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Ideal palate width = size of tongue

Chilly
Active Member

I am currently going through an expansion via MSE. I’ve measured my tongue and it’s 60mm wide in the back third portion. The middle is around 55mm. I’m currently at 47mm of IMW. My lower jaw is still trapped behind the narrow upper jaw. My incisors and canines are retro incline. I started around 39-40mm inter-molar width. The expansion is helping my incisors expand outwards. Should I get another expander? My orthodontist is too conservative with the expansion. I had asked for the 12 mm but he said I would only need 4mm and wouldn’t need more. Ha here I am with way more than 4mm and still not enough. Im pretty sure it’s the 8mm size. I also would like to keep my wisdom teeth . I’m 18 and my lower wisdom teeth came up but the uppers haven’t. 

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Topic starter Posted : 18/06/2021 10:55 pm
Chilly
Active Member

 

 Here’s a pic of my palate. 

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Topic starter Posted : 18/06/2021 10:56 pm
Apollo
Reputable Member
Posted by: @chilly
I am currently going through an expansion via MSE. I’ve measured my tongue and it’s 60mm wide in the back third portion. The middle is around 55mm. I’m currently at 47mm of IMW. My lower jaw is still trapped behind the narrow upper jaw. My incisors and canines are retro incline. I started around 39-40mm inter-molar width. The expansion is helping my incisors expand outwards. Should I get another expander? My orthodontist is too conservative with the expansion. I had asked for the 12 mm but he said I would only need 4mm and wouldn’t need more. Ha here I am with way more than 4mm and still not enough. Im pretty sure it’s the 8mm size. I also would like to keep my wisdom teeth . I’m 18 and my lower wisdom teeth came up but the uppers haven’t.
 

Why is the expansion screw only turning on one side? The part where you engage the little wrench should remain in the middle and both sides should move laterally as you advance, but the picture shows only the left half of your MSE turning while the right is still fixed in the starting position. This doesn't mean that it's giving asymmetric leftward expansion of the maxilla, the mechanism will still push equally on both sides, but it will limit the total expansion potential if half of the threads on the screw aren't being used. I don't see a midline diastema. Do you think your suture has separated yet? How many turns have you made? The size of your MSE will be etched on the framework (8, 10, or 12). I can't read it on this low resolution picture. But, you'll only be able to get half of that expansion potential if it is stuck on one side as it appears. I'm not sure that measuring your tongue width is a good indicator of your goal intermolar width. After MSE expansion, my intermolar width is about 46mm, and my smile now looks quite broad even though the tongue still can't spread out totally flat on the palate. You can only expand the maxilla as far as the lower teeth can be moved in the alveolar bone to align the bite, unless you want to use more advanced techniques like SFOT or MSDO to expand the mandible.

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Posted : 19/06/2021 2:39 pm
AlexanderPerrier
New Member

@apollo

what is an appropriate IMW such that one can expect to have no health problems, or is it all relative to ones skull size?

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Posted : 19/06/2021 3:03 pm
Apollo
Reputable Member
Posted by: @alexanderperrier

@apollo

what is an appropriate IMW such that one can expect to have no health problems, or is it all relative to ones skull size?

I don't know, but I typically refer people to this quote from Dr. Mike Mew in his youtube comments section:

Posted by: @apollo

Dr. Mew's note in the comments of his video on intermolar width is interesting:

"Important note; modern adults (or anyone over the age of 9) tend to have a molar width of 29 to 34mm. Anyone with 35 to 38mm will find it much easier but still very hard to make progressive improvements without any formal therapy, and as a rule of thumb when I finish therapy any one who can maintain 38mm or more without retainers tends to maintain good alignment almost indefinitely, with a minimal effort. During childrens treatment expand to 42mm for a girl and 44mm for a boy, clearly some of this is tipping of the molars. Ancient man had an inter-molar width in the high 40's to low 50's."

