When maxillary expansion is necessary
Maxillary expansion is prescribed in cases of an anatomically narrow palate and a deficiency of the transverse dimension of the jaw, when the width of the upper dental arch is insufficient for physiological occlusion with the lower teeth. Visually, this condition may manifest as dental crowding, facial asymmetry, airway narrowing, a high-arched palate, and malocclusion—most often crossbite or distal bite.
It is especially important to identify the problem in children in a timely manner, when craniofacial structures are still in an active growth phase. The earlier treatment begins, the higher the chances of achieving a stable result without surgical intervention in the future. However, adults should not postpone diagnosis either—modern methods make it possible to safely and effectively correct maxillary constriction even after skeletal growth is complete.
The influence of tongue posture on maxillary development
One of the key factors in proper maxillary formation is the physiological position of the tongue. At rest, the tongue should be in contact with the palate, providing natural pressure that stimulates the growth of the jawbone. This constant contact ensures correct development of the palatal arch, facial symmetry, and the formation of a harmonious bite.
In the presence of functional disorders, such as ankyloglossia (a shortened lingual frenulum), the tongue physically cannot occupy the correct position. As a result, the jaw does not receive the necessary stimulation, and its development is disrupted. Even with sufficient bone potential, improper tongue function leads to deformation of the dental arches and tooth displacement.
Mouth breathing and its influence on the craniofacial region
Breathing patterns play an important role in the development of a narrow maxilla. With chronic mouth breathing, normal air pressure in the nasal passages is disrupted, muscle tone decreases, and the tongue position changes—it drops down, ceasing to perform its supportive function.
In children who breathe through the mouth for prolonged periods (for example, due to adenoids, chronic rhinitis, or enlarged tonsils), narrowing of the maxilla, malocclusion, and elongation of the face are often observed. In addition to aesthetic changes, such patients suffer from sleep disorders, increased fatigue, reduced concentration, and even headaches.
Therefore, the comprehensive approach to treatment always considers the causes of mouth breathing. In cases of obstructed nasal breathing, consultation with an ENT specialist is recommended to eliminate anatomical or inflammatory causes interfering with normal airflow.
Ankyloglossia and its influence on maxillary development
Ankyloglossia is a congenital anomaly in which the lingual frenulum is shortened or excessively thick, restricting tongue mobility. This seemingly minor deviation has a serious impact on the formation of the craniofacial complex, especially in childhood.
When the tongue cannot freely rise and contact the palate, it does not perform its biomechanical function of stimulating maxillary growth. As a result, the bone grows narrow and high, forming the so-called “gothic” palate. This leads not only to deformation of the dental arches, but also to impaired nasal breathing, and later—to difficulties in speech and swallowing.
Correction of ankyloglossia is carried out with a simple surgical procedure—frenulotomy or frenuloplasty. In childhood, the intervention is minimally traumatic and often performed without anesthesia. However, it is extremely important to combine this procedure with myofunctional therapy to retrain muscle groups and establish correct tongue posture. Only with this combined approach can a stable and predictable result be achieved.
The role of myofunctional therapy in maxillary expansion
Myofunctional therapy is a system of exercises and training techniques aimed at normalizing the functions of the oral, tongue, cheek, and lip muscles. Its goal is not only to eliminate harmful habits (mouth breathing, improper swallowing, tongue thrusting between the teeth), but also to develop correct muscle activity patterns that promote natural maxillary expansion.
With regular exercises, the tongue assumes its physiological position against the palate, pressure on the dental arches becomes balanced, and breathing becomes nasal. All this leads to normalization of maxillary growth, improvement in posture, sleep, and even speech function.
In children, therapy is especially effective: during active growth, soft tissues and muscles are easily retrained. In adults, it requires more time and effort but also brings results—especially in combination with orthodontic treatment or appliance-based correction, such as using MSE.
Myotherapy is the foundation of a comprehensive approach. Without it, even the most advanced orthodontic methods may provide only temporary results: if the causes of deformation are not eliminated, relapse is likely.
Appliance methods of maxillary expansion
Appliance-based expansion of the maxilla is an orthodontic method aimed at creating additional space in the upper dental arch by widening the palatal suture. This method is used in both children and adults, taking into account anatomical and age-related features.
In children, removable or fixed orthodontic appliances are most often used, such as the Haas appliance, Hyrax, or screw plates. They exert gentle but consistent pressure on the palatal suture, stimulating transverse bone growth. In children, the suture has not yet fully fused, so the process occurs physiologically and with minimal discomfort.
