Oral Surgery/SARPE


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

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


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.


Faculty at numerous hospitals


New York Dental Society Journal

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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