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DNA Appliance - Began January 2020  

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Thomas22
Eminent Member

I’ve been wearing a DNA Appliance for two months. 

The initial scans showed an intermolar width of 36.4.

My lower jawbone was also significantly recessed, and the condyle was worn away.

The doctor put me in a y splitter, and a two piece expander for my lower jaw. The second appliance has two metal prongs which prevent my jaw from slipping backwards. This is adjustable.

 Every month I undergo a take home sleep test, and based on that, the prongs on the lower jaw appliance are adjusted. In effect, I will keep on advancing the prongs until my sleep apnea disappears. 

 My sleep isn’t getting better yet, I still don’t dream, but I do breathe more easily when I’m awake. I can usually breathe through both nostrils now, for example. 

I have the perception that my sense of smell is improving as well. 

The appliances aren’t uncomfortable, and at worst, they just feel tight when I put them on. I have been experiencing some pain at my suture points though, as well as mild headaches.

I don’t remember how I discovered functional appliances. They made immediate sense to me though. My facial structure looks normal, if you cover the lower half of my face. The lower half just looks too small, disproportionate to the upper half. I assume this is because my jaw is in the wrong position. If I jut my jaw forward, then it looks proportionate. 

I was told the process would take me two years in total. 

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Posted : 14/02/2020 1:02 pm
Neigh liked
toomer
Eminent Member

Thanks for posting your progress!  Do keep us up to date!

I am in a similar boat - dealing with TMJ right now, not sure if my condyle is worn away or not as we only did a CBCT, not a MRI.  But I'm in a bite split for 4-6 months, and my doc is a DNA provider so we'll chat about the DNA appliance after we resolve the TMJ and jaw alignment issues.

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Posted : 19/02/2020 8:51 pm
Thomas22
Eminent Member

@toomer

Any reason not to tackle both at once?

I'm using the MRNA version which, as mentioned above, will move the jaw forward to the correct position.

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Posted : 19/02/2020 9:25 pm
eternally12
Active Member

Just wondering how you're going with your treatment. I'm about to undergo DNA treatment when my appliance arrives (supposedly within the next 3 weeks), however my doctor has only prescribed the top appliance and not the bottom one at this stage. Are you turning yours every 4 days and have there been any more improvements since last time?

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Posted : 21/03/2020 8:06 am
Thomas22
Eminent Member

The process is so gradual, it's hard to notice progress. 

With that said, it has cured my snoring. And I do feel that I can breathe more easily through my nose. I turn the screw once a week, and when I do, I can certainly feel it. I don't feel it in my jaw or in my teeth though, it's the suture lines in my maxilla. You can feel the pressure, edging on pain. It's not difficult, but it is noticeable.

It's also sore to the touch, especially where my Maxilla meets my Zygomatic, and nasal bones.

Wearing the device opens my Eustachian tubes, which is welcome. My right side Eustachian tube was always closing up on me.

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Posted : 05/04/2020 9:28 pm
Thomas22
Eminent Member

Photos are taken from the Homeoblock website. The green in the lower images shows growth, and or movement.

It's my hope that I'll see similar improvements, given the devices work the same way. The more time I spend reading, and reflecting on my own Craniofacial Dystrophy, the more I appreciate I've got a lot of work to do. My mandible, for example, is unhooked on one side (for lack of a better way of describing it) and has rotated left. As a result the midline doesn't match the midline of my upper jaw.

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Posted : 11/04/2020 5:20 pm
Robbie343
Trusted Member

@thomas22

are you noticing your mandible come forward with expansion? Did your doctor say any thing about remodeling the condyles? 

 

ReplyQuote
Posted : 11/04/2020 5:42 pm
Thomas22
Eminent Member
Posted by: @robbie343

@thomas22

are you noticing your mandible come forward with expansion? Did your doctor say any thing about remodeling the condyles? 

 

  • I have a heavy beard, so I can't see physical changes in the lower half of my face. I think it's come forward slightly, but I'd need to shave to tell.
  • The doctor said that he normally sees condyle repair as treatment progresses, but he's never seen complete recovery.
  •  One of the downsides to the DNA Appliance is that the providers are unlikely to be experts. They're not designing the appliance for example, Dr. Singh's team is. So my doctor, he doesn't always have answers for me unfortunately.

 -

 I happen to own a mild Hyperbaric Chamber, and I'm getting back in the habit of using it daily. Hyperbaric oxygen speeds bone repair, and remodeling, and I'm hopeful that this will help quicken the work of the appliance. We'll see.

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Posted : 11/04/2020 6:12 pm
Thomas22
Eminent Member

I noticed my first dental progress.

There are gaps opening up between my lower front teeth. They were very crowded and overlapped each other, and that's starting to change. You can see where the springs in the DNA Appliance are pushing them out, on their own trajectories.

Just 1.75 more years to go 

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Posted : 15/04/2020 6:06 pm
Neigh
Active Member
Posted by: @thomas22

I’ve been wearing a DNA Appliance for two months. 

The doctor put me in a y splitter, and a two piece expander for my lower jaw. The second appliance has two metal prongs which prevent my jaw from slipping backwards. This is adjustable.

i've never heard of this with DNA. I've visited three providers now, and every one of them informed me that DNA would only help broaden my maxilla. He said specifically that DNA would do nothing for the mandible or lower jaw(which would require a BSSO).

As my pallet is mostly narrow towards the front and not the back, I basically gave up on the DNA through provider. It would improve my smile(why most people want it), but probably not help my sleep apnea very much at all. I decided there's no point in paying $8000 for something I can do myself as the DNA is basically just a slightly modified y splitter.

