To perform palatine disjunction in atrophic maxilla in children it is necessary to request hand and wrist radiographic examination to verify the bone age and indication of the procedure. The case report describes how the bone age assessment was performed based on the hand and wrist radiographic exam, or also known as carpal exam, in a rapid maxillary expansion (RME). A female patient, 11 years old, with nocturnal habits of nighttime bruxism, onychophagia and mouth-breather, with permanent dentition. The patient had Angle class I malocclusion, anterior crossbite, maxillary atresia and crowding of the teeth. Through carpal examination, it was possible to determine that the patient's estimated bone age was between 13 and 14 years, and that she was 6 months to 1 year before the pubertal growth peak. This information validated the possibility of performing maxillary disjunction with the modified hyrax disjunction appliance using the activation protocol of ¼ turn in the morning and ¼ turn at night for 7 days. After successful RME treatment, with disruption of the midpalatal suture, the patient had the activation mechanism of the appliance locked, was followed up for 6 months and then referred for fixed orthodontic treatment. In view of what was presented, we concluded that success in RME depends on the correct interpretation of the carpal examination, preventing simple cases from evolving into a worsening of the condition due to carelessness/imprudence on the part of the professional responsible for the treatment plan.
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