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Arch expansion followed by the TRAINER or Biobloc therapy or fixed appliance

When the upper dental arch is expanded it will inevitably result in an increase in the width of the nasal passages.
It also provides room for the tongue to rest and function in the palate. Often, especially in the younger child, arch expansion will result in the vault of the upper arch falling also increasing the height of the nasal passages.
Research has shown that arch expansion usually relapses but not always.
Very soon it became clear, that Orthodontically induced transverse sizes of dental arches are very unstable.

Before treatment, stages during treatment and one year after treatment.

We need a well developed upper arch to train the tongue to rest and function there. More importantly we need the tongue to rest and function in the palate to maintain the expanded arch form. We all see relapse after arch expansion but I hope we all see arches that remain stable long term after expansion. In my experience the arches that remain stable after expansion are those where the tongue retains the changes. A few children make this functional change themselves without help, but most children need myofunctional training to help establish a good tongue in palate posture.
For this reason I always follow arch expansion with either a TRAINER or Biobloc appliances or both.

If there is a posterior cross bite, which there usually is in mouth breathing children, I will start by correcting the crossbite with a Biobloc expansion appliance. In the child in the early mixed dentition I will use a palatal arch retainer to maintain arch form while I establish nasal breathing and improved muscle function. For this I use a TRAINER often with the Breathing Well Programme I will describe later. In the late mixed dentition and permanent dentition I tend to use a Biobloc 3 or postural appliance after arch expansion, again often with the Breathing Well Programme.
This girl presented with a chronic mouth-breathing pattern in the early mixed dentition. The posterior cross bite and the anterior open bite are typical of the mouth-breathing pattern. Using Orthotropic therapy using a series of Biobloc appliances the upper arch was expanded and the upper incisors advanced. The mandibular posture was then corrected with a lip seal and nasal breathing. The pattern remained stable long term as the patient maintained the nasal breathing pattern, a lip seal and the teeth in or near contact at rest.
Seven years after treatment with no retention or fixed appliances used.
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The Pre-Orthodontic TRAINER Worn for a minimum of one year