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Got MARPE/MSE intalled  

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Agendum
Eminent Member

I am 28 yrs old with narrow palate and subjectively suboptimal breathing airflow so I went an scheduled it to be done. Not sure if MARPE/MSE are interchangeable at this point as when I asked what kind of device I was going to get prior was and was told it was modified MSE II. The orthodontist marketed it on her website as MARPE without indicating the MSE keyword that many people are interested in.

I will be doing about 8mm with the total cost of about $8000. The appliance and its installation are about $2000 and the Invisalign following it will be the rest of the cost (along side narrow palate my lower arch is very crowded with a highly recessed lower canine.)

I am posting this nearly a day after its installation. For me I had to get spacers between my first molar and back molars because of the crowding 1 month before the appliance was to be installed (so that it can anchor the arm onto the molars.) When I arrived I was noted to have particularly very dense and thick bone at the palatal suture (no tongue was going to cope through that) so longer screws were needed to pass through the bone. The installation included a few local anesthetic injections which the orthodontist overrated at being painful but wasnt (likely due to adequate topical anesthetic.) Was given 800 mg of Ibuprofen as well.With the palate numbed I could hear the screws squeaking as it was manually turned (with a hand tool) screwing into my bone. Then a Peridex rinse of was done. I was shown how to turn the screw making 2 turns (1-2 turns a day.)

The worst part of it so far was initially leaving the office. On the hour long ride home, the discomfort. Well......discomfort is an understatement! The feeling is hard to describe but for hours it felt like........imagine inhaling frozen crushed powdered black pepper, with a tinge of ouch! The discomfort is of the annoying variety, where you are easily agitated and bothered by sounds like people talking. Any kind of suction in the mouth feels kinda weird, so you end up using your rear tongue to swallow saliva rather than your buccinators. The discomfort described went away after waking from sleep (after only being awake with the device for 3 hours.)

 

Additional notes:

-Chewing with the appliance is very weird as the part of the metal arms interupts molar contacts which is weird eating.

-Was able to eat Salmon and M&M's very awkwardly followed by a salt rinse.

-Instead of going full out on expansions like 10mm+ we are going more conservatively so that the Invisalign can upright my lower molars to meet the expanded upper arch

-Next month when I return we are going to evaluate and possibly try out protraction (ortho said that it has minimal effect but I want to experiment anyway to report its efficacy as a method.)

-This post was created about 20 hours after installation with only the initial 2 turns will post relevant updates.

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Posted : 18/06/2020 8:19 am
Thomas22 and Apollo liked
tentpepperoni
New Member

keep us updated

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Posted : 22/06/2020 8:57 pm
Agendum
Eminent Member

Update #1:

-9 Days after installation, 18 turns on my modified MSE II appliance.

-Nasal breathing noticeably better as I was plagued by chronic stuffy noses, finally unobstructed access to my wind pipe.

-No suture split yet, no tenderness along it beside the area (of suture) where MSE screws in

-No diastema yet, or signs of it

-Very slightly more youthful appearing skin (skin quality and how it overlays underlying bone)

-Maxillary body subjectively feels slightly more full but might be an illusion of feeling the soft tissues

-Malar base very slightly widened but no noticeable effect on zygomatic arch

-Floating bite, cant find a good resting position early on, gets worse with time on top of the obtrusive metal arms and bands anchored on the molars

-No pain where screws are but feels like a plaque-like film is coating the rear side of the appliance even after brushing with interproximal brushes

-Food stuck constantly

 

 

-This widening has made my already asymmetries more noticeable to me (my poor occlusion throughout my life has shifted the cant of my face relative to my body, I have a slightly tilted face despite my other cranial features being normal.)

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Posted : 25/06/2020 1:51 pm
Apollo liked
MagnumOpus
Eminent Member

Hi, I also just got the MSE 2 installed last week. However I am following 1 turn per day, per my ortho, and which Ronny Ead suggests in his recent video "MSE Risks and Potential Complications" at 4:30. And this is the Ting Protocol which is 1 turn per day. Ron Ead says this slow rate is better for avoiding asymmetries.  And the corticopuncture won't heal soon enough that 1/day is a problem. What I mean is if the diastema usually happens from 20-40 turns, the corticopuncture won't be healed by this time so it's fine to do 1/day. Have you asked your ortho about this? Still, 2/day is fairly slow so it's probably fine.

-MO

-MO

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Posted : 25/06/2020 2:47 pm
Agendum and Apollo liked
Agendum
Eminent Member

@magnumopus I did not have corticopuncture, just the appliance with its screws drilled into the bone, I havnt asked my ortho about it yet. I wouldnt really be the one to ask about this, sorry.

As for asymmetries, my skull/face are already asymmetric beyond my palate, I dont think can really correct that (or atleast not afford it if anything exists.)

Ive seen all of Ronald Ead's videos and I like his assessment on it with and his favoring slower expansion but so far 2/day still feels comfortably slow to me as I would have expected to feel like there would be more pressure in my bones from all the brute force of the appliance but I do not.

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Posted : 25/06/2020 3:34 pm
Apollo liked
MagnumOpus
Eminent Member

@agendum

Oh ok. Thanks for clearing that up. I've also noticed improved nasal breathing so far. Keep me updated, I plan to try to use the facemask in the future after sutures disarticulate. Trying to get forward protraction but I know it can be difficult in adults. 

Yeah 1/day is quite slow. I've felt slight tension with turns that goes away after 10-30 minutes so far. I assume with more turns the tension will last longer. 2/day seems fine. 

