The Greatest Guide on Palatal Expansion

[extraz]

Everything I've learned about Maxillary Expansion.​

(get your popcorn, because I've learned a lot)

1. What Palate Expansion Is​

Palate expansion is an orthodontic technique that widens the upper jaw by applying lateral forces to the maxilla.
It can be done with:

A. Tooth-Anchored Expanders​

• Example: RPE (rapid palatal expander)
• Anchors into teeth, not bone
• Tends to cause more dental tipping and alveolar flaring rather than true skeletal widening, since its anchored to the teeth of course. (Think about it, if the expander is using the teeth as support to hold itself up, it's obviously going to push the teeth and flare them quite a bit)

B. Bone-Anchored Expanders​

• Examples: MARPE, MSE, FME
• Uses mini-implants screwed directly into the palate (TADS)
• Forces go into bone, not teeth
• Produces greater skeletal expansion and less tooth movement
• Used in older teens and adults because sutures are more closed

FME is the newest, and most revolutionary. It's also my favorite, and I'll go into that later.

2. Symptoms That Palate Expansion Can Help Improve​

Widening the maxilla can influence several functions:

Airway & Breathing​

• Can increase nasal cavity volume
• Improve nasal breathing efficiency
• Can reduce nasal congestion (if you ever sound like there's mucus in your throat/nose when talking and you're not even sick, chances are your palatal width is subpar)
• Better airflow → improved oxygen saturation during sleep

Sleep Quality​

• May reduce snoring
• Can decrease mouth-breathing during sleep

Dental & Bite Issues​

• Corrects crossbites
• Creates space for crowded teeth

Tongue Posture & Mewing​

• Wider palate → more tongue space obviously

3. Facial Changes From Palate Expansion​

Expansion affects the maxilla, which plays a major role in midface support and shape. The exact changes vary by device:

A. Effects on the Midface (General)​

Can Change:​

• Midface width
• Cheek support
• Eye area harmony
• Nasal base width

Least Changes to:​

• Maxilla forward projection (unless combined with protraction facemask)
• Orbital shape

Pay attention to the infraorbital and the zygos. Huge difference.

1. MARPE / MSE​

These bone-anchored expanders can sometimes cause:

• Midface Drop-Down / Vertical Lengthening​

• Because the plates are anchored lower, forces spread the palate downward and forward
• Slightly longer midface look in some cases

• More Lateral Skeletal Widening​

• Greater skeletal split of the midpalatal suture
• More change at the nasal cavity and zygomatic buttress

• Bizygomatic Width​

• If your bizygomatic is a flaw, expansion can help a lot.

• Eye Separation Appearance​

• Using scans of the skull, we can actually see that the orbitals spread out a bit. My ortho told me this could lead to more under eye support, and wider set eyes. Not 100% confirming this until I expand myself.

Side Note:
MSE and MARPE are bone anchored with TADS screwed into the palate, but still anchor onto the teeth for more support. This can cause flaring of the teeth.

2. FME (Facegenics Midfacial Expander)​

Anchored differently, so there's different biomechanics.

• Less Downward Movement​

• Forces are delivered higher and more symmetrically, since it doesn't anchor onto teeth for extra support like MSE and MARPE.
• Tends to preserve midface height, due to its increased dimensional stability compared to other expanders. (will show this in the FME vs MSE/MARPE section below)
• Less risk of “midface drop” that some report with MSE/MARPE

• More Forward/Upward Changes With FME​

FME combos extremely well with protraction facemask therapy. The expander alone can provide forward growth, which most of you wont believe so check this out from one of the providers: (this is on an adult by the way.)

• Similar Skeletal Expansion but Better​

• Less dental tipping
• Less alar flaring
• Changes focus more on bone, not teeth

FME VS MARPE/MSE
I told you all earlier that FME was better. Check out this comparison on dimensional stability of the custom MARPE and FME.
MARPE:

FME:

Dimensional Stability matters immensely. The more stable, the better. This is why FME has no vertical drop, and MARPE does.
FME also doesn't use teeth as support, so there's less teeth flare, and it's purely bone difference. If you want the most facial changes, FME is the way.

4. Maxillary Protraction + CCW Rotation (Huge for Facial Changes)​

A. Facemask (best used with an expander to loosen the sutures and allow the bone to move forward with how malleable the maxilla is)​

Using upward and forward vector with the facemask causes:

• Counterclockwise (CCW) rotation
• Improved midface support
• Reduced under-eye hollowing

Why FME + Facemask Is Better​

FME:

• Anchors high
• Maintains midface height
• Pulls maxilla forward AND up
• Avoids vertical drop

MARPE/MSE + facemask can still work, but

• There is slightly more vertical tendency
• May require vector correction with elastics/headgear

5. Tooth-Anchored vs. Bone-Anchored Expanders​

Tooth-Anchored Expander Problems​

• Dental tipping (teeth lean outward instead of bone widening)
• Alveolar bending
• Gum recession risk
• Limited skeletal change
• Less stable in older teens/adults

Bone-Anchored Advantages​

• True skeletal expansion
• Less dental strain
• More predictable suture split
• Works in older adolescents/adults
• Better for combining with facemask protraction
• Cleaner aesthetics (less unintended vertical/dental movement)

6. Summary​

Palate expansion:

• Widens the upper jaw
• Fixes bite/crowding
• Improves airway and tongue posture
• Can improve sleep quality
• Affects facial aesthetics well if you have the right flaws. Don't expand if you're midface is already wide, if your eyes are already wide set, etc. If your bizygomatic to bigonial is unideal for this as well, don't do it.

Bone-anchored devices (FME > MARPE/MSE > tooth-anchored):

• Give cleaner skeletal changes
• Less dental tipping
• Better for facial aesthetics
• Work better with facemask protraction

FME + Facemask (Upward Vector):

• Best combination for forward/upward maxillary movement
• Helps maintain or reduce midface vertical height

Asymmetry Fear in Expansion:

• FME has almost perfect symmetric expansion. It's relatively new, but you can check out some of the case studies on reddit. Compared to the asymmetry horror stories on MARPE, FME takes the win.
• If you have an ortho that's smart and tracks your expansion, they'll know how to minimize asymmetry.

With the differences in facial effects of the FME and MARPE, I suggest this plan:
Long and recessed midface, with poor width: FME + Facemask
Short midface with poor width: MARPE
Midface with adequate width, but lack of projection: Minimal expansion while prioritizing protraction with the facemask (still need to expand a bit to loosen the maxillary sutures and make it malleable, which will help guide the midface forward)
Common Misconception I want to clear up:
This obviously wont come close to any surgery, but expansion and orthodontics is needed to create the canvas for your health, and face. Fix your teeth, your jaw issues, and then you'll be free to do whatever it takes to build your bones. You don't want to build bones on a face with a malocclusion, or severe asymmetry, because then it'll be a bigger issue. Fix your structural issues with orthodontics, then you can paint your perfect canvas.
First post on here, so go easy on me. I made the post Christmas themed for you guys if you couldn't tell (I don't care if its a month away)

 

[V4MPIR3]

nerd

 

[extraz]

nerd

i didn't choose to be this way

 

[V4MPIR3]

i didn't choose to be this way

"i didn't choose to be this way"

 

[extraz]

"i didn't choose to be this way" View attachment 4353990

jesus dude why does it seem like you’re fuming so hard

 

[V4MPIR3]

jesus dude why does it seem like you’re fuming so hard

Sorry
Do you want to be my friend

 

[extraz]

Sorry
Do you want to be my friend

sure dude i think we got off to a bad start