 

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Posted : 19/06/2021 3:52 pm
Chilly
Active Member

 

@apollo Most of the diastema is between the canines and incisors. The suture did split. I felt pressure building for the first 3 or so days. I felt relief between the front teeth.I’m not sure how many turns exactly. I start at 39mm just been keeping track of the mm. I did have a diastema but wasn’t big. My lower teeth are tilted inwards so I’m not sure how much I’ll get from uprighting them. I’ve always had an asymmetrical face probably from clenching. My right side of the face looks more forward than the left. Like I always had a dimple on my right side.

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Topic starter Posted : 19/06/2021 4:31 pm
Chilly
Active Member

 

@apollo my bite is a overbite. If I let my lower jaw relaxed and come forward it’s more of a edge to edge bite/underbite. Like the front part of my palate is retro inclined and the teeth need to be pushed out. My back third has always been good but inter-canine width is narrow. If clenching with molars left me with wide intermolar width. Wouldn’t clenching the incisors make the canine width wider ? I have been doing teeth slightly apart mewing. But when I had first discovered mewing back like 3 years ago I used clench the molars.  

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Topic starter Posted : 19/06/2021 4:45 pm
Apollo
Reputable Member

The MSE is supposed to give near parallel expansion along the midpalatal suture, so there should be about equal expansion in the anterior and posterior. However, some of the increase in intermolar width will be from the arms putting pressure on the first molars and pushing or tilting them directly. I don't know if or how clenching would impact the expansion processes.

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Posted : 19/06/2021 10:24 pm
Chilly
Active Member

@apollo I’ve noticed improvement in cheekbones. Would pushing the teeth cause improvement in zygos? I believe jaw hacks made a video touching on this. The orthodontist places the mse evenly but when it expands one side is more stubborn. I’ve been trying to thumb pulling on the stubborn side . I don’t know if it’s doing anything. Doesn’t narrow palates cause asymmetry. The bite ends up favoring one side. I’ve noticed slight improvements in symmetry from the expansion. I’m leaning more towards having a narrow palate causing my asymmetry. My lower jaw is well developed and I have wisdom teeth in and well erupted. My orthodontist seems inexperienced I don’t know why he didn’t cut the arm bands from the mse on my last visit. They are not the soft metal armbands they are the rigid hard metal kind. Touching back to how much you can expand this video talks about it at 1:04:51 mark https://www.pathlms.com/pcso/events/1648/video_presentations/143837

i couldn’t understand what she says at some part due to her accent. She does say that maxilla expansion isn’t limited by the suture or the bite. It’s limited by _____ i couldn’t understand what was said afterwards. I think she said the ramus? So how ever wide the lower jaw is ? Determines how wide the maxilla can expand is what I’m getting from it 

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Topic starter Posted : 20/06/2021 12:30 am
Apollo
Reputable Member
Posted by: @chilly

I believe jaw hacks made a video touching on this. The orthodontist places the mse evenly but when it expands one side is more stubborn. I’ve been trying to thumb pulling on the stubborn side . I don’t know if it’s doing anything. Doesn’t narrow palates cause asymmetry. The bite ends up favoring one side. I’ve noticed slight improvements in symmetry from the expansion. I’m leaning more towards having a narrow palate causing my asymmetry.

The asymmetry JawHacks spoke about in his videos is different than what's happening with your MSE. His expansion encountered more skeletal resistance on one side like you are describing so half of his maxilla moved farther from the midline than the other half. You can see this in the picture from when he completed expanding here:

Notice how the part where the little wrench articulates to make the turns remained at the midline and the two halves with the TADs moved apart to either side. He got some warping of the framework from his rapid turn protocol, but the asymmetry he reported was in the two halves of his maxilla bone, not the two halves of the MSE framework. It should look like this at the end of expansion:

Both sides of the MSE move away equally from the midline when you turn the screw. Now here is your picture cropped:

See how the part where the little wrench articulates is off to the right side of the midline (left side of picture) and only the left side of your MSE advanced while the right side is stuck in its starting position next to the TADs? As I said in my first post, this doesn't reflect one side of the maxilla bone moving more than the other or greater skeletal resistance on one side like JawHacks reported. In other words, the midline of your palate is still about half way between the TADs, but the midline of the MSE screw is off center. This is a problem with the mechanism of your MSE and will limit how many turns you can get or the total expansion potential if half of the MSE isn't advancing. Maybe the threads are stripped on the right side?

