RPE, Expander, Schwartz

PURPOSE: The purpose of this appliance is to widen the arch(es) usually to aid in the correction of a crossbite (usually due to a functional shift), resolve crowding, and/or expand overly constricted arches, particularly in the posterior region. When designing your appliance, make sure you communicate your goal to the lab so that the design is optimal.

DELIVERY: Seat the appliance with your fingers. If teeth have been lost or new teeth have erupted since the impression, you may need to adjust with an acrylic bur. The appliance should seat evenly with no rocking and adhere securely to the teeth. The patient should be able to remove and reinsert the appliance properly.

Week 1: The first week is an adjustment period for the patient. The patient should wear the appliance 24/7, except for eating and sports.

Subsequent Weeks: The patient should activate the appliance 1x-2x per week and continue to wear the appliance 24/7 except for eating and sports. The frequency will vary with the skeletal maturation of the patient. Do this on the same day consistently and chart the number of turns completed. It’s best to activate the appliance at night after brushing teeth to minimize discomfort.
Turn the appliance in the direction of the arrow. Make sure you are always turning the same direction and completing the turn fully before removing the key. You should see the next hole before you remove the key. If you can’t see the next hole, the turn isn’t fully completed. If they key doesn’t have a safety handle, tie floss on the key before sending it home with the patient. Tell the patient to bring the expander and the key to every appointment.
APPLIANCE CHECKS: It’s best to check the appliance every 4-6 weeks to ensure that the turns are being done properly. At each appointment check the jackscrew length with a periodontal probe and document. Also check the fit of the appliance to ensure it still fits properly. Adjust as needed to accommodate new teeth or loose teeth. Check the teeth that are being activated with floss to see if contacts are opening. Usually after 2-3 months, you will see the crossbite correct and/or the crowding begin to resolve. The arch form will become U-Shaped. Once you have acquired the optimal amount of space, retain for 3 months full time. This stabilizes the outcome. Palpate the roots around the buccal plate for any fenestration or pathology. You will have some relapse, so it’s best to expand a little bit more than needed.

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