A palatal expander is an orthodontic device designed to widen the upper jaw (maxilla) by applying controlled pressure. This treatment corrects a narrow palate, which often causes dental crowding and bite problems. While the procedure is routine for children whose facial bones are still developing, adults can definitively get a palate expander, though the method is significantly more complex and often requires surgical assistance to achieve true skeletal widening.
The Biological Constraint: Why Adult Expansion is Different
The main hurdle in adult palatal expansion is the structure of the upper jaw, specifically the midpalatal suture. In children, this suture, which runs down the center of the roof of the mouth, is flexible, making separation easy with a mechanical expander alone. Non-surgical expansion works in children because the bone halves are not yet fully fused, allowing for pure orthopedic, or skeletal, separation.
By young adulthood, typically around ages 12 to 15, this central joint has undergone ossification, meaning the flexible tissue has hardened into fused bone. Attempting traditional expansion on a fused suture in an adult primarily results in the outward tilting of the teeth and surrounding dental bone, a process called dental tipping. This undesirable dental movement is less stable than skeletal widening and can lead to side effects like root resorption or gum recession.
Methods of Adult Palatal Expansion
Overcoming the resistance of the fully fused midpalatal suture requires specialized techniques that bypass the limitations of simple tooth-borne expanders. The two primary methods for achieving skeletal expansion in adults are Surgically Assisted Rapid Palatal Expansion (SARPE) and Miniscrew-Assisted Rapid Palatal Expansion (MARPE).
Surgically Assisted Rapid Palatal Expansion (SARPE) involves a minor, outpatient surgical procedure performed by an oral surgeon. The surgeon makes precise cuts (osteotomies) in the upper jaw bone to create a controlled fracture in the fused midpalatal suture and surrounding structures. Following the surgery, a traditional rapid palatal expander is placed and activated over the following weeks to gradually widen the maxilla. This combined approach ensures the expansion is skeletal, separating the bone halves, rather than just tipping the teeth.
Miniscrew-Assisted Rapid Palatal Expansion (MARPE), also known as Maxillary Skeletal Expander (MSE), is a newer, less invasive option that often eliminates the need for extensive surgery. This method uses a custom-made expander anchored directly into the palatal bone using four or more small titanium screws (TADs or miniscrews). Anchoring the device directly to the bone instead of the teeth delivers force directly to the midpalatal suture, allowing for skeletal separation in many skeletally mature patients. This non-surgical approach is attractive for young adults who can achieve sufficient expansion without the morbidity associated with a surgical procedure.
Conditions Treated by Palatal Expansion
The primary purpose of adult palatal expansion is to correct a transverse maxillary deficiency, where the upper jaw is too narrow relative to the lower jaw. This corrects common dental issues like a posterior crossbite, where the upper back teeth bite inside the lower back teeth. Correcting this bite relationship is fundamental to proper chewing function and preventing uneven wear.
Expansion is also frequently used to create necessary space in the dental arch to alleviate severe dental crowding. By widening the palate, the orthodontist can gain several millimeters of arch length, often preventing the need to extract permanent teeth before starting comprehensive orthodontic treatment like braces or aligners.
Beyond purely dental concerns, palatal expansion can address functional issues related to the airway. A narrow maxilla often constricts the nasal cavity floor, leading to reduced nasal airflow and chronic mouth breathing. Widening the palate can increase the volume of the nasal and oral cavities, which may improve breathing, reduce snoring, and alleviate symptoms of mild to moderate obstructive sleep apnea.
Post-Procedure Expectations and Recovery
The overall treatment timeline for adult expansion is divided into two main phases: active expansion and retention. The active phase, where the patient or a helper turns the expander screw daily, typically lasts four to six weeks. During this time, a temporary gap often develops between the two upper front teeth, which is a normal sign that skeletal separation is successfully occurring.
Once the desired width is achieved, the expander is locked in place for a retention phase, which is a period of stabilization. This phase usually lasts three to six months or more, allowing new bone to fill in and solidify the widened suture. Removing the device prematurely can compromise the stability of the expansion and lead to relapse.
Recovery for MARPE is generally minimal, often involving only a few days of mild discomfort managed with over-the-counter pain medication. If SARPE is performed, recovery from the minor surgery typically lasts about one week, followed by active expansion over several weeks. In both cases, the expansion procedure is usually the first step in a longer orthodontic journey, continuing with traditional braces or aligners to close the front tooth gap and finalize alignment.