Is this lower jaw thing extremely new? My consults were almost a year ago and I know this field is legitimately growing by leaps and bounds. I'm literally set to order a y splitter this week.

There are gaps opening up between my lower front teeth. They were very crowded and overlapped each other, and that's starting to change. You can see where the springs in the DNA Appliance are pushing them out, on their own trajectories.

That's great! How is this working? Surely your jaw isn't going to widen? Did they do anything surgical at all, like splitting a bone or anything like that?

ReplyQuote
Posted : 15/04/2020 6:25 pm
Thomas22
Eminent Member

@neigh

 They make a Sleep Apnea version they call the MRNA. It's the normal mandible expander, with a mandibular advancement device bolted on.

 I have no data or studies to back it up, but I think it will be more effective than a normal expander, and it will help speed the growth process. By 'curing' apnea, which mine has, you'll spend more time in deep sleep, and in turn, I believe you'll see more rapid bone growth. Or, to flip it around, poor sleep won't [Rude Language or Insults are not tolerated] that healing process.

 I don't know if it's new.

@neigh

 There is no surgical component.

 I do believe it will widen my jaw.

 With work shut down, I've had the opportunity to read a lot of studies, and look at a lot of before and after photos.

 If you scroll up, you'll see the 3D skull images, with the green shading denoting movement or growth. With the after photos, the jaws do look wider. Now part of that may be movement, it may be the "trapped mandible" moving forward as the maxilla expands, but either way, the patient's faces do look broader at the base. I do believe part of it is growth though, palate expanders may not restore your face to what it should have been, but they do transmit forces throughout your facial complex, and that force, by law, should promote bone remodeling. So even if the bulk of the growth is in the dental ridge, you should see symmetrical, and sympathetic, growth in other areas of your face.

 How much growth? I don't know.

 Studies of adult patients often talk about 2mm or 3mms of growth at the Zygos.

 If I remember correctly, this was from a six year follow up.

 Look at how much higher his cheekbones are, and how his mandible has moved, or grown. And this is a much older man.

ReplyQuote
Posted : 15/04/2020 6:46 pm
Neigh liked
Thomas22
Eminent Member

@neigh

https://smlglobal.com/mrna-appliance

My lower device is identical, my upper device is a Y splitter, unlike the one pictured.

-

One thing that I wonder about, the growth figures are tabulated at the end of the study periods. Be they 7 months, 12 months, or two years.

What do those patients faces look like at the three year mark, or the four year mark?

When does remodeling process actually finish?

Growth in one area of the face will provoke corresponding changes in other parts of the face, and I believe that the face will take some time, after you've fully expanded the device, to balance out.

ReplyQuote
Posted : 15/04/2020 6:49 pm
Thomas22
Eminent Member
Posted by: @neigh

That's great! How is this working? Surely your jaw isn't going to widen? Did they do anything surgical at all, like splitting a bone or anything like that?

 One last comment.

 I listened to a podcast of Dr. Belfor this evening, and he specifically says that the Homeoblock lengthens the Ramus. Which I assume would also widen the jaw as well.

 He also believes that his unilateral bite block is responsible for a lot of the facial growth. The bite block on his device, a flat raised piece of plastic, works as a proxy for the hard food that is missing from our diet, in his words.

 The DNA Appliance also has a bite block.

ReplyQuote
Posted : 16/04/2020 2:13 am
Thomas22
Eminent Member

I continue to feel mild pain in and around the frontal process of my maxilla where it meets the nasal bone. Both sides. It's the sort of pain you take an Advil for, and it disappears.

I assume the bones are under pressure from the appliance. So I should see growth there?

We'll see.

-

Dreaming, I certainly do dream now. Which I didn't do before treatment. That indicates my sleep has improved.

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Posted : 20/04/2020 3:56 am
toomer
Eminent Member
Posted by: @thomas22

Any reason not to tackle both at once?

I'm using the MRNA version which, as mentioned above, will move the jaw forward to the correct position.

No, I am not quite sure why.  I feel quite certain I will be in a DNA+mRNA combo if/when we start ... so I don't know why he wanted to go with the bite splint first.  It just seems to be his process - he says this is a very conservative approach.  

Given that my lower jaw was retruded backwards and both condyles out of position (assuming both are still there) it seems like he wants to get the lower jaw mostly into the position it wanted to be in first ... and then we'd take the necessary 3D CBCT scans and try to build a strategy to fix the maxilla.  

The bite splint has definitely done something for my bite and my TMJ.  Some of my TMJ symptoms I was experiencing (facial/sinus pain) are a bit better.  And some that I didn't realize I had - such as limited range of shoulder motion - also seem to be clearing up.  Unfortunately, bringing the lower jaw forward without any changes to the maxilla yet has moved me to an underbite with a posterior open-bite.  So I'm now dependent on the bite splint for eating for the time being. But I've only got a few more months, and then we do the full "airway" analysis - and I assume that gets shipped off to Vivos for design/development of my appliance strategy.

ReplyQuote
Posted : 20/04/2020 11:17 pm
Thomas22 liked
toomer
Eminent Member
Posted by: @thomas22

I turn the screw once a week, and when I do, I can certainly feel it. I don't feel it in my jaw or in my teeth though, it's the suture lines in my maxilla. You can feel the pressure, edging on pain. It's not difficult, but it is noticeable.

That's fascinating.  You're the first person I've heard report that, and in a way I find that very encouraging!  The biggest complaint/concern with appliance strategies is obviously things like tipping teeth, pushing teeth through the alveolar structures, etc.  You only have to browse this forum for a while to see all the horror stories about Ronald's AGGA case to get pretty scared.  

You'll hear from orthodontists saying you don't get palatal growth with a DNA Appliance, only a DOME or MSE will do it.  But if you're experiencing pain there, that really would seem to indicate that you might be getting growth at the palatal suture.  So I'm actually really excited to hear you report that!

Out of curiosity, what has your provider said - if anything - in terms of checking for safety over time?  Are there periodic re-scans via CBCT to make sure you're not pushing the teeth out of the alveolar process or other issues?

ReplyQuote
Posted : 20/04/2020 11:23 pm
toomer
Eminent Member
Posted by: @thomas22

Dreaming, I certainly do dream now. Which I didn't do before treatment. That indicates my sleep has improved.

Were you clinically diagnosed with sleep apnea before you started this?  I'm not sure if you said so or not.

I was diagnosed (in-lab AHI of 41.8).  I can definitely tell you that once I got onto CPAP, I started to dream again - so that's another positive sign that it's working for you.

Oh, and that routine of having to get up and pee in the middle of the night, usually 3-5 nights per week?  That disappeared immediately.  I had no idea that was tied to my sleep apnea.

If you really want to track how your sleep is doing, there are overnight logging pulse oximeters you can buy from Amazon for not too much.  I have the Wellue O2 ring ... and when I have my CPAP mask on, I typically log 94-98% oxygen levels all night.  If I take a nap on the couch on my back ... ugh ... crashing down into the 80's.  So if you're interested in a feedback mechanism ... that might be an interesting one for you.

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Posted : 20/04/2020 11:32 pm
toomer
Eminent Member
Posted by: @neigh

i've never heard of this with DNA. I've visited three providers now, and every one of them informed me that DNA would only help broaden my maxilla. He said specifically that DNA would do nothing for the mandible or lower jaw(which would require a BSSO).

You're not alone in this.  I've spent the better part of the last 4 months trying to track down as many patient stories and details as I can ... and ... it's just not made clear at all.

But here you can see a patient story from many years ago, and you can clearly see the lower appliance has an adjustment mechanism in the center ... and he talks about the adjustment process.  So clearly there's a mandibular strategy as well.  

http://epiorthodontics.blogspot.com/2011/09/update-and-some-new-information.html

ReplyQuote
Posted : 20/04/2020 11:41 pm
Thomas22
Eminent Member
Posted by: @toomer
Posted by: @neigh

i've never heard of this with DNA. I've visited three providers now, and every one of them informed me that DNA would only help broaden my maxilla. He said specifically that DNA would do nothing for the mandible or lower jaw(which would require a BSSO).

You're not alone in this.  I've spent the better part of the last 4 months trying to track down as many patient stories and details as I can ... and ... it's just not made clear at all.

There's so little good information out there. I haven't found a single patient account of the changes they experienced through the end of treatment.

That's why I created this thread. Hopefully it will be useful to other people.

Ideally I'll be able to put up post treatment numbers that show how much growth there was too.

-

With the lack of information, I think that goes back to Vivos.

It's simple to market the Appliance as an Apnea treatment. Apnea is a known medical condition, covered by insurance, where you can readily measure the severity. Vivos can also document how the device reduces Apnea events, or even cures the condition.

It also allows them to make a promise they can keep. The device will help you sleep better.

They don't have to worry about patients who didn't see the cosmetic changes they'd hoped for.

Also how would you document and present the variable bone growth that patients experience when using the device? It must vary quite a bit from patient to patient. And how does that improvement compare to what they should have been? You can't establish what they should have looked like. And what medical condition are you treating? Cranial Dystrophy isn't considered a condition (yet).

Dr. Belfor does market Homeblock as a "face lift" and an "anti-aging device" but it's tricky, because all he can really do is present individual case studies, that show how patients look more attractive after treatment.

ReplyQuote
Posted : 21/04/2020 1:21 am
Thomas22
Eminent Member
Posted by: @toomer
Posted by: @thomas22

Dreaming, I certainly do dream now. Which I didn't do before treatment. That indicates my sleep has improved.

Were you clinically diagnosed with sleep apnea before you started this?  I'm not sure if you said so or not.

I was aware of the fact I snored but I never thought much about it. When I did my consult, they gave me a take home sleep test. My AHI was just above the threshold for moderate Apnea. I'd like to say it was in the mid twenties? I don't remember.

I took another test in early February and my AHI had dropped to 16. I believe that immediate improvement came from the lower appliance, holding my jaw forward.

Better health was one of my hopes for this. Given how rough I feel when I sleep without the device, I do think it's helping.

It also shows me that I had no idea how poorly I was sleeping before treatment. 

ReplyQuote
Posted : 21/04/2020 1:27 am
Thomas22
Eminent Member
Posted by: @toomer
Posted by: @thomas22

I turn the screw once a week, and when I do, I can certainly feel it. I don't feel it in my jaw or in my teeth though, it's the suture lines in my maxilla. You can feel the pressure, edging on pain. It's not difficult, but it is noticeable.

That's fascinating.  You're the first person I've heard report that, and in a way I find that very encouraging!  The biggest complaint/concern with appliance strategies is obviously things like tipping teeth, pushing teeth through the alveolar structures, etc.  You only have to browse this forum for a while to see all the horror stories about Ronald's AGGA case to get pretty scared.  

You'll hear from orthodontists saying you don't get palatal growth with a DNA Appliance, only a DOME or MSE will do it.  But if you're experiencing pain there, that really would seem to indicate that you might be getting growth at the palatal suture.  So I'm actually really excited to hear you report that!

Out of curiosity, what has your provider said - if anything - in terms of checking for safety over time?  Are there periodic re-scans via CBCT to make sure you're not pushing the teeth out of the alveolar process or other issues?

That was poorly worded on my part. I feel the pressure around my eyes and nose, and not in my mid palentine suture. I assume that’s because the bones are being compressed at those sutures.

I do believe that the DNA Appliance and the Homeoblock promote bone growth throughout the facial complex though.

You can see it in the scans that Dr. Belfor has on his website.

Dr. Belfor credits the plastic bite block on his device. If that’s true, it could explain why people might be getting different results than from the older devices.

Teeth tipping, my doctor does a visual examination once a month. He doesn’t appear to be concerned, and I haven’t seen any changes in the gum line. I’m also expanding the device at very slow rate. Just .25mm a week. 

ReplyQuote
Posted : 21/04/2020 5:54 am
toomer
Eminent Member

@thomas22

Yeah you’re the first I’ve seen have a ~7 day schedule on turning the screw.  Was that the initial recommendation from the provider, or did you talk a bit about it?  Other patients have been doing 4-5 days in between turns ... so just trying to get a sense on how they determine the schedule.

 

 

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Posted : 21/04/2020 9:19 am
mr-sand-man123
Active Member

I just got my DNA appliance today. I had to travel to a dentist in another province (I'm in Canada), so it was mailed to me. So I'm a little bit apprehensive about doing my treatment remotely, though this Covid-19 situation has basically made that a requirement anyway. But the dentist is pretty confident that we can communicate via videos and photos, and skype if needed. It concerns me a bit not being able to have a thorough examination to be sure it's fitting properly and not doing damage to my teeth. It feels pretty snug right now, but they said that it would at first. I'm really hoping it can get me enough expansion to improve breathing and eliminate my sleep problems that I think are mainly due to Upper Airway Resistance...I don't know if I'll ever get a definitive diagnosis since it's not severe OSA.

I opted to just get the upper appliance, since my lower teeth are decently straight and wide, and my scans showed that I don't necessarily have a really narrow airway in my throat... it seems to be mostly my nasal area that's narrow. So I didn't really want to spend twice as much money for something I wasn't sure I needed. Though I am wondering if the mandibular advancement component might have been helpful for me...I just kind of gambled on the upper appliance alone helping me since it's half the price - and I'm still a bit skeptical about this appliance doing what it claims to be able to do - so I didn't really want to spend twice as much money on something that is kind of a gamble. I've been told that when the upper appliance expands the maxilla, that it makes room for the mandible to come forward a bit, so I figured that would maybe be good enough. The lower mRNA, as far as I know, isn't doing any permanent remodelling anyway, it's just functioning as MAD while you sleep. 

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Posted : 21/04/2020 10:27 pm
Thomas22 liked
Thomas22
Eminent Member

@toomer

 I don't know. I will ask on my next visit.

 

ReplyQuote
Posted : 21/04/2020 11:14 pm
Thomas22
Eminent Member

@mr-sand-man123

 Speculation. I assume your mandible would move forward, as your maxilla expands. That's what all the devices claim at least.

 Does your device have a bite block though, a raised plastic surface on one side?

 If Dr. Belfor is right, then you won't see the same bone growth in the rest of your face without one.

 This is one I wonder about. He tells this story in interviews, but he chanced across one sided bite blocks. He hired a stringer to make orthodontic devices for his office, and the man he hired included unilateral bite blocks in them. The man had apparently learned to do this in Europe.

 Belfor says his patients, who largely worked in Broadway, started coming back to him, claiming their bone structure was changing. Their bones were growing. 

 To my knowledge, he's never done a comparative study that shows the effectiveness of a device with one, vs one without. He does say that it's the pressure on the nerves underneath the teeth that triggers growth. I don't know how he established this.

The lower mRNA, as far as I know, isn't doing any permanent remodelling anyway, it's just functioning as MAD while you sleep. 

 It does expand the lower jaw ridge. It may also expand the jaw itself, perhaps. But that assumes that growth in the ridge, triggers growth elsewhere. And I have no science to substantiate that.

 

ReplyQuote
Posted : 21/04/2020 11:30 pm
mr-sand-man123
Active Member

@thomas22

 

Right, sorry I meant the mRNA isn't permanently moving the mandible forward....it is meant to expand the lower jaw though.

 

My appliance doesn't have any bite pads. I'm pretty skeptical about all this epigenetic/nerve stimulation talk, but maybe there's something to that. I honestly don't know if the DNA appliance is meant to cause a whole lot of bone growth in the face anyway...it's just pretty minimal expansion in the jaw that may cause some changes to physical appearance but I don't think it's usually that dramatic.

 

ReplyQuote
Posted : 21/04/2020 11:41 pm
Thomas22
Eminent Member
Posted by: @mr-sand-man123

@thomas22

 

Right, sorry I meant the mRNA isn't permanently moving the mandible forward.... 

I don't know. I assume the growth of the Maxilla is more important. I viewed the MAD as a sort of a stop gap that would fill in until the jaw growth took it's own course.

My appliance doesn't have any bite pads. I'm pretty skeptical about all this epigenetic/nerve stimulation talk, but maybe there's something to that. I honestly don't know if the DNA appliance is meant to cause a whole lot of bone growth in the face anyway...it's just pretty minimal expansion in the jaw that may cause some changes to physical appearance but I don't think it's usually that dramatic.

Dr. Singh doesn't sell the facial changes, but it's at the top of Dr. Belfor's list. I think it goes back to marketing, and how they've decided to make their money.

Some cases are pretty impressive. Others, not so much.

I'm pretty skeptical about all this epigenetic/nerve stimulation talk

 And I think that's warranted. Dr. Belfor's papers note the changes he sees in patients, but he doesn't explain the actual mechanism for the changes. He says it's pressure on the nerves underneath the teeth but doesn't go further. I think he may have chanced into something that works, but that he doesn't fully understand.

-

The bite block is located on the side of the face that's underdeveloped, so in my case the left side.

 I do find myself chewing on the block.

ReplyQuote
Posted : 21/04/2020 11:54 pm
toomer
Eminent Member
Posted by: @thomas22

Dr. Belfor credits the plastic bite block on his device. If that’s true, it could explain why people might be getting different results than from the older devices.

Have you come across anything from Dr. Belfor on why he goes with a unilateral bite block?  I believe the DNA Appliance is typically configured with bite acrylic on both sides, no?  At least some of the photos I've seen seem to have bite plates/blocks/whatever extending across all the molars on both sides.

ReplyQuote
Posted : 24/04/2020 11:38 am
Thomas22
Eminent Member
Posted by: @toomer
Posted by: @thomas22

Dr. Belfor credits the plastic bite block on his device. If that’s true, it could explain why people might be getting different results than from the older devices.

Have you come across anything from Dr. Belfor on why he goes with a unilateral bite block?  I believe the DNA Appliance is typically configured with bite acrylic on both sides, no?  At least some of the photos I've seen seem to have bite plates/blocks/whatever extending across all the molars on both sides.

The DNA Appliance actually has a bite block. There's a raised surface on one side of the acrylic.

-

Belfor as mentioned had a stringer who made orthodontic devices for him. He found that patients experienced bone growth wearing these devices, and so when he created the homeoblock he included it. 

He uses your dental imaging to determine which side of your face is less developed, and locates the block on that side of the device. 

Dr. Singh does the same thing with the DNA appliance. 

I assume that you transmit more force through your jaws with the one sided block.

ReplyQuote
Posted : 24/04/2020 12:09 pm
eternally12
Active Member

I started my DNA appliance a couple weeks ago and have bite blocks on both sides of my appliance. I was a bit concerned about having bite blocks though because of the risk of it causing an open bite with the back molars, but so far the bite blocks are comfortable. I know it’s meant to be beneficial for the bone to be frequently chewing, that’s why Mike Mew encourages his patients to chew gum often, and I imagine that that is the purpose of the bite block. 

I’ve noticed pretty good changes so far even in just a few weeks. My right nostril seems to be intaking more air than it did previously and my lips seem to be slightly more symmetrical. There’s also a bit more space for my tongue already. I’ve been expanding 1 turn every 4-5 days, though my doctor said to start with one turn a week to see how it goes and then we would move to turning every 4 days. But I’ve noticed the appliance is generally quite loose around day 4 so have been adjusting it accordingly already.

In my opinion the actual bone remodelling and more evident facial improvement changes probably occur within a few years after treatment, provided proper tongue posture is maintained after the treatment. I imagine that teeth will likely move through the alveolar bone first regardless, but as long as the bone is healthy and continuing to remodel/expand during treatment I don’t necessarily see an issue with this. As long as you’re not overzealous with the speed of your expansion, and as long as there is consistent pressure on the roof of your mouth both from your tongue and the device, my theory is the bones will show growth over time, provided the teeth remain stable during expansion.

 

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Posted : 25/04/2020 11:59 pm
toomer
Eminent Member

@eternally12

Thanks for the updates on your progress!  I thought I had seen bite surfaces on both sides of the appliance.

Has your provider talked about grinding those down over time?  That may help with any posterior open-bite concerns.  That's what my provider does right now with the occlusal bite splint he's got me in (before we get to the DNA appliance part).  Every few weeks I go in, and I'm not making contact on all molars, so he grinds a bit down each time and checks them with bite papers until I'm making contact on all molars on both sides.  Then I go away again for a few weeks, and we repeat the process again.

I would assume the same could be done with the DNA Appliance - in fact, I thought that was supposed to be part of the standard process.  Otherwise - as you state - how do you not end up with a posterior open-bite?

How "loose" is the appliance after 4 days?  Is it so loose, it would be falling out of position at night, so you almost feel like you have to adjust earlier than 7 days?

Also, if you don't mind my asking - what's your general age range?  Obviously, making these changes are a bit easier for younger bodies than older bodies.  Also, had you been having any sleep apnea and/or TMJ issues which caused you to seek out this treatment protocol?

 

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Posted : 26/04/2020 1:11 pm
eternally12
Active Member

@toomer 

I’m not too sure but I actually believe one of the points of contention that Dr Belfor had with Dr Singh was the bite block. The homeoblock always only has a bit block on one side, which Dr Belfor states is to promote growth on the underdeveloped side, whereas the DNA appliance from my understanding either has a bit block on both sides or none at all - probably to balance the bite. I do notice on mine occasionally there is one side hitting the molars first, depending on the position of my jaw in that moment.

I’ve actually not had a proper bite in a few years because of previous extraction orthodontics which left my jaw misaligned and very asymmetrical. As a result the tips of my front teeth usually touch slightly first when my mandible is more relaxed, but I have a very slight posterior open bite already. So it’s difficult for me to say, but I’m thinking I will likely need braces/Invisalign of some sort at the end of the DNA appliance treatment to help fix the occlusion of my molars. I’ve noticed even with the slight expansion in the past few weeks my molars already bite differently, and the edge to edge contact on my incisors has slightly reduced.

