Palatal expander role in orthodontics – life changing!!

When you go to the orthodontist or dentist, you often see the “regular” panoramic x-ray that rotates all the way around the patient’s head.  This is an acceptable x-ray if one is just straightening teeth, but shouldn’t your orthodontist be doing more?  (Hint: the answer is YES!) What if there was a better x-ray technology that shows substantially more information with the SAME amount of radiation?  What if this information was able to detect and aid in the treatment of avoiding a life long debilitating health issue like sleep apnea, while also giving you that perfectly straight smile? Well there is!  At Bauer Dentistry and Orthodontics we have this technology and it’s our 3 dimensional CBCT.  We want our patients to have the best and that is why we choose to purchase the iCAT FLX and use the palatal expander to aid in sleep obstruction prevention and elimination!

Instead of this static 2 dimensional image

We get a 3 dimensional image that we can rotate, section, and manipulate to give WAY more information

 

Palatal expander use to prevent and eliminate sleep apnea and airway constrictions

While 3d CBCT technology has many benefits to dentistry and orthodontics (like knowing exactly where unerupted and impacted teeth are) the advantage of this technology in regards to sleep apnea is in airway analysis.  The most non-invasive way to prevent sleep apnea or reduce it is to increase the airway volume.  The ONLY way we can do this in orthodontics is with the use of a palatal expander.   Depending on your source of information 1-5% of children have obstructive sleep apnea, a disorder in which tissues in the throat constrict during sleep, causing repeated pauses in breathing. Loud snoring is the most obvious symptom, but daytime sleepiness and attention problems are also red flags.  This condition like many others is a bell shaped curve. A significant percentage of children have constricted airways that would also benefit from an increase in airway space but aren’t diagnosed with sleep apnea.

Why would an orthodontist not use palatal expanders?

They probably don’t have a 3 dimensional x-ray machine and thus they don’t know what they don’t know!  Most up to date orthodontists today have embraced 3d CBCT and are doing airway analysis on their patients similar to our Northbrook colleague Dr. Kaspers who wrote this great article about palatal expander use to fix airway issues.

There is no question that many growing patients can undergo early ortho treatment WITHOUT an expander.  We know that the light forces our Damon brackets use can accomplish some things that an expander does. Therefore, in some cases we can eliminate the need for an expander.  Typically mothers think non-palatal expander orthodontics is a great new way to treat their children when the reality is the exact opposite!  Not using palatal expanders is the opposite of being technologically savvy. Once one utilizes the proper tools, like a 3D xray, you discover that orthodontic diagnosis and treatment planning becomes much better. The orthodontist can do more than just straighten the teeth can be addressed.  Long story short: There are indications for using an expander, but you will never know them without the proper diagnostic tools!!

Can’t DAMON braces do what an expander can?

Yu et al. compared an expander and Damon braces and reported both successfully increase the arch width and correct moderate dental crowding.   When expanding the arch width, the Damon brackets that we use protrude the incisors and expand the dental arch by buccal tipping of bicuspids and molars. However, an expander expands the maxillary base along with the whole upper dental arch and can maintain the incisors in upright position.  Layman’s terms is that expander changes bone and teeth and Damon primarily moves teeth.  There are no long-term follow-up studies of Damon used in this manner so long-term stability is largely unknown.  Concerns are that Damon will cause recession in the facial areas where teeth are being tipped and since tipping is relied on instead of bodily movement, relapse is a concern.  Basciftci 2015 Korean JOrtho – Notice this Damon study DOES NOT use 3D technology.

What does a palatal expander look like?

The use of expanders is still very popular; however, the design & size of the expander has changed significantly. Take a look at the expander we use:

Why are 3 dimensional xrays so critical for orthodontics and deciding when to use expanders?

Many orthodontists are working off of 2 dimensional x-rays but obviously our bodies are in 3 dimensions.  So  an orthodontist using 2 dimensional xrays can really only deal effectively with what they see in the mouth and in the 2D image. That typically means just dealing with the teeth.  Once you see what is happening in 3 dimensions you are able to diagnosis individuals with potential airway issues.  Some parents will be highly suspicious their child has an airway issue because they snore or wheeze, don’t sleep well at night, or have irritability or attention issues.   To confirm this suspicion the first thing a pediatrician or ENT will do is take a 3D x-ray to evaluate & measure the airway!

Young patient treated with a palatal expander showing the increase in airway volume

Using our 3D x-ray technology, we can measure EXACTLY how narrow the airway is.  In the case above most of the airway at the start of treatment was in RED, which means very constricted. The total volume is 9.3cc.   After 6 months of expansion using a palatal expander you can see the difference.  Notice all the green and yellow areas now?  These colors represent acceptable and good airflow!  The new total volume is 13.5cc.  So the airway measurement went from 9.3cc to 13.5cc, a 32% increase!  Once treatment was over this patient’s mother informed us he had more energy during the day. He was no longer tired after his basketball games!  Although this patient’s parents never noticed an issue before they definitely noticed the difference afterwards!

*Just a note that at all software are great at measuring the airway space as Dolphin software has not shown to have good correlation between physical exams AJO 2017

Airway diagnosis and management IS THE NEW WAY OF ORTHODONTICS!

We fully embrace and utilize 3D imaging technology for you and your children.  The only reasons some doctors are not utilizing yet is because the technology is expansive and it takes a great deal of time and effort to learn how to read & interpret these xrays.  We are offering this technology at no additional charge, it is part of your complimentary orthodontic evaluation.  As an orthodontic patient at Bauer Dentistry and Orthodontics we will provide you with the best treatment technology allows. Treatment will involve management of both the bones and teeth AND the airway!  THAT’S just one of many things that sets our practice apart from all the rest!

 

As an orthodontist who is embracing diagnosing airway issues in a pediatric population with increasing obstructive sleep apnea, I am able to work easily & closely with local ENT’s for tonsil & adenoid removal if needed, or simply ORTHODONTIC TREATMENT VIA an expander.

 

Research supporting using palatal expanders to increase airway space and treat sleep apnea

Expanders increase airway space Zhao 2010 AJO-DO

Increase in nasal space volume and function De Felippe 2008 AJO-DO

Palatal expanders used to treat sleep apnea and maintain results Villa 2011 Sleep Breath

Palatal expander reduce mouth breathing Torre 2012 Clinical and Experimental Dentistry