Rapid Palatal Expanders (RPE)
by Gerald H. Smith, DDS, DNM
The ALF System, which incorporates the Cranial Indicator Diagnostic System developed by this author, focuses on treating a dynamic cranial occlusal mechanism. The twenty-eight bones that make up the skull are directly influenced by all applied orthopedic, orthodontic, and abnormal occlusal forces. The treatment concept of adjusting the maxillary ALF appliance to reset cranial balance at each visit is the one attribute that sets this system apart from RPE and all other conventional and functional orthodontic therapies. Once practitioners become aware of this paradigm shift, it becomes obvious that existing orthodontic treatment modalities are deficient.
The following seven key factors are missing in RPE treatment:
- RPE Appliances do not apply gentle forces.
- RPE Appliances prevent cranial bones from realigning after daily expansion.
- RPE Appliances have no control of correcting cranial bone misalignment.
- RPE Appliance therapy has no indicator analysis to guide expansion.
- RPE Appliances expand the wrong region of the maxillae.
- RPE Appliances restrict normal primary cranial motion.
- RPE Appliance cannot correct 3-dimensional cranial distortions.
A recent case study clearly portrays the above disadvantages of RPE treatment. A female in her mid twenties was treated with the RPE technique. Approximately three-quarters the way through maxillary expansion, the patient developed acute facial pain, migraine headaches, visual distortions, vertigo, peripheral numbness, an insensitivity to her body, fatigue, TMJ pain, cervical and low back pain. Unfortunately her practitioner had no insight into the structural distortions that were induced. The patient began her long journey visiting osteopaths, chiropractors, acupuncturists, dentists, neurologists, naturopaths, physical therapists and healers in an attempt to resolve the symptoms. Any positive changes were short lived because the underlying structural problems were not being addressed.
Diagnostically the patient's cranial motion was severely distorted. The excessive pressures generated by the RPE appliance caused the base of her skull to go into a reverse motion on inhalation. This tension extended from her head down through the base of her skull all the way to her sacrum. Initial treatment involved resetting her cranial motion. Upon adjusting her skull, much of the pressure in her head and facial pain dissipated.
The patient was referred back to her treating dentist for fabrication of an ALF appliance.This author works with local dentists to guide them along on correcting the underlying cranial distortions. A collaborative effort is one of the best ways of raising skill levels. This technology must be integrated into all orthopedic/orthodontic practices.
It makes no difference what RPE appliance design is used, the common denominator with all RPE appliances is that they are all rigid, torque the human skull/body via the dural tube and fascial planes and are unable to correct existing cranial distortions and in most cases even create new distortions. Unfortunately most dentists do not even know that they do not know about these issues.