Why should expansion start as soon as it’s needed?

Expansion is done when a patient has breathing issues or narrow arches or both. Narrow arches can be treated and resolved at any age with general orthodontics, however breathing issues become much harder to treat with age. When a patient has breathing issues it is most likely related to a narrow airway. The airway size is determined by the width the of the roof of your mouth (upper palate) which is a bone with a suture down the middle. This suture/seam in the bone begins to fuse and harden during puberty making it a much more difficult process to treat breathing disorders in older patients. Expanding early means a retainer must be worn in order to maintain the space created. The retainer must be worn for 4-6 months until the teeth on each side of the two upper front teeth grow in. This means the patient will be wearing a retainer at night for longer than if we had waited to start expansion but it’s important that the breathing issues are addressed now. The patient will also have a wide “grown up, adult” smile that they will grow into as their permanent teeth erupt. Breathing issues can have a big effect a child’s development and overall quality of life so it’s important to help them breath better as early as

Before Expansion                                                                                            After Expansion

MARPE

What is it? What makes it different from a traditional expander?

As an orthodontic office that focuses on airway health, we are always looking for the most updated methods to better serve our patients. One of these advancements that has been proven effective in many journal articles is MARPE, or Mini-implant Assisted Rapid Palatal Expansion.

What is MARPE?

MARPE is a type of palatal expander that uses mini-implants, or mini anchors, to expand the upper jaw. The mini-implants are placed in the roof of the mouth using local anesthesia, a procedure that we do in our office. They are connected to a palatal expander that is used to widen the upper jaw by turning it at home. The process of expansion occurs at the suture, which is the “joint” where the right and left bones of the upper jaw meet.

How is MARPE different from traditional RPE?

Traditional RPE also widens the upper jaw by turning at home, but it is done using an expander that is connected to the teeth. RPE is most ideal for young children (5-9 years old). It can be used predictably anytime before puberty, however the amount of expansion at the suture can be limited in the older children.

MARPE, on the other hand, is connected directly to the roof of the mouth with four mini-implants. This allows for greater bone expansion at the suture, which can be beneficial for patients with airway concerns such as sleep apnea / sleep disordered breathing and difficulty nasal breathing / mouth breathing.

Early expansion for children is only done for a few reasons; airway concerns, narrow bone structure, severe crowding of the teeth or dental crossbite. Airway concerns are best addressed when a person is still young as the bones are mailable and the process is much easier and more comfortable than when a person has gone through puberty. A narrow airway can have adverse health effects like trouble breathing and poor sleep. Narrow bone structure can make future orthodontics more challenging and can impact the final outcome. If the upper jaw is too narrow to the point where the teeth need to be tipped in order to correctly fit over the bottom teeth it can leave the teeth in a more vulnerable position. Severe crowding can be uncomfortable for the patient and impact the functionality of the teeth. It can also effect the over hygiene of the mouth as it can create food traps and make brushing, flossing and overall maintenance harder. Crowding also makes it hard for new teeth to erupt properly, increasing the chance of an ectopic eruption. An ectopic eruption is when a tooth erupts improperly either from the upper gums, or palatially through the roof of the mouth. Dental crossbite is when instead of the upper arch is slightly wider than the lower arch allowing the teeth to fit nicely over the bottom teeth the upper arch is narrow and the upper teeth fit inside the lower arch. This can cause problems with the bite and functionality.

Airway concerns and narrow bones structure require skeletal metal expansion (MARPE) which will widen the upper palatal bone to create more room for the tongue, teeth and airway. Severe crowding and dental crossbite can be treated with with dental expansion, Invisalign or braces. If a patient doesn’t have any of the above issues, we plan for dental expansion as a part of full treatment once all the teeth come in.

As we get further into summer, many patients have questions about traveling with their retainer. The most important thing is to always bring your retainer with you. 

A retainer ensures that your teeth stay in the position that your orthodontist left them. As time goes on, your teeth will try to move back into their original pre-treatment position. The longer you don’t wear the retainer, the more your teeth will move. It can take as little as two weeks without wearing your retainer for your teeth to shift enough to the point where they will no longer fit!

Life happens and a retainer can break or get lost. This is why we now provide patients with two sets of retainers (two upper arch & two lower arch). If anything happens to one retainer you can easily switch to your back up. If both sets of retainers get lost/destroyed ect. patients are always welcome to come back and get a new replacement retainer. A replacement retainer costs $410 per arch ($820 for a SET of upper and lower).