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PALATAL EXPANDERS

Palatal expanders are a common orthodontic procedure, also known as rapid palatal expander, rapid maxillary expansion appliance, palate expander, orthodontic expander, Haas or Hyrax. Your child’s orthodontics will use this to bring the upper and lower teeth together by widening the upper jaw.

The most common reasons for using a palatal expander include posterior cross bite, crowding of the teeth, some cases of malocclusion, rhino logic and respiratory ailments, cleft lip, and cleft palate. Dr. Dixon will work closely with you and Dr. Matthews to figure out the best care for your child.

When is palatal expander needed?

Our professionals correct posterior crossbites as soon as they are discovered because it is a great time to obtain more room for other unerupted teeth.  Also, a posterior crossbite, if it’s only on one side, can cause the lower jaw to grow asymmetrically to that side.  Therefore, correction of a posterior crossbite helps prevent asymmetrical growth of the lower jaw.

One reason for separating a mid palatal suture is because it is better to do this procedure at a younger age before the palatal suture becomes fused.

With adults, the maxilla can be expanded by using an RPE and having surgery performed by an oral surgeon. This procedure is called Surgically Assisted Rapid Palatal Expander (SARPE). During the surgery the palatal suture is opened with side releasing incisions and all the expansion is completed at one time.  Some orthodontists will have the patient turn the expander after the surgery but most lets the oral surgeon complete the task.

How do you turn or activate an expander?

Palatal ExpanderActivation of an RPE is done by a parent, guardian or another person.  You can’t turn it yourself.

The patient will be provided a wire that inserts into the small hole in the screw of the expander. It’s used much like a key and can be plastic or wire. The patient’s parent will have the child lay down on his or her back in good lighting. Next the child will tilt his or her head backward to provide a clear view of the RPE. Safety is important so the ‘key’ should be attached to a string to prevent it from going down into the patient’s throat.

  • Hold the key with two fingers
  • Place the key into the front hole of the rapid palatal expander then rotate backward until it stops moving
  • Pull the key out towards the back of the mouth.  You should now be able to see a new hole in the front for your next turn.  If you do not turn the screw completely to the back, the new hole in the front may be partially block and the wire won’t go into it when needed.  If that’s the case, you have to find the hole in the back of the mouth and complete the turn. Usually turning once or twice/day is a good enough.
  • Any additional instructions will be provided at the time of your visit. Call us if you have any additional questions.

What is a Rapid Palatal Expander?

Rapid Palatal ExpanderA Rapid Palatal Expander (RPE) is an upper appliance that places pressure on the upper jaw (maxilla) by turning a midline screw.  The pressure separates the mid palatal suture thus making the maxilla wider, which can correct crossbites and creat space.  RPEs are used often to correct posterior crossbites.

When is palatal expander needed?

During an examination, an orthodontist evaluates the overlap of the posterior teeth.  The upper teeth should overlap the lower teeth by about half the width of the upper tooth.  When the upper teeth are on the inside of the lower teeth in the back sections of the mouth, it is called a posterior crossbite.  You can read more about the different types of crossbites by reading this article called, “What is a Crossbite?”

We correct posterior crossbites as soon as we see them because we can obtain more room for other unerupted teeth.  Also, a posterior crossbite, if it’s only on one side, can cause the lower jaw to grow asymmetrically to that side.  Therefore, correction of a posterior crossbite helps prevent asymmetrical growth of the lower jaw.

Posterior and Anterior Crossbite. Since we are separating a mid palatal suture, it is better to do this procedure at a younger age before the palatal suture becomes fused.

With adults, the maxilla can be expanded by using an RPE and having surgery performed by an oral surgeon. This procedure is called Surgically Assisted Rapid Palatal Expander (SARPE). During the surgery the palatal suture is opened with side releasing incisions and all the expansion is completed at one time.  Some orthodontists will have the patient turn the expander after the surgery but most lets the oral surgeon complete the task.

How do you turn or activate an expander?

Activation of an RPE is done by a parent, guardian or other person.  You can’t turn it yourself.

The patient is given a small wire that inserts into a small hole in the screw of the expander.  I call this wire a key.  The key can be fancy with a plastic handle, but I just like the wire type.  Have the patient lay down on the bed or couch where there is good light.  Then, the patient tilts their head back so that the RPE can be seen clearly.

Make sure that a string of floss is attached on the key so it doesn’t go down the patient’s throat.

Hold the key with two fingers.  Place the wire (Key) into the front hole of the rapid palatal expander and then rotate it to the back of the mouth until it stops.  Pull the key out towards the back of the mouth.  You should now be able to see a new hole in the front for your next turn.  If you do not turn the screw completely to the back, the new hole in the front may be partially block and the wire won’t go into it when needed.  If that’s the case, you have to find the hole in the back of the mouth and complete the turn.

We consider that one turn, from front to back.  Usually a patient will turn the expander once or twice a day for so many days.  Then, you stop turning the expander and have the orthodontist evaluate the width to see if more turns are needed.
Rapid Palatal Expander Turning KeyRapid Palatal Expander After Turn

How long is an rapid palatal expander used?

After your orthodontist tells you that you have turned the expander enough, and the crossbite is eliminated, they will leave the RPE in place for about three months. This is so that the palatal suture can be closed with new bone formation and become stable. If an RPE is removed early, some of the width gained could be lost.

Space after Rapid Palatal ExpanderDuring the expansion, a space my develop between the central incisors. This is normal and when you stop turning the RPE, the gum tissue between the central incisors will pull the incisors closer together possibly eliminating the new space.

What types of palatal expanders are there?

There are basically two types of fixed rapid palatal expanders. The Hyrax expander is usually easier for the patient to keep clean. The Haas expander has acrylic added to it so the pressure from the expansion screw is placed on the teeth and on the soft tissues of the hard plate. The Haas expander is harder to keep clean. The removable palatal expander is easily removable and doesn’t achieve bony orthopedic movement, just tipping of the posterior teeth.  It is basically a Hawley retainer with an expansion screw in the middle.  It can be used in certain circumstances but not for expanding the mid palatal suture.

Does a palatal expander hurt?

No, it doesn’t hurt.  After you turn the expander you will feel pressure.  The pressure lasts for about 4 to 5 minutes. The pressure feels like taking your thumb and pushing on your teeth.  So an expander is not painful.  You will have some pressure after activation for a few minutes and then it dissipates.

Precautions to take with your expander?

  • Be careful not to eat sticky foods
  • Brush the expander when you brush your teeth
  • There are certain foods that cannot be eaten while an expansion device is in place.  This would include sticky and hard foods.