A palate expander is an orthodontic device used to widen the upper jaw, or maxilla, by applying gentle outward pressure. While this treatment is commonly associated with children whose facial bones are still developing, adults can also receive this treatment. Modern orthodontic and surgical advancements have made upper jaw expansion a viable option for skeletally mature patients, offering a path to correct bite issues and improve breathing.
Understanding Adult Bone Structure
The primary difference between pediatric and adult palate expansion lies in the anatomy of the midpalatal suture. This suture is the connective tissue that runs down the center of the roof of the mouth, separating the two halves of the maxilla. In children, this suture is composed of soft, flexible cartilage, which allows traditional palate expanders to easily separate the two bone segments.
As a person reaches skeletal maturity, typically in their late teens or early twenties, this suture fully calcifies and fuses, becoming a rigid, bony union. This fusion increases the resistance to expansion significantly, making it impossible to achieve skeletal widening using only the tooth-borne expanders successful in younger patients. Attempting traditional expansion on a fused suture would result only in the tipping of the teeth, not true skeletal expansion of the jaw.
Treatment Options for Adult Palate Expansion
Since the fused midpalatal suture prevents non-surgical widening in adults, two main types of treatment have been developed to bypass this biological barrier. The choice between them depends on the patient’s specific anatomy, the degree of expansion required, and the thickness of the bone.
The first approach is Surgically Assisted Rapid Palatal Expansion (SARPE), a combined orthodontic and minor oral surgery procedure. A maxillofacial surgeon performs strategic cuts (osteotomies) in the upper jaw bone, including the midpalatal suture, to weaken the structure. An expander is then fitted and activated, using the cuts to facilitate the separation of the maxilla. This technique is often recommended for patients who require a significant amount of widening or those with a particularly dense, fully fused suture.
A less invasive option is Miniscrew-Assisted Rapid Palatal Expansion (MARPE). This method uses Temporary Anchorage Devices (TADs), small titanium screws anchored directly into the palatal bone, to support the expander. By anchoring the expander directly to the bone rather than the teeth, the force is applied directly to the midpalatal suture, minimizing unwanted side effects like dental tipping. MARPE can achieve true skeletal expansion in many adults without the need for traditional surgery, providing a more conservative alternative for moderate expansion needs.
The Patient Experience and Recovery
The adult patient journey begins with the placement of the expander, a custom-fitted appliance cemented or screwed into the palate. The active expansion phase typically lasts only a few weeks. During this time, the patient or a caregiver uses a small key to turn the central screw of the device once or twice daily, gradually widening the jaw.
A visible sign that the expansion is working is the temporary appearance of a gap (diastema) between the two upper front teeth. Patients commonly report feeling pressure or tightness across the bridge of the nose and cheeks, rather than sharp pain, especially after an activation turn. Temporary side effects like lisping, increased saliva production, and difficulty chewing are common during the first few weeks as the mouth adjusts.
Following the active expansion phase, the expander is kept in place for a stabilization or retention period, generally lasting three to six months. This retention phase is crucial because it allows new bone tissue to mineralize and fill the space created at the midpalatal suture, permanently stabilizing the wider jaw position. After the expander is removed, the patient transitions to traditional orthodontic treatment, such as braces or aligners, to close the front gap and align the teeth, leading to long-term improvements in bite and nasal airflow.