The palate, commonly known as the roof of the mouth, forms a significant part of the oral cavity and nasal floor. This structure is composed of both hard and soft tissues, playing a role in speech, breathing, and eating. A frequent question in orthodontics involves whether traditional braces can widen this foundational structure. This article clarifies the distinct roles of braces and specialized orthodontic appliances in addressing various dental and skeletal concerns.
Braces and Tooth Movement
Traditional braces primarily function to move individual teeth into desired positions within the dental arches. These orthodontic appliances consist of brackets, which are small attachments bonded to the teeth, and archwires that connect them. The archwires are periodically adjusted, applying continuous, gentle forces to the teeth. Over time, this sustained pressure facilitates the remodeling of the bone surrounding the tooth roots, allowing the teeth to gradually shift through the alveolar bone.
The mechanism of braces is limited to dental repositioning and bite correction by altering the alignment of teeth. They are highly effective at straightening crooked teeth, closing gaps, and correcting various forms of malocclusion, such as overbites or underbites, by moving teeth to improve their interdigitation. However, braces are not designed to exert forces directly on the underlying jaw bones, specifically the maxilla, which constitutes the upper jaw and forms the hard palate. Consequently, they do not possess the mechanical capability to expand the skeletal width of the palate itself.
How Palate Expansion Works
Palate expansion, distinct from tooth movement, involves widening the upper jaw bone, or maxilla, itself. This is achieved through specialized orthodontic appliances known as palatal expanders. These devices work by applying controlled, outward pressure to the two halves of the maxilla, which are joined together by a connective tissue seam called the midpalatal suture. In younger individuals, this suture remains unfused, making it amenable to separation and subsequent new bone formation.
Rapid Palatal Expanders (RPEs) are common appliances that feature a screw mechanism requiring daily or periodic activation by the patient or parent. Each turn of the screw applies gentle, continuous pressure, gradually widening the suture over several weeks. Once the desired expansion is achieved, the expander is typically kept in place for several months to allow new bone to solidify in the widened space, stabilizing the skeletal change. For adults, where the midpalatal suture has fully fused, non-surgical expansion is often not possible, and procedures like surgically assisted rapid palatal expansion (SARPE) or micro-implant assisted rapid palatal expansion (MARPE) may be considered to achieve skeletal widening. These methods involve surgical weakening of the suture to allow for expansion.
Why Palate Expansion is Recommended
Orthodontists recommend palate expansion for several specific reasons, primarily to address skeletal discrepancies in the upper jaw. One common indication is to create sufficient space for crowded permanent teeth. When the upper jaw is too narrow, teeth may not have enough room to erupt properly, leading to misalignment and impaction. Widening the palate can provide the necessary space, potentially reducing the need for tooth extractions.
Another significant reason for palatal expansion is to correct a posterior crossbite. This condition occurs when the upper back teeth bite inside the lower back teeth, indicating a narrow upper jaw relative to the lower jaw. Expanding the palate helps to establish a proper bite relationship, where the upper teeth correctly overlap the lower teeth. Additionally, a narrow upper jaw can sometimes contribute to restricted nasal airways, and in some cases, palate expansion may offer a secondary benefit of improving breathing by widening the nasal cavity. This improvement in airway space can contribute to better overall respiratory function.
Age and Expansion Considerations
A patient’s age significantly influences the feasibility and approach to palate expansion. Palatal expansion is most effective and predictable in children and adolescents because their midpalatal suture is still cartilaginous and has not fully fused. During these developmental years, the suture can be gently separated, allowing for true skeletal widening of the maxilla. The bone remodels relatively quickly in response to the expansive forces, and new bone fills the gap created.
As individuals age into adulthood, the midpalatal suture progressively ossifies and becomes fully fused, typically by the late teenage years. This fusion makes non-surgical expansion of the palate considerably more challenging or often impossible to achieve skeletally. In adults, attempts at non-surgical expansion primarily result in dental tipping, where the teeth are pushed outward without actual widening of the jawbone, which can lead to undesirable outcomes. Therefore, adult palate expansion often necessitates surgical assistance, such as SARPE or MARPE, to physically separate the fused suture and allow for true skeletal expansion. An orthodontic consultation is crucial to assess individual skeletal maturity and determine the most appropriate treatment approach.