RPE can be tooth supported, bone supported or both. Effects The expansion process usually results in a large gap between the patient's two top front teeth, often known as diastema. This gap is closed naturally and the teeth may overlap which leads to braces being needed. Some may develop a large space while others do not develop a space at all. It usually takes a week or two for one to adjust to eating and speaking after first receiving the rapid palatal expander. This process requires patients to turn the expansion screw themselves to widen the expander. For expansion that is not managed by the patient and on the lower jaw, a bionator appliance may be a more suitable alternative. Slow expansion Slow expansion techniques expands maxilla at a much slower rate compared to the rapid maxillary expansion technique. In slow expansion technique, a patient is ordered to turn the screw 4 times which amounts of 1mm per week. Patient is instructed to turn the jackscrew at the same rate for next 8–10 weeks to achieve the desired expansion. This slow rate of expansion allows skeletal and dental changes to happen in a 1:1 ratio. This means that equal amount of dental and skeletal expansion is achieved, compared to RME technique where mostly skeletal expansion is achieved initially. Slow expansion has also been advocated to be more physiologic to the tissues of the maxilla and it causes less pain. Some studies have reported that diastema in slow type of expansion also happens less due to the interdental fibers having chance to close the space as the maxilla is being expanded. Implant-supported expansion Mini-implant assisted rapid palatal expansion (MARPE) involves the forces being applied directly to the maxillary bone instead of the teeth. This technique involves placing anywhere from 2–4 mini-implants in the palatal vault area of maxilla to anchor the RME appliance to the screws. The patient is then asked to turn the jackscrew with the rapid approach over next two weeks. This technique allows palatal expansion to be performed in young adults, in which the palatal suture is already fused, a result which was previously only achieved surgically. It has the advantage of being minimally invasive compared to SARPE and of achieving a greater degree of skeletal expansion compared to dentoalveolar expansion. In most adults, especially males a surgical assist may be recommended to achieve consistent outcomes, such as