Expansion Versus Extraction
In the past it was common practice to wait until age 11 or 12, when all of the permanent teeth were in, to begin orthodontic treatment. Findings have shown that by starting treatment between the ages of 7 and 9 it is possible to treat a patient without having to remove permanent teeth and a more esthetic and stable result is accomplished.
Whenever the teeth are crowded (this information can be calculated ahead of time from a panoramic X-ray) it means that the bone width is smaller than the sum of the tooth width. Crowding is a result of a discrepancy between total tooth size and bone space available for the teeth.
In order to increase size of the bone, which is an orthopedic change, it is necessary to apply a certain degree of force to the bone that braces alone cannot do. Braces can only tip the teeth out to make space, but in order to have a stable bite it is necessary for the teeth to sit as close to the middle of the bone as possible. Therefore in cases where there is moderate to severe crowding, to avoid extractions of permanent teeth, it is necessary to increase the total width of the bone with an Expander. Studies have shown that treatment with an Expander, in addition to braces, results in significantly favorable long-term changes in upper and lower arch measurements. This is a current trend among the more progressive Orthodontists to correct crowding without extractions and the results are a more esthetic and full smile.
Results of Expansion treatment in lieu of extractions