Palate Expansion Update: Concerning CBCT Scan Results

I am long overdue for a progress update! Last time I posted, I shared some progress pics, and was about to get a CBCT scan to reassure myself and my orthodontist that we weren’t pushing my teeth out of the bone.

Well…unfortunately, the CBCT scan was not reassuring. In fact, it was pretty concerning. At some point I’ll get around to posting screenshots from the scan, but for now, I’ll just share a snippet from the radiology report:

cbct scan results

In layman’s terms? Although the CBCT scan isn’t precise enough to tell us whether the roots of my teeth are fully poking through the bone, it can tell us that the bone outside of the roots on my upper teeth is extremely thin. And that’s not good.

Side note: Did you see what they said about my airway? Reduced airway space is one of the main risks of retractive orthodontics, and another reason why I need my maxilla expanded and pulled forward!

Anyway. Needless, to say, the CBCT results were pretty soul-crushing. I mean, I had spent a lot of time and money covering my bases and making sure I was doing this the right way, and I felt so confident that I was on the right track. Not only did this scan derail me completely, it also showed me that once again, all of the “experts” I had put my trust in might have been wrong.

The new plan

For now, I’m paused. Not quitting – just paused. I’m still wearing my expander at night to retain the expansion I’ve gotten so far, but I haven’t turned the key since I got the CBCT results back in July. And I gotta say – the silver lining of all this is not having to wear that dang thing during the day for now! So nice to not be all lispy and metallic.

I’ve sought advice from as many people as I could, but I still feel a little lost. The biggest letdown has been getting no response from Dr. Brad about my CBCT results. Prior to the scan, he was so confident in saying that the fear of pushing teeth out of the bone was just conventional wisdom. He had never had any issue with it, and my local orthodontist was just being paranoid. But sure, go ahead and get the scan for peace of mind.

Well, post-scan, me and my ortho have followed up with him countless times seeking his feedback and advice, but it’s just been crickets. You have no idea how much I hoped and prayed in that first week that he would come back with some kind of wisdom, like maybe “oh, that’s nothing to be concerned about. We’ve seen similar scans in our patients, but the body adapts, and the bone will regrow and thicken over time.” Or “huh, that is a little concerning. Why don’t you contact my office to make a phone appointment with me, and we can discuss further?” Or even “I’m sorry, this is not something I have experience with and am not able/willing to advise you.” But I got nothing.

I’m trying to give him the benefit of the doubt. Maybe he’s just really busy, and a non-local patient who only saw him once is not a priority. I guess I could understand that. But really, it just feels like yet another situation where a healthcare professional has talked a big game, convinced me that I could trust them, and then abandoned me and stuck their heads in the sand as soon as my experience didn’t align with their belief system. (Who’s bitter? I’m not bitter. Pshhh.)

I did have one reader mention that they were considering starting treatment with Dr. Brad, and wanted to check in on how my treatment was going before moving forward. I’ll just say that I no longer would enthusiastically recommend him, but I also wouldn’t necessarily warn people away from him. I’ll let you guys know if anything changes.

Thankfully, my local orthodontist (Mary Walton, located in Cary/Raleigh NC – go to her!) has been amazing. She’s been really understanding, didn’t say “I told you so” even though she totally could have, and is more than willing to be patient and be “paused” with me.

I also sought advice from a few others. Ian Hedley, a UK orthodontist who does adult palate expansion and NCR, was kind enough to respond to my email. He said:

“Pushing teeth off their bone support is always the orthodontists biggest fear. I have never had a patient who this has happened to, my only suggestion is that you slow down the rate of expansion so that the bone has time to remodel itself thus preventing dehiscence.”

(Dehiscence: loss of alveolar bone on the facial (rarely lingual) side of a tooth that exposes the root.)

I also talked to Mike Mew at this year’s Ancestral Health Symposium, and his work has given me a slightly different perspective that I’m definitely going to pursue. I’ll talk about all that more in a future post, I think, but for now, I am trying to incorporate “mewing” while the more aggressive expansion is paused.

Revised thoughts on palate expansion in adults

I can’t remember how much I’ve talked about the idea of adult palate expansion as a whole, but I wanted to briefly address the issue in light of these recent developments. Basically, there are two opposing camps:

Camp 1: Conventional Wisdom. Once you stop growing, true expansion of the palate is not possible, because all the sutures in your bones are fused. Any “expansion” achieved as an adult is the result of pushing the teeth out of the bone and teeth tipping. Any evidence you may see to the contrary does not exist. It is a hallucination and does not deserve discussion.

Camp 2: The Enlightened Fringe People. Dentists and orthodontists are stupid and barbaric and they are 100% wrong always. We expand adult palates all the time with great success, and the fear of “pushing teeth out of the bone” is silly and unfounded and does not deserve discussion.

You guys, I was SO hoping that the Enlightened Fringe People were right. But as usual, the truth is somewhere in the middle.

My theory? I don’t think Ian and Brad are lying that they’ve expanded hundreds of adult palates without pushing teeth out of the bone. But I also think they didn’t check for it. You can have dehiscence without losing teeth – I mean, you have to push teeth really far for them to actually fall out. It’s entirely possible that had I continued expansion without doing the CBCT scan, I would’ve lost all of the bone covering the roots of my upper teeth, but I wouldn’t have known. And maybe the bone would have partially (or even fully) regrown, eventually. That seems like something the body would do, after all.

I’ll be exploring this much more in the future, but for now, just remember that nothing is black and white. And just because someone is sure they’re right, and you want them to be right, doesn’t mean that they are.

The Crane update

I do plan to continue trying to use the Crane while I am paused, because (in my mind, at least) the goal of the Crane is to pull the entire maxilla forward, which should have very little impact on the movement of individual teeth, and therefore shouldn’t worsen the dehiscence situation. And guess what?! I actually managed to wear the Crane all night (while sleeping!) for an entire week! I guess I finally got used to having it around my neck, and while it’s still really not comfortable and my neck is usually a bit sore in the morning, it’s manageable.

I’ve fallen off the wagon again because I’ve had a lot going on recently and needed to prioritize a good night’s sleep, but I feel confident that once things settle down, I’ll be able to consistently wear it and hopefully start seeing some results that way.

Alright, that’s all I have for you for now! It’s been so great seeing you guys following along, so always feel free to comment :)


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