Treatment Example: Narrow Upper Jaw – Removable Palatal Expansion

This treatment example shows a palatal expansion appliance that is removable — without cemented bands and without screws in the palatal bone.

Anonymized presentation of a real treatment case, professionally published by our practice.

Palatal expansion — that is, the gentle widening of a narrow upper jaw — does not necessarily require a fixed cemented appliance. There is a minimally invasive alternative: a removable appliance anchored with tooth-colored attachments. This treatment example shows how we corrected a crossbite in a child at our practice in Cologne using this approach. For a general overview of how palatal expansion works, see our guide to palatal expansion — here we focus on a specific case.

The Initial Situation

An eight-year-old child came to us with a crossbite: The upper jaw was too narrow, so the upper teeth closed behind the lower teeth on the sides. A narrow upper jaw not only crowds the teeth — it can also affect nasal breathing and further dental development. In such cases, widening the palatal suture during the growth phase is a proven and gentle approach.

Treatment Planning

Traditional palatal expansion appliances are anchored firmly to the teeth with bands and cement — or, in more severe cases, with small screws in the palatal bone. Both methods work reliably, but have disadvantages: Plaque accumulates easily around a fixed appliance, gum inflammation often appears after just a few weeks, and some families are put off by the idea of screws in the palate. Instead, we planned the attachment-anchored variant co-developed by our practice: It is held in place by small, tooth-colored retention elements — similar to aligner technology — and can be removed for eating and cleaning. Planning was done digitally based on a 3D scan.

The Treatment

After bonding the retention elements, the appliance was fitted. It is widened like the traditional version using a small expansion screw in the center of the palate — but the family turns it at home themselves, usually a quarter turn per day as instructed. The appliance was worn all day and removed only for eating and tooth brushing. Because it is removable, teeth and gums remained easy to clean: The professional publication showed practically no signs of inflammation around the appliance, unlike what commonly occurs with cemented devices. For the child, this meant eating and brushing teeth as usual, with no bands or cement in the way.

The Result

Within a few weeks to months, the upper jaw was noticeably widened and the crossbite corrected. More space was created in the upper jaw and a balanced lateral bite – achieved with an appliance that could be removed and cleaned thoroughly. The result is then stabilized and, if necessary, treatment continues with another orthodontic appliance for children.

Why we present this case

The attachment-anchored appliance for palatal expansion is a development on which our practice has published professionally – the publication documents three children aged eight and nine (see our professional publication The attachment-anchored appliance for palatal expansion). It shows how an established treatment can be implemented using modern, hygiene-friendly methods. Honestly assessed: It does not replace every traditional palatal expansion – it is removable and therefore only works if worn consistently; in cases of very pronounced narrowing or in adults whose palatal suture has already ossified, other, sometimes surgically supported procedures remain necessary. For you, this means: Whether this gentle approach is suitable for your child can be clarified after a thorough diagnostic examination – more on our page about orthodontics for children and adolescents and in our guide Recognizing and treating crossbite.

Frequently asked questions about palatal expansion

What is the difference to traditional palatal expansion?

The traditional version is fixed to the teeth with bands and cement, sometimes additionally with small screws in the palatal bone. The attachment-anchored appliance is held by tooth-colored retention elements and is removable – both have the expansion screw in the middle. The advantage lies in oral hygiene: teeth and gums remain freely accessible.

At what age is palatal expansion appropriate?

Usually during the growth phase, as long as the palatal suture has not yet ossified – often in the primary and early mixed dentition, typically around elementary school age. The exact timing depends on individual development and is determined orthodontically.

Is the treatment painful?

Usually not. When turning the screw, a slight feeling of pressure or tension may occur in the upper jaw or at the bridge of the nose. Systematic evaluations show that discomfort occurs mainly in the first few days and then decreases significantly.

How long does the expansion take?

The actual widening is often achieved in a few weeks; this is followed by a stabilization phase so that the result holds. The total duration can only be estimated more precisely after the diagnostic examination.

Is palatal expansion also possible in adults?

Only to a limited extent. As we age, the palatal suture ossifies, so purely orthodontic expansion is often no longer sufficient and must be surgically assisted. We discuss this individually and — if necessary — in an interdisciplinary approach.