#palateexpansion

[winegeekette]

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[fullmetalbrackets-blog]

Chapter 1. Extraction vs. Expansion

  I’m not sure what lead me to believe that getting braces would be as simple as walking into the office and asking for them to be installed, but that is certainly not the case. My initial meetings with the orthodontist were intensive assessment sessions. Panoramic and bite-wing X-rays were taken, along with multiple photographs of my teeth, jaw and smile in different positions, all under the same unflattering lighting. My mouth and teeth were measured and remeasured. The fullness of my lips and width of my cheekbones were discussed. Impressions were taken and molds made. A periodontist poked and prodded my tender gums to rule out bone loss and gum disease. I was asked to open and close my jaw until it ached while the dentist palpated the movement of my temporomandibular joint.  When the dentist finally had enough data, I was called back in to the office for another consultation, this time to explain what all the tests had revealed. 

My teeth and gums were deemed healthy enough to proceed, but I was warned of several possible complications, including bone loss, gum recession, tooth collapse, and the potential failure of two previously root-canal treated teeth to budge from their comfortable little sockets, no matter how gently eased by the wires. I was told that the crown I had just spent $1500 on would probably be damaged and need to be replaced after treatment, that I will need veneers to lengthen my upper incisors, and of course, will have to finally get that implant to replace my lost premolar. 

The dentist then presented me with three options in order to make room in my mouth for my teeth to align properly. Either my upper (maxillary) dental arch has to be widened to accommodate my teeth, or there need to be fewer teeth to accommodate. My options were to try a lengthy treatment with thick specialty wires that would slowly expand the arch by pulling the outside surfaces of my teeth toward my cheeks; to use a palatal expander to push my teeth outward and open the midline suture of the hard palate; or to undergo multiple extractions, sacrificing my three remaining premolars to open up space to be occupied. 

With different risks and benefits associated with each treatment, ultimately the choice came down to identifying the best possible outcome that could be achieved, with the fewest complications. Extractions would be simple, but likely to make my small chin look sunken and weaken the appearance of my jawline.  The palate expander is commonly used in children and adolescents, but is not always effective in adults, whose palates are oft believed to be fused after puberty.The wire-only approach would be complicated, slow, and carry a higher risk of the bottom incisors collapsing from the required force. With the advice and input from my dentist, I chose to attempt palatal expansion. In the event that treatment fails to achieve separation of the two halves of the maxilla, we will move on to wire-only expansion, leaving extractions as an absolute last resort.