-MO

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Posted : 25/06/2020 9:04 pm
Apollo and Agendum liked
Agendum
Eminent Member

@magnumopus I go back in 3 weeks for checkup and Ive already asked about facemask but my ortho said that the facemask has little effect but I will still try it and report on it since information on it is very scarce.

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Posted : 25/06/2020 9:37 pm
Apollo liked
MagnumOpus
Eminent Member

@agendum Got it. Have you felt pressure on your 1st molars, where the MSE bands are attached? I definitely feel some soreness here which was originally making me worried there's too much tooth borne force.

However, 1. It's pretty minor soreness, 2. I think this amount of soreness won't cause any molar damage, which is the main thing I would be worrying about. 3. it may just be "getting used to" the expansion and the soreness will go away in a couple weeks. And 4. Some orthos cut off the molar attachment after the diastema, per Ron Ead. I think this is to avoid further tooth tipping. So even if there is minor tooth tipping it may be fine for just 1-2 months until the attachments are cut off, leaving only the bone anchored screws. But I think Ron Ead said Dr. Ting does this, i'm not sure if other orthos do.  I don't think it's a big deal overall that I feel soreness. But it's enough to make me not want to chew hard on tough foods right now.

-MO

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Posted : 25/06/2020 11:13 pm
Agendum and Apollo liked
Agendum
Eminent Member

@magnumopus I have it anchored on my 1st molars, there is pressure when chewing on them at  some angles. I agree, I feel there is too much force anchored on the molars too as most of the expansion so far appears to be towards the back (no diastema at 20 turns so far.) I try to chew with my incisors to avoid the discomfort/soreness of the anchored molars.

My 2nd molars, especially my left 2nd molar was naturally tipped but now it seems a little bit more with very slight twisting in orientation. Not sure if its more about my own unique aveolar arch shape (more of a narrow rectangular "arch.") My premolars are more inward but with good uprighting. Im 28 so my age might make it more likely that the force is mismatched with the suture and tooth anchorage.

I was going to ask my ortho about the removal of the arms soon (and other questions.)

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Posted : 26/06/2020 9:37 am
MagnumOpus and Apollo liked
MagnumOpus
Eminent Member

@agendum Oh ok. Is there any thread for all the MSE patients, or MSE+ facemask patients? I know some individuals have made threads like yours, but I wonder if there is 1 thread for everyone to discuss the things we've been talking about. For example, ideal angle to pull at for facemask? I have seen the simulations and some papers that have been mentioned on this site mentioning between 0 and 30 degrees, or directly out from the occlusal plane (0 degrees) to 30 degrees above the plane. But I wonder which is best. 

-MO

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Posted : 26/06/2020 12:19 pm
Agendum liked
Thomas22
Trusted Member

I would love to know how your faces changes though treatment, and if the device resolves asymmetries.

 

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Posted : 26/06/2020 11:19 pm
Agendum liked
Agendum
Eminent Member

Update #2:

When at 22 turns I noticed that the MSE II appliance started slowly shifting to my right side of the palate flush against  part of my ridge. The arms are of a different material strength (being called weak) which caused them to warp due to my bone being uniquely dense. Initially the arms had a bout a 1mm clearance from my palate+aveolar ridge, I could clean through them by squeezing an interproximal brush but now I cannot really due that on the right side but now the arm on the left side has more clearance (which isnt really cradling my ridge though as it anchors onto my left molar that feels more discomfort now.)

The problem is that I have a kind of Torus Palatinus (not like the images where it looks bumpy but more like additional thickness) so my bone is VERY dense. The screws hold very well with no warping so far but the appliance cannot break my suture without warping the arms.

The next step is that we will order another modified MSE II and reinstall it in a few weeks but this time I will use an extensive Corticopuncture (said to be twice as painful as the initial installation.) Originally, prior to the initial installation I suggested that we do corticopuncture but my ortho sided on trying less invasive methods and it turns out that I was right to suggest it. Not being adamant about it lost me a few weeks of expansion, kind of wasting alot of time and frustration (with tooth discomfort.) I have stopped expanding until my next appointment in 3 weeks and have also reversed some expansion due to the discomfort.

Only positives of the couple of weeks of slight expansion of the alveolar ridge by maybe a milimeter is that I have slightly better access to my airways through nasal breathing and that the alveolar ridge is aesthetically wider at the back (only from slight tooth tipping from the molars but not from the premolars to the incisors.) No sign of a diastema due to a failure of splitting the suture. I dont have a good explanation for it but the skin around my midface (beside the nose/under the eye rim) seems to be fuller.

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Posted : 01/07/2020 7:38 pm
Apollo liked
Apollo
Reputable Member
Posted by: @agendum

The screws hold very well with no warping so far but the appliance cannot break my suture without warping the arms.

Thanks for the update and sorry to hear about this complication! I also have a palatal torus and I worry about this kind of problem myself. Did they take an X-ray showing that the screws are still vertical? I wonder if faster activation in the range of 4-6 turns per day until diastema as recommended by Dr. Won Moon would be more successful in cases like ours with thick/dense bone. 

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Posted : 01/07/2020 8:44 pm
Agendum liked
Agendum
Eminent Member

@apollo Yeah, the screws are firmly uprighted since we took a 2nd xray (I might post the DICOM files after Ive completed the treatments some time from now.)

I dont think intensity+speed is the answer since the weak materials of the arms of the appliance mismatch with the durability of the MSE implant acting more as guiding stabilizers than force absorption. I think having the PT (palatal torus) almost guarantees the need for a corticopuncture as Ive learned today and from other people's anecdotes (scarce as it is.) It seems like MSE providers are being a bit picky with who they perform corticopunctures on, its appearing that it should be the default for those with dense bone. My ortho even passively suggested options including surgically cutting through it which really we wanted to avoid, Im currently paying for this out of pocket.

