Example: Orthopaedic maxillary or palatal expansion in an early teenager. A temporary diastema develops with successful expansion due to the mid-palatal suture separation.
Level of evidence: Moderate
Suitable for ages: 8 to 15 years old (the maxilla transverse stops growing shortly after the canines erupt and the ability to achieve orthopaedic expansion is minimal in the late teenage years with any appliance bonded to teeth only; TAD-based expanders have shown abilities to achieve orthopaedic expansion of patients above 20 years old however the available evidence is still currently weak to moderate)
Indications: Transversely constricted maxilla, narrow palate, bilateral and unilateral posterior crossbites
Contraindications: No transversely constricted maxilla relative to the mandible, well interdigitated maxillary sutures (mid to late teenagers and older), immature skeletal structures and nasal septum (too young patients can have any expansion distort their vomer and nasal profile), any orthodontic acquired risks.
Treatment Objectives and Biomechanics
- Orthopaedic expansion of maxilla
- Elimination of posterior crossbites
- Eliminate/manage/refer for causative factors (e.g. adenoiditis and tonsilitis)
Appliances / Treatment modalities
- Fixed appliances – Hybrid hyrax palatal expander (bonded or banded), Quad-helix, W-expanders, Fan expanders etc.
- Skeletal anchorage – TAD supported (MARPE or C-expander)