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Posted : 20/06/2021 5:29 pm
Chilly
Active Member

@apollo I understand now. My orthodontist is inexperienced so much for “12 years of experience”. It is expanding too much on my right side. The cheekbone is very prominent. Do you have any suggestions how I should go about this? Would getting another expander fix it ? Maybe get it position the opposite way to expand the other side. 

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Topic starter Posted : 20/06/2021 6:19 pm
Apollo
Reputable Member
Posted by: @chilly

@apollo I understand now. My orthodontist is inexperienced so much for “12 years of experience”. It is expanding too much on my right side. The cheekbone is very prominent. Do you have any suggestions how I should go about this? Would getting another expander fix it ? Maybe get it position the opposite way to expand the other side. 

It is possible that you are getting asymmetric skeletal expansion like JawHacks, but I don't think it is caused by the problem with your MSE only turning on one side. The way the screw is turning, it is still pushing the TADs on both halves of the Maxilla sideways equally, but it cannot separate the TADs as far when one half isn't advancing. So if you are getting asymmetric skeletal expansion, replacing the MSE for a new one wouldn't solve the problem that your bones are putting up more resistance on one side. Deliberately making the new MSE only turn on the opposite side wouldn't help because the force is still distributed equally to the TADs on both sides. That being said, I can't really notice asymmetric expansion on the picture of your face and smile. The discrepancy in the bite was obvious in the JawHacks case:

You can see how his upper teeth were totally outside his lower teeth on his left side (right side of picture), but relatively aligned on his right side. So if your goal is just to get more millimeters of expansion, then a second round with a new MSE might be what you want. They would have to position the MSE slightly forward or backward from the old one or wait at least 3 months for the bone to heal.

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Posted : 20/06/2021 6:51 pm
Chilly
Active Member

@apollo i also have a feeling that if he palate isn’t wide as it’s used to be . You’ll have asymmetries. The palate can’t just keep expanding on one side and neglect the other side. My right side teeth are more outwards than my left. I have a feeling that it’ll check a point where it can’t expand anymore on that side. Then the wider side will act as the anchor to expand the narrower side. Body always returns to homeostasis. Even sitting at 47mm my smile is still narrow. This goes back to the width of the tongue. My tongue is measuring around 55-60m that’s without it being flat pressed. 

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Topic starter Posted : 20/06/2021 8:15 pm
Limebike
Eminent Member

@chilly I just wanted to stop by and second your argument that the size of the tongue should be a critical benchmark for the shape of the palate. Had we all been properly mewing, our palates would have grown around the tongue.

I also have a large intermolar width but am considering further expansion since my tongue is still not fully fitting. Like in your case, my tongue is also on the bigger side. The other muscles in my body are also on the larger side and keep their volume without any workout whatsoever (I have a mesomorph/endomorph body type).

I wanted to compare your palate with mine and took the liberty to overlay a picture of my upper jaw onto your picture (using a similar size of the teeth as a way to properly scale for comparison). It is similar in the posterior region but my anterior arch is narrow (it may have gotten wider as this picture is a few months old and I have been expanding my anterior part in the meantime), see also my post if someone is interested: https://the-great-work.org/community/case-discussions/need-advice-should-i-get-mse-facemask-any-better-options/#post-38801

Click on the picture to see the GIF animation:

 

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Posted : 20/06/2021 9:53 pm
Chilly
Active Member

