On Palate Expansion

 Contrary to the common cliche that beauty is skin deep, beauty is actually bone  deep.  A fully-developed bone structure serves as a proper support structure for the soft tissues of the face.  If you are performing a self analysis of your facial appearance, it is critical that you begin with an assessment of your bone structure. This is important for several reasons.

Firstly, experts recommend that all bony procedures be completed first.  This is because bony procedures have a significant impact on the soft tissues of the face.  So, for example, if you get a nose job (rhinoplasty) and later decide to get jaw surgery, the movement of the facial bones will alter the appearance of your nose and may undo much of the benefit from the rhinoplasty.

Secondly, many cosmetic procedures are merely compensating for a lacking bone structure.  Implants and fillers augment lackluster chins, cheekbones, and lips.  All of these areas depend on underlying bony support which, if lacking, affects their prominence. 

Finally, a misaligned bone structure may be an indication of functional problems.  These include malocclusions (such as open bites, overbites, underbites, etc.), and underdeveloped jaws which indicate narrow airways and a high potential for future problems such as sleep apnea and TMJ.   

Perhaps the most important bone in the face, as argued by John Mew, the inventor of Orthotropics (an alternative to traditional orthodontics to be discussed at a later time), is the upper jaw (or maxilla), which is highlighted in green in the picture below.  This bone will therefore be the focus of this blog entry. 

When we were kids, no one envied those poor souls who got palate expanders.  These devices are anchored to the teeth and work by gradually separating the two halves of the upper jaw, which is divided by the midpalatal suture (this suture, by the way, is the subject of much controversy to be discussed shortly).  It doesn't sound pleasant.  But these same individuals that we pitied are now the ones we envy.  Broad smiles.  Defined Cheekbones.  Wide facial structures.  Don't believe an orthodontic device can make a significant difference in facial structure?  Think again:

The photo above shows a pair of identical twins.  The twin on the left received extractions, whereas the twin on the right received palatal expansion.  Note the difference not only in the width of the smile, but the entire face!

If you had a palate expander as a child, rest assured that those few weeks of torture were totally worth it.  If not, and you have concerns about an underdeveloped maxilla, it's not the end of the world but we may have some work to do.  Lacking Cheekbones?  Want a happier, wider smile?  Read on!

Adult palate expansion is a new and highly controversial area in the field of orthodontics.  According to the classical ideology, the midpalatal suture is fused around age 14, making surgically assisted palatal expansion, or SARPE, the only way to remedy a narrow upper jaw in an adult.  It is widely believed that since this suture is fused, the use of an expander without surgery in adult will result in mere dental tipping (that is, moving teeth within the confines of the existing bone structure).  However, recent research has demonstrated that in many cases adult palate expansion IS possible without surgery.  This makes more sense when we view the sutural changes not as fusion (a black and white term), but as having higher interdigitation in adults.  The chances of successfully opening the suture are greater when the device is anchored to more than the typical 4 teeth.  One study found that nonsurgical palate expansion for young adults is a viable option when the device is anchored to 6 teeth.  Some orthodontists have had success in expanding patients into their 50's (though most orthodontists have yet to see the light). 

Of course, since this is a relatively new area, it is important to take it slow.  Slow palatal expansion and continuous monitoring by a professional who specializes in dentofacial orthopedics is probably your best bet for successful expansion in an adult. 

So, if you want to expand your palate, what are your options?  As mentioned, you can get SARPE.  However, it is likely that a nonsurgical option would be successful.  These options include a fixed appliance (such as a hyrax), as shown below:

If you choose this method, it is best to do it over a longer period.  The rapid expansion approach may be riskier in adults. 

Another interesting option is the homeoblock device (shown below), which was invented by New York dentist Theodore Belfor.  This removable device is worn at night and has been shown not only to broaden smiles and straighten teeth but to subtly enhance facial appearance in adults.  The main drawback is that it requires continuous adjustment, and a longer period to see results (I was told it would take 3 years by a dentist).

Since I'm not that patient, and since my other procedures may interfere with wearing this device for 3 years, I have decided to get a Schwartz expander.  This, like the homeoblock, is a removable device.  However, it is typically worn continuously for several months.  I can't wait to get this baby:

The ortho I'm working with promises true sutural expansion.  Wider smile and fully developed maxilla, here I come!