Orthodontic Expansion

The maxillary (upper jaw) bone features a suture down the middle of the palate.  Beginning in the early teens this suture begins to fuse (earlier in girls, later in boys) and at some point by early adulthood it is no longer possible to expand the bone simply with an orthodontic appliance.  In adults, surgery is required to aid the expansion.  During the window of opportunity between the time the 1st molars erupt around age 6 and until college age the bone may be expanded laterally by either a removable appliance like a retainer with a screw in the middle or by an expander cemented to the teeth.  This is termed orthopedic expansion as we are actually modifying the bone.  There are three main justifications for maxillary expansion:

  • 1) The maxilla is so narrow that it does not fit the width of the lower arch leading to a posterior crossbite.  This may be masked if the lower posterior teeth are tipped inwards towards the tongue to compensate for the narrowness of the upper jaw.
  • 2) Crowding is due to the narrowness of the jaw.  Expansion creates a space between the central incisors which is then used to align the teeth.  A related issue is protruding incisors.  Much like a balloon squeezed in on the sides a narrow arch will cause the maxillary incisors to protrude.
  • 3) To alleviate crowding in a normal arch form.  Care must be taken in this area because overexpansion may be unstable; expansion in the maxilla may not be matched in the mandible because the mandible cannot be expanded in the same manner; overexpansion may not be esthetically pleasing in a smaller facial structure leading to a stuffed chipmunk appearance.

The main two variants of fixed expanders are either spring activated or screw activated.  The spring devices are a W-arch or a Quad helix.  The orthodontist expands the spring and then cements it on to the teeth to provide slow steady pressure outwards and it is then activated approximately once a month.  The screw activated types are collectively referred to as Rapid Palatal Expanders or RPEs and are cemented to the teeth.  Haas expanders cover part of the palatal tissue; bonded expanders cover all the posterior tooth surfaces and are usually used for children in a mixed dentition stage especially as an anchor point for reverse pull headgear and a conventional RPE is cemented to 2 or 4 teeth.  As the name implies, RPEs work much more rapidly to expand the suture at a rate of a fraction of a mm a day over 1 to 3 weeks.  It is then left in the mouth for approximately 2 months while the expanded bone recalcifies.   There are proponents of a Schwarz expansion appliance for the mandibular arch but unlike the maxillary arch the bone in the mandible does not have a suture that can be expanded.  An expansion appliance in the mandibular arch will simply tip the teeth outwards in an unstable manner.

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We went to an evaluation at an orthodontist before this one and the price seemed kind of high so then I came to an evaluation here & not only was the price lower but immediately we felt very comfortable and loved the atmosphere of the office. The staff is wonderful, always on time & Dr. Bentele is a great Dr. - very knowledgeable, friendly & with excellent communication. I would recommend this practice to everyone!

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Dr. Bentele makes the patient feel comfortable with his skill and calm confidence. He's honest about the treatment needed and tries to keep the patient informed of the treatment.

Dr. Bentele is our orthodontist for our two children. He provided clear treatment plans with a practical approach. Dr. Bentele does all of the banding and bonding himself and the office appointments are appropriately scheduled. Our children get in and out quickly and the office is never overscheduled, resulting in short waits and unhurried treatment. We're very satisfied and would recommend our friends to see Dr. Bentele!

Dr. Bentele and all staff have been very professional and the cost was reasonable. The approach of not having braces on longer than necessary is one area where I have seen other children suffer (children who went to other orthodontists). The way Dr. Bentele explains what he is doing and why has been good for my daughter to learn the importance of her treatment. I appreciate Dr. Bentele's patience with us as we experienced a difficult financial time during the beginning of our process.