The activation of a maxillary expansion screw should be limited to twice a week to allow proper physiological adaptation of the surrounding bone and soft tissues. Excessive activation, such as daily turns, can cause overloading of the midpalatal suture, leading to pain, tissue inflammation, and potential damage to the periodontal ligament. Controlled, gradual expansion ensures stable skeletal changes without compromising the patient's comfort or anatomical integrity. This conservative protocol also reduces the risk of relapse and optimizes the effectiveness of maxillary expansion treatment.

Reference: Contemporary Orthodontics, 6th Edition.