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How to fix my Maxillary Cant? 19M (Pics)
Hi guys, this is my first time posting here so please let me know if I'm not doing anything correctly.
Short backstory: Had proper nose breathing as a kid, developed bad allergies at around age 14 and started mouth breathing. Fast forward 5 years at 19, my face has noticeably grown downwards and I have developed a canted maxilla. I found Mike Mew on YT and started mewing 3 months ago. Initially, mewing made my mouth and throat incredibly sore and dry. Now I mew all day and night without thinking about it.
All that said, I have attached 3 photos - my normal gummy/girly looking smile, a forceful smile that hopefully shows the cant better, and a side profile picture.
My bite has always been fine. I have all my 32 teeth. Bottom wisdom teeth are in, top ones are almost in. I have never had braces before. Functionally I am fine, but the asymmetry makes me extremely self-conscious in the work environment. Ideally, I would like to fix the canted plane as well as reducing the gummy smile. I think the gummy smile indicates I need a CCW maxilla rotation in a big way? I have read that a 2 jaw surgery can be used to fix this, and also seen articles about using TADs and 1 jaw surgery. If there was a way to fix this no surgically I would be thrilled, however, surgery is doable if it's the only way.
If anyone has recommendations for the procedure that would best improve my face, please let me know. Thank you.
Yes, so in understanding from Dr. Sue Lee's slides... you have basically been somewhat trapping your lower jaw's growth by the top teeth being back.... possibly tongue tie?
The cant and asymmetry are related... you can start to understand this from Dr. Sue Lee's work. She is a miracle worker. On your left side, the cant means that the palate is deformed in and must be more out... this would ideally help the asymmetry but I don't know the specifics of her treatment... and the hard thing about asymmetries are you need counter-pressure points... (Newton's 3rd law)… which is why I kind of like saggital for asymmetry... like a 3-way split turn-key where the left side is activated initially. Anyway, I don't know what caused all this. It could be from ongoing sideways head position (such as laying on side watching TV with hand under head). It looks like you may not have had enough sunlight? The look you have as being "girly" in your words is basically from a more forward maxilla than mandible. However, your maxilla needs to be where it should be. You can additionally confirm that the maxilla is retruded using the nasolabial angle. Advancement of the maxilla through a proper reformation of the deformed palate should also better support the nose... as the top of the anterior palate is the bottom support for the nose. So, you may be able to get a little straighter nose. The big outstanding question in my mind is about the lower jaw. It may already be too late to advance it. Age 10 to 12 has the most growth... but you can see what its natural abilities are in movement forward. For example, here you're smiling with teeth nicely together. If you move your lower jaw forward as far comfortably as you are able, where does your bite end up? If you are able to advance (hold in in a forward - albeit lower to try out - forward position) the bottom jaw, then the bone can be moved forward that amount... This may need lower jaw surgery, but it could be very simple. For example... if you look at faceliftdentistry.com you'll notice they do no jaw surgery, but work with the relative positioning of the jaws. If the jaw is short, they can't fully address class 2, but they just rewrite teeth essentially for just shy of $100k. Yes, it's that important for some people to avoid surgery. There are risks. So... I guess my point is that if you can do a true palatal remodeling (THIS IS ALL THANKS TO DR. SUE LEE - A BRILLIANT MIND)… then if you look at her video of her patient from Asia... it could potentially be similar. Of course, that's a child, but she is doing real deforming of palates on adults to greater or lesser extents. Anyway, as the palate itself is lifted up, then this allows for the mandible to drive forward. You won't be able to drive your mandible forward so well without driving the maxilla up... but you don't actually want to drive the maxilla up per se into the nasal area... but to transition it to be more forward. This possibly can be done with AGGA as well. I am no expert. Just like to look at things. As your teeth have a natural inclination backwards, tipping out a bit forward can't be terrible. Also, DNA appliance with Y-split should be just as fine... but you'd want separate controls. See... the tools can be interchanged relatively easily. It's more of a matter of what you are trying to accomplish - where you want to go. So... ultimately, moving the maxillary teeth forward may allow for a great rotation of the mandible forward. Typically, this is done with a bite plane. Otherwise, your teeth fit how they fit and it is what it is. There may be opened up gaps with a proper formation of the palate, so I'm not sure how to handle that... basically you can plaster bone-looking material onto teeth to resolve tooth-size discrepancy, you can shift teeth forward to fill the gaps or do implants. Did you have any teeth removed? I wouldn't mess around much with your eye position.
Also, I want to share this video: https://www.youtube.com/watch?v=CAsBdrZmFmk In watching this, you can see that your maxilla is retruded.