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Posted : 01/07/2020 9:24 pm
Apollo liked
mamabear2020
New Member

@agendum  Did you get the corticopuncture done?  My family and I also are going through MSE.  My son is 18 and the Dr did not do corticopuncture, but his palate is not splitting and seems to be slightly warping after 24 turns (1 turn per day).  We are going to Dr. Ting and he wants to do surgical assist if there is no split in the next few weeks.  I got mine with corticopuncture because I am older and have a torus.

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Posted : 31/07/2020 3:20 am
Agendum
Eminent Member

@mamabear2020 After what was supposed to be my appointment ended up with a delay due to my ortho ordering my MSE wrong, so I had to wait another month (corticopuncture initially scheduled for last week but now re-scheduled to 8/11.) I have recently had my failed-MSE removed and replaced it with a retainer awaiting the new MSE to be built. The new MSE will be configured to be placed slightly more anteriorly + corticopuncture with additional perforations. My ortho loosely suggest a surgical split but I did not want to go down that road, neither did she. I think the arms of the appliance are anticipating a lower threshold to split the maxilla but patient palatal suture stubbornness varies too much.

Im beginning to think that corticopuncture should be the default option from many the anecdotes of failure to split the suture, the corticopuncture seems like a better way to standardize the process. My error was not being more insistent when I suggested corticopuncture prior to the initial installation as my assumption was correct over my ortho's conservatism. I will have to see for myself once I get it but I will post more updates.

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Posted : 31/07/2020 6:55 am
Agendum
Eminent Member

Update #3:

 

After the initial installation failed due to thicker bone (palatal tori) I have got it re-installed to be placed a few mm further forward with corticopuncture. It was a little more painful from the swelling this time around but after sleeping for a few hours the pain subsided but its still a bit tender.

 

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Posted : 11/08/2020 11:44 am
Apollo liked
Apollo
Reputable Member

Your torus looks pretty small.

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Posted : 11/08/2020 1:20 pm
Agendum
Eminent Member

@apollo Its mild but enough to need the corticopuncture. My ortho commented more on the bone density she saw in the scans than what she saw from looking into my mouth in her evaluations.

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Posted : 11/08/2020 1:47 pm
byemiek
New Member

Im new in this forum, I sit to see your evolution! Thanks for share

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Posted : 16/08/2020 3:39 pm
Agendum liked
mysterecessed
Active Member

@agendum 

Hey, I have a few questions:

1) Have you found out the difference between MSE and MARPE? I found a doctor who say she offers MARPE too, hasn't mentioned MSE.

2) Would you consider your cost of $8000 ($2000 MSE, $6000 invisalign etc.) expensive for this type of thing? I read that Ronald Ead had to pay more for his, it's in a youtube comment, I remember he mentioned it was more than $10k, though I'm not too sure and can't find the video with the comment now. 

3) You describe the discomfort on the way home, did they not give you additional painkillers for after the surgery?

4) What made you go with MSE instead of a DNA appliance?

Also read that you are experiencing increase asymmetry when expanding. It sounds scary that it might make your face even more assymterical. Has your doctor said anything about this or mentioned this possibility before the installation?

Will continue following your thread. I have a Torus Palatinus too, in fact I didn't know that the top palate was supposed to be flat before coming to this forum, I don't think mewing will help me split the suture.

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Posted : 20/08/2020 10:59 pm
Agendum
Eminent Member

@mysterecessed

1) The ortho that I went to lists her procedure as MARPE on her website and paperwork but informed me that I was given a MSE II appliance. I am still confused as to wrether its interchangeable or not. Some call MSE a form of modified MARPE.

2) I was surprised to hear that it wasnt around $10K+ because of the anecdotes Ive heard about its cost. I think the high cost circulating was because of Ronald Ead's case, he spends alot of  time with orthodontists which is how I think they priced it for him. In the price summary got for mine, I thought that the MARPE/MSE would have been most of the cost but its likely that Invisilign costs more because it takes many months of treatment from an ortho whereas (ideally) the rapid skeletal expansion only takes a few months.

3) I didnt take enough ibuprofen prior, Im not used to taking painkillers. The swelling is mostly the problem with subsides after taking a long nap. I was given ibuprofen after the installations but I didnt not take enough earlier (a fault on my part.) If you cant sleep, its actually better to go for a walk since I was pacing around at home (I walked the dogs with my dad to distract me.) Im kind of a baby with pain so Im not much of a reliable testimony.

4) I chose MSE over DNA because Ive researched the importance in bone-bone expansion for someone with as stubborn bone as mine. Soft and slow forces of my tongue or appliance werent going to be enough to cross the threshold at my age (28.) Ive spent alot of time comparing the various scans of airways of patients with different kinds of expanders (considering their age and other their individual morphology) and began to see the obstacles of conventional tooth-bone appliances. I found this presentation to summarize some of my views on expansion very helpful https://www.pathlms.com/pcso/events/1648/video_presentations/143837

-One important highlight of skeletal expansion was the expansion of the nasal floor, Ive always had stuffy noses and poor access to the back of my airways. Surprisingly when I got my first scan in my consultation I discovered that my pharyngeal cavity had good volume but it seems that my narrow nasal cavity was a slight bottleneck to that airway. My tongue is recessed to the rear due to insufficient space as well. 

-The skeletal expansion aspect was a big selling point for me, for both functional and aesthetic purposes, Ive always had the suspicion that my problem was of a lack of maxillary space so anything prioritizing that caught me eye. Id be lying if I didnt admit a big reason why I chose this was for asthetics but I knew that aesthetics and function are usually one in the same. MARPE/MSE have been shown to have some effects on the maxilla due to it skeletal expansion and it shows, little for interpretation. Lateral deficiency is a common asthetic issue that is resolved with maxillary expansion. My approach was more of a corrective on aesthetics rather than to exceed my genetic potential.

-The turn offs for DNA appliance was that experience I had with the ortho I had a consultation with, he told me that patients had tooth tipping and changed the subject to shill for his ALF appliance that was overpriced. In retrospect, I felt like I was in some marketing funnel, especially with the use of buzzwords indicative of the pop-science of the time of its creation (like epigenetics.) I could be unfairly evaluating DNA protocol but my "spidey senses" were giving me sketchy vibes. There are only a few low resolution images to refer to of patients with it and its always the same handful of reoccurring patients and comparative scans are sometimes at different depths (Im not sure if its frauding or just accidental.) I just dont trust that it would be effective for me. I would rather go with rapid maxillary expansion because it takes out the guess work. I generally see the DNA appliance as trying to emulate the tongue's dynamic forces but are insufficient with a stubborn suture. My views on correcting late jaw development are Suture-centric. DNA protocol intends to explore a less suture-centric method for corrective remodeling but it doesnt seem very convincing, especially with it being tooth-borne.

-Acrylic expanders dont commit to their purpose as well as bone-bone appliances that work 24/7. Ideally I thought that the DNA appliance applied dynamic forces intelligently (almost like the tongue) with a corrective and gradual bone remodeling course but it doesnt appear to show its effectiveness (atleast to me.) With the "dumb" rapid expansion I can get with bone-bone appliances I can allow my tongue posture to make the small corrective adjustments for gradual remodeling. I started out interested in the DNA appliance but then I came to value the brute force of maxillary expansion for my own case.

From what Ive looked into, it seems asymmetry is definitely something to look out for but I think its more about preexisting asymmetry from living years with canted occlusion. In my case I have a slight canted maxilla, my face+bite is almost imperceptibly slanted to which even my lower jaw follows this cant. My lateral deficiency of my upper teeth restricted my lower teeth/jaw from expanding in development so I project that after expansion, there might be some potential for remodeling (with corrected occlusion) but even that might be wishful thinking. It depends on what you prioritize.

If you have palatal tori, insist on corticopuncture. From other people's anecdotes, it seems to me that patients are feeling their orthos are being too conservative in their approach, I think its because MARPE providers want to highlight the non-invasiveness of regular installations which is an attractive selling point of it in the first place. I think performing corticopuncture with palatal tori removes alot of the anxiety and uncertainty of the suture split.

 

Hope this helps.

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Posted : 21/08/2020 7:46 am
Agendum
Eminent Member

 

Update #4:

24 turns and what drove me to post was the relevant change of a diastema. In the last two days I added in an additional turn mid-day (a total of one day ahead of schedule due to my anxiety of splitting the suture as to not tip my molars.) It is really bizarre to me, a few hours ago my incisors were touching, then after my most recent turns I got a tender, slight burny/achey feeling on my midpalatal suture up to my nasal opening. Within an hour I check the mirror and I have a 1mm diastema! It seems as if the anterior portion was catching up to the corticopuncture site in that short time frame. It was those last turns that caused suture split, but Im not sure if there is a split posteriorly. I intend for this to be parallel expansion but this more anterior MSE II placement might affect the outcome.

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Posted : 21/08/2020 8:04 am
Apollo liked
mysterecessed
Active Member

@agendum

Damn, thanks for the detailed response. I'm definitely still deciding between MSE or DNA. A huge part of me not wanting to get MSE would be seeing how Ronald Ead's teeth became during MSE. I mean, it's not for a very long while, but it still sucks and is kinda scary. That and the possible pain and discomfort of having something constantly inside your mouth. Also, I've read that MSE doesn't create forward growth and upswing and only expands laterally, is this true?

Btw, are you saying DNA doesn't do anything for the mid-palatal suture? Just wanted to clarify.

Also, what was your starting IMW? Mine seems to be somewhere around 40-43mm. I also seem to have either a slight class 3, or an open bite (incisors meet but molars don't).

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Posted : 21/08/2020 9:27 pm
Agendum liked
Agendum
Eminent Member

@mysterecessed Ronald Ead's mouth became messed up because of AGGA, but his mouth has had so much work done that his case is rather exceptional.

I thought that the MSE would be more cumbersome in my mouth but its not as obstructive as one might think. Its the swelling from the installation and midpalatal suture split that have discomfort/pain events but are only a few hours. Most of the time you dont really feel it, worst part for me is that in my narrow mouth I keep biting my tongue (the tooth bands catch my tongue tissue sometimes.)

That is correct, MSE is not an appliance that expands foreward. The beauty is in its simplicity, that it primarily expands laterally. Its likely the best  at what it does.

I dont believe DNA splits it but I could be wrong. If its tipping teeth in some patients it doesnt seem to have a suture splitting effect in them.

My starting IMW is abour 33-34mm, projected to get about 8mm (Im trying to get more hopefully.) You have a decent IMW, so you may have a hard time convincing an ortho that you'd be a candidate for the procedure. You might not even need it. Your molar open bite might be related to tooth uprighting.

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Posted : 21/08/2020 11:23 pm
JordanR
Active Member

Not surprised you needed corticopuncture.

Something I have not been able to find any information on, or come to answer myself is, why exactly do MSE-like appliances need to attach to the molars at all?

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Posted : 22/08/2020 8:57 am
Agendum
Eminent Member

@jordanr Not exactly sure either. I think its to stabilize the expansion since there is a lot of resistance at the zygomaticomaxillary buttress. I do hear that some orthos choose to cut the arms off the MSE appliance at certain points of expansion.

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Posted : 22/08/2020 11:30 pm
Apollo
Reputable Member

Has your diastema gotten any wider from turning the past couple days, or has it stayed about the same since you noticed it?

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Posted : 23/08/2020 3:17 pm
Agendum
Eminent Member

Its stayed the same, its flat 1mm clearance according to measuring tape, practically unchanged. The picture I uploaded didnt really do it justice, its a diastema that can be seen a few feet a way. There is some tenderness but it feels more like a Pacman suture split than a parallel one so far.

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Posted : 23/08/2020 8:27 pm
Apollo liked
Apollo
Reputable Member
Posted by: @agendum

It feels more like a Pacman suture split than a parallel one so far.

Can you actually feel an indentation on your pallet between the two sides of the suture by pressing with a finger or fingernail? I got a very small gap between my teeth (even smaller than yours), but I don't think my suture has actually opened yet, and the gap hasn't gotten any bigger.

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Posted : 23/08/2020 8:58 pm
Agendum
Eminent Member

@apollo theres a thin ridge of bone (tori) that seems to obstruct me from feeling it in the rear but I have no sense that any split occurred posteriorly.  The front using my fingernail feels a bit like soft tissue, less than tested with the parts of my mouth 

You'll feel it when your suture splits, I had that tiny tiny gap early expansion but for me the diastema forming split occurred in as a single event lasting an hour. I havnt heard anyone else describe their split like mine but it might be because of palatal tori. I remember reading that you have a heavy case of palatal tori, did you get corticopuncture?

 

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Posted : 23/08/2020 9:31 pm
Apollo liked
Apollo
Reputable Member
Posted by: @agendum

I remember reading that you have a heavy case of palatal tori, did you get corticopuncture?

I have a relatively minor torus (much less prominent than most of what you see if you google torus palatinus), but mine is more conspicuous than yours. The two halves of my torus look to be moving to the sides away from the midline. I did have a corticopuncture performed. 

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Posted : 23/08/2020 9:52 pm
Agendum
Eminent Member

@apollo My ortho and I discussed grinding down the bone in passing but I havnt heard much about it as an option.

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Posted : 24/08/2020 8:12 am
Apollo
Reputable Member
Posted by: @agendum

@apollo My ortho and I discussed grinding down the bone in passing but I havnt heard much about it as an option.

My orthodontist mentioned this too, but I'm not sure it would have helped.

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Posted : 25/08/2020 9:47 pm
mysterecessed
Active Member
Posted by: @agendum

@mysterecessed Ronald Ead's mouth became messed up because of AGGA, but his mouth has had so much work done that his case is rather exceptional.

I thought that the MSE would be more cumbersome in my mouth but its not as obstructive as one might think. Its the swelling from the installation and midpalatal suture split that have discomfort/pain events but are only a few hours. Most of the time you dont really feel it, worst part for me is that in my narrow mouth I keep biting my tongue (the tooth bands catch my tongue tissue sometimes.)

That is correct, MSE is not an appliance that expands foreward. The beauty is in its simplicity, that it primarily expands laterally. Its likely the best  at what it does.

I dont believe DNA splits it but I could be wrong. If its tipping teeth in some patients it doesnt seem to have a suture splitting effect in them.

My starting IMW is abour 33-34mm, projected to get about 8mm (Im trying to get more hopefully.) You have a decent IMW, so you may have a hard time convincing an ortho that you'd be a candidate for the procedure. You might not even need it. Your molar open bite might be related to tooth uprighting.

Cool, so would I be right to say that the worst thing that you and your orthodontist are expecting to happen to your teeth would be an 8mm gap between your front two teeth? Unlike Ronald Ead who seemed to develop gaps between his molars and even his incisors/premolars and such. Also, would you happen to know why his teeth became so yellow as well? I'm not sure if he addresses it in his videos.

May I ask what you mean by "Your molar open bite might be related to tooth uprighting"? Would something like invisalign braces be used instead of DNA or MSE to solve this?

I definitely have a recessed maxilla though, my main goal is to achieve forward growth and upswing, but tbh from what I've read, no device (MSE or DNA) outrightly promises this effect and it'll be a gamble for me to commit to either system in hopes of achieving this. Is that right?

Did you talk to your provider about upswing and forward growth before getting MSE? It seems like something I should definitely ask my potential provider(s) about but I'm not sure if those terms are considered "taboo" or will get laughed off/dismissed.

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Posted : 29/08/2020 10:09 pm
Agendum
Eminent Member

@mysterecessed I currently have about a 2mm gap between my teeth but its not as bad asthetically as I thought it would be (a slightly fuller expanded face from more bone support might be compensating for that gap but we will see.) Im not sure about the yellowing of the teeth but plaque does collect on top of the MSE. When I got my first one removed I was disgusted at how much plaque and debris there was even with me meticulously cleaning it with a interproximal brush. Maybe theres more total food debris that can be in the saliva, Im not sure. The actual worst part of this is a concern over my last molars, I still have some problematic tooth contact due to preexisting flared upper molars. They are contacting the lower molars and slightly moving them through the aveolar bone but it might be due to the cant of my jaw.

