Nonsurgical rapid maxillary expansion in adults: report on 47 cases using the Haas expander

Rapid maxillary expansion (RME) in the adult is thought to be an unreliable procedure with several adverse side effects and, consequently, surgically assisted RME is considered the preferred procedure. The purpose of this paper is to study the efficacy of nonsurgical RME, and to determine the incidence of complications such as relapse of the expansion, pain and tissue swelling, tipping of the molars, opening rotation of the mandible and gingival recession. Rapid maxillary expansion using a Haas expander was examined in 47 adults and 47 children. A control group of 52 adult orthodontic patients who did not require RME was also studied. Students' t-test, and the analysis of variance followed by the Scheffe test were used to determine if there were significant differences among time periods and among the 3 study groups. The mean transarch width increase was similar in adults and children who had RME; 4.6 +/- 2.8 compared to 5.7 +/- 2.4 mm for the molars and 5.5 +/- 2.4 compared to 5.7 +/- 2.5 mm for the second premolars. In the adults, transarch expansion and the correction of the posterior crossbites were stable following discontinuance of retainers (mean 5.9 years). If the expander was properly fabricated, and turned no more than once a day, the procedure was well-tolerated. Rapid maxillary expansion in adults flared the molars buccally only 3 degrees per side. The mandibular plane and lower facial height were unchanged. The adults achieved 18% of their transmolar expansion at the height of the palate and the remainder with buccal displacement of the alveolus. The children achieved 56% of their expansion by an increase at the height of the palate with the remainder due to displacement of the alveolus. There was some buccal attachment loss (0.6 +/- 0.5 mm) seen in the female subjects associated with RME, but the extent was clinically acceptable. This resulted in significantly longer clinical crowns, but rarely caused exposure of buccal root cementum. Complications were infrequently observed or of minimal consequence. The results indicate that nonsurgical RME in adults is a clinically successful and safe method for correcting transverse maxillary arch deficiency.