If you were my little brother, I'd suggest to get SLDA on the top with braces. For the bottom I'd get the mytap http://tapintosleep.com/dentist/products/mytap/ I think that would do pretty nicely. It may not get you 100% there, but somewhat. I'd also suggest the DNA appliance with 3-way split on top and I can't really see your bottom teeth, but with all saggital, it's best to have a second (lower) to offset tipping of teeth. Primarily, I would start with a unilateral positioning (left side) to mitigate some asymmetry. There's a trick on this. I'll PM you more if interested. Then give that time to stabilize as the lower jaw is drivin forward a bit. The acrylic between the teeth would help to move forward the bite. If the bite is the same, the lower jaw gets confused. I would start soon, as to capture any remaining lower jaw forward growth. Probably would need to address one of the ways above. In my opinion, the big crux of the decision making is how far naturally forward you can position your lower jaw. For more on surgery-less jaw repositioning, see faceliftdentistry.com You are inhibited by the lower jaw's natural advancement Then the teeth are all rewritten for just shy of $100K there. But you get the idea.... some of their class 2 patients end up improved, but not entirely. I'm not sure how to do this, though... because in order to drive the chin forward, sometimes you need to intrude teeth or push the mandible up. But pushing up without going out can take up precious nasal cargo area.
You are an excellent candidate for Mewing, by the way. Is your tongue restricted? I might at least start with Mewing... get your tongue to push your top front teeth forward. Intermittant is fine... it just strengthens the tongue. You may be mailable or not in your bones... hard to tell. The risk of pushing too hard is that the lower jaw disarticulates and can end up with asymmetries of the chin. Anyway,... I hope you're grasping the basic concepts of what to do for a non-surgical intervention approach. However, you may be too far gone for getting away without surgery on the bottom. I would immediately pick up a musical instrument to blow on. Your airway behind your mandible looks restricted. Read more on this here: http://www.airwaydevelopment.com/2014/06/link-airways-obstructive-sleep-apnea-faces/ Smaller airway behind mandible is often implicated with low energy - or so I've noticed.
You can go for surgery... such as here: https://youtu.be/yFPwOM8Azzc
Regardless, though, you need to find and address the root cause. Potentially tongue tie? Bone compound deficiency? Vitamin D (hormone D from the sun) will help with bone growth & a blood test reveals who's low... (basically everyone). I'd try to eek out as much growth left as you can! Take walks breathing through the nose. Exercise generally (not stressing about where you're breathing) but don't overdo - this may injure the airway. Pick up the didgeridoo or saxophone, trumpet or harmonica...other brass instruments... things like that. This will push against your airway from the inside-out. Check this out: https://www.youtube.com/watch?v=yFPwOM8Azzc
These are all just some thoughts... but I'm not a doctor. You would need to find a doctor who is able to be reasoned with as far as palatal reshaping. Many don't even know it's a possibility... but maybe they would for your age. Your bones aren't old and hardened as some. Braces won't do it as well...that's more orthodontic... and orthopedic is preferable. Braces could do some, but to get your top teeth forward, you want to reshape the palate forward. Even stuff like Dr. Bill Dickerson's things can do that. In fact, as I think about the lower jaw... he's got the best appliances for lengthening/advancing the lower jaw. He has a network of trained dentists to various extents and they all work with cants. The thing is... you'll need something good for your top front teeth to push forward the palate and possibly widen. Widening to fix the deformation on the one side can disarticulate arches, so I'd honestly just try to do that after getting a little forward movement. You can do this a number of ways.. such as AGGA/FAGGA/CDA then go wide with SLDA or a MODIFIED Saggital treatment (that's what I'm learning about currently and believe there's some good options there.. but I'd just likely go with someone who is closer to your house. You can see who's close on the LVI network here: https://www.facebook.com/groups/tmjtmdosa/ or who's close on the vivoslife network here: https://www.vivoslife.com/find-a-doctor.html or by searching DNA and local orthodontics. Some got booted from the site, although they can use the equipment well. Also.. you can contact Dr. Sue Lee directly... https://www.envisium.com/find-a-dentist If you're near Boston, I'd definitely see Dr. Sue Lee and she can work with your local orthodontic provider by supplying the equipment. However... I am not sure I'd go with Dr. Lee in this case with your teeth tipped in... and here's why. The palate seems to want to angle more TPed in when rotating the palate out. I think saggital provides better support. So if you want the best of all worlds...I'd do something completely brand new. Saggital 3-way split... push out the front only at first... use the front bar to limit teeth tipping. Acrylic between back molars to advance chin. Then do left push-out. Dr. Bill Dickerson's treatment on the bottom to grow the chin forward. I haven't seen anyone who does forward growth like him. You're going to sacrifice width on the mandible as the bone gets displaced into length. I know this sounds girly, but bringing a chin forward will help somewhat your proportions. I may opt for distraction osteogenesis on the lower at this point, though, to get on with it. Dr. Bill Dickerson's I don't have... but basically he does a nice job. I would probably, though, do something unprecedented... I can PM you!