@limebike Yes if we were breast fed for 2 years at least. You would naturally have a forward grown and wide palate. The tongue would have more than enough room and be able to overpower any forces trying to narrow the palate. Try measuring your head’s width and see what percentile is your head in. My head width is 7 inches which falls into the top 99 percentile. Check out this thread by Eddiemonkey  https://the-great-work.org/community/main-forum/what-is-your-starting-intermolar-width/#post-2570  

Your palate looks about the same as mine so I’m guess you got a big head like me lol. I’ve noticed how much my lower jaw dwarfs my upper. Hence why it is trapped behind in overbite position. It’s either your body gives you an overbite trapping your jaw behind or gives you an underbite not allow you to bite. Both require more wide. If you are able to provide the width the tongue will be able to push out the front teeth. Giving a broad C shaped arch. I don’t feel at ease breathing through my nose even at 47 intermolar width. Breathing has definitely improved but it’s still not where I want it to be. Like it gives me an anxiety feeling. We all know how the tongue effects the posture. I don’t believe you can fix posture without giving enough room to the tongue. Straight posture should be done effortlessly. I’ve also noticed my  ATG squats improve. And my toes widen up. There’s definitely a connection through out the body. Narrow palate effects balance within the body. 
 
Wow reading through what I just wrote I definitely have ADHD.I’m all over the place take what you will with that being said. 

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Topic starter Posted : 20/06/2021 11:12 pm
Limebike
Eminent Member

@chilly I am completely with you on your points!

I will remember to measure my head but I will first need to figure out an accurate way to measure it.

 

I fully agree that we need to provide enough space for the tongue and good occlusion. This is absolutely critical to attain a stable long-term result that does not require permanent retention via retainers.

I started out with a slight underbite / incisal edge-to-edge situation, and as I was expanding and protracting my maxilla, my lower jaw kept coming forward with the maxilla, so I had to keep going with the maxillary expansion+protraction. My incisors must have moved more than 6 mm forward in the process (started around September 2020), but my mandible kept following. A month ago, I established a safe overjet of about 2 mm, but my mandible came foward again, as my bite is slowly closing due to the intrusion of my posterior teeth I cannot fully bite down right now, which is why I am working to get a proper occlusion.

Being able to close your mouth more such that the angle between your lower jaw and the ground gets more and more parallel is important. It will allow you to more easily lift your tongue (as the distance between lower jaw and roof of your mouth will get smaller) and also facilitates a natural lip seal that does not require any significant effort.

Let's keep on pushing 🙂

 

PS: How are you measuring your intermolar width. From the inside gingival of the 1st molar or from the outside edges?

Here is the plaster model of my palate (which I used to make my expanders):

PPS: We definitely have some form of ADHD. 

PPPS: Your choice for the title is 1000 IQ. I was immediately impressed when I read it.

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Posted : 20/06/2021 11:41 pm
Chilly
Active Member

@limebike The more you expand the width your maxilla will come forwards as well.Ive noticed improvements in my upper lip and overall my face doesn’t look depressed like before. Used to have this constant frown on my face. I measure my IMW the same way you do. Press your tongue forwards with the tip on the spot. Teeth apart you’ll notice how your tongue will flare out from the sides pushing on the teeth. That’s the area that is too narrow for the tongue. I noticed my tongue pushes on my back molars but does not stick out crazy like it does with the anterior. That’s why the IMW isn’t a one size fits all solution. Since some people have bigger tongues and need a bigger palate to accommodate it.

Interesting enough ADHD is connected to narrow palates. https://www.westonaprice.org/health-topics/dentistry/from-attention-deficit-to-sleep-apnea/  

Wow looking at your palate mold again  I just noticed how narrow your palate still is. Your palate is mixture of a V and a U. Referring back to Weston A price’s work they all had these big C shape arches. Do you have your upper wisdom teeth ? I can’t tell.  


 

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Topic starter Posted : 21/06/2021 1:10 am
Limebike
Eminent Member

@chilly Yes, my anterior part looks very narrow in the mold picture. The mold was taken 1 month ago. This is why in the second picture you see me with my expander for the anterior part. The thing is, as you push your anterior part forward, it immediately looks narrower unless you also push it laterally at the same time. This explains why some people with wide arches that are too far back in the face also need expansion, because as you close things towards the front (mesially), everything narrows.