So far I do not think I’ve had any/much teeth tipping. I have a Y-plate appliance and the acrylic towards the front seems to have a decent suction hold when I place my tongue properly underneath it. It feels like a very gentle pressure on my palate just above the front teeth and seems to help keep my sinuses clearer (just as my tongue does when in its proper position without the appliance in). Perhaps it actually does help drop high vaulted palates - the way Dr Singh described the point of the acrylic.

I will say though, my tongue posture without the appliance in during the day does seem to be a bit worse. But I’m thinking this is due to the constant changes in my mouth so my tongue isn’t sure exactly where to sit comfortably currently. 

I’m 23 FYI. I have had constant TMJ and breathing issues ever since I had extraction orthodontics in my mid-late teens. It was actually a few years ago when I kept wondering why my voice kept getting tired very quickly and couldn’t project properly that I started delving deeper and realised it’s because my tongue was constantly pushed into the back of my throat, and my jaw was not relaxed. I had constant neck pain at that time which I’ve mostly resolved by trying to keep my tongue pushed forward out of my airway. However in doing so I’ve had constant TMJ and clicking on the right side of my jaw especially. I also noticed maybe two years ago that I would frequently stop breathing for extensive periods of time when lying down. Anyway, fast forward to 3 months ago and I met with Dr Mahoney who suggested I do a sleep test. I had never actually considered this before. I didn’t end up doing the sleep test through his clinic though because he lives interstate, so I managed to find a local provider who knows Dr Mahoney and has recently started using the DNA appliance. He also recommended I do a sleep test before he treated me and it was from that that I found out I have mild sleep apnea (AHI was about 13). He has started me off on doing a full turn about once a week but like I said I felt that a week was actually too long in between turns so have been doing it every 4-5 days which is what he said we would be changing to anyway after my next appointment. It’s definitely not loose to the point of falling out after 4 days, but there is definitely a lot less pressure felt, if any at all. 

I am also unsure as to whether I’ll be getting the mRna appliance. I only have the upper one currently and my doctor doesn’t seem to think I’ll need the lower one - at least not at this stage. 

 

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Posted : 27/04/2020 9:10 am
toomer
Eminent Member

@eternally12

Thanks for the update!  I think slower progress is better, as long as the appliance is not falling out.  You want to give the structures time to adapt to the movement, so that the movement doesn't get ahead of the body.

FYI - found a DNA paper which talks about the expected process for the bite plates, I expect those will get ground down at some point in your process:

"The occlusal acrylic was also selectively equilibrated and gradually removed, to permit the lower teeth to track the changes in the occlusion."

https://clinmedjournals.org/articles/jsdm/journal-of-sleep-disorders-and-management-jsdm-3-014.php?jid=jsdm

 

 

 

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Posted : 27/04/2020 11:14 pm
Thomas22 liked
Thomas22
Eminent Member
Posted by: @eternally12

@toomer 

DNA appliance from my understanding either has a bit block on both sides or none at all

 

My RNA Appliance has a unilateral bite block. It's on the lower appliance.

The acrylic is raised on the left side to act as a bite block. If you lay the appliances on top of each other, they only touch on the left side, there's a gap on the right side of several milimeters.

I have an open bite on the left side of my jaw.

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Posted : 27/04/2020 11:20 pm
eternally12
Active Member

@thomas22

Is the purpose of the bite block on your left side to stimulate further growth on that side? Do you think it could potentially make the open bite worse by any chance?

 

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Posted : 27/04/2020 11:29 pm
eternally12
Active Member

@toomer

Thanks for that! I believe adjusting every 4 days is pretty standard with the DNA appliance - I know of a few others also adjusting theirs roughly at the same rate. There’s also some evidence which Dr Mew quoted to suggest the semi expansion rate is the most ideal and allows for teeth stability whilst still allowing sufficient time for bone growth. I can’t remember which video it was in but it was on the Orthotropics channel.

 

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Posted : 27/04/2020 11:31 pm
Thomas22
Eminent Member

@eternally12

"Is the purpose of the bite block on your left side to stimulate further growth on that side?"

 We never talked about it. But I assume so, I'm going to ask when the office reopens in May, and I have my next follow up.

 "Do you think it could potentially make the open bite worse by any chance?"

 No. They've treated too many patients with these devices for that to be an issue.

-

There was a study done at the University of Illinois where the team glued a piece of acrylic to one tooth, inside the mouth of a rat. A bite block. They showed bone growth.

 

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Posted : 27/04/2020 11:38 pm
Thomas22
Eminent Member

It appears I sprained my lower left canine. I may need to pause expansion for a few weeks to allow it to heal.

I may also need to move more slowly. Doing less than a full turn (.25mm) a week. 

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Posted : 09/05/2020 1:37 am
eternally12
Active Member

@thomas22

I’m sorry to hear that! Is that sprain from the DNA appliance?

I haven’t had any issues yet with mine, except the acrylic needs to be shaved down more by my dentist because it sort of feels like it’s scraping the side of my palate a bit. And I don’t see him for another month...

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Posted : 09/05/2020 2:58 am
Thomas22 liked
Thomas22
Eminent Member
Posted by: @eternally12

@thomas22

I’m sorry to hear that! Is that sprain from the DNA appliance?

I haven’t had any issues yet with mine, except the acrylic needs to be shaved down more by my dentist because it sort of feels like it’s scraping the side of my palate a bit. And I don’t see him for another month...

It's probably a couple of factors.

