Palatal Expanders In Pediatric Dentistry: A Review

Palatal expansion is a fundamental interceptive orthodontic procedure in pediatric dentistry aimed at correcting transverse maxillary deficiency during periods of active craniofacial growth. Early identification of maxillary constriction by pediatric dentists enables timely intervention, optimizing skeletal responsiveness of the midpalatal suture and preventing progression to complex malocclusions. This review outlines the growth and maturation of the pediatric maxilla, indications for palatal expansion, classifications of expanders, expansion protocols, and their skeletal, dental, and functional effects. Evidence highlights that palatal expanders are most effective in the mixed dentition phase, producing significant transverse skeletal widening, correction of posterior crossbites, alleviation of crowding, and improvement in airway dimensions and sleep-disordered breathing. Proper appliance selection, controlled activation, and an adequate retention phase are essential to ensure stability and minimize relapse. Overall, palatal expansion plays a pivotal role in guiding harmonious craniofacial development, improving oral health–related quality of life, and reducing the need for invasive orthodontic or surgical interventions in adulthood.

1. 1
   Shen J, Liu Z, Shuai J, Yin Y, Wang Z, Ding W, Chung CH, Chen Q, Zhao X. Transverse dentoalveolar development in Chinese children and adolescents: A cross-sectional study using revised Andrews' Element III analysis. Am J Orthod Dentofacial Orthop. 2025 Feb;167(2):144-153. doi: 10.1016/j.ajodo.2024.08.015. Epub 2024 Oct 24. PMID: 39453340.
2. 2
   A. Midori Albert, et.al, "Craniofacial Changes in Children-Birth to Late Adolescence" ARC Journal of Forensic Science 2019:4(1) : 1-19.
3. 3
   Agarwal A, Mathur R. Maxillary Expansion. Int J Clin Pediatr Dent. 2010 Sep-Dec;3(3):139-46. doi: 10.5005/jp-journals-10005-1069. Epub 2010 Sep 15. PMID: 27616835; PMCID: PMC4993819.
4. 4
   Andrucioli MCD, Matsumoto MAN. Transverse maxillary deficiency: treatment alternatives in face of early skeletal maturation. Dental Press J Orthod. 2020 Jan-Feb;25(1):70-79. doi: 10.1590/2177-6709.25.1.070-079.bbo. PMID: 32215481; PMCID: PMC7077945.
5. 5
   Zhao J, Jin H, Li X, Qin X. Dental arch spatial changes after premature loss of first primary molars: a systematic review and metaanalysis of split-mouth studies. BMC Oral Health. 2023 Jun 28;23(1):430. doi: 10.1186/s12903-023-03111-x. PMID: 37380944; PMCID: PMC10304618.
6. 6
   He J, Jiang L, Song S, Mo S. Transverse differences between cleft lip and palate and noncleft palate with skeletal Class III malocclusion using buccolingual inclination: a cone-beam computed tomography retrospective study. BMC Oral Health. 2022 Dec 22;22(1):631. doi: 10.1186/s12903-022-02675-4. PMID: 36550501; PMCID: PMC9783461.
7. 7
   Sheats, R. D. (2014). Rapid Maxillary Expansion for Pediatric Sleep Disordered Breathing. https://doi.org/10.15331/JDSM.4142
8. 8
   Beretta, M., Canova, F. F., Gianolio, A., Mangano, A., Paglia, M., Colombo, S., & Cirulli, N. (2021). ZeroExpander: Metal-free automatic palatal expansion for special-needs patients. 22(2), 151–154. https://doi.org/10.23804/EJPD.2021.22.02.12
9. 9
   Martins, M. T., Vitorino, V. de M., Rodrigues, L. V., Lages, E. M. B., Pretti, H., Vale, M. P., Paiva, S. M., & Pordeus, I. A. (2021). Impact of Wearing Palatal Expanders on the Quality of Life of Children Aged 8 to 10 Years. 21, 0166. https://doi.org/10.1590/PBOCI.2021.054
10. 10
    Jang, W., Choi, Y. J., Cha, J., Kang, Y., Kim, E., & Kim, K. H. (2024). Three-dimensional evaluation of dentopalatal changes after rapid maxillary expansion in growing children. American Journal of Orthodontics and Dentofacial Orthopedics, 165(1), 103–113. https://doi.org/10.1016/j.ajodo.2023.07.016
11. 11
    Bacci, H. (2025). Effects of modifying the post-curing protocol on transparency and the fit capacity of directly printed expanders for pediatric patients. Journal of Dental Health, Oral Disorders & Therapy, 16(2), 33–36. https://doi.org/10.15406/jdhodt.2025.16.00639
12. 12
    Ahsan, M., Narala, B., Ednick, M., & Kier, C. (2023). Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients. Current Opinion in Pediatrics. https://doi.org/10.1097/mop.0000000000001287
13. 13
    Viarani, V., Festa, P., Galasso, G., D’Antò, V., Putrino, A., Mariani, A., Bompiani, G., & Galeotti, A. (2025). Randomized Controlled Clinical Trial toEvaluate Skeletal and Dental Treatment Effects of Rapid Maxillary Expansion in Children: Comparison Between Two-Band Expander and Bonded Palatal Expander. Applied Sciences, 15(13), 7187. https://doi.org/10.3390/app15137187
14. 14
    Ferrario, V. F., Garattini, G., Colombo, A., Filippi, V., Pozzoli, S., & Sforza, C. (2003). Quantitative effects of a nickel-titanium palatal expander on skeletal and dental structures in the primary and mixed dentition: a preliminary study. European Journal of Orthodontics, 25(4), 401– 410. https://doi.org/10.1093/EJO/25.4.401
15. 15
    Toshniwal, N. G., Nair, S., Manerikar, R., Ogale, R., & Mishra, S. (2025). Correcting posterior transverse inter-arch discrepancy with non-helical expander – A prospective study. Journal of Global Oral Health, 0, 1–6. https://doi.org/10.25259/jgoh_34_2024
16. 16
    Bratu, D. C., Bratu, E. A., Popa, G., Luca, M. M., Balan, R., & Ogodescu, A. (2012). Skeletal and dentoalveolar changes in the maxillary bone morphology using two-arm maxillary expander. Romanian Journal of Morphology and Embryology, 53(1), 35–40. https://www.ncbi.nlm.nih.gov/pubmed/22395497
17. 17
    Inchingolo AM, Patano A, De Santis M, Del Vecchio G, Ferrante L, Morolla R, Pezzolla C, Sardano R, Dongiovanni L, Inchingolo F, Bordea IR, Palermo A, Inchingolo AD, Dipalma G. Comparison of Different Types of Palatal Expanders: Scoping Review. Children (Basel). 2023 Jul 21;10(7):1258. doi: 10.3390/children10071258. PMID: 37508755; PMCID: PMC10378123.