Also an interesting thing: I am not using any retention on the posterior part, which I had also expanded by around 5-8 mm. I am mewing for retention and there was no relapse whatsoever 🙂

I did not grow any wisdom teeth in my upper arch. I only had one wisdom tooth in the lower arch.

By the way, I was a mouthbreather when I was a teenager and kept my tongue in my lower jaw, which developed really nicely though as a result.

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Posted : 21/06/2021 1:32 am
Apollo
Reputable Member
Posted by: @chilly

Touching back to how much you can expand this video talks about it at 1:04:51 mark https://www.pathlms.com/pcso/events/1648/video_presentations/143837

i couldn’t understand what she says at some part due to her accent. She does say that maxilla expansion isn’t limited by the suture or the bite. It’s limited by _____ i couldn’t understand what was said afterwards. I think she said the ramus? So how ever wide the lower jaw is ? Determines how wide the maxilla can expand is what I’m getting from it 

You're right that she says "you cannot expand the maxilla beyond the ramus." The upper jaw has to fit inside the lower jaw. She's talking about this case where you can see that the maxilla is expanded to the point that it is almost making contact with the inner surface of the ramus of the mandible.

If you expanded the mandible surgically with something like MSDO, it would allow for more expansion of the maxilla. I believe most nonsurgical mandibular expansion using techniques like a quad helix or removeable acrylic expander mostly move teeth, and remodel or bend alveolar bone to upright the lower teeth over the basal bone, but some minor expansion of the body of the mandible can also occur, which would give a little more room for expansion of the maxilla.

Posted by: @apollo

Small amounts of widening of the basal bony width of the mandible can occur by orthodontic stimulation of bony deposition on the lateral borders of the corpus mandibularis.

 

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Posted : 21/06/2021 11:53 am
Chilly
Active Member

@limebike The teeth move forwards as you expand. This creates enough room for wisdom teeth and opens air way. Improving wellbeing since you get more air in. 
 Once you give the tongue enough room and keep mouth shut. The tongue is not gonna leave the palate. I don’t even think about mewing much anymore. I just focus on breathing through nose and keep my mouth shut everything else just falls into place. Tongue stays glued without thought. 


 

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Topic starter Posted : 21/06/2021 3:10 pm
Chilly
Active Member

@apollo Do you know of any studies done where they expand a lot? The maxilla seems to just need the width and it comes forwards with expansion. I feel as most patients that get an expansion don’t expand enough. If you get 1mm of forward movement from expanding 10 mm. I know most people’s maxilla is recessed by 4-6 mm so could it just be they don’t have enough width? I have yet to see a case where someone has 50 something intermolar width and is recessed. It’s seems that what people think is forward growth is just an extremely wide intermolar width. Since the wider the width the more pushed out the cheekbones and better soft tissue displacement. My maxilla actually came forward 2mm. It used to be recessed by 5mm. I need about 2 more mm. This goes back to the tongue tongue width. It’s like I need about the another 7-8 mm expansion. So I’ll be around 54-55 mm intermolar width.

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Topic starter Posted : 21/06/2021 3:38 pm
Chilly
Active Member

 

@apollo here’s a side profile 

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Topic starter Posted : 21/06/2021 3:45 pm
Limebike
Eminent Member

@chilly You have a very good side profile already! You are doing quite well, congratulations!

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Posted : 21/06/2021 4:36 pm
Apollo
Reputable Member

I don't think the answer to get more forward change is just more transverse expansion. Your profile looks better than mine, but I guess we're always more self-critical. I couldn't expand my maxilla much farther without surgery on my mandible to be able to align the occlusion, but I could still really benefit from more forward change since I started with a skeletal class iii.

