A narrow arch form is a common problem that leads to crowding of teeth in the mouth. When a patient has a narrow arch form it can be easily widened as a growing child but as an adult it is a task that can require surgery to accomplish. Using a rapid palatal expander (RPE) with mini implants is a new way of treatment that doesn’t require surgery and can result in the same beautiful, wide smile. In order to gain more space in the arch form of an adult orthodontic patient pressure must be applied to the upper jaw bone.

 The upper jaw consists of two maxillary bones. These bones grow as we age and begin to fuse together soon after puberty. However when further growth is needed an expander (RPE) can be used to separate the bones and provide more room for the tongue, teeth, or to correct the bite of the patient  The above CT scan was taken on a patient of Dr. Ribeiro in an article from the Journal of Orthodontics. He shows how the two bones separate on a patient who was treated with a RPE

 The rapid palatal expander is an appliance that contains a screw in the middle and is attached to the molars and sometimes premolars using dental adhesives  The screw is turned a certain number of times a day determined by the doctor to put pressure on the teeth and bone  This pressure forces the two maxillary bones apart and creates more width in the arch form

 I have been assisting orthodontists for seven years and narrow arches are a common issue  As a child expansion of a narrow arch can be fixed with only a RPE  The child in the upper picture has a RPE appliance  As an adult the maxilla bones have fused together and expansion cannot be easily achieved without surgically altering the fused part of the bones Adults have two options: Surgery assisted RPE  This treatment requires going to an oral surgeon that removes and resistance of the fused bones  Soon after the surgery the orthodontist places a RPE and begins pushing the two bones apart Mini implant RPE  A technique that is now being used by Dr. Michael Meru and other orthodontists is a RPE appliance with mini implants  There are two additional arms attached to the RPE and two small implant screws are placed into the opposite maxillary bones

 This is a RPE and the circles are the small implants that are secured in each side of the maxilla  The implant looks like a small screw and is placed with an instrument similar to a screw driver Photo of patient currently being treated by Dr. Meru, DDS

 The patient receives the appliance and implants are secured into the bone  There is pressure when the implant is placed and after turning the appliance to expand  For a few days the patient will feel sinus pressure as the pressure on the two palatal bones increases  Once the force is great enough the fused bones “pop” and then further expansion is easier to achieve  Dr. Meru currently has several patients that have a MIRPE (mini implant RPE)  Patients that would other wise need extractions or surgery to make enough room for their teeth are having success with this method  After expansion is complete the teeth can more easily be moved into place  The patients are turning the screw in the RPE for two weeks and then the appliance is left in place for six months to let the bone heal  Treatment is then finished normally resulting in a broad smile

 "Dr. Mike Meru, DDS." Personal interview. 1 Mar  "Finn Orthodontics. Dr. Brian H. Finn." Finn Orthodontics. N.p., Web. 2 Mar  Helmkamp, Mary. "THREE-DIMENSIONAL EVALUATION OF IMPLANT- SUPPORTED RAPID." (2012): n. pag. Web. 10 Feb  Ludwig, Bjorn, Bettina Glasl, Jay Bowman, Dieter Drescher, and Benedict Wilmes. "Miniscrew-Supported Class III Treatment with the Hybrid RPE Advancer." Journal of Clinical Orthodontics 44.9 (2012): Print.  Musich, David, and Matthew Busch. "S.A.R.P.E." Narrow Upper Jaw. N.p., n.d. Web. 2 Mar  Ribiero, Gerson, Arno Locks, Juliana Pereira, and Mauricio Brunetto. "Analysis of Rapid Maxillary Expansion Using Cone-Beam Computed Tomography." Dental Press Journal of Orthodontics 15.6 (2010): n. pag. Web. 10 Feb  Thompson, DDS, Joseph. "What Is a Rapid Palatal Expander?" Ask an Orthodontist.com RSS. N.p., Web. 2 Mar