1. The fixed palatal expander is an orthopedic appliance to widen the upper arch.

2. Once the palate has been expanded, new bone fills the space. A temporary side effect is a space between the upper front teeth. This is a normal consequence and demonstrates that the expander is working properly.

3. The expander is usually activated for 3 to 4 weeks, and then left passively in the mouth for an additional 2 to 3 months.

4. Once the orthodontist has cemented the device in place, an adult will be required to check and activate it every day unless directed otherwise (usually twice a day by turning a key in a particular direction).

1. Place the activation key in the front hole and turn it toward the back of the mouth. Make sure you turn it until the next hole appears in the front of the mouth.

2. Repeat this procedure for additional activations, which is usually twice a day, once in the morning and once in the evening.