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Posted : 21/06/2021 5:49 pm
Limebike
Eminent Member

@apollo do you have photos/documentation for your case or is there an old thread where we can find it?

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Posted : 21/06/2021 7:45 pm
Chilly
Active Member

@apollo I’ve been taking mk677 and getting all the fat soluble vitamins along with raw milk . My lower jaw definitely grew from 16-18 year old. The maxilla can only grow as wide as the lower jaw. The good thing is your lower jaw never stops growing. I’m not sure how old you are but you could try mk677 to speed up the process. It’s definitely been helping me. What is the restriction preventing you to expand further ? 

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Topic starter Posted : 21/06/2021 8:27 pm
Apollo
Reputable Member
Posted by: @chilly

@apollo I’ve been taking mk677 and getting all the fat soluble vitamins along with raw milk . My lower jaw definitely grew from 16-18 year old. The maxilla can only grow as wide as the lower jaw. The good thing is your lower jaw never stops growing. I’m not sure how old you are but you could try mk677 to speed up the process. It’s definitely been helping me. What is the restriction preventing you to expand further ? 

My orthodontist says that we can use invisalign to upright the linugally inclined lower teeth to align with my expanded upper arch, but if I expanded the upper arch much farther I wouldn't have enough alveolar bone around the lower teeth to push them out to meet up. This is the same reason JawHacks needed SFOT for his mandible on the side that expanded farther. I'm in my late 30s. Varbrah recommended mk677 during his MSE+FM expansion, but I never tried it.

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Posted : 21/06/2021 8:44 pm
Apollo
Reputable Member
Posted by: @limebike

@apollo do you have photos/documentation for your case or is there an old thread where we can find it?

I've taken a lot of pictures before, after, and along the way, but I haven't shared them for anonymity and because they don't show obvious change or standardized camera settings, angles, lighting, etc.

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Posted : 21/06/2021 8:52 pm
Limebike
Eminent Member

@apollo @chilly      How old are you guys? I am in my 30s and male

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Posted : 21/06/2021 8:56 pm
Apollo
Reputable Member
Posted by: @limebike

@apollo @chilly      How old are you guys? I am in my 30s and male

late 30s, male, so I feel lucky that my midpalatal suture split.

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Posted : 21/06/2021 8:58 pm
Chilly
Active Member

@limebike I’m 18 about to turn 19.

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Topic starter Posted : 21/06/2021 9:34 pm
Chilly
Active Member

I guess I still have my youth to help achieve my goal. Mk677 will definitely give you a boost. Try it out it takes a while to kick in but you’ll notice within 2-3 months.

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Topic starter Posted : 21/06/2021 9:40 pm
Limebike
Eminent Member

@chilly @Apollo We are all gonna make it!

 

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Posted : 21/06/2021 10:22 pm
Chilly
Active Member

 

I have an anterior crossbite now. Malocclusions are changeable. They all stem from narrow palates. My lower jaw isn’t trapped anymore and it shows how narrowed my palate is since the lower jaw is overlapping it. That’s also what is causing asymmetry in my face and body. Do you guys think I should face pull? The stupid hook broke off of the mse. So I only have one hook and that hook is on my stronger side lol.

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Topic starter Posted : 22/06/2021 11:29 am
Apollo
Reputable Member
Posted by: @chilly

Do you guys think I should face pull? The stupid hook broke off of the mse. So I only have one hook and that hook is on my stronger side lol.

If you get a second round of MSE, you could have the protraction hooks back. It's complicated to try and attach elastics without the hooks, and I wouldn't recommend pulling from just one side to avoid asymmetry. If you really have the hard molar arms, they might be more effective for translating the tension onto the TADs, but I've never seen a case where they ordered the hard arms. It would actually make more sense to use them in a case where the midpalatal suture has already separated.