In adults, when the suture is already ossified and hardly responsive to expansion without surgical assistance, special devices such as MSE (Maxillary Skeletal Expander) are used. These appliances are anchored not only to the teeth but also to the bone, providing more stable and directed expansion. In some cases, surgical assistance may be required—for example, during SARPE (Surgically Assisted Rapid Palatal Expansion).
Appliance-based expansion allows one to:
- correct a narrow maxilla;
- eliminate dental crowding;
- improve nasal breathing;
- create harmonious facial proportions;
- prevent more complex orthodontic problems in the future.
A properly selected appliance, regular orthodontic supervision, and adherence to recommendations are the key conditions for achieving a stable and predictable result.
Features of maxillary expansion in children and adults
The process of maxillary expansion varies greatly depending on the patient’s age. In children, bone growth is not yet complete, and interventions are highly effective even with mild myofunctional or removable orthodontic appliances. Treatment is gentle and physiological, without the need for surgery.
In adults, the situation is different: sutures are ossified, tissues are less plastic, and thus a more complex approach is required. As a rule, bone-borne appliances (e.g., MSE) are used, sometimes in combination with surgery. Retention becomes mandatory, since relapses in adults are common without proper stabilization.
Thus, the earlier treatment begins, the easier, faster, and more physiological it is. However, modern technologies make it possible to effectively solve the problem of maxillary expansion even in adult patients—it is only important to choose the correct method and ensure an interdisciplinary approach.
Stages of treatment with the MSE appliance
Treatment with MSE is carried out in two clearly defined stages—the active phase and the retention period. Each plays a key role in achieving a stable and safe result.
Stage 1. Active expansion
After the appliance is placed, the patient receives detailed instructions for screw activation. Usually, this involves 1–2 turns per day, corresponding to 0.25–0.5 mm of expansion. This approach ensures gradual and controlled bone movement, reducing the risk of soft tissue trauma and overload of support zones.
The active expansion process lasts from 2 to 4 weeks, depending on the required width. During this time, the patient regularly visits the doctor to monitor progress. Symmetry of expansion, condition of the mucosa, and patient comfort are also monitored.
Visually, expansion may appear as a small gap between the central incisors—this is a normal temporary phenomenon that is later corrected with orthodontic treatment.
Stage 2. Retention (stabilization of the result)
After the active phase is completed, the appliance remains in the mouth for 3 to 6 months. This is essential: the bone in the area of the expanded suture must not only be separated but also stabilized with the formation of new bone tissue.
During retention, the patient no longer activates the appliance. It functions to fix the achieved result. The doctor continues to monitor the condition of the suture, teeth, and oral tissues. Sometimes a bracket system or aligners may be installed in parallel for initial tooth position correction.
Neglecting retention can lead to relapse—partial or complete return of the maxilla to its original state. Therefore, adherence to timing and medical supervision are mandatory conditions for a successful result.
An interdisciplinary approach: the key to successful maxillary expansion
Effective maxillary expansion is rarely the task of one specialist. To achieve a stable, harmonious result, coordinated work across several fields of medicine is required.
The orthodontist is responsible for diagnosis and selection of the correction method—whether appliance-based treatment or myofunctional therapy. He or she determines which type of expansion is appropriate for the patient: active, passive, or surgically assisted.
The ENT specialist becomes involved when the patient has mouth breathing, chronic rhinitis, adenoid hypertrophy, or other conditions interfering with normal nasal respiration. Without addressing these factors, orthodontic treatment may be ineffective or produce only short-term results.
A speech therapist or myofunctional therapist works to restore correct tongue function, swallowing, and muscle tone. This is especially important in cases of a shortened frenulum or incorrect tongue posture at rest.
Such a comprehensive approach makes it possible not only to expand the maxilla but also to create an anatomically and functionally stable situation in which the dentoalveolar system develops and functions properly.
Conclusion
Maxillary expansion is not only an orthodontic procedure but also an important step in forming proper breathing, swallowing, speech, and overall facial balance. Modern methods allow effective treatment in both children and adults, taking into account age-related features and bone condition.
Early diagnosis, the correct choice of expansion method, and, most importantly, coordinated work among specialists of different profiles are the key to a successful, long-lasting result. By expanding not only the maxilla but also the treatment approach, we achieve not just a beautiful smile but a healthy and functional system for life.