drlena_dds

Orthodontics, cosmetic and reconstructive dentistry

08/15/2026

How does the size of your mouth affect tongue posture and what does this mean for your health?

08/12/2026

How to achieve difficult movements with Invisalign? Add TADs and SFOT

08/05/2026

Another facial trauma case. alone is high risk for fractures.

08/04/2026

We don’t treat by age — we treat by anatomy.

Two 30-year-olds walk in with the same transverse deficiency. One expands skeletally with a bone-borne appliance. The other doesn’t. Same age, same complaint, different outcome.

The variable isn’t the birthday. It’s the midpalatal suture.

Angelieri et al. (2013) gave us a CBCT-based staging system for exactly this reason — because chronological age is a poor predictor of whether the suture will open. Fusion begins posteriorly, in the palatine bone, and progresses anteriorly. Stages A through C are typically responsive to conventional or miniscrew-assisted expansion. Stage D and E patients need a different conversation, and a different force system.

You cannot see any of this on a pan. You cannot see it on a lateral ceph. You cannot palpate it.

Which is why every expansion case in my practice starts with a CBCT — not to justify the scan, but because the staging changes the appliance, the anchorage, and what I tell the patient about what’s realistic.

This is the material I teach when I lecture on skeletal expansion to other clinicians, and it’s the same conversation I have with adult patients who’ve been told expansion “isn’t possible after growth stops.” Sometimes that’s true. Often it isn’t. The scan tells us which.

Save this for your next expansion consult.

Questions about whether you or your child is a candidate? DM me.

airwayorthodontics orthodontics adultorthodontics transversedeficiency angelieri suturematuration orthodonticeducation nycorthodontist manhattandentist airwayhealth orthodontist

07/29/2026

Contraindications to minimally invasive mid-palatal piezo corticotomy assisted ? If you had facial trauma that was repaired in such a way that crossed the sutures that are meant to split orthopedically. This patient needs

07/27/2026

Suture maturation plays a crucial role in how fast someone can expand, even for a young female. This young woman and her twin sister had trouble expanding but both finally did and love their results!

07/18/2026

Narrow jaw and class 2 skeletal in an 11 year old: expansion gets us half way there. The lower jaw was in the wrong position for years because the upper was so small. A cl2 vertical grower stays that way unless something changes very early on.

07/15/2026

Severe deep bite and overbite in a 9 year old. What do we treat first?

07/14/2026

Crossbite correction with custom bandless using a slow turning protocol and facemask to correct a compensated underbite. Elastics to complete arch symmetry. Nasal breathing improved, improved, function is healthy and is beautiful and happy.

07/13/2026

Four years old. Adenoids already removed. Class II, deep bite, upper incisors flared.

The second opinion? He has spacing in the upper front, so nothing needs to be done.

But that spacing isn’t room. It’s splaying. The incisors are flared out, the bite is deep, the lower molars are tipped in — every part of that picture is compensation. Put the incisors back where they belong and the “space” disappears, because it was never space. It was a symptom.

The reason given to wait was anchorage. No adult molars yet, so nothing to push against.

The anchorage is already there. Baby molars have wide, divergent roots sitting in bone. They are the anchor. We use them while we have them.

Nothing needs to be done is not a diagnosis. It’s a decision — and someone made it for this kid.

If you’ve been told to wait and something still doesn’t sit right with you, get another set of eyes on it. 📌 Save this for your next appointment.

NYC — DM to book a consult 📩

airwayorthodontics palatalexpansion adenoids nycmom nycparents pediatricdentist orthodontics palatal expansion

Address

111 Broadway Suite 1707
New York, NY
10006

Opening Hours

8am - 5pm

Telephone

+16469565463

Website

https://www.drlenadentistry.com/

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