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Posted : 22/06/2021 12:19 pm
Chilly
Active Member

@apollo it’s a hassle to wrap the elastic around the mse arms. I don’t know why the orthodontist made the arms so damn long. That [Rude Language or Insults are not tolerated] was hella flimsy and broke off. Im still not sure what size this Mse is. I can’t see the size written on it. I’m sitting at 47mm currently. Maxilla recessed 3mm. Incisors are retro inclined.I’m not sure how much I’ll gain from proclining the incisors. Maybe 1-2mm Might be able to squeeze another .5-1mm out the the expansion. Jaw surgery would definitely be overkill for me. The way I see it if I give my tongue enough width. Since I’m still young I’ll be able to grow the forward growth from the tongue alone.

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Topic starter Posted : 22/06/2021 12:42 pm
Chilly
Active Member

@apollo My Mse is the size 12mm. I did only get half of the MSE. Around 6 mm. They didn’t even get X-rays to check for bicortical engagement. I’ll need that refill. It makes me a little mad how they told me off saying the orthodontist had 12 years of experience and knew what he was doing.Here we are needing a round 2. 

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Topic starter Posted : 04/07/2021 12:12 pm
Apollo
Reputable Member
Posted by: @chilly

@apollo My Mse is the size 12mm. I did only get half of the MSE. Around 6 mm. They didn’t even get X-rays to check for bicortical engagement. I’ll need that refill. It makes me a little mad how they told me off saying the orthodontist had 12 years of experience and knew what he was doing.Here we are needing a round 2. 

Did they say what was wrong with the MSE mechanism to make only one half advance? Good luck and keep us posted if you decide to go for another round! 

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Posted : 04/07/2021 1:00 pm
Chilly
Active Member

I had gone for an appointment 1-2 months back. He had just told me to keep expanding and all good. He just took a quick look at it. I’ll be calling in Tuesday to speak with the orthodontist and let him know. My bet is that it wasn’t   bicortical engaged. It causes screw drag. He didn’t want screw the screw all the way. I remember him saying how he didn’t want it going into the sinus cavity but that’s exactly what needed to happen. It might also be why I noticed only little improvement with nasal breathing. I remember Dr.Moon saying how you are suppose to feel a need to squeeze when the screw go in But I never did.  https://youtu.be/w7D3l3X2B5g This video at 12 minute mark.

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Topic starter Posted : 04/07/2021 3:54 pm
Apollo
Reputable Member
Posted by: @chilly

I had gone for an appointment 1-2 months back. He had just told me to keep expanding and all good. He just took a quick look at it. I’ll be calling in Tuesday to speak with the orthodontist and let him know. My bet is that it wasn’t   bicortical engaged. It causes screw drag. He didn’t want screw the screw all the way. I remember him saying how he didn’t want it going into the sinus cavity but that’s exactly what needed to happen. It might also be why I noticed only little improvement with nasal breathing. I remember Dr.Moon saying how you are suppose to feel a need to squeeze when the screw go in But I never did.  https://youtu.be/w7D3l3X2B5g This video at 12 minute mark.

During insertion, there's a tickle like you need to sneeze as the TADs enter into the nasal cavity. There can still be bicortical engagement if the tip of the TAD extends into the second cortical layer of bone that makes up the floor of the nasal cavity even if it doesn't protrude through into the nasal cavity. For example, the anterior bone is often thicker, so the back TADs might protrude through and cause the sneeze sensation while the front TADs just reach the second cortex without protruding, especially if they order the same length TADs for both the front and back. The provider should be able to feel more resistance to turning as they pass through both cortical layers. Screw drag happens when the TADs push laterally through the bone during expansion, like a plow through soil, rather than splitting the suture. You might have screw drag, but that wouldn't cause only on side of the MSE to advance. You'd see the TADs on both sides move away from the middle of the appliance where the little wrench engages, but they'd be moving through the bone rather than displacing the bone with them.

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Posted : 04/07/2021 9:46 pm
Chilly
Active Member

@apollo I’ve noticed when I do a turn i don’t feel any pressure or anything. It’s like the turn is doing nothing. I think it started happening around 45-65 turns. So