A palatal expander is a fixed orthodontic device designed to widen the upper jaw, or maxilla. This appliance works by applying gentle, continuous pressure to the mid-palatal suture. Widening the palate is commonly recommended to correct a crossbite, create necessary space for crowded permanent teeth, and improve the alignment of the upper and lower teeth. While the expander is cemented securely to the back molars, it can occasionally become dislodged or fall out entirely. This is a common occurrence that orthodontic practices are prepared to handle.
Immediate Steps to Take
The moment you notice the appliance is loose or has completely fallen out, remain calm and safely retrieve the device. If the expander is completely detached, place it inside a small, clean plastic bag or a retainer case to prevent it from being lost or damaged. You should immediately inspect the mouth for any signs of injury, such as cuts or abrasions from sharp edges, and rinse with warm salt water if any irritation is present.
Contact the orthodontic office without delay, as this situation constitutes an emergency appointment. Explain clearly that the appliance has fully dislodged, providing details about when and how it happened. Avoid the temptation to attempt to clean the appliance with abrasive materials or try to force it back into place, as this can cause damage to the expander, the teeth, or the delicate gum tissue. Follow any specific instructions provided by the orthodontic team regarding pain relief or temporary measures until your scheduled emergency visit.
Reversal of Orthodontic Progress
The primary concern when a palatal expander falls out is the rapid reversal of the skeletal expansion that has been achieved. The expansive force applied by the device is what keeps the mid-palatal suture separated. Once this constant force is removed, the surrounding tissues immediately begin to exert pressure to close the newly created space.
This biological reversal can occur quickly, with a significant amount of the expansion potentially lost within the first 24 to 48 hours. The speed of relapse makes the situation time-sensitive, as the two halves of the maxilla will begin to re-fuse or shift back toward their original, narrower position. If the expander remains out of the mouth for an extended period, the jaw may shrink to the point where the existing appliance no longer fits. In such cases, the entire expansion process may need to be restarted, necessitating the fabrication of a new appliance and significantly delaying the overall treatment timeline.
Common Reasons for Appliance Failure
Appliance failure is most often attributed to a breakdown in the bond between the expander’s bands and the molar teeth. The most frequent cause of bond failure is the consumption of foods that are sticky, hard, or chewy, which can exert excessive force on the appliance. Eating items like caramel, taffy, or crunchy ice can physically pull the cemented bands away from the teeth.
In some instances, the cementation process itself may be a contributing factor if the tooth surface was not kept completely dry during the initial bonding procedure. Moisture contamination can compromise the strength of the orthodontic adhesive, leading to a weakened bond that fails under normal chewing forces. Less commonly, an improperly seated band or a manufacturing irregularity in the appliance can create a point of weakness, causing the expander to loosen over time. Understanding the cause can help prevent the issue from recurring once the appliance is re-secured.
Repair and Readjustment Strategy
Upon arrival at the orthodontic office, the clinical team will first conduct a thorough assessment of the patient’s mouth and the dislodged appliance. The orthodontist will measure the amount of expansion achieved and check for any signs of relapse to determine the correct course of action.
Minimal Relapse: Re-cementation
If the expander is undamaged and the relapse is minimal, the most straightforward strategy is simple re-cementation. The appliance will be cleaned, and the teeth surfaces will be meticulously dried and etched before a new layer of orthodontic cement is used to rebond the expander securely to the molars.
Minor Relapse: Re-activation
A second scenario involves noticeable but minor relapse where the existing expansion is partially lost. In this case, the orthodontist may need to perform a controlled re-activation by turning the central screw a few times before re-cementing the appliance to regain the lost width.
Significant Relapse or Damage
The third and most complex scenario is significant relapse or damage to the appliance itself, such as a fractured frame or broken band. If the jaw has narrowed too much for the old expander to fit, or if the device is structurally compromised, a new impression must be taken to fabricate an entirely new appliance.