In some cases, permanent teeth may not be able to align properly due to an underdeveloped upper jaw. Signs of this problem can often be identified through crowding of the teeth, upper tooth protrusion, tongue thrust, difficulty chewing, mouth breathing, snoring, headaches and deviation of the lower jaw.

When the upper jaw isn't large enough to allow for proper alignment of the permanent teeth, interceptive treatment in the forms of palate expansion or tooth extraction may be required to correct the problem.

Expansion

As one of our preferred methods for treating an underdeveloped dental arch, expansion is an increase in the overall width of the palate before braces are applied. Treatment consists of attaching a special appliance to the upper back teeth. Once the appliance is activated, it is left in place for several weeks while the teeth gradually respond to the newly developed space. Upon completion, a noticeable improvement in the patient's profile, smile and jaw function become more apparent. Ultimately, leading to a brighter and more beautiful smile!

Types of expanders

"Bonded" Rapid Maxillary Expander

"Banded" Rapid Maxillary Expander
**Note: There may be attachments present on the cheek side of the bands

Troubleshooting with the expander

1. How do I turn the expander?
The key is inserted into the hole that is facing towards the front teeth.

While keeping the key securely in the hole, push slightly down and towards the back of the mouth until the key stops against the rear horizontal bar (in the direction of the arrow on the appliance). Remove the key being certain not to “unturn” the screw, or the effective expansion from that activation will be negated.

2. I can’t find the hole to start the activation/there is no hole available in the front of the expander.
It is likely that the center screw has unturned partially, leaving only one hole visible, likely in the center.

To correct this, first you must insert the key into the center hole and then complete the “half-turn” by pushing the key to the back. This will bring up the next hole in the front, where the key can then be inserted to do the complete next activation. [See previous question for how to correctly turn the expander.]

3. The expander seems to be loose on one side. What should we do?
Don’t do any more turns if you think the expander may be loose. Call the office (347-0946) and we will schedule a comfort appointment to check it and recement it if needed. Keep the area nice and clean until we can examine it.

It’s important to regularly check your braces for bent or loose wires and brackets. In the event of a loose/broken wire or bracket, call our office immediately to arrange an appointment for repair.

Extraction

Extraction is the process of completely removing a tooth from its socket. Generally, tooth extraction is avoided as a form of treatment by orthodontists unless teeth are being extracted for the following reasons:

• Tooth is severely impacted and surgical exposure is very risky
• Tooth is badly decayed
• Tooth is traumatized and has fractured roots
• Inadequate bone support exists for the tooth
• Dental midline is asymmetrical
• Jaw discrepancy needs to be compensated
• Concern over the fullness of patient's profile

Interproximal reduction (IPR)

This is a technique in which the orthodontist uses a thin, flexible diamond file to gently smooth and recontour the enamel between adjacent teeth. It is an invaluable technique that is often used to alleviate mild to moderate amounts of crowding when expansion and/or extractions are not the best treatment options for a patient's unique malocclusion. It can also be used to reshape teeth to look more attractive in appearance.

This procedure is done in small increments, removing only approximately 0.2 millimeters of enamel between two adjacent teeth at one time. Since there are no nerve endings in enamel, the procedure is painless and does not require any anesthetic. The interproximal reduction is strategically distributed among several teeth and additively will provide the needed space to align crowded teeth.

There have been numerous clinical studies that have shown that IPR does not make teeth more susceptible to decay. Furthermore, the studies have concluded that the gums supporting teeth that have had IPR are not more prone to developing gum disease.

For more information about IPR, please visit the web site of the American Association of Orthodontists, www.braces.org and search under the term interproximal reduction.