Dateline: Division of Orthodontics, University of Minnesota, Minneapolis, June 1972.
Holy Grail Rules to be followed:
Maxillary expansion is only for kids.
The adult maxilla cannot be expanded.
The intercanine width is inviolate—widening it is unstable, will cause recession, and lead to tooth loss.
Teeth must be removed in crowding cases to avoid advancing them, recession, and inevitable tooth loss.
These were the rules I learned in my orthodontic training at the beginning of my residency. Being an Eagle Scout and rule follower, I never questioned them or those who made such statements.
Much has happened since then. Let me describe some of the milestones that changed my thinking.
1982: After 11 years of marriage, I straightened my wife’s crowded teeth, advancing them dramatically without removing any. They didn’t fall out. Hmmm…
1985: I met an orthodontist who expanded the intercanine width 3.5 mm per side with arch wires in every case. At his urging, I did the same. No recession, no tooth loss. Smiles were broader, people were happier, and my practice flourished with patients traveling long distances. Hmmm…
Mid-1980s: I began laterally expanding adult maxillas without surgery, long before TADs were available. No recession, no tooth loss. Hmmm…
1989: I reopened orthodontic extraction spaces (upper lateral incisors) for a 27-year-old woman by massively advancing her upper and lower anterior teeth. The pain pattern she had lived with since her original treatment disappeared and has remained gone. No recession, no tooth loss. Hmmm…
1990: I reopened a bicuspid extraction space in my own maxilla to place a 7 mm implant, and expanded my maxilla 7 mm non-surgically, without TADs, without recession, and without tooth loss. Hmmm…
Late 1990s–2022: I reopened extraction spaces and massively expanded adult maxillas and mandibles non-surgically for patients from more than half the states and several foreign countries to address sleep and breathing issues. Again, no TADs, no surgery, no recession, no tooth loss. Hmmm…
2020: I further expanded both dental arches for my wife, reaching nearly 10 mm of expansion from her original width. No recession, no tooth loss. Hmmm…
2018: I reopened bicuspid extraction spaces and non-surgically expanded a 63-year-old patient, increasing intermolar width from 26 mm to 38 mm. Combined with MMA surgery, this resolved his severe OSA. No TADs, no surgery, no recession, no tooth loss. Hmmm…
In the 2010s and beyond, MARPE courses began to proliferate and spread across orthodontics. Yet my decades of experience expanding adult arches—non-surgically, without TADs, without recession or tooth loss—raise important questions.
Adults can expand. I’ve seen it, I’ve done it, and patients have benefitted profoundly.
