A maxilla that is too narrow can be expanded without bonding a fixed appliance. This article introduces a removable alternative anchored to bonded attachment points, which facilitates oral hygiene.
Minimally invasive, attachment-anchored appliance (LAMItec) for palatal expansion as an alternative to cemented or skeletally anchored systems.
Palatal Expansion: More Space in the Upper Jaw – Gentle and Removable
In some children, the upper jaw is too narrow. This often results in crossbite and insufficient space for the permanent teeth.1 A proven solution is rapid palatal expansion (RPE), in which the still-open growth suture in the middle of the palate is gently widened. The underlying specialist publication from our practice presents a particularly gentle, removable variant of this treatment. In the following, we explain what this involves in understandable terms.
What Is Palatal Expansion?
The upper jaw consists of two halves connected in the middle by a growth suture (the so-called midpalatal suture). In children and adolescents, this suture is not yet fully ossified. This is used to advantage: with an appliance that is slowly widened using a small screw, the two halves can be gently separated. This creates more bone and more space – the dental arch becomes wider2, crossbite can be corrected, and often even nasal breathing can be improved.3 The ideal time is during the primary or early mixed dentition, because the suture is still open at that stage.4 More on this in our patient guide on palatal expansion.
Why a Removable Alternative?
Palatal expansion appliances are usually cemented in place or anchored in the bone with small screws.5 This works well but has disadvantages: Fixed appliances make oral hygiene considerably more difficult. After just a few weeks, gingival inflammation often appears6, and the risk of caries and decalcification also increases.7 Not every child – and not every family – wants small screws in the palate.
The Idea: Inspired by Aligner Technology
The appliance presented in the professional publication is removable. It is held on the teeth – similar to modern clear aligners – via small, tooth-colored retention elements (attachments) that are simply bonded on. This way, the removable appliance sits securely but can be removed for eating and brushing. The result: unrestricted oral hygiene and significantly less gum irritation. This treatment is a typical example from orthodontics for children and adolescents and belongs to the removable appliances.
How Does the Treatment Work?
After bonding the retention elements, the custom appliance is fabricated. The family turns the small screw themselves according to instructions – usually a quarter turn per day. The appliance is worn all day and removed only for eating and oral hygiene. As with any removable treatment, good patient compliance is crucial for success.
What Do the Treatment Results Show?
The specialist publication presents three treated children (aged eight and nine). In all cases, the crossbite was successfully corrected and the upper jaw noticeably widened – the necessary space for the teeth developed within just a few weeks to months. Particularly encouraging: unlike with fixed appliances, virtually no signs of inflammation were observed on the gums. Afterward, the result is stabilized and treatment continues as needed with another pediatric orthodontic appliance. We have prepared one of these cases in patient-friendly format: Treatment example: Narrow upper jaw – removable palatal expansion. You can also read background information on this topic in our article Recognizing and treating crossbite.
Sources
- Agarwal, A., & Mathur, R. (2010). Maxillary expansion. International Journal of Clinical Pediatric Dentistry, 3(3), 139–146. https://doi.org/10.5005/jp-journals-10005-1069
- D’Souza, I. M., Kumar, H. C., & Shetty, K. S. (2015). Dental arch changes associated with rapid maxillary expansion: A retrospective model analysis study. Contemporary Clinical Dentistry, 6(1), 51–57. https://doi.org/10.4103/0976-237X.149292
- McNamara, J. A., Lione, R., Franchi, L., Angelieri, F., Cevidanes, L. H., Darendeliler, M. A., & Cozza, P. (2015). The role of rapid maxillary expansion in the promotion of oral and general health. Progress in Orthodontics, 16, Artikel 33. https://doi.org/10.1186/s40510-015-0105-x
- Dahiya, A., Maheshwari, S., Gupta, N. D., & Goyal, S. (2000). Maxillary expansion – an interceptive modality in mixed dentition. Journal of the Indian Society of Pedodontics and Preventive Dentistry, 18, 24–28.
- Wilmes, B., Nienkemper, M., & Drescher, D. (2010). Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: The hybrid hyrax. World Journal of Orthodontics, 11, 323–330.
- Abbate, G. M., Caria, M. P., Montanari, P., Mannu, C., Orrù, G., Caprioglio, A., & Levrini, L. (2015). Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. Journal of Orofacial Orthopedics, 76(3), 240–250. https://doi.org/10.1007/s00056-015-0285-5
- O’Reilly, M. M., & Featherstone, J. D. (1987). Demineralization and remineralization around orthodontic appliances: An in vivo study. American Journal of Orthodontics and Dentofacial Orthopedics, 92(1), 33–40. https://doi.org/10.1016/0889-5406(87)90293-9
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