@darkindigo Thank you for the long and detailed response! I will try to address the questions you brought up.
You are pretty much right about what caused it. After thinking back over the last several years I realized I developed a habit of always sleeping on my left side with my hand under my head for support. I am sure this is what caused the deformity over time. This combined with mouth breathing from allergies.
After reading your message I went to a mirror to see how much I can move my jaw forwards. I can indeed move it forwards and go from my natural bite to an underbite. I have attached a couple gifs that hopefully illustrate how much movement there is. One thing that struck me, and I've sort of noticed this before, is how down swung my front teeth (presumably my whole maxilla?) are. Does this say anything about my case? You can see it pretty well in the 3/4 profile view gif.
I have all my adult teeth, no extractions. Last two upper wisdom teeth half way in.
I started Mewing about 3 1/2 months ago. I won't share it here as I looked kind of hideous before mewing, but I can PM it to you. It's not an accurate progress pic, but it shows how my throat area looked naturally before I heard about tongue posture. I mew 24/7 now, I do it in my sleep (pretty sure I'm suction holding it). I think I have a little bit of a tongue tie, but it doesn't restrict me from exerting pressure all along the top of my palate. So are you saying I should let the tip of my tongue press into my front teeth to tilt them out to a more natural angle? I heard this isn't a good idea but maybe it's what I want for my case. I don't think I've ever had issues breathing, or sleep apnea or anything. I know it was pretty near impossible to Mew when I first learned about it, that took a couple of weeks but now it's subconscious.
I really appreciate all the options you brought up - things I've never heard of before. It will take some time for me to look things over.
You listed a lot of options and doctors I could try to go with. I feel a little overwhelmed. I would like to talk my case over in person with a doctor, but I don't want to get one biased to just one method of treatment. Does that make sense? Do you have any suggestions there? Thanks, sorry, this is just all new to me.
EDIT: I guess I don't know how to PM you with additional pics.
This is great. Yes, all Myofunctional exercises are unique to the individual. Your maxilla is coming down in the front...and that’s fine...you don’t want to push the palate up into the nose area...but you’ll want to get the palate to come more forward. Think of it as like maliable plasticy clay. Does that make sense? I mean your teeth are in in... but you don’t want orthodontic movement so much as orthopedic. To get orthopedic, there’s so many ways to do it...like agga or fagga or crazat or dna and depending on your age..braces (though not as much TBH...unless in conjunction). Palatal is good like SLDA (which I think is really great)...or even pushing with the tongue forward. See, here’s the thing. No one out there can tell you where your tongue should be. You feel it. If it feels good pushing those front teeth out...listen to your body. People quit listening.
So basically you can fix this..as you see...your chin has a good range of motion. It’s being trapped by your weak front maxilla. So..you just pop that out (bone base..not just moving forward teeth)...but reforming the palate. Teeth matter last. You want your palate right. Dr. Mew cannot as much as the next person say where all people should have their tongue. It’s all individual. Listen to your body. Does your tongue feel good pushing forward your front teeth? Honestly, I do prefer appliances. However... the thing about appliances is you can’t get hung up on them. What are you trying to do with your face? See?
Ex. There are thousands of ways to widen. They all widen. There are hundreds of ways to move forward a chin...they all move forward a chin. The difference is orthodontic vs. orthopedic. You don’t just want orthodontic. I may recommend a dentist with Las Vegas Institute. I would also recommend who does AGGA/FAGGA/CDA or ideally!!! SLDA. Your particular case would be an amazing transformation with Dr. Sue Lee. She is a genius. Out of Boston, she’ll work with any local dentist and supply her amazing equipment. You’d pair with braces. You could also facepull it out a bit. I just think it’s a risky proposition. When you pop it out...your teeth will migrate forward and hopefully you’ll fit the rest of your wisdom teeth in. Your profile looks really good with your chin more forward.
I guess I gave you a lot of options, because few people understand this. Finding someone close to where you live may be a challenge...so if you find someone who does this stuff near you, then you just scored! 🙂 Controlled arch orthodontics is something you can search for. Usually they do AGGA. If you search for RAGGA they are part of LVI.
What's a canted maxilla?
Canted is just crooked..not level left to right. Most cants are not noticeable to others if less than 1 degree. Many who do at-home aligners get canted arches and this reflects in the eyes often. We don’t often consciously notice this in others as pretty much everyone is asymmetrical. In fact, perfect symmetry looks weird. However, those with pronounced asymmetries (including myself) look a little off to people...if only subconsciously.
