Palatal Expansion in Adults: Non-Surgical Skeletal Development

Insufficient maxillary width continues to be one of the most constant problems facing the orthodontic clinician. The high vaulted and v-shaped palate creates problems of arch form, crowding, occlusion, tongue function, breathing and esthetics. If opposed by a more rounded horseshoe shaped mandibular arch it can create a posterior trapping effect on the mandible. In this compromised jaw relationship the patient is often relegated to a Class II or pseudo-Class III effect (Fig. 1), caused by a poorly developed mid-face. The result may be a trapped or blocked mandible and the attendant joint dysfunction and and/or dental breakdown. Palatal expansion has long been advocated as the first step toward resolving not only the maxillary width, but also the mandibular dysfunction. This can be treated in adults in a predictable non-surgical manner free of the trauma and morbidity of a surgically assisted expansion. It is not only possible, but very safe and predictable with the fixed Haas appliance.¹ We have accomplished this on hundreds of adults over the past thirty years.