RAPID MAXILLARY

EXPANSION (RME)
FELIX THUNGADY, DRG., SP.ORT.
ARCH EXPANSION
Duration :
1. Rapid maxillary expansion devices
2. Slow expansion devices
HISTORY
◦ 1860  Emerson C. Angell, double
jackscrew kind of an appliance, expand
maxilla of a 14.5yo female, 0.25
inch(6.35mm) in 2 weeks resulting in midline
diastema
◦ 1877  Walter Coffin, coffin spring, mid-
palatal suture in young children
◦ Slow expansion devices remained in vogue
◦ 1956  Korkhaus reintroduced the
appliance in the USA
◦ Andrew Haas popularize the rapid maxillary
appliance, with extensive research on
animals
PHILOSOPHY
The RME appliance is essentially a dentofacial orthopedic
appliance, which tends to produce its changes by splitting the
mid-palatine suture. The rationale being that if extreme forces are
applied on to the palatal shelves, the interlying suture splits and
results in true skeletal changes. The teeth are generally used for the
purpose of transmitting the forces onto the maxillary bone.
ANATOMY OF THE MID-PALATINE
SUTURE AND THE MAXILLA
◦ The hard palate is composed of the palatine process of the maxilla and the
maxillary process of the palatine bones
◦ The palatine bones together with the maxilla also form the floor of the nose
and a part of the lateral walls of the nasal cavity
◦ The inter-palatine suture joins the paired palatine bones at their horizontal
plates and is a continuation of the intermaxillary suture. Theoretically, it forms
the junction of the three opposing pairs of bones – the premaxillae, the maxilla
and the palatines. Practically, they are treated as a single entity - the mid-
palatine suture (MPS).
EFFECTS OF THE RME
◦ On the Maxillary Teeth and Alveolar Bone
EFFECTS OF THE RME
◦ Maxillary Skeletal Effects
The palatine processes separate in a triangular or wedge-shaped manner when viewed
occlusally(Fig.21,2E). A similar triangular opening is also seen in the supero-inferior
direction, maximum towards the oral cavity and progressively less towards the nasal
aspect (Fig. 21.2F).
EFFECTS OF THE RME
◦ On the Mandible
The mandible rotates downward and backwards
due to the downward movement of the maxillary
posterior teeth in a buccal direction, there by
giving the effect of opening the bite (Fig. 21.2C)

◦ On the Nasal Cavity and Adjacent Cranial

Bones
The RME tends to increase the intranasal space
as the outer walls of the nasal cavity move apart
and the palatal shelves flatten out, making the
nasal floor broader. The parietal as well as the
zygomatic bones show signs of some form of
realignment at the sutures, especially in younger
individuals
Indications for RME use
RME appliances are ideally indicated in growing individuals with severely constricted
maxillary arches, involving airway impairment or mouth breathing tendencies. They are
also indicated in other cases of:
◦ Posterior cross bites with real or relative maxillary deficiency
◦ Cleft patients
◦ Along with facemask therapy
◦ Class III cases with minor maxillary deficiency
◦ As part of interceptive orthodontics
TYPES OF RAPID MAXILLARY
EXPANSION APPLIANCES
Over the years numerous types of RME appliances have been
used. They can be best classified as:
◦ Removable appliances (The appliance basically consists of a screw in the
midline with retentive claps on posterior teeth. The acrylic plate is split in the middle
and activations of the screw forces the two halves apart to result in the desired
expansion. This appliance is more effective when used in the early mixed dentition
phase)

◦ Fixed appliances:
◦ Tooth-borne (Isaacson type, Hyrax type)
◦ Tooth and tissue-borne (Derichsweiler type, Hass type)
ACTIVATION OF THE RME APPLIANCE
◦ The basic principle of the appliance involves the generation of forces that are capable of
splitting the mid-palatine suture. Hence, the forces should be definitely more than the usually
used orthodontic forces. The forces generated are close to 10 to 20 pounds (4.5-9Kg)
◦ An expansion of 0.2 to 0.5 mm should be achieved per day
◦ The screw is activated at between 0.5 to 1mm per day and about 1 cm of expansion can
be expected in 2 to 3 weeks
◦ Timms has suggested an activation of 90°, morning and evening for patients up to the age
of 15 years. In patients above this age, he suggests an activation of 45° four times a day
◦ Zimring and lsaacson recommended, two turns per day for initial 4 to 5 days followed by one
turn per day in growing individuals. For adults they recommended two turns each for the first
two days followed by one turn per day for the next 5 to 7 days and then only one turn every
alternate day till the desired expansion is achieved
Retention Following RME Therapy
MARPE (Miniscrew-Assisted Rapid Palatal
Expander)