@darkindigo Everything you've said has been very encouraging about my case, thank you a lot. I am worried about finding suitable clinics in my area. I live near St. Louis. After some searching, I found two LVI doctors that appear to practice AGGA https://www.citysmilesstlouis.com/ , https://www.springfieldsmiledoctor.com/ , and http://www.aostl.com/ is another practitioner that appears to handle jaw growth, but doesn't say LVI and looks like the treatment might only be offered to younger children. I contacted Envisium, and they responded saying they had nobody in my state offering SLDA.
The one thing you mentioned that confused me is I don't want to push my maxilla up into my nose area. I thought forwards and upwards was a good thing? When I look at my face, it looks like my maxilla is angled down quite a bit. You can see it in the gif, and also makes my smile look gummy. I want it to come forward and also tilt up so the gum is less visible, and my occlusal plane is more horizontal to the ground when my head is upright. Am I thinking correctly here?
So all the cases I see with AGGA only create forward growth. So if the palate is level already it looks really great, but in my case, I think mine is downward angled and the result would be forward and down. Like I want it tilted up and then forward.
And all that to say, my original goal is to fix my goofy, crooked smile - which after comparing with other images online I think is about 3 degrees, which is in the "noticeable to others" range. So does the asymmetry fix itself when using an appliance like AGGA? Sadly I don't think I will be able to do SLDA since there is no treatment for it in my state.
I really like how my jaw looks when I swing it forwards like in the gif I posted. Ideally, I want the maxilla to come forward and up a bit to meet it there. I can hold my lower jaw in that position right now, although it takes a tiny bit of effort since it is used to my normal position. Does this mean my muscles would eventually adapt and be able to hold it constantly in that new position once the maxilla came forward?
Thanks, I know I'm asking lots of questions. Your answers have been super helpful.
LVI docs are supposed to be trained to fix cants. It depends on the classes they took. If you go to the Facebook group, there is good info on AGGA that you can direct toward them. There they can direct you to check what training the people had. Tell them what you want. It likely won’t be with your chin up that far forward... as your vid... but anytime you push out the front, it kind up tips up from its current positioning from what I am aware. Check out this vid: https://www.youtube.com/watch?v=HMeYJOGo0C0 The nance button is pushing out the palate.. as you can see...the teeth want to tip up and they’re controlling them with braces from going bucked. Just explain to those who you consult with what you want. However, you’ll definitely want forward movement... if after the palate shoots up and out in the front you need to refine its movement more (ex...more on the palatal ridge) you can try stuff like this: https://the-great-work.org/community/main-forum/lab-visit-with-pictures/#post-16371 (bottom photo)...but you don’t really want to buck your teeth, so I’d probably keep rectangular wire braces up front for better control. That front bar on that lab photo is supposed to be adjusted to keep the front teeth from tipping out. Anyway... I would be surprised to find a problem. And if you go too much near the top of the teeth at first...then getting forward orthodontic movement might be a little more challenging. I am just guessing here..but am fairly intuitive. However, someone who’s used the appliance can better explain. In fact, Dr. Bill Dickerson runs the FB group himself. If you search LVI Global there is a link from their main site to the FB one. 🙂
Sure thing. I would ask more to LVI Facebook group. If you search LVI global online then there’s a link from their main site to the FB one. Dr. Bill Dickerson manages it. Yes, you want the low portion on the droopy part of the maxilla to lift and come forward... And maybe overall, but I was taking more of the back portions... but they can ascertain that better...the occlusal plane. I am in over my head and defer to experts. 🙂 As you lift up, you may be able to get rid of the crook in your nose or minimize it. 🙂
It may be that following AGGA you may need something like this: https://the-great-work.org/community/main-forum/lab-visit-with-pictures/#post-16371 (bottom photo)...but I doubt it because they can pull the teeth forward and get some orthodontic effect. You’re still pretty young. Just do me a favor and give me an after photo!
You’re not likely to get the result of your lower teeth in front of your upper..but even minor improvements are usually noticed and appreciated. It’s like a haircut. It looks different..even with smaller changes. So, you will notice it and hopefully you notice it with better health and energy.
Do NOT go with Agga. It is a farce. The dentists doing it do not know how to work with braces. It is a one size fits all. My daughter started it and within months her face was elongated. Her teeth extruded and she had a cant. So much build up in the back teeth screwed up the bite. No Ortho would touch her after because it was such a messed up case.
LVI is a joke. I contacted a lawyer who said he had so many cases against LVI teaching these untested methods to dentists.