Nonsurgical expansion of the maxillary transarch width in adults to correct posterior crossbite has been thought to be unsuccessful, unstable, and have undesirable side effects. In the first part of this article, 2 patients with bilateral crossbite who achieved 8-11 mm of maxillary expansion are described. Data from a large sample (47 adults) are reviewed and demonstrate successful and stable expansion with insignificant complications. In the second part of this article, nonsurgical maxillary and concurrent mandibular expansion is used in adults for the correction of constriction of both arches. Associated with arch constriction are incisor crowding, deficient anterior arch contour, dark buccal corridors, and lingual inclination of the posterior dentition. This group of signs is defined as bidental arch constriction syndrome, a common, but not previously described, malocclusion. Two cases demonstrate the malocclusion and its treatment. Data from 30 nonsurgical cases and 10 cases in which both jaws were expanded with surgical distraction are reviewed. There were no significant differences in the expansion achieved, as both expansion techniques were equally effective.
http://www.semortho.com/article/S1073-8746(11)00109-5/fulltext
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Nice find.
Here's the powerpoint presentation to go along with it, lots of cool images and info in here:
It's interesting that they suggest an intermolar width below 34mm indicates arch constriction and a candidate for expansion. Several of us, including myself, have reported intermolar widths of about 34mm, so maybe this is approximately the size when problems start to become apparent and people seek out solutions.
Yes and Mew himself says that once a person is at 35mm, they have a good chance of being able to create changes with just the tongue. So somewhere around the 34-35mm range must be the sweet spot for the body being able to take care of itself. Any lower than that and you might be in a really tough spot and in need of the help of an expander.
I took some time to read that PDF more closely and there is some really great information in there. I think it should be required reading for anyone who is going to expand their palate using these types of appliances that we are using. The doctor who wrote that study just used the expander itself to create the changes, so you can see some tipping in the final result, but still it isn't that bad. The thing that stood out to me the most was that it says that overexpanding is important. Perhaps that's to make up for the tendency for the teeth to slightly relapse when treatment is over?
I've actually just noticed something about the study. Check the bottom-rightmost picture in this image:
See how the tongue is mashed in between the bottom teeth? That's a very improper tongue posture and is probably the reason this patient needed expansion and had a crossbite. The fact that he didn't fix his tongue posture means that he will probably have a relapse of some sort down the line. Just more proof of why Mews ideas are so valuable.
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