Oral Surgery/SARPE

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Question
Hello
I am 39 years old and 20 years ago, I had surgical assisted rapid palatal expansion followed by braces and then removable retainers. I was almost 19.5 years old and I had stopped growing about 4 years earlier. This treatment was to correct my crossbite, which caused me to have a fairly significant malocclusion. I had a bonded expander attached to my upper teeth followed by the surgery about a week later. My surgeon did the first few turns of the expander and I completed turning the expander a few weeks to a month later. About 3 months after the expansion of my palate was complete, my orthodontist removed the expander and I wore top and bottom braces for about 10 months. This was followed by top and bottom removable retainers, which I wore full time for another 3 months, and then every night for another 3 months. (While I wore the expander, he put braces on my bottom teeth and on my front top 6 teeth that were not covered by it.) I diligently followed all of the instructions by my oral surgeon and orthodontist. My ortho. told me to wear my retainers at night, as needed to maintain my bite, which I wore about once a week.

For about 7 years, my bite was very comfortable. It then began at feel a little off but I was able to restore it by wearing my top retainer more than my bottom one.

A little over a year ago, my bite began to feel off and I noticed and felt my top right front tooth tilting slightly inward as well a cross bite, more so on my right posterior side. I did see my surgeon who examined me and recommended I see an orthodontist. The one who treated me retired. Iíve seen 3 orthodontists who are recommending either braces or Invisalign for about a year. They said the only way to totally fix my cross bite would be to have another palatal expansion surgery, which they do not recommend. I also have no intention of having this a second time.

-I have recently read that palatal expansion in adults can be possible without surgery? Do you agree, or would you be doubtful of any orthodontist claiming this?
-Also, is it possible that I have a posterior cross bite on my right side because Iíve usually slept on that side?
-Was I a few years too young to have SARPE? Should I have waited until I was in my early 20ís?
-Should I have worn the expander for longer than 3 months once my palate was fully expanded?
-Should I have worn a palatal bar once the expander was removed to act as a retainer to prevent too much relapse?

Thank you

Answer
Hi Ben,
No I do not believe in orthodontic treatment. After age of 14, ortho can not fix a true crossfire. It sounds like you may need to get braces and have jaw surgery to bring the jaw forward. I understand you are not interested BU I wouldn't do anything otherwise that may damage the gums and bones around your teeth. I don't think you have done anything wrong in the past. Usually the orthodontist maintains the expansion by braces.
I think you should be seen by an Orthognathic surgeon and really be evaluated clinically.
Good luck  

Oral Surgery

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Majid Jamali, D.M.D. Fellowship trained in corrective jaw surgery

Expertise

Diplomate, American Board of Oral & Maxillofacial Surgery Full scope Oral & Maxillofacial Surgery, Orthognathic Surgery, Genioplasty and Anesthesiology I have completed an additional two years of fellowships in orthognathic surgery and anesthesiology field.

Experience

Faculty at numerous hospitals

Organizations
AAOMS ADA ASDA NYSDS

Publications
New York Dental Society Journal

Education/Credentials
Tufts University: Dental School SUNY Down-State Medical Center: OMFS residency Robertwood Johnson Medical Center: Anesthesiology fellowship Lenox Hill hospital: Orthognathic fellowship

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