Expert: Dr. Randolph Myerson - 2/7/2009

Question
I just went to the orthodontist about an hour ago and was told that I needed a Palatal Expander. Problem is he can not guarantee that I will not need surgery because I am 19 almost twenty in May. Im am very scared of the surgery and also scared that I will waste time and go through pain in vain when in the end I might still need the Palatal Expander. Is there a way for him to tell before he puts this on? He says no, that he has to see how I react while having the Palatal Expander on. Cant I do a special X-Ray or something? Please let me know before I waster my time and money.

Thank You soooooo much!!!
Diandra Nolasco

Answer
I'm sorry to say there is no diagnostic test that will clarify the need for surgery.  Actually, in many offices the surgical approach to palatal expansion is always done for all patients older than 17 years of age.  This is based on many years and many cases of palatal expansion done without the assistance of the surgical procedure.  In many of these cases the expansion failed over time or there were problems with gum and bone recession years later.  So it's not just a matter of whether or not the palate will expand without surgery.  We're also concerned with the long term effects on the dentition.
Surgically Assisted Rapid Palatal Expansion (SARPE) involves placement of the palatal expander appliance which is cemented onto the upper teeth.  Before the appliance is expanded a surgical procedure is done, often in the oral surgeon's office under sedation.  It usually doesn't involve a stay in the hospital and recovery takes just a few days.  The expander appliance is adjusted by the patient twice a day and adjustments are usually completed in one or two weeks, depending on the amount of expansion necessary.
I usually see my patients one week following surgery and the surgeon and I alternate seeing the patient on a weekly basis during the expansion phase over the next few weeks. My patients have all been completely fine at the first one week appointment and have experienced no difficulties.  They are all amazed at just how quickly and easily the expansion proceeds and the only complaint is the rather large space that opens between the upper central incisors due to the expansion.  This is managed by placing a plastic tooth there and gradually reducing the size of that tooth as the upper teeth are moved into place.