I bit down incorrectly, and quite hard, and that canine collided with my upper teeth. The pain started perhaps an hour or two later.

The ligaments are likely loose from expansion.

I may have also been too aggressive about expanding my lower jaw. That area is a bit of a train wreck, with teeth crowding each other, and often overlapping each other.

I had also developed the habit, good or bad, of chewing with that canine, while wearing the appliance. With them in, I would apply pressure to the canine.

-

I had that happen too, it was painful in my case. They took me in for a quick visit and shaved it down.

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Posted : 09/05/2020 3:11 am
eternally12
Active Member
Posted by: @thomas22
Posted by: @eternally12

@thomas22

I’m sorry to hear that! Is that sprain from the DNA appliance?

I haven’t had any issues yet with mine, except the acrylic needs to be shaved down more by my dentist because it sort of feels like it’s scraping the side of my palate a bit. And I don’t see him for another month...

It's probably a couple of factors.

I bit down incorrectly, and quite hard, and that canine collided with my upper teeth. The pain started perhaps an hour or two later.

The ligaments are likely loose from expansion.

I may have also been too aggressive about expanding my lower jaw. That area is a bit of a train wreck, with teeth crowding each other, and often overlapping each other.

I had also developed the habit, good or bad, of chewing with that canine, while wearing the appliance. With them in, I would apply pressure to the canine.

-

I had that happen too, it was painful in my case. They took me in for a quick visit and shaved it down.

Ah so it was from the lower appliance...I see. 

You have been eating with the appliance in? I didn’t even think it was possible - at least not with the upper appliance. Maybe the lower is different.

I definitely am a big advocate of chewing tough foods particularly on the molars - I think this helps reduce teeth tipping. But if your ligaments are quite loose perhaps it would be better to invest in something like Acceledent or a similar machine to help stimulate the area? Not sure.

Also, I have had some good progress recently with my appliance. Most of my TMJ pain on the right side of my jaw has subsided! It’s not cracking as often when I try to open my mouth wide, so that can only be good news. I imagine the TMJ issues may even be completely gone when I expand another millimetre or so. 

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Posted : 09/05/2020 3:24 am
Thomas22 liked
toomer
Eminent Member
Posted by: @thomas22

 

I had also developed the habit, good or bad, of chewing with that canine, while wearing the appliance. With them in, I would apply pressure to the canine.

 

Was that recommended by your provider - eating with the appliance(s) in-place?  I would have thought most providers would have steered clear of that.  The DNA Appliance was always billed as an "after dinner, and overnight" protocol.

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Posted : 09/05/2020 4:04 pm
toomer
Eminent Member
Posted by: @eternally12

But if your ligaments are quite loose perhaps it would be better to invest in something like Acceledent or a similar machine to help stimulate the area? Not sure.

Also, I have had some good progress recently with my appliance. Most of my TMJ pain on the right side of my jaw has subsided! It’s not cracking as often when I try to open my mouth wide, so that can only be good news. I imagine the TMJ issues may even be completely gone when I expand another millimetre or so. 

This is the first time I've heard of this Acceledent machine - is this often used by people going through an expansion process?  I guess since appliances like the DNA are working mostly in the alveolar process just like braces ... anything that helps for stability of orthodontic teeth moving would help here?

Great to hear that your TMJ issues have been subsiding!  My TMJ (+ OSA, + tinnitus, etc.) is one of the reasons I've always leaned towards the DNA approach.  The fact that the provider can keep grinding down the bite wings over time to make sure your occlusion lines up seems like a solid approach for dealing with a messed up bite.

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Posted : 09/05/2020 4:08 pm
Thomas22
Eminent Member
Posted by: @toomer
Posted by: @thomas22

 

I had also developed the habit, good or bad, of chewing with that canine, while wearing the appliance. With them in, I would apply pressure to the canine.

 

Was that recommended by your provider - eating with the appliance(s) in-place?  I would have thought most providers would have steered clear of that.  The DNA Appliance was always billed as an "after dinner, and overnight" protocol.

I don't eat with it in. I don't think I could, there's not enough space, and you'd probably bend a wire.

When I say chew, I'm just chewing on the appliance plastic.

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Posted : 09/05/2020 4:28 pm
Thomas22
Eminent Member
Posted by: @eternally12

Acceledent

Does it speed bone growth?

If it just accelerates tooth movement, I would be concerned about ultimately pushing the teeth out of the bone ridge.

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Posted : 09/05/2020 4:32 pm
eternally12
Active Member
Posted by: @thomas22
Posted by: @eternally12

Acceledent

Does it speed bone growth?

If it just accelerates tooth movement, I would be concerned about ultimately pushing the teeth out of the bone ridge.

I imagine it does both. Anything that would stimulate the jaws would probably help speed up tooth movement if you’re undergoing orthodontic treatment, whilst also speeding up bone remodelling. I have never tried it but I know a lot of people use it alongside Invisalign treatment.

It apparently delivers a series of evenly distributed, high-frequency micro pulses to the upper and lower Jaws. By stimulating the soft tissue and bone, these micro pulses increase the blood supply to the site, which in turn speeds up the remodelling of the jawbone. Apparently it’s also meant to decrease tenderness during orthodontic treatment. I personally wouldn’t mind trying it and I don’t see how it would cause any harm when used in conjunction with the DNA appliance. 

I believe there are a few other devices like this, so may be worth shopping around. I just mentioned Acceledent because it has had some studies done on it and I’ve seen dentists on YouTube use it. 