18. 18
    Palatal expander approved!. BDJ In Pract 38, 170 (2025). https://doi.org/10.1038/s41404-025-3129-z
19. 19
    Merry , Rasool I, Mittal S, Aggarwal I, Palkit T. Slow expansion in orthodontics -A review article [Internet]. Int Dent J Stud Res. 2022 [cited 2025 Dec 14];10(3):85-91. Available from: https://doi.org/10.18231/j.idjsr.2022.019
20. 20
    Guerrero-Vargas JA, Silva TA, Macari S, de Las Casas EB, Garzón-Alvarado DA. Influence of interdigitation and expander type in the mechanical response of the midpalatal suture during maxillary expansion. Comput Methods Programs Biomed. 2019 Jul;176:195-209. doi: 10.1016/j.cmpb.2019.05.007. Epub 2019 May 13. PMID: 31200906.
21. 21
    Angelieri F. Prediction of rapid maxillary expansion by assessing the maturation of the midpalatal suture on cone beam CT. Dent Press J Orthod. 2016 Nov–Dec;21(6):115-125. doi: 10.1590/2177-6709.21.6.115-125.sar.
22. 22
    Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR, Benavides E, McNamara JA Jr. Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013 Nov;144(5):759-69. doi: 10.1016/j.ajodo.2013.04.022. PMID: 24182592; PMCID: PMC4185298.
23. 23
    Bucci R, D'Antò V, Rongo R, Valletta R, Martina R, Michelotti A. Dental and skeletal effects of palatal expansion techniques: a systematic review of the current evidence from systematic reviews and meta-analyses. J Oral Rehabil. 2016 Jul;43(7):543-64. doi: 10.1111/joor.12393. Epub 2016 Mar 23. PMID: 27004835.
24. 24
    Yoon A, Abdelwahab M, Bockow R, Vakili A, Lovell K, Chang I, Ganguly R, Liu SY, Kushida C, Hong C. Impact of rapid palatal expansion on the size of adenoids and tonsils in children. Sleep Med. 2022 Apr;92:96-102. doi: 10.1016/j.sleep.2022.02.011. Epub 2022 Feb 19. PMID: 35390750; PMCID: PMC9213408.
25. 25
    Georgiadis T, Angelopoulos C, Papadopoulos MA, Kolokitha OE. ThreeDimensional Cone-Beam Computed Tomography Evaluation of Changes in Naso-Maxillary Complex Associated with Rapid Palatal Expansion. Diagnostics (Basel). 2023 Apr 2;13(7):1322. doi: 10.3390/diagnostics13071322. PMID: 37046539; PMCID: PMC10093383.
26. 26
    Beretta M, Federici Canova F, Gianolio A, Mangano A, Paglia M, Colombo S, Cirulli N. ZeroExpander: Metal-free automatic palatal expansion for special-needs patients. Eur J Paediatr Dent. 2021 Jun;22(2):151-154. doi: 10.23804/ejpd.2021.22.02.12. PMID: 34238007.
27. 27
    Martinez M, Nascimento JV. 276 - Digital palatal expansion with a removable clear aligner expander in a growing patient: A case report. J World Fed Orthod. 2025 Dec;14(6):490.
28. 28
    Kurnaz M, Dayan E. Comparison of the effects of maxillary expansion applying rapid maxillary expanders or clear aligners in mixed dentition : A 3D finite element study. J Orofac Orthop. 2025 May 9. English. doi: 10.1007/s00056-025-00590-1. Epub ahead of print. PMID: 40343446.
29. 29
    Alhazmi N. A novel electronic keycontrolled expander for precise asymmetric palatal expansion. Front Dent Med. [In Press].
30. 30
    Bruni A, Ferrillo M, Gallo V, Parrini S, Garino F, Castroflorio T, Deregibus A. Efficacy of clear aligners vs rapid palatal expanders on palatal volume and surface area in mixed dentition patients: A randomized controlled trial. Am J Orthod Dentofacial Orthop. 2024 Sep;166(3):203- 214. doi: 10.1016/j.ajodo.2024.04.006. Epub 2024 Jul 26. PMID: 39066746