Types of Palatal Expanders for Kids: A Practical Overview

Part 2 of 2 in the Airway Appliance Series

Understanding Expanders and Airway Appliances: A Practical Overview of Tools and Approaches

Part 2: Expander & Appliance Overview

Please read some background info in my previous article “Part I: Foundational Concepts Before Choosing an Appliance.”

This is an overview of some of the most common appliances.---

A Transitional Tool: MyoMunchee 

The MyoMunchee occupies a category of its own. It functions more like a chewing and oral tolerance building tool than a traditional orthodontic appliance.

It can be a helpful starting point for children who mouth breathe or are transitioning away from pacifier use. Their FAQ section offers helpful background, but here are some basics to know:

· Bebemunchee for ages 6 to 18 months must be ordered by a professional

· Sizes for 18 months and older are available direct to consumer

· Use begins with very short sessions, about 1 minute, gradually building to 10 minutes twice daily

Active chewing sends important signals to the jaw bones that support growth. Many families use MyoMunchee to build tolerance before introducing appliances worn for longer periods. Some families try it independently, while others work with a 

MyoMunchee trained provider.

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Passive Oral Trainers and Habit Support Devices

Passive oral trainers are prefabricated, flexible devices worn primarily during sleep and sometimes for short daytime sessions. Examples include Myobrace, HealthyStart Habit Correctors, Vivos Starter appliances, and Toothpillow Part I.

These devices aim to:

· Encourage nasal breathing

· Support lip seal and tongue posture

· Passively retrain oral muscles

They are often used as entry level tools for younger children and may help build tolerance for future appliances. In some cases, they are also used between orthodontic phases as a retainer like option that still allows jaw growth.

Important limitations to understand:

· They do not directly expand the midpalatal suture, so they are not true expanders

· Success depends heavily on consistent wear

· Nasal breathing must already be possible (though it may not be the preferred pattern for breathing vs. mouth breathing).

· They may be difficult for children with tethered oral tissues or strong gag reflexes

· Marketing often emphasizes avoiding braces, which can be misleading. These tools support muscle function and development but do not eliminate the need for further treatment in all cases

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Eruption Guidance Appliances

Eruption guidance appliances are made of firmer material and are often considered a next step after oral trainers, typically used once adult teeth begin erupting. Examples include Healthy Start Eruption Guidance, Vivos Grow, Vivos Way, and Toothpillow Part II.

These appliances:

· Guide erupting teeth into more favorable positions

· Continue influencing jaw development through altered muscle forces

· May address early crowding and bite discrepancies

They are usually worn overnight with additional active daytime use, often involving biting exercises. Many programs incorporate structured exercises alongside appliance wear.

It is worth noting that Toothpillow is a treatment program rather than a single appliance. It uses appliances made by Myobrace or Vivos in combination with oral exercises, nasal hygiene, and professional supervision. It is available both in person and virtually, making it a helpful option for families with limited geographic access to trained providers.

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Functional Activators and Bioactivators

Some appliances resemble oral trainers but follow different treatment philosophies. These include Dentosophy, Dentosophie, Dentosofia, A.M.C.O.P., PosturePro, and various bioactivators commonly used in Europe under names such as Eptamed devices.

These appliances:

· Are typically worn overnight

· Are paired with daily exercises and breathwork

· Are prefabricated but selected more intentionally based on individual jaw and dental patterns

While they may look similar to trainer style devices, the philosophy focuses on improving how bones relate to one another. This may support better alignment of the teeth and jaws and can also influence posture throughout the body.

A notable limitation is accessibility. These appliances are more commonly available in Europe, and provider directories are limited, so families may need to do additional research.

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Lightwire Appliances 

Advanced Lightwire Functional Appliance (ALF)

The ALF is a thin, fixed wire appliance designed to work with natural cranial rhythms.

Its intended effects include:

· Gentle maxillary expansion

· Support for tongue posture

· Reduction of cranial tension

This approach is often favored by families seeking a low force, biologically oriented option, particularly for sensitive children.

Considerations include:

· Requires specialized provider training

· Changes tend to be slower and more subtle

· Often paired with body based therapies

· Activation is performed by the provider Some providers are listed in online directories (like this one or this one), while others are not. You may have to search for unlisted individuals offering such treatments in your area.

Crozat Appliance

The Crozat appliance shares a similar philosophy to the ALF and historically inspired its development. It is often used to influence posterior tooth positioning more than anterior expansion.

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Clear Aligners in Growing Patients 

Clear aligners such as Invisalign First, Invisalign, ClearCorrect, Angel Aligners, and SureSmile are often thought of as tooth moving devices.

In adults, this is largely true, though with advanced techniques much can be accomplished even in adulthood. At any age, uprighting teeth and creating space for the tongue can still influence airway health. When used early in children, aligners may support jaw development by allowing bones to grow into improved positions.

If we think of aligners as providing dentoalveolar expansion rather than sutural expansion, they may still be appropriate in certain cases.

Pros:

· Comfortable and tongue friendly

· Discreet

· Often available for children as young as age 6

Cons:

· Removable and easy to lose

· Require responsibility and consistent wear

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Hybrid Systems: Aligners with Functional Support 

Nuvola OP and Nuvola Junior System

Nuvola combines clear aligner therapy with functional and bioactivator principles. In addition to guiding dental alignment, it supports tongue posture and overall cranial balance.

· Nighttime plus limited daytime wear for younger children, typically age 4 and up

· Full time wear for teens and adults

· Includes short daily active use with a supplemental device

Originally developed in Italy, Nuvola is gaining traction in select U.S. clinics focused on TMJ and sleep health, with training often associated with Dr. Steven Olmos.

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Braces: A Reframed Perspective

Many parents say, “We don’t want braces.” This hesitation is understandable, but often rooted in outdated assumptions.

The concern is not braces themselves, but retractive approaches that sacrifice airway space in pursuit of straight teeth. Braces remain a valuable tool when used by a provider with an expansive, airway conscious philosophy.

Potential benefits include: