When I first came out of dental school, palate expansion with an orthodontic device was limited to children and young adolescents. We thought the palatal suture was closed and fused, and we could no longer use a fixed orthodontic device to change the shape of the maxillary arch and expand the palate. Today we know that we can do palate expansion for patients who are older, and we have the additional ability to do surgically facilitated orthodontic treatment.

Why is this important?

Because today we understand how the shape of the maxillary palate, the shape of the arch form, and the ability to put the tongue solidly against the roof of the mouth have a positive impact on eliminating apnea, hypopnea, and breathing issues.

At what age is palatal expansion with an orthodontic device no longer effective?

I asked this question to two board-certified orthodontists whom I respect. And interestingly, I got the exact same answer. They both said that until age 35 we can get palatable expansion with a fixed orthodontic device. And after age 35, it may work but it becomes unpredictable. The older a patient is beyond their mid-thirties, the less predictable the results are. The patient must understand this when they accept treatment.

When I inquired if they had attempted palatal expansion on a patient over 35, both orthodontists said they had done so with good results, but treatment is slower and thus takes longer. They explain to patients that they can try surgically facilitated ortho with a palate expander, and if it doesn’t work, there is a pure surgical solution. The patient can choose to skip over the orthodontic device and go straight to the surgical solution. They fully inform the patient about the options, and the risks and benefits of treatment. They’ve had adults over 35 choose to proceed with treatment.

Up until age 35, palate expansion with an orthodontic device is predictable and a treatment we can confidently recommend. There are alternative treatments for adults over age 35.

Can Invisalign or other aligners expand the palate?

Aligners do not expand the palate. They can, however, widen the arch and alveolar bone by 1 to 2 mm. Putting this in perspective, this is a widening of less than a tenth of an inch (about 0.08 in). Aligner treatment can be used to reposition the teeth to make more space for the tongue to press solidly or more solidly against the roof of the mouth. For many adult patients, this is a treatment modality that improves their airway.

The goals of palate expansion with an orthodontic palate expander or pure surgery are to achieve greater than 1 to 2 mm of expansion.

At the Pankey Institute

Comprehensive dentistry that addresses the airway and breathing is a common topic of conversation among dentists who participate in Pankey courses. We welcome these conversations. Because every patient presents with a complex of factors, I advocate for a holistic approach to looking at underlying causes of apnea, hypopnea, and breathing issues.

At Pankey, we have a very in-depth Essentials Series that cover an array of important dentistry topics. During our Essentials 1 course, we include a special Airway Management section for dentists to practice on a regular basis. Check out our upcoming course dates here.

Here are four Pankey Webinars you may want to view to develop your understanding of the importance of the airway in the patient’s total health and what dentists are doing to integrate airway support in their practice. It’s exciting to see the expertise that has developed among our faculty and participants. Some have developed into niche providers to better serve the needs of their communities.

1. The Goals of New Orthodontics: How Airway Thinking is Impacting Dentistry
2. Breathing and Airway Support
3. Open the Airway Tonight and Other Tips from the Dental Sleep World
4. Airway Centric Dentistry