Chapter 4: The Truth About Expanders and Self-Ligating Braces

“I went to an orthodontist and they told me my child needs a palatal expander.” Many times when we are a second opinion on treatment, we hear this.

Spectacular Smiles, Superior Customer Service: Today’s Orthodontics 

Bill M. Dischinger, DMD

Key Takeaways

• Traditional palatal expanders can have negative side effects, such as pushing molars out of the bone, potentially leading to future gum and bone problems.
• Self-ligating braces, like the Damon System, use a small door to hold the wire, significantly reducing friction compared to traditional ties.
• Light-force orthodontics, made possible by low-friction systems, works with the body’s natural biology to move teeth gently and efficiently, minimizing inflammation and pain.
• By using light forces, modern braces can widen the dental arch naturally, often eliminating the need for palatal expanders.

For the first 5-6 years of my orthodontic career, I used expanders on a very large percentage of my young patients. Around 2005 though, some research began to surface about some of the negative side effects that can occur after expander use in patients that have all their permanent teeth already in.

The main concern was that in some cases the molar hooked to by the expander would get pushed out of the bone and not heal properly. Long term, this would lead to gum and bone problems, which require gum grafts or other procedures as an adult to correct.

This does not occur in a majority of patients, but how would you feel if you were on the operating table getting ready for heart surgery, and the surgeon told you “Most of the time this goes great, but 25% of my patients die during this.” I’d jump off the table. Thankfully, orthodontics is not life or death, but we’d still like to avoid causing damage as we perform the orthodontics.

A New Approach: Light-Force Orthodontics

I decided I needed to find a different way to widen my dental arches and make room for the teeth. This began my journey into seeing how effectively light-force orthodontics can change our mouths. We will learn what light force orthodontics is in the coming pages.

While at my residency at Tufts University in Boston, I heard a remarkable lecture by a brilliant orthodontist from Spokane, Washington. His name was Dwight Damon and he had invented a brace system called the Damon System (not very originally named, I know).

Since the 1940’s, braces had the wires held in place by little stainless steel wires secured around each brace. In the 1980’s the color ties were invented (you know, all the colors the kids have on their braces?). Where technology was at the time, these were the only ways to hold the wire in place, and this didn’t change for almost 60 years!

Dr. Damon changed that though. His brace had a little door that opened, the wire was put into the brace (just like other braces) but then the door was closed, keeping the wire in the brace. OK, what’s the big deal?

A Lesson in Physics: Friction and Teeth

Well for that, unfortunately I’m going to have to first give you a physics lesson, followed by a biology lesson. I promise it will be way more fun than reading your old high school science books. Let’s start with Physics.

My wife loves to make me move our furniture around. Before my boys were old enough and strong enough to help me, I had to do it all by myself. One day at Home Depot, I saw this thing called Furniture Caddy.

It consisted of these little coasters that you would put under each leg of the furniture piece. When you put these in place, you could literally push the furniture with one finger. Why though? Friction. By putting these smooth, plastic discs under the feet, it gave a smooth, slick surface that easily slides on the floor. It greatly reduced the friction that was normally being generated between the contact of the furniture foot with the floor.

Yeah, so that relates to teeth how? Remember those ties that held the wire in place? They held it in place very tightly. By doing that, it’s like putting a bungee cord around the brace and wire. For the wire to move, it has to overcome all the friction generated by that tie against the wire.

To move any tooth, the wire has to slide through all the braces on the teeth behind that crooked tooth. If we have those ties on the wires and braces, the friction is high and the wire can’t slide (just like my furniture without the caddies) towards the back, and the front teeth flare forward. That’s not a good thing and results in a “bucked tooth” smile.

To combat that, the orthodontist needed to extract teeth in order to pull those front teeth backwards into the extraction spaces and counteract this movement. This is another reason there has been a high rate of extracting historically.

A Lesson in Biology: Force and Inflammation

Problem number two is that to overcome that friction to just actually move a tooth, we had to push really hard on them. What do you think happens to our teeth when we push on them? Inflammation, and then the teeth hurt.

Inflammation is not a good thing. We want to minimize inflammation as much as we can. When inflammation occurs, the teeth don’t move as efficiently because the body reacts first in a negative way. So, to minimize inflammation, we push more gently on the teeth.

During the first week of my orthodontic residency program in Boston, I read the 2nd chapter in my text book. A doctor named Carl Sandstedt in 1926 said that we should only push on the teeth with a maximum of 26 grams of force. This is because when blood flows through the capillaries, that is how much force it pushes outward against the walls of the vessel.

If the force is above that, the wall collapses and blood no longer can flow to the tissues around the tooth. When this happens, oxygen can’t get to the cells that cause the bone to change to allow the tooth to move. Okay Carl, got it. 26 grams of force.

Now on to Chapter 3: Orthodontic wires. It said, “Orthodontic wires exert a force of 60-120 grams of force. These are the fundamental working wires of orthodontics.” What? Wait a minute. Carl told us to not go above 26 grams. Is there something I’m missing?

There was no explanation, because the technology needed to use forces as low as Carl had told us to use had not been invented yet. Our brace systems had too much friction to let us use forces that low.

The Damon System Difference

Dr. Damon’s system eliminated friction. Now, all we had to do was overcome the biological force needed to move a tooth. We could use way lighter wires to move teeth. We were now moving teeth in a biologically appropriate manner.

We were working with the body rather than against it. The body is amazing. If you guide it, it responds. If you hammer it, it rebels. Hammering is what we used to do in orthodontics.

Now I can decide what is the lightest force I can use to accomplish my objective. A completely different mindset from what I had prior to seeing this technology. This now allows us to gently push or guide the teeth where we want them to go.

I can get the bone to adapt and change in ways we never could before the Damon System. I no longer need that palatal expander to widen the upper jaw. The bone will now widen as it is guided to do so with the light forces.

Dr. Damon completely opened my eyes to how I could treat patients. It took me over 6 years to fully realize and master this concept, but now I am able to treat the body in a healthy, more naturalistic way.

You may be asking, “Why doesn’t everyone use this method, then?” Well, I don’t know, but when change is made it takes time. As I stated, it took me 6 years to master this technique and most of us aren’t willing or patient enough to go through a learning curve such as that.

There are orthodontists that continue to use traditional braces with 40 year old technology, and state that Damon braces, or braces similar to them don’t matter. But let me ask you this. What would you rather have pushing on your teeth? Heavy forces that cause high inflammation or light forces that gently move the teeth with minimal inflammation? I know, me too!

Frequently Asked Questions

Q: Do I really need a palatal expander?
A: Not always. While expanders were once common, modern low-friction braces like the Damon System can often widen the dental arch using gentle, light forces. This works with the body’s natural ability to adapt, potentially avoiding the need for an expander and its associated risks.

Q: What are self-ligating braces?
A: Self-ligating braces, such as the Damon System, use a built-in door or clip to hold the archwire in place instead of traditional elastic or metal ties. This design drastically reduces friction, allowing teeth to move more freely, comfortably, and efficiently.

Q: Why is “light force” orthodontics better?
A: Light forces work in harmony with your body’s biology. Heavy forces can cause inflammation and pain by cutting off blood flow to the tissues around the teeth. Gentle, light forces allow for continuous blood flow, which is necessary for the cells that remodel bone and allow teeth to move, resulting in a more comfortable and biologically sound treatment.