patients (out of 100's) in 25 years who did not respond to adult arch development; one was a female in her 50's, the other was a male in his 80's! I am currently treating a female in her late 70's who is responding nicely to treatment.Why is this such a controversial subject in dentistry? I can't tell you the answer to that question but what I can tell you is that the ramifications of non-treatment can literally be deadly. How else, for example, are you going to permanently improve a patient's airway who suffers from sleep apnea and can not tolerate a CPAP machine? Untreated sleep apnea is deadly. How else can you treat a patient suffering from symptoms of TMJ Dysfunction that are the result of an underdeveloped maxillary arch?Adult arch development is achieved using simple, comfortable, removable dental appliances. These appliances must be worn 12-16 hrs/day to be effective and the average case requires 12 months of treatment. Braces or clear aligners are almost always required after arch development but because sufficient space is now available to straighten teeth (thanks to arch development) most cases can be completed in less than 12 months using braces or clear aligners.Good luck!

John McDonald, DMD · Answer

Your palate may appear narrow to your dentist, that does not mean you need braces.  "Narrow" is a subjective opinion.  Narrow palates only need to be corrected if it is necessary to reach the treatment goals of the patient.  If you are happy with your bite and smile, your palate is fine.   With regards to Dr Lockhart's comments:  notice he used the word "arch development" even though you asked about expansion, and also note,  Dr Buren's answer specificly was about expansion.  The term "arch development" has no meaning in orthodontics.  It is not a term that is officially recognized by the American Association of Orthodontists.  Expansion has a very specific meaning and can be measured and has been found to have age limits.

Jennifer L. Buren, DDS, MS · Answer

During childhood and adolescence, the maxilla (upper jaw bone) is actually 2 separate bones that meet in the middle. The suture where these bones meet is not fully ossified (fused) until the late teens/early 20's (this varies quite a bit by the person).  When the expander is anchored to teeth on both sides and widened/expanded, it applies pressure to the teeth which in turn transmits that pressure to the bones. This causes the bones to move apart and "split" in the middle. Expanders can be used in adults, however you will not likely get actual widening of the upper jaw unless a surgery is first performed to separate the two bones.  Without surgery, you can expect to see "dental expansion" in an adult as the teeth get pushed out, but this needs to be carefully monitored by an orthodontist since it is very possible to push the teeth too far and actually move them out of the bone.  This can cause gum/bone loss and even result in the loss of teeth.  Any expansion treatment will need to be in done in conjunction with "comprehensive treatment" which includes braces or in some cases removable aligners.  
If you are happy with your teeth and a slightly narrow jaw is not affecting your function (eating, breathing, speaking, etc) or the health of your teeth, you may be just fine with no treatment.  I would definitely continue wearing your retainers as you will absolutely see a change in the alignment and even the bite of your teeth over time without them.  If you are considering orthodontic treatment, be sure you're evaluated by an orthodontic specialist who routinely does surgical cases so he/she can talk with you about all of your options.

Does palate expansion work for adults and, if so, does the appliance require braces? (photo)

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Does palate expansion work for adults and, if so, does the appliance require braces? (photo)

Answers (3)

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