Rapid maxillary expansion is indicated in cases with a transverse discrepancy equal to or greater than 4 mm, and where the maxillary molars are already buccally inclined to compensate for the transverse skeletal discrepancy. It is important for the clinician to remember that the main resistance to midpalatal suture opening is probably not the suture itself, but in the surrounding structures particularly the sphenoid and zygomatic bones. The nasal cavity width gain averages of 1.9 mm, but can be as wide as 8 to 10 mm. RME and nasal airflow: Anatomically, there is an increase in the width of the nasal cavity immediately following expansion thereby improves in breathing. The posterior maxilla expands less readily because of the resistance produced by the zygomatic buttress and pterygoid plates.Д®ffect of RME on mandible: There is a concomitant tendency for the mandible to swing downward and backward. Maxillary posterior teeth: There is buccal tipping and extrusion of the maxillary molars. 19 This distema is self-corrective due to elastic recoil of the transseptal fibers. It is estimated that during active suture opening, the incisors separate approximately half the distance the expansion screw has been opened, 18 but the amount of separation between the central incisors should not be used as an indication of the amount of suture separation. Maxillary anterior teeth: From the patientвЂ™s point of view, one of the most spectacular changes accompanying RME is the opening of a diastema between the maxillary central incisors. Palatal vault: Haas 18 reported that the palatine process of maxilla was lowered as a result of outward tilting of maxillary halves.ДЄlveolar process: Because bone is resilient, lateral bending of the alveolar processes occurs early during RME, which rebounds back after a few days. Maxillary halves: Haas 18 and Wertz 19 found the maxilla to be frequently displaced downward and forward. 17 It is pyramidal in shape with the base of pyramid located at the oral side of the bone. Viewed frontally, the maxillary suture separates supero-inferiorly in a nonparallel manner. Maxillary skeletal effect: When viewed occlusally, Inoue found that the opening of the midpalatine suture was nonparallel and triangular with maximum opening at incisor region and gradually diminishing towards the posterior part of palate. This article aims to review the maxillary expansion and commonly used appliances.Д®ffect of RME on Maxillary and Mandibular Complex The clinical conditions indicating maxillary expansion include crossbites, distal molar movement, functional appliance treatment, surgical cases for instance arch coordination or bone grafts, to aid maxillary protraction and mild crowding. 5- 8 If the force is strong enough, separation occurs at the maxillary suture. 10- 15 During treatment, transverse forces tip the buccal segments laterally 4 and with proper appliance design, 3rd-order moments will induce bodily translation. 2, 3 Normal palatal growth is nearly complete by age 6, 9 and increasing interdigitation of the suture makes separation difficult to achieve after puberty. Practitioners select treatment appliances based on their personal experiences and on the patientвЂ™s age and malocclusion.

Since each treatment modality has advantages and disadvantages, controversy regarding the use of each exists. Three expansion treatment modalities are used today: rapid maxillary expansion (RME), slow maxillary expansion (SME) and surgically assisted maxillary expansion. Correction of the transverse discrepancy usually requires expansion of the palate by a combination of orthopedic and orthodontic tooth movements. 1 The work was discredited at the time, but the technique is now generally accepted as a relatively simple and predictable orthodontic therapy. Angell published in Dental Cosmos in 1860. The earliest common cited report is that of E.C. Maxillary expansion treatments have been used for more than a century to correct maxillary transverse deficiency.

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