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 Fixed palatal suture appliances commonly known as RPE’s or PSA’s are designed for fast and efficient expansion of the upper jaw by separating the mid-palatal suture. This procedure also allows for the creation of more space for the eruption of the permanent teeth and correction of the bite.



Brush the appliance including the metal bars & screw in the same way you brush your teeth.  A waterpik device can be helpful. Use the proxy brush provided to clean under the bars. When you are unable to brush after eating use water swished around in your mouth to help dislodge any food particles.



At first, eating will be more difficult; take small bites & eat soft foods until this is overcome (usually a few days to a week).  After that, you should be able to eat almost everything you did before with some exceptions.


Avoid: Hard foods: Ice cubes, Frozen Candy Bars, Hard Candy….

Sticky foods: Chewing Gum, Taffy, Caramels, Gummy Bears..

These foods can cause the appliance to become damaged or loose. If this occurs call your doctor’ office on the next business day.


Effects: You will notice several things as the expander does its job. 


Speech: Your speech will be affected. This is not permanent & the best way to get used to this is to speak aloud as much as possible; try reading out loud or singing.


            Soreness: Your teeth may be sore for the first few days. To help with this you may want to take Advil or Motrin every 6 hours. However, chewing & talking are the best ways to get your mouth used to this new feeling. Do not skip day, because skipping days will only extend the amount of time you experience soreness & may complicate treatment.


Pressure or tingling of the mouth, tongue, cheeks & nose. Your bite will feel off as the width of your palate changes. As the palate expands the teeth will not fit together properly, this is normal.

A space between your front teeth: Although this is a good sign from the standpoint of your treatment, it can be disheartening from a cosmetic point of view. By the time you stop turning the screw, the space may look large enough to fit another tooth. This space should close by itself within a short time.

Turn your expander will be activated 2 turns a day for 2 weeks. If you miss a turning, double turn the next time.


Each turn of the key opens the expansion screw 0.25mm

  • Have the patient lie on a surface, such as a bed or couch. It is helpful if there is a source of light, such as a reading light, available so that the inside of the mouth can be illuminated.

  • You have been given a special key for activating the appliance. The key is a piece wire attached to a long acrylic handle.

  • There is a hole at the front of the expander that the key will fit into.

  • Insert the key and begin to push so that they hole turns toward the back of the patients’ mouth.

  • When you can see a new hole appear at the front of the expander, you have completed the turn.

  • Remove the key from the hole by pushing on the handle on the handle downward toward the tongue & slightly inward toward the throat.  Be careful not to pull forward on the key when removing it from the screw as this will back-up the screw, de-activate the appliance, & make the next activation difficult.


After removing key look to see that the new hole is visible & in position for the next activation.


If the screw has backed up & the hole is not visible:

  • Rotate the wire on the key to a 45° angle to the handle.

  • Insert the key into the hole that is not readily visible at the back of the screw.

  • Complete the turn by pushing the key toward the back of the mouth until the new hole is visible at the front of the screw.

  • Remove the key as instructed above.


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