05. Upper Arch/Palatal Expansion

• Reasons for this include the following below. You may use your testing technique to determine if any of these apply to you. 
  • • Your palate is too narrow. Chronic mouth breathing feeds into this developmental pattern. To learn more about why we develop narrow faces read here.
    • You have enlarged turbinates or polyps in your nasal cavity reducing the flow of air here.
    • You have increased neuromuscular tension in your head, neck and/or below which closes down your airway.
    • You have sinus congestion due to underlying toxins and/or pathogens.
    • Or some or all of the above as they tend to contribute to each other.

• If you are mouth breathing during sleep, there is a tendency for your jaw and thus tongue to slide back into your throat which can potentially occlude your airway. This may happen more if you sleep on your back. Furthermore, if your palate is too narrow, your tongue can have a difficult time posturing on the roof of your mouth (preferred place where your tongue should naturally rest) making it more likely to mouth breathe. This fosters a pattern of the tongue sliding back into the throat occluding the airway.

• If you are mouth breathing during sleep it disrupts the pressure relationship within your airway making it more likely for your airway to collapse.
• If you are not appropriately using your diaphragm and abdominals to breathe this can also affect the air pressure in your airway making it more prone to collapse.
• Malocclusion creates increased neuromuscular tension in your head, neck and jaw and even below to your rib cage, pelvis and feet. This can also make your airway prone to collapse.

• MARPE refers to Microimplant Assisted Rapid Palatal Expansion and uses microimplants anchored in the palate and maxillary bone to achieve rapid skeletal expansion, typically over a period of 3–6 months. Once the desired expansion is achieved, the appliance is maintained to allow the newly widened bone to remodel and stabilize. Orthodontic treatment, such as Invisalign or braces, is then used to align the teeth and optimize the bite.
• This approach provides the most true palatal expansion (skeletal expansion) and has been shown to increase the width of the nasal cavity and surrounding airway structures.
• MARPE is generally best suited for individuals who require significant expansion and/or improved nasal patency. While removable oral expansion appliances, Invisalign, and traditional braces can produce some widening of the palate through dental and alveolar bone remodeling, they are limited in the amount of expansion they can safely achieve and have not been shown to significantly widen the nasal cavity.
• When excessive force is used to create dental expansion alone, teeth may be moved beyond the supporting bone, potentially leading to bone loss, gum recession, instability, and other periodontal complications.
• Because MARPE achieves expansion through the underlying skeletal structures rather than primarily by tipping teeth outward, it greatly reduces the risk of moving teeth outside their supporting bone.

Oral Appliance Therapy encompasses a number of different appliances which fit into the dental arches to expand the arch laterally and/or forward. With these approaches, the alveolar bone of the dental arch and teeth remodel to expand, not the palatal suture. As a result, the upper arch opens up which gives more room for the tongue to rest in the palate reducing the likelihood of mouth breathing. Because the palatal suture does not widen, as it does with MARPE, there is no widening of the nasal passages.

Caution must be exercised with these type of appliances as too aggressive expansion force can potentially shift the roots of the teeth out of the bone leading to bone loss and gum recession.

Examples of these appliances are:

• DNA Appliance: A removable expander that can expand both forward and sideways (laterally) with bilateral bite blocks. Typically worn 16 hrs/day. The entire process can take 1-2 years. Orthodontia may be required afterwards. Because this appliance is positioned within the palate, the tongue rests lower and may need to be retrained afterwards to position up.
• Homeblock: A removable expander that can expand both forward and sideways (laterally) with an asymmetrical bite block to help address asymmetrical facial development. Typically worn during sleep plus 4 hours while awake. The entire process can take 1-2 years. Orthodontia may be required afterwards. Because this appliance is positioned within the palate, the tongue rests lower and may need to be retrained afterwards to position up.
• ALF (Alternative Lightwire Functionals)-A lightwire expander that is more gentle than the DNA or Homeoblock appliances. It is also much less bulky. Typically it is fixed and not removable but sometimes it can be. It allows the tongue to rest in its natural position up on the palate vs the DNA and Homeoblock appliances.  You are able to talk normally with an ALF vs the other appliances. The intention is to wear it 24/7 and the entire process can take 1-2 years. Orthodontia may be required afterwards.
• Myobrace: A relatively inexpensive oral appliance system that not only gently expands the dental arches and helps to realign the teeth but it also trains the tongue to rest on the palate and swallow correctly. Typically worn during sleep and at least 1 hour during the day. Sometimes it can result in an edge to edge bite which may require additional oral appliance therapy or orthodontia.

This includes traditional braces or Invisalign which can help open up your dental arch while also restoring your bite alignment.

Caution must be exercised with expanding the arch too aggressively as the expansion forces can potentially shift the roots of the teeth out of the bone leading to bone loss and gum recession.