In the past 20-25 years, orthodontists have increased their use of expanders on patients of all ages. One reason for this trend is a better understanding of how to use expanders based on an abundance of research on the topic. Another reason for expander use is a desire by orthodontists and patients to rely less on extraction of teeth. While it is still necessary in some cases to remove some permanent teeth, there can be no question that expanders have greatly reduced this need. So, what exactly does an expander do? How does it work?
The expanders that we use in our office are generally made by fitting some normal orthodontic bands or rings on the first permanent molars. Once these bands are fit, an impression or mold is made of the upper jaw, and the bands are removed and sent off to the lab. The lab then makes a model of the upper jaw based on the impression and fabricates the expander by soldering wires to the bands.
Back in the office, the newly fabricated expander is then fit back into the mouth and cemented with special “glue for the teeth”. At this time, the patient and guardian will be shown the procedure for “turning” or activating the expander. We usually show the guardian and then allow them to try it while we watch to make sure they are comfortable with the procedure. When the activation is done, the patient generally does NOT feel any sharp pain. The patient may feel some pressure on the molars where the expander is attached or below the nose where the bones of the upper jaw meet. This pressure may last 15 or 20 minutes. If activation is done before bedtime, the patient generally sleeps off any mild discomfort.
When the expander is activated, the gentle pressure applied to the teeth is transferred to the underlying bones of upper jaw. Prior to completion of the adolescent growth spurt, the two bones that make up the upper jaw have not entirely fused in the roof of the mouth. It is because of this fact, that an expander can do its job of moving these two bones further apart widening the upper jaw and making more space for alignment. Once the bones are gently moved apart after activating for a few weeks, bone will slowly fill in the gap. This bone fill in will take a few months. This is why an expander is left in place after activation is complete.
If your expander is working properly, after about a week of turning, you should see a small gap form between the two front teeth. The gap is bigger for some patients than others. Don’t worry, the gap is temporary. We usually tell patients to call if they don’t see the gap.
What if you are older than an adolescent and your upper jaw bones have already fused? Well, you can still get jaw expansion, but it is a little more involved. You will need to visit an oral surgeon for a small surgical procedure to loosen those bones back up prior to activating the expander.
So that’s it! That’s how an expander works. It may be a little annoying, but usually, the results are well worth it!
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