April 17th, 2019
Last month we shared with you the necessity for some patients to receive treatment with palatal expansion for proper spatial development of the palate and in some instances to allow for successful orthodontic treatment. The importance of expansion to correct for maxillary constriction or crossbite is not only important to allow ample spacing for incoming teeth, studies find that this constriction can also be a factor in airway restriction in children resulting in decreased nasal airways and impaired respiratory function.
Further studies show that treatment of palatal developmental problems become more complex with age. Therefore, younger patients are more responsive to early orthodontic intervention with expansion as less pressure is required to achieve the desired result. However, in the past, orthodontic treatment with a palatal expander relied heavily upon the patient and at a great cost.
A Rapid Palatal Expander (RPE) is a device bonded into place using the patient’s teeth as anchors. It can markedly increase the width of the upper jaw allowing upper and lower teeth to fit together. For some patients, this additional room may prevent the need for extraction as more space is created for the permanent teeth to come in. The device is connected by a screw in the middle which joins the two sides. Over time, and at doctor prescribed intervals, the patient or their parent uses a “key” to turn the screw - expanding the palate and therefore creating the necessary space for proper dentition. As the jaw expands, new bone fills in between the two halves of the palate in a process called distraction osteogenesis.
Following the prescribed treatment is critical to success with palatal expansion,” said Dr. Yan Razdolsky of Forever Smiles. “The learning curve is often too great, and the burden placed upon the patient and parent is often too much.”
RPE treatment often requires several appointments and expansion can take anywhere from a few weeks to several months. Treatment includes impressions, followed by the seating of the appliance and follow up visits for progress checks. Compound that schedule with extra visits due to the inability of patients or parents to perform proper home treatment… then patients can expect more visits. Indeed, that can be a challenge to treatment!
However, Dr. Razdolsky has discovered a great treatment alternative for Forever Smiles patients in the self-activating, leaf-spring expander.
“Once in a while, an invention appears which fundamentally changes the whole game. Leaf is a game changer,” said Dr. Razdolsky. “Once we started using it, we quickly realized the benefit both to treatment and the patients.”
The Leaf Self Expander is a product of Leone Orthodontics of Florence, Italy, a company with which Dr. Razdolsky has held a close professional relationship with the head engineer Gabrielle Scommegna since the late ’90s. The design of the Leaf Self Expander is similar to that of a conventional rapid palatal expander, but instead of a midline jackscrew it uses double nickel titanium leaf-shaped springs (see Fig. 1). When placed, the springs are compressed with an applied force so that as the spring recovers or returns to its original curve-like shape during deactivation which results in a strategically calibrated expansion of the upper arch (see Fig. 2-5). What’s better is that according to the manufacturer, the Leaf Self Expander requires no effort on behalf of the patient and perhaps only minor clinical observation throughout treatment to confirm results are on track!
Pre-loaded to the patient’s unique needs each spring’s super-elastic and flexible properties release predetermined, controlled, and continuous forces throughout treatment as they decompress. Therefore, expansion therapy with this self-activated device relies solely on a pre-defined course of treatment.
“We see a number of patients every day. With the Leaf Expander we can cut down on unnecessary appointments and save our patients extra trips and aggravation,” said Dr. Razdolsky. “This also results in improved clinical efficiency. With the Leaf Expander, we only have to see a patient every 6-8 weeks. It just makes the whole experience so much better.”
“We like to think our patients love us, but maybe now they can love us even more,” he added. “Fewer appointments and less time in the chair is a win, win for everyone.”
“Plus, parents do not have to activate the RPE expander on a daily basis and no further action on part of the patient or the doctor is necessary once the appliance is activated,” said Dr. Razdolsky. “That is revolutionary.”