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This is a self-study course that can be started and stopped at your leisure!


This 1.5 hour CE course* will investigate the traditional means of using RME during interceptive treatment to expand the palate of patients with CL&P and contrast that to a new and innovative approach that uses just braces and wires.

Traditional treatment of patients with cleft lip and palate (CL&P) involves using rapid maxillary expansion (RME) to expand the maxilla during interceptive treatment in preparation for placement of the alveolar bone graft.  However, many of these patients do not actually have a posterior transverse discrepancy.  Instead, they have a narrow, V-shaped maxillary arch which is narrow in the middle and posterior thirds, and are often premaxillary deficient.  Therefore, traditional RME often over-expands the posterior segments and under-expands the middle and anterior segments of the arch, creating arch coordination issues with the mandibular arch.

In addition, expanders present many challenges such as food impaction, discomfort, speech issues, etc. that can make placement and maintenance challenging both for the practitioner and the patient.  And turning of the hyrax key is not always easy for the parent(s).

*DOC is a Certified CE Provider in the State of Florida


  • A review of the different iterations of the traditional Hyrax appliance and the problems therein.
  • Presentation of an unconventional approach whereby braces and wires are used to develop the arches, avoiding the need for expanders.
  • Comparison of the two methods with respect to comfort, ease of use for the patient and practitioner, retention, and accessibility by the plastic surgeon for fistula repair and/or alveolar bone graft placement.

Multiple case samples will be presented to demonstrate the efficiency and efficacy of archwire development in the treatment of CL&P patients.


  • Course Cost: $145
  • CE Hours: 1.5
  • Original Release Date: December 1, 2022
  • Expiration Date: December 1, 2025
  • Refund/Cancellation Policy: No refunds – all course purchases are final.
  • Prior Experience Required: No
  • Teaching Methods: Electronically Mediated Online Course


Michael K. DeLuke, DDS, MDS
Board Certified Orthodontist
President, DeLuke Orthodontics
Owner, DeLuke Orthodontic Coaching


DeLuke Orthodontic Coaching is a for-profit dental CE Provider


  • Opening
  • The Traditional Way of Expanding CL&P Patients [00:11:45]
  • A Superior Approach – Developing the Arches of CL&P Patients [00:15:39]
  • Case Samples
    • Case 1 [00:13:30]
    • Case 2 [00:15:38]
    • Case 3 [00:12:14]
    • Case 4 [00:10:34]
    • Case 5 [00:19:45]
  • Learning Assessment
  • References
Interested in purchasing the course?
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