Treatment Example: Narrow Upper Jaw – Removable Palatal Expansion

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

Anonymized presentation of a real case, professionally published by our practice. Every case is different: the treatment approach, duration, and outcome of this individual case cannot be transferred to other patients.

A 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 via tooth-colored attachments. This treatment example shows how we corrected a crossbite in a child at our practice in Cologne. For how palatal expansion works in general, please refer to our guide on 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 bit 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 period is a proven and gentle approach.

Treatment Planning

Traditional palatal expansions are firmly anchored to the teeth with bands and cement — or, in larger cases, with small screws in the palatal bone. Both work reliably, but have disadvantages: Plaque easily accumulates 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 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, as with the traditional variant, via a small expansion screw in the center of the palate — only the family turns it at home themselves, usually a quarter turn per day as instructed. The appliance was worn full-time and removed only for eating and oral hygiene. Because it is removable, teeth and gums remained easy to clean: In the professional publication, practically no signs of inflammation appeared around the appliance, unlike what frequently occurs with cemented devices. For the child, this meant eating and brushing teeth as usual, without bands and cement in the way.

The Outcome

Within a few weeks to months, the upper jaw was noticeably widened and the crossbite corrected. This created more space in the upper jaw and an even lateral bite – achieved with an appliance that could be removed and thoroughly cleaned. Afterward, the result is stabilized and treatment continues if needed with another pediatric orthodontic appliance.

Why we present this case

The attachment-anchored appliance for palatal expansion is a development our practice has published on 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 carried out with modern, hygiene-friendly means. To be honest: It does not replace every conventional palatal expander – it is removable and therefore works only if worn consistently; in cases of very pronounced narrowness 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 is something we will gladly determine after a thorough diagnosis – 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 from conventional palatal expansion?

The conventional version is firmly anchored 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 – the expansion screw in the middle is present in both. The advantage lies in oral hygiene: teeth and gums remain freely accessible.

At what age does palatal expansion make sense?

As a rule during the growth period, as long as the palatal suture has not yet ossified – often in the primary and early mixed dentition, roughly during elementary school age. The exact timing depends on individual development and is determined orthodontically.

Is the treatment painful?

Usually not. Turning the screw may cause a slight pressure or tension sensation in the upper jaw or at the nasal root. 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 to ensure the result holds. The total duration can only be estimated more precisely after the diagnosis.

Is palatal expansion also possible in adults?

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