Maybe invisilign would work but Im not the right person to ask this as Im just a layman. You already have a workable IMW so it might be an option as Im trying to reach your starting IMW.

Well, my orthodontist agreed to do protraction after expansion but told me to expect very little if any movement at my age (28, nearly 29.) Jaw surgery would really be the only way to be sure you'd get some foreward growth. We are still in the "stone age" of good foreward growth methods unfortunately. Its not taboo but I think they feel that its results are very underwhelming, when I brought it up my ortho tried to focus as little as possible acting as if it didnt even exist. I still recognize it (protraction) as experimental and have little hope for its effectiveness but Im one of  few people giving comprehensive anecdotal accounts on the MSE experience. I partially want to attest if FM is a waste of time or not but as some say "mm are miles on the face." Its estimated to give you 0-3 mm max as Ive heard for males.

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Posted : 29/08/2020 11:31 pm
Silver
Trusted Member
Posted by: @agendum

@mysterecessed I currently have about a 2mm gap between my teeth but its not as bad asthetically as I thought it would be (a slightly fuller expanded face from more bone support might be compensating for that gap but we will see.) Im not sure about the yellowing of the teeth but plaque does collect on top of the MSE. When I got my first one removed I was disgusted at how much plaque and debris there was even with me meticulously cleaning it with a interproximal brush. Maybe theres more total food debris that can be in the saliva, Im not sure. The actual worst part of this is a concern over my last molars, I still have some problematic tooth contact due to preexisting flared upper molars. They are contacting the lower molars and slightly moving them through the aveolar bone but it might be due to the cant of my jaw.

Maybe invisilign would work but Im not the right person to ask this as Im just a layman. You already have a workable IMW so it might be an option as Im trying to reach your starting IMW.

Well, my orthodontist agreed to do protraction after expansion but told me to expect very little if any movement at my age (28, nearly 29.) Jaw surgery would really be the only way to be sure you'd get some foreward growth. We are still in the "stone age" of good foreward growth methods unfortunately. Its not taboo but I think they feel that its results are very underwhelming, when I brought it up my ortho tried to focus as little as possible acting as if it didnt even exist. I still recognize it (protraction) as experimental and have little hope for its effectiveness but Im one of  few people giving comprehensive anecdotal accounts on the MSE experience. I partially want to attest if FM is a waste of time or not but as some say "mm are miles on the face." Its estimated to give you 0-3 mm max as Ive heard for males.

Can't you just mew normally once you get enough transverse space? I don't understand why everyone is so interested in the FM—wouldn't mewing with your tongue be a trillion times more effective?

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Posted : 04/10/2020 12:21 am
Agendum
Eminent Member

@silver The difficulty in breaking the sutures with a vaulted and narrow palate (with a large tongue) is a monumental task, or even for some supposed bone remodeling. My tongue had to scallop to even fit on the roof of the mouth like a skilled contortionist, it would be unfeasible to maintain this position for the hope that some force could slowly remodel the suture or bone around it after my age of >25 years old. When I got the MSE the amount of mechanical force needed to make a split was immense, to think that the people are trying to use tongue posture to split the suture after 25 years old is now laughable.

The thing about mewing is that the body would've formed the correct tongue posture as a natural habit but people cannot mew correctly not because of some lack of technique but because of structural issues like lack of airway space. Poor tongue posture is a symptom of poor structural development. The only practical benefit of things like consciously mewing is more on maintaining tongue posture acting as your craniofacial retainer (preventing things from getting worse.) For people like me with the challenges, tongue posturing is futile due to insufficient space (I cannot fit much of my tongue in my own mouth like many people here.)

FM results hasnt come to any consensus yet, some say that it does zero change anywhere, some say that it may/may not achieve counter-clockwise maxillary rotation, some say that the protraction is only dentoaveolar and some results are saying that 1-3mm total maxillary protraction is possible (a translation of bone position.)

The reason why FM is paired with MSE is because MSE (if successful) can loosen or break the sutures of the maxilla. Some patients get loosened zygomaxillary and pterygomaxilllary sutures which might benefit protraction. This is all still experimental so its hard to say as even I havnt gone through it yet. Im currently having complications in my own process of MSE (I have to go through a 3rd round of MSE installation.) Theres too much skeletal resistance to attribute any realistic chance for mewing to affect the other sutures of the face (unless you spend a decade in the hopes of imperceptible remodeling after age 25.) Mewing as an internet phenomenon has shown to be presenting unrealistic expectations of its efficacy. If the tongue were effective I wouldnt have sought out this procedure.

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Posted : 04/10/2020 9:54 am
Silver
Trusted Member
Posted by: @agendum

@silver The difficulty in breaking the sutures with a vaulted and narrow palate (with a large tongue) is a monumental task, or even for some supposed bone remodeling. My tongue had to scallop to even fit on the roof of the mouth like a skilled contortionist, it would be unfeasible to maintain this position for the hope that some force could slowly remodel the suture or bone around it after my age of >25 years old. When I got the MSE the amount of mechanical force needed to make a split was immense, to think that the people are trying to use tongue posture to split the suture after 25 years old is now laughable.

The thing about mewing is that the body would've formed the correct tongue posture as a natural habit but people cannot mew correctly not because of some lack of technique but because of structural issues like lack of airway space. Poor tongue posture is a symptom of poor structural development. The only practical benefit of things like consciously mewing is more on maintaining tongue posture acting as your craniofacial retainer (preventing things from getting worse.) For people like me with the challenges, tongue posturing is futile due to insufficient space (I cannot fit much of my tongue in my own mouth like many people here.)

FM results hasnt come to any consensus yet, some say that it does zero change anywhere, some say that it may/may not achieve counter-clockwise maxillary rotation, some say that the protraction is only dentoaveolar and some results are saying that 1-3mm total maxillary protraction is possible (a translation of bone position.)

The reason why FM is paired with MSE is because MSE (if successful) can loosen or break the sutures of the maxilla. Some patients get loosened zygomaxillary and pterygomaxilllary sutures which might benefit protraction. This is all still experimental so its hard to say as even I havnt gone through it yet. Im currently having complications in my own process of MSE (I have to go through a 3rd round of MSE installation.) Theres too much skeletal resistance to attribute any realistic chance for mewing to affect the other sutures of the face (unless you spend a decade in the hopes of imperceptible remodeling after age 25.) Mewing as an internet phenomenon has shown to be presenting unrealistic expectations of its efficacy. If the tongue were effective I wouldnt have sought out this procedure.

Sorry, what I meant is why pick the FM after successful MSE treatment instead of just mewing afterwards? If you finally get enough space, and the sutures are loosened, wouldn't that make mewing with your tongue much more effective than FM protraction?

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Posted : 04/10/2020 6:36 pm
Agendum
Eminent Member

@silver I think I heard Won Moon describe that the bones re-fuse within a month or two, the window is a small time for the opened facial sutures. The FM provides stronger and more consistent foreward force than the tongue can offer (many hours a day considering the space in the mouth.) Lateral expansion is only half the battle to allow the tongue for corrective tongue posture. You can do both FM and mewing at the same time.

 

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Posted : 05/10/2020 9:26 am
Silver
Trusted Member
Posted by: @agendum

@silver I think I heard Won Moon describe that the bones re-fuse within a month or two, the window is a small time for the opened facial sutures. The FM provides stronger and more consistent foreward force than the tongue can offer (many hours a day considering the space in the mouth.) Lateral expansion is only half the battle to allow the tongue for corrective tongue posture. You can do both FM and mewing at the same time.

 

Isn't the point of the MSE to create enough space so that you can do that? When I had my tongue tie released, I automatically swallowed correctly and woke up with my tongue suctioned to the palate (as much as it is able to with my buccally tipped molars). Mewing correctly is continuous—24/7, but the FM is only as many waking hours as you can stand to have it on.

 

Do those sutures re-fuse within a month or two of MSE splitting the suture, the end of expansion, or whenever you take the device out?

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Posted : 05/10/2020 8:42 pm
Agendum
Eminent Member

@silver Not enough according to differing circumstances, the lower jaw (and funds) can be a limiting factor for how much you can expand. I do not have a tongue tie, just inadequate space so our conditions are different.

The FM adds unique kinds of force that the tongue doesnt offer: Translational movement. Its not the best but better than nothing. Again, you can do both at the same time but I think tongue posture should be seen more as a retainer than directly shaping the face.

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Posted : 06/10/2020 9:50 pm
Silver
Trusted Member
Posted by: @agendum

@silver

The FM adds unique kinds of force that the tongue doesnt offer: Translational movement. Its not the best but better than nothing. Again, you can do both at the same time but I think tongue posture should be seen more as a retainer than directly shaping the face.

Not to be antagonistic, but for the sake of others who may be trying to decide about MSE for themselves: that literally is the point of mewing, and you can achieve translational movement with your tongue, and if you can do it correctly, that ought to be the fastest way to do so. What else shapes the face when growing? It's the tongue, lips, and mastication muscles.

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Posted : 07/10/2020 9:33 am
Agendum
Eminent Member

@silver Tongue posture affects foreward movment by rotation, it has some cascading effects on the bones to a small effect but its forces are different than a mechanical appliance like a FM. Mechanical appliances are intended to aid one's inablitity to perform certain tasks. The options of appliances/procedures we have today are unimpressive but its all we have in this day and age. Its basically experimental.

"The doing it correctly" is based on your preexisting bone structure and soft tissue situation. Lateral expansion alone isnt enough for some people to perform good tongue posture correctly.

Posted by: @silver

What else shapes the face when growing?

Need I remind you that this is in the Adult Case Discussions?

 

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Posted : 07/10/2020 11:47 am
Lee liked
Silver
Trusted Member
Posted by: @agendum

@silver Tongue posture affects foreward movment by rotation, it has some cascading effects on the bones to a small effect but its forces are different than a mechanical appliance like a FM. Mechanical appliances are intended to aid one's inablitity to perform certain tasks. The options of appliances/procedures we have today are unimpressive but its all we have in this day and age. Its basically experimental.

"The doing it correctly" is based on your preexisting bone structure and soft tissue situation. Lateral expansion alone isnt enough for some people to perform good tongue posture correctly.

Posted by: @silver

What else shapes the face when growing?

Need I remind you that this is in the Adult Case Discussions?

 

I think you're just tongue-tied lol

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Posted : 07/10/2020 2:21 pm
Blacbeast
New Member

Hi,

 

I'm 26 years old and I recently got MSE installed. About 25+ turns in and I see no Diastema visible as of now...

Since you had an unsuccessful first attempt(1) I would like to ask you how painful was it to when the corticopuncture was performed?

 

And (2) did you notice any molars flaring out during your initial expansion? Please have a look at the attached picture.. the first one being on the day of installation and the last one being now.

 

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Posted : 10/10/2020 3:19 pm
Agendum
Eminent Member

@blacbeast Hello, your case looked similar to my first case but I had less tooth tipping which occurs the longer the device is in. Your arch looks similar to mine with the squareness starting at the canine but my palate was more vaulted.

I was worried myself when I had a lack of diastema, I turned for a few more days then called my ortho. You should arrange for a new installation with corticopuncture. The intensity of the corticopuncture depends on how your ortho interprets your scans, to which they can assume that your bone density. I had to get a more punctures (my ortho even suggested surgical splitting which we didnt want to do.) The corticopuncture was more of an additive effect of the discomfort of the installation. The main source of discomfort/pain will likely just be the 4 screws penetrating your palate. It heals and closes surprisingly quick but you will need to focus on cleaning. Lots of Ibuprofen early on though, taking it before the procedure. It wasnt much different than the 1st installation since I knew what to expect. While waiting for a new MSE device to be made consider asking your ortho to cut off the arms in the mean time.

Even on my 2nd current MSE I have dental molar movement+tipping, I had to keep it in without turning due to complications. I have the split with some expansion but I stopped. I have to let the scar-type bone form in the middle until I can start another round of MSE which will take a few months. In the mean time (in a couple of weeks) I will start Invisilign to correct some of the dental problems including removing the arms.

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Posted : 10/10/2020 11:24 pm
Blacbeast
New Member

@agendum thank you for replying.

 

Is it not possible de-rotate, remove the MSE, and puncture the suture and then reinstall the MSE. do I have to a new MSE installed?

It took close to 1 month for the MSE to arrive and a couple of weeks for the  fabrication work to be completed... I'm just not sure if I want to repeat the process again...the reason I say this is because...if we can use the mse to "flare out " the molars, we should also be able to bring it back to its original position, right? Why get a new MSE..?

 

Just my thoughts but I could be wrong.

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Posted : 11/10/2020 2:10 am
Agendum
Eminent Member

@blacbeast I dont think the screws would hold if you just swapped the with new ones for a new appliance.

Prior to my 2nd installation I caught the flaring very early so Im not too sure on how to proceed if it advanced that far. The flaring would slow down when a sutural split occurs. For me the flaring slowed down when I got mine, then it hit a point of resitstence which I think was the cheek buttress, then the flaring issue returned (to which I paused expansion when I noticed less skeletal expansion.)

I think you might be able to reverse some of the flaring by reversing-turning the device but there is some discomfort/pain when you do that, so'd you have to talk to your ortho. I had to reverse myself a few times to get out of the discomfort but when I mentioned that I did that on both MSEs my ortho didnt really like that.

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Posted : 11/10/2020 2:31 pm
Agendum
Eminent Member

Another update: scan is from August

 After around 24 turns the split occured and at around 40 I got onesided dental movement on my right side where my rear molars got shifted more to one side so I paused the turns and contacted my ortho. I think its because of my poor canted occlusion. The right molar where the band was became free floating without molar contact while the left molar maintained contact with the lower molar. The right side of my bite has always been problematic due to crowding (with my lower right canine recessed and internally rotated.)

I waited a month and got the arms of the MSE removed because it was digging into the side of my palate due to the angle of the my palate's cant. I also got scanned to make the first part of my invisilign (1st 15 trays) to correct the occlusion while we wait for new "scar-like" bone to fill in the gaps.

I return to get my 3rd MSE  in a few months after I complete the 15th invisilign tray.

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Posted : 28/11/2020 1:53 pm
Apollo liked
Lee
 Lee
Eminent Member

@agendum 3 MSEs to get to 8 mm?

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Posted : 30/11/2020 3:43 pm
Apollo
Reputable Member
Posted by: @agendum

I return to get my 3rd MSE  in a few months after I complete the 15th invisilign tray.

Your 2nd MSE had to be placed a couple millimeters anterior to the position of the first MSE, right? Will the 3rd MSE be back at the posterior position in approximately the same area as the 1st MSE? If so, is that why you need to wait for the bone to heal so that the TADs are stable and not inserted into the space where the 1st TADs pierced and dragged through the bone? How many months do you have to wait?

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Posted : 01/12/2020 3:55 pm
Agendum
Eminent Member

@apollo I return for checkup in February to get my 2nd MSE taken out but I think we can return to a original placement this time. I think the holes made by the 1st one have already healed, Im not sure though. We're waiting for the gap between the parrallel expansion was to fill in with bone.

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Posted : 01/12/2020 8:00 pm
Apollo
Reputable Member
Posted by: @agendum

@apollo I return for checkup in February to get my 2nd MSE taken out but I think we can return to a original placement this time. I think the holes made by the 1st one have already healed, Im not sure though. We're waiting for the gap between the parrallel expansion was to fill in with bone.

Why do they want the midpalatal suture split to fill in before proceeding?

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Posted : 01/12/2020 11:29 pm
Agendum
Eminent Member

@apollo to ensure that I dont loose any of the expansion that I did get.

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Posted : 02/12/2020 2:17 pm
Apollo
Reputable Member
Posted by: @agendum

@apollo to ensure that I dont loose any of the expansion that I did get.

Interesting, so they are worried you'd relapse in the few minutes between removing the old MSE and installing the new one. I guess that makes sense. Will they perform the cortipuncture again?

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Posted : 02/12/2020 7:54 pm
Silver
Trusted Member
Posted by: @apollo
Posted by: @agendum

@apollo to ensure that I dont loose any of the expansion that I did get.

Interesting, so they are worried you'd relapse in the few minutes between removing the old MSE and installing the new one. I guess that makes sense. Will they perform the cortipuncture again?

As well as the substantial risk that the TADs of the second expander would just drag through the immature bone in the gap, unlike it would with dense bone. My ortho is doing the same thing.

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Posted : 02/12/2020 9:44 pm