Palatal Expanders and Anterior Growth Appliances for Kids

What are the Different Palatal Expander Treatment Options?


maxillary expander optionsAs parents we always want the best for our kids. Things near the top of the list are straight teeth and overall health. But did you know they are closely related. A critical part of chid development is proper growth of the mouth, nasal passageways and a healthy breathing pattern during sleep. Palatal expanders can be very helpful in overall child development in this regard. In this article, we review the different palatal expander treatment options used by Dr. Adams at Maryland Holistic Dentist in Burtonsville Maryland.

Dr Gary Adams is the owner and dentist of MHD in the DC Metro area

Can you imagine breathing through that crowded mouth? Good luck huffing and puffing through there. Expanders are appliances that work in concert with muscle forces and naturally present growth factors to develop beautiful smiles, proper facial profiles, healthy breathing patterns during sleep, and overall health.

Kids Expanders and Growth Appliances Video by Dr. Adams

Braces Vs Expanders:

Braces are more about straightening teeth and the goal of maxillary expansion is growing the jaws to be the a healthy size and shape. The optimal treatment in every case is to grow the jaws to be the proper size and shape and then align the teeth. Often times teeth will become naturally straighter after treatment  with expanders. Creating enough room for teeth to fit can allow teeth to fit without crowding or being crooked. Usually orthodontics is necessary after expansion therapy, but in some cases an acceptable cosmetic result can be obtained with expanders alone.

Schwarz Appliance stimulates Growth of the Jaws and Airway

schwarz expander growth applianceThe Schwarz appliance is one of the most versatile facial growth appliances available. The appliance is a removable appliance worn 10-12 hours per day. The palatal expander should be put in after dinner and worn through the night. The Schwarz can be designed to promote growth of upper and lower jaws more forward, taller and wider. As the jaw bones grow, so do the surrounding facial bones and surrounding soft tissues such as lips, cheeks. The result is growth of the entire facial structures and the lower 1/2 of the face in particular.

Warning signs that a child is not growing properly:

  1. mouth breathing especially at night
  2. dry lips and swollen tonsils
  3. crowded crooked teeth. This is the physical evidence that the mouth and nasal passageways are not growing optimally and something needs to be done or else.

The Schwarz can be custom designed to stimulate bone growth where it is specifically needed. The picture above shows an upper appliance that can be adjusted forwards and wider. Additionally the back teeth have acrylic covering them. This is called a bite plane. The “bite plane” is shaped purposely to control how the lower jaw rests on it. The bite plane is usually shaped to create a more forward resting lower jaw position. A forward bite position stimulates the lower jaw to grow forward. The upper Schwarz is most often coupled with a lower complimentary device.

lower schwarz applianceThe lower Schwarz only stimulates wider growth of the mandible.  Schwarz appliances are very easy to tolerate and can be taken out during the day and during eating. The Schwarz appliance is Dr. Adams’ favorite appliances to correct crooked crowded teeth and night time breathing issues in kids. The end result of the treatment is more room for the teeth to fit, improved facial profile, larger mouth and nasal passageways, improved breathing and airway, and a larger nicer looking smile.

How do Expanders and Growth Appliances Work:

Palatal expanders work by placing light pressure in the direction where bone needs to grow. The natural action of muscles such as tongue pressure, cheek and lip movement will do the rest in most cases. Occasionally tongue and lip ties need to be released and myotherapy (tongue exercises) may be completed

The DNA appliance is an FDA cleared treatment for sleep apnea. The DNA is very similar to the Schwarz appliance and it works for adults using the same growth patterns. The AGGA is an adult growth appliance.

ALF Appliance for Severe Teeth Crowding and Misalignment

ALF expander applianceALF stands for advanced lightwire functional. The ALF is a springy wire that stays in the mouth 24 hours a day and puts a constant outward pressure. The tongue pushes up against the wire creating natural expansive pressure.  The wire can be custom made to fit around teeth that are in narrow spaces and crowded up against one another. Most of the time, the ALF will need to be followed by another expansive appliance once it corrects the severe crowding

Twin Block for Controlled Anterior Growth

twin block anterior growth expanderso called “Twin Block appliance” because the growth technique depends upon upper and lower appliances that requires the lower jaw to bite more forward. Using a forward bite to correct retrognathia is called functional orthodontics for some reason. The Twin Block was Invented by Dr. William. The Twin Block technique is well tolerated and has a high rate of success as long as the appliance is worn after dinner and through the night. The Twin Block design like the Schwarz allows for width and forward growth of the upper arch and width growth of the lower arch. The Twin Block may be a better choice than the Schwarz when more forward growth of the lower jaw is needed.

Crozat Lightwire Appliance

crozat maxillary expanderThe Crozat expander is the sister appliance of the ALF. Very similar design the the advanced lightwire except the Crozat crosses from one side of the palate to the other in additon to spanning the back surfaces of the teeth. The Crozat uses the forces of the tongue to aid in expansion or growth of the jaw bone. The Crozat has a tendency to use a thicker wire than the ALF and it is usually used in cased where more expansion in the back of the palate is needed as compared to the ALF. Neither the ALF or the Crozat use a bite plate and therefore are not capable of much forward growth of the lower jaw or so called “functional” growth.

Hyrax Fixed Maxillary Expander

hyrax palatal expanderThe Hyrax expander is the go to for many orthodontists. It only expands the maxilla. It also expands the back part of the mouth the same as the front. The Hyrax does a good job of arbitrarily growing the maxilla wider. And it does so at a very fast rate. The Hyrax is an example of a “rapid palatal expander.” All the above appliances are slow palatal expanders that are capable of growing the mouth in several different directions outwards and forwards. The above appliances also grow the mouth in a shape that respects and mimics the natural shape of the mouth or the growth pattern is intentional. Dr. Adams does not use rapid palatal expanders because he believes slower expanders produce a better result.

Myobrace Expander System

Myobrace palatal expander is a popular system because it is easy for the doctor to deliver care to the patient. Unfortunately while the system does promote some growth, it is not calibrated or calculate for any specific growth. most people who are treated require more expansion and orthodontic treatment after use of the Myobrace.

What are the Risks of Not Doing Necessary Expansion Treatment?

Ultimately when the mouth, upper airway and the bite are not developed and optimized overall Health will suffer. Usually sleep apnea and tmj problems are just the start of the problems. Additional health problems related to poor sleep and sleep apnea are:

  1. thyroid and metabolic problems
  2. weight gain
  3. heart and cardiovascular disease
  4. tmd problems and teeth clenching
  5. obstructive sleep apnea


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