QUESTION AND ANSWER
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Question from Anas Najjar, May 2015
Dear Dr. Wick,
Hope this email finds you well.
I'm an orthodontist and I attended one of your lectures a few years ago. During that lecture, you mentioned that during your years of practice you have found no need to go through a 'surgically assisted rapid palatal expansion' (SARPE). You mentioned that in your practice, you simply deliver a standard Haas expander, even if the patient is an adult who is well past the teen years, and you slow down the activation to accommodate for the patient's advanced age.
I am writing to get some more information on this, as I am finding it exceedingly difficult to convince patients to proceed with any type of surgery. Do you still do slow/non-surgical expansion on adults in your practice? How slow do you prescribe the RPE activation? What if the patient has gingival recession on the buccal segments, do you still proceed with caution or is that an absolute contraindication? Are there any other instructions/recommendations you give to the patient or would recommend to an orthodontist trying this technique?
Thank you very much for your time! I hope to see you lecture again soon.
Anas Najjar DMD
Answer from Dr. A
First, I would tell you that we have not had surgical assisted RPE in MANY years on any patient, regardless of age.
I think the best way to answer your questions is to refer you to information in two of my books:
1) Alexander Discipline ... pages 82 - 84. This describes the RPE design.
If you do not have the book, I will attempt to briefly answer your questions as presented.
- No adult traverse surgery for many years
- RPE design has jackscrew deep in the palate to the 1st molars. Angulate jackscrew. First bicuspids and molars should be BANDED
- Usually turn once a day
- Turn once per day unless too much discomfort, then skip to every other day
- Patient "squeezes" on back teeth as much as possible
- gingival recession - watch carefully - review brushing patterns with patient. My example in the book has this gingival problem pretreatment, but it is not affected with RPE tx.
- Continue turning until molars almost in reverse posterior crossbite
- Seal ... continue to squeeze... chew gum if helpful
- Inform patient a diastima may develop during treatment. This is good!
- Keep RPE in mouth for 6 months after sealing if possible. Bracket anterior teeth after 4-5 months if desired
- Get into finishing archwires (17x25) soon to establish torque control of maxillary teeth
- Life time retention - 6 months full time... night only, lifetime
2)Long Term Stability - pages 100 - 104. Detailed example of an adult patient:
Hope this helps. Let me know if you have further questions!
Best Regards, Wick