December, 1998
Spotlight: Nitanium Palatal Expander2
Originally published: April, 1996
Transverse expansion of the palate has been used by orthodontists for over 100 years to produce additional room in the maxillary arch. Today there are numerous removable appliances such as the Schwarz plate, Jackson, Crozat, Saggital, etc., which incorporate either jackscrew or coffin-type adjustments. All of these appliances depend upon a high amount of patient cooperation, and most of these appliances are lost (by the patient) during the first month of treatment resulting in disappointment to the patient, patient and orthodontist.
There are also fixed/removable appliances, such a the transpalatal bar, W-arch, quad helix, Potter arch, Wilson multi-action palatal, Cetlin-type rotators, etc. Some of these appliances can also be easily dislodged. Mosts of these devices must be removed and adjusted by the orthodontist every 3-to-4 weeks and have intermittent forces (up to 2 pounds) which are often unpredictable.
Most rapid palatal expanders (RPE) are fixed appliances that utilize a jack screw and (sometimes) acrylic assemblies. These devices require: two upper bicuspid bands and two molar bands soldered to a jack screw (often referred to as a Hyrax); an impression; a working cast; cleanup; lab services and cementation. These devices are activated by the patient, rely upon a high amount of patient cooperation, and tend to generate excessive pressure on the mid-palatal suture. Additionally, the relapse rate for these devices can approximate 45-percent, depending upon the amount of sutural opening. Many RPE appliances can cost $100 or more.
Other appliances such as the Pendulum Appliance are fixed appliances which incorporate an expansion screw and nickel titanium wire to distalize molars. Again, these appliances are highly dependent upon patient adjustments. These appliances have limited applications, and if used as directed, can be very expensive.
Ortho Organizers Nitanium® Palatal Exander2 ™ (NPE2) is a fixed/removable nickel titanium appliance. The Nitanium Palatal Expander² imcorporates an innovative lingual attachment with adjustable ortholoy arms and a horizontal lingual sheath that is spot-welded to maxillary molar bands. A locking indent fastens the expander securely to the maxillary molar band and, thereby, enchances the safety of the system. To prevent removal, the appliance may be also secured by Hand-EE-Lasts or stainless steel ligatures.
The continuous low force exerted by the NPE2 appliance on the maxillary teeth and mid-palatal suture approximates the physiologic ideal postulated by prominent researchers. Bell says, “Histologic findings reported in conjunction with slow expansion procedures suggests that sutural separation occurs at a rate which allows for the maintenance of tissue integrity during the adjustment to maxillary repositioning and remodeling”. The Nitanium Palatal Expander² is capable of delivering a uniform low continuous force to the mid-palatal suture.
The physical changes produced by the appliance on the palate are a consequence of harnessing nickel titanium’s shape memory and transition temperature. Nickel titanium can be processed to a set shape which it constantly returns to after being deformed. This is called shape memory. Nickel titanium can also be alloyed to produce metal with a specific thermal transition temperature. Ortho Organizers’ transition temperature is 94°F. At temperatures above the transition temperature, the inter-atomic forces bind the atoms tighter, producing stiffer metal. At temperatures below transition temperatures, the inter-atomic forces weaken, producing a very flexible metal.
Clinically, when you take the NPE2 (with a transition temperature of 94°F) and chill it, the appliance becomes flexible and is easy to bend to facilitate placement. As the mouth begins to warm the appliance (and subsequently reaches 98°F), the device becomes stiffer as the shape memory is restored and the expander exerts a continous low force on the teeth and mid-palatal suture to produce the expansion. As expansion begins to take place, the stiffness in the appliance may cause slight pressure which can be relieved by the patient sipping a cold fluid. This feature makes the appliance very “patient friendly” because the patient can mitigate the pressure response.
Ortho Organizers’ Nitanium Palatal Expander2 (NPE2), has the capacity to rotate, upright, expand and distalize the maxillary molars while simultaneously expanding the bicuspid segment. From the time of insertion, until completed expansion, the appliance can be adjusted by the clinician if desired.
In summary, the device is self-activated by body temperature, automatically expands to its predetermined shape, requires no manipulation by the patient or practitioner, permits the patient to mitigate the pressure response, produces a low constant pressure on teeth and mid-palatal suture, and has a built-in safety system.
Lilia Cyr
07. Dec, 2010
I recently saw this appliance demonstrated at an orthodontics r course and was impressed by the simplicity. It bends easily with endo ice, and went back to it’s original shape as described in room temperature in approx 5 min. I like that patient compliance is not a hindrance and can see this being incorporated into my practice. The orthology arms are of a high gauge and a little difficult to bend, but it’s a great invention.