 

 

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Posted : 09/05/2020 6:53 pm
Thomas22 liked
Thomas22
Eminent Member

That makes sense  

I have a mild hyperbaric chamber, and one of the benefits is that it increases blood flow to areas that have little. 

Hyperbaric chambers have also been used to speed the healing of broken bones. They increase blood flow, but they also increase the number of stem cells by a factor of eight. 

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Posted : 09/05/2020 7:02 pm
eternally12
Active Member

@thomas22

A mild hyperbaric chamber?! That’s very cool. Have you used it much during your DNA treatment?

I know with Acceledent it’s meant to be used for 20 mins every day. 

 

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Posted : 09/05/2020 7:09 pm
Thomas22
Eminent Member
Posted by: @eternally12

@thomas22

A mild hyperbaric chamber?! That’s very cool. Have you used it much during your DNA treatment?

I know with Acceledent it’s meant to be used for 20 mins every day. 

 

I’ve used it inconsistently. I’ve been using a medication that’s contradicted. 

High pressure chambers are often used in sports medicine. They’re good for healing ligament and bone damage. Among other things. 

They turbo charge the healing process. 

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Posted : 09/05/2020 7:37 pm
eternally12
Active Member

I have had to shave down the acrylic several times now myself as it has been consistently cutting into my soft tissue since the last 2-3 turns. I haven’t found any need to see my dentist yet but I’ll probably advise him to shave down more at my next appointment in 2 weeks.

On the bright side my lower jaw is definitely starting to stabilise a lot more. Unfortunately now my mid lines are way off now that it’s started to find a comfortable position, and I’m going to need a lot more expansion on my right side compared to my left arch. I wonder if there is a way with the appliance to perhaps slow the rate of expansion on one side compared to the other so that the side that is significantly recessed can catch up, and I don’t just mean via a bite block...

More good news: I caught up with a friend today who I haven’t seen since getting the DNA appliance and they asked me if I lost weight - which I haven’t (in fact I’ve gained slightly during this lockdown period). And I think it’s because now that my mandible is more forward, my lower jaw is more prominent which makes my face look slimmer. They also mentioned my teeth look even straighter than before (they were already straight from braces), and even thought I may have got them done! So pretty happy in that regard. 

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Posted : 16/05/2020 7:46 am
Thomas22 and PaperBag liked
PaperBag
Estimable Member

@eternally12 Nice to hear it's working well for you. The DNA appliance seems to be great for more minute/complex facial problems, as opposed to the usual train of thought of just pushing everything forward.

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Posted : 16/05/2020 3:18 pm
Thomas22 liked
Thomas22
Eminent Member

When I was a child, I had a normal smile, but by the time I reached eight grade, it looked a little strange.

When I smiled, I developed a deep nasiolabial fold on side of my face, and on the other, well, it looked normal. I looked pretty peculiar.

That's gone away... I don't think it's bone growth, but perhaps it's the lower device shunting my jaw forward? I don't know.

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Posted : 22/05/2020 2:27 am
eternally12
Active Member

@paperbag

One thing I have found super interesting is that the DNA appliance seems to be correcting the tilting of teeth from previous orthodontic work without the need for brackets to be placed on each individual tooth. The idea that expansion alone is enough to guide teeth into their natural position seems to hold true (at least to a degree). I’ve noticed that from previous orthodontic work my upper arch midline had been tilted to the left to try and align the mid lines, however this was a mistake on the orthodontist’s part as he never set the jaws in their natural position in the first place. As I have expanded with the appliance my upper mid line seems to be uprighting to how it naturally was before orthodontic treatment, although it does not align perfectly with the lower jaw mid line now as my lower jaw is still finding a new stable position to sit comfortably.

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Posted : 22/05/2020 7:30 pm
Thomas22 liked
Thomas22
Eminent Member

I need to send my device back for replacement. So I'll be without for four weeks. It's covered under warranty, so it's free, but still, annoying.

Either the wires in the lower are bent incorrectly from adjustment, or my mouth has changed shape so much that it no longer fits correctly. I don't know.

 

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Posted : 23/05/2020 1:31 am
eternally12
Active Member

@thomas22

Is that just the lower appliance? 

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Posted : 23/05/2020 2:15 am
Thomas22
Eminent Member
Posted by: @eternally12

@thomas22

Is that just the lower appliance? 

I only have a problem with the lower appliance, but they require you to send both back at once. Apparently there are several companies that make the devices, and four weeks is a good turnaround. Some of the companies are slower.

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Posted : 23/05/2020 2:18 am
eternally12
Active Member

@thomas22

That’s annoying that they require both to be returned. What if you lose some of the expansion you’ve obtained? Or has your dentist made you a temporary retainer?

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Posted : 23/05/2020 2:20 am
Thomas22
Eminent Member
Posted by: @eternally12

@thomas22

That’s annoying that they require both to be returned. What if you lose some of the expansion you’ve obtained? Or has your dentist made you a temporary retainer?

No temporary retainer.

I'm curious, because they're taking a new impression to create these. Presumably I will lose some expansion while we're waiting, so how well will these devices fit when they arrive?

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Posted : 23/05/2020 2:22 am
eternally12
Active Member

@thomas22

Yes, it will be interesting to see how much you’ve expanded and how much relapse there might be during this 4 week period.

What do you guys think about turning the screw a half turn every 2-3 days instead of a full 0.25mm every 4-7 days? 

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Posted : 23/05/2020 6:16 am
Thomas22
Eminent Member

That makes sense to me. It might even be better?

Compliance might be harder though, patients would have a harder time remembering their schedule.

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Posted : 23/05/2020 2:15 pm
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