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Got MSE today; DOME next week; protraction experience anyone?

Mr_Man
(@mr_man)
50+ Forum Posts

I'm getting a combination DOME w/ MSE-like-appliance (already got the appliance itself installed today).  I know others have discussed using protraction w/ MSE by itself (i.e. elastics), but does anyone have information or experience with protraction along with DOME or SARPE?  Would the protraction be more/less effective than it would be with MSE alone?

You can see the device in the picture below (there's a before and after pic):

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Topic starter Posted : 14/06/2022 8:20 am
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Apollo
(@apollo)
500+ Forum Posts

Where would you connect the elastics for extra-oral traction? Typically there will be J hooks off of the molar bands on an MSE if protraction is indicated. Also, do the TADS on your MARPE have bicortical engagement, extending from the roof of the mouth to the floor of the nose like an MSE, or are they relying on the surgical release to reduce the resistance making that less necessary for lateral expansion? I could see TADS tilting forward if you're connecting elastics to the molar arms or elsewhere and there's not bicortical stability.

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Posted : 21/06/2022 4:14 pm
Mr_Man
(@mr_man)
50+ Forum Posts

@apollo There are hooks on the molar bands (see attached photo), and thankfully the screws are indeed engaged bicortically (this was something my ortho discussed).

I'm also going to get bollard plates on my mandible, between the lateral incisors and canines, for anchorage, so that I can have almost constant protraction via elastics.

You can probably tell from the photo that I need quite a lot of transverse expansion; it's possible that the first MARPE appliance isn't enough and I'll need another one after maximizing the first one.  My lower IMW is over 50 mm, as measured between the inner cusps of the first molars

hooks upper
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Topic starter Posted : 22/06/2022 2:41 am
Apollo
(@apollo)
500+ Forum Posts

Nice! So the Dome procedure will release the midpalatal suture and the lefort 1 zygomatic buttress cut. Will it also release the pterygomaxillary junction? I wonder if your providers are worried about the extra-oral traction inducing a traumatic fracture and excessive maxillary mobility. I guess they wouldn't have put the protraction hooks on if they thought that was a real risk.

I did try adding facemask with my MSE, but my separation was facilitated by only midpalatal cortipuncture. If I got any sagittal displacement it was modest. I would have liked to try bollard plates, but that wasn't something my provider offered.

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Posted : 22/06/2022 5:48 am
Mr_Man
(@mr_man)
50+ Forum Posts

@apollo No, there won't be any surgical pterygomaxillary disjunction; just the midpalatal and buttress releases, like you said.

My ortho said to expect maybe a couple millimeters or more of forward protraction; the surgeon performing the DOME said "don't count on" any protraction but he wouldn't be surprised if I got a couple mm (I guess he's more skeptical).  It can't hurt to try, of course.  My ortho did say something about how the transverse expansion may induce some loosening of the pterygomaxillary junction just based on the transverse movement, so we'll see

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Topic starter Posted : 22/06/2022 8:56 am
Mr_Man
(@mr_man)
50+ Forum Posts

Ok, DOME is done, and the turning hs begun (total of 1.5mm so far).  I should be able to begin the elastics very soon; you can see part of the bollard plates in this picture:

bollards
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Topic starter Posted : 27/06/2022 7:43 am
Apollo liked
Apollo
(@apollo)
500+ Forum Posts

@mr_man can see more of a central diastema already!

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Posted : 29/06/2022 11:30 pm
Mr_Man
(@mr_man)
50+ Forum Posts

@apollo Yes!  It's bigger now of course; I'll eventually be putting more pictures up.  That's one of the advantages of DOME -- not having to wait for the diastema, because the orthodontist turns the screw while you're under anesthesia at the end of the DOME procedure, to make sure the diastema appears

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Topic starter Posted : 30/06/2022 4:40 am
Mr_Man
(@mr_man)
50+ Forum Posts

Happy 4th everybody! 

Here's where I am with the turning; I'm less than halfway through but you can already see a ton of transverse progress.  In the forward direction, it's hard to guess how far I've moved but I'm guessing 1mm so far.  It's also difficult to tell how much forward movement is affected by the intraoral elastics vs simple geometry of the upper jaw expanding, but either way is good

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Topic starter Posted : 04/07/2022 11:04 pm

THE GREAT WORK

Warning:
Your Cranial Sutures Need To Be open for CranioSacral / Jaw Development!