1. What is Palatal expansion?

- Expansion of the maxillary arch is often necessary for the correction of some of
the relatively common malocclusions like
Maxillary constrictions (narrow maxillary base or wide mandible)

And also for the correction of skeletal disharmony and dentofacial deformities like
Class III malocclusions, pseudo class III with posterior crossbite and/or
constricted maxilla .

- Pts with cleft palate , collapsed maxilla

- In a patient with decreased maxillary width and dental crowding, where there is a
considerable amount of tooth size arch length discrepancy- in order to gain arch
length, in order to gain space for aligning teeth- expansion may be the correct
choice.

All these are actually nothing but Transverse deficiency of the Maxilla.

2. Types of expansion :
Orthodontic, Orthopaedic, Passive

Orthodontic expansion means- Conventional fixed appliance and different types of

removable appliance.

-There is lateral movement of the buccal segments

- buccal tipping of the crowns
- lingual tipping of the roots

Orthopaedic Expansion-
CHANGES are produced in the skeletal structure. Dentoalveolar expansion is less.
Ex: RME causes separation of mid palatal suture, and also affects circumzygomatic &
circumaxillary suture. After expansion, new bone is deposited in the mid palatal
suture.

Passive Expansion-
Ex: Frankel appliance – when we shield the dentition from forces of labial and buccal
musculature. – results in passive expansion.

3. Now our topic of discussion is actually Rapid Palatal Expansion:

This is example of a true Orthopaedic Expansion
-It involves split opening of the maxillary suture & movement of the palatal shelves
away from each other.

- it involves rapid force application to the posterior teeth. The forces are transmitted to
the sutures and the sutures open while the teeth move minimally relative to the
supporting bone.
- This conept was reported in the literature in 1860 first in the Dental Cosmos by
Emerson C Angell.

The management of transverse maxillary constriction with rapid palatal expansion

(RPE) is mostly indicated inmixed dentition cases until the period of
adolescenece.1 The prognosis of RPE is dependent on the extent of interdigitation
of the maxillary suture, and its effect is reciprocally related to the success of
expansion, which means, that the higher the amount of interdigitation and the
greater the synostoses at the sutures, the lesser are the changes of the splitting of
the maxilla without an additional surgical procedure

In young adults and adolescents after the pubertal growth spurt with advanced
skeletal maturity, the effects of non-surgical RPE differ consideratbly.1 It has been
showed that there are higher success rates of RPE in young population and the
success rates decreased with increasing age up to 18 years and 21 years

Complication of Tooth Borne RPE:

pain, swelling, buccal root resorption of supporting teeth, buccal cortical plate and
bone resorption, and bone dehiscne.4,6-8 Some studies have also shown ischemia,
and necrosis in the palatal mucosa when maxillary sutures do not positive react
due to the transverse-forces with a RPE.

The reason for the failure of RPE is because of the higher rigidity of the craniofacial
structures in patients who are skeletally mature.

The maturation process of the midpalatal suture has been studied using histologic and
micro-computed tomography of autopsy samples, which Melsen describes using a three-
stage maturation process.

In the infantile period, from a coronal-slice perspective, the suture appears as very
broad and Y-shaped with the vomer bone lodged in a furrow between the two halves of
the maxilla.

The juvenile period is characterized by bony projections into the suture from the right
and left maxilla creating a winding suture.

In the adolescent period, bony interdigitation continues and the suture becomes
progressively more tortuous.

Finally in adulthood, around the third decade of life, the suture eventually becomes
obliterated by calcified tissue

As this process progresses, the bony projections continue to interlock and the suture is
considered “closed” around age 16 years in females and 18 years in males. In adulthood,
around the third decade of life, the suture eventually becomes obliterated by calcified
tissue. The fusion process begins at the posterior aspect of the suture and progresses
anteriorly, but there is considerable variation between individuals with regard to timing
for the initiation of obliteration and its rate to complete fusion.

Although RME has been recognized as a safe, reliable orthopedic procedure that allows
elimination of the maxillary transverse deficiency in growing patients, 9,50–52 there are
many studies that have investigated the unwanted effects of expansion on periodontal
tissues, sutures, and the dentition. 9,51,53–55 With an increase in skeletal maturity and
closure of the circummaxillary sutures, the risk of these side effects increases,
necessitating surgical assistance to achieve the desired skeletal width.

The reason for the failure of RPE is because of the higher rigidity of the craniofacial
structures in patients who are skeletally mature. Therefore, SARPE procedure is used in
these patients for the management of transverse maxillary deficiency

. A miniscrew-borne expander applies forces primarily to the microimplants to transmit

the forces directly to the bony maxilla instead of the teeth or periodontium, thus
eliminating unwanted dental tipping.60 There are various appliance designs and a recent
clinical study using one design found an 86.96% success rate in young adult patients
(mean age of 20.9 ± 2.9 years), with stable results after 30 months of follow-up

Interestingly, Cantarella et al. found that MARPE resulted in a significant increase in

width at the interzygomatic level, whereas traditional tooth-borne RME has shown
negligible effects on the displacement of the zygomatic bone. 28 The zygomatic bone
tended to rotate outward along with the maxilla with a common center of rotation
located near the superior aspect of the frontozygomatic suture, more posteriorly and
laterally than what has been reported in the literature for tooth-borne expanders. Bone
bending takes place in the zygomatic process of the temporal bone during miniscrew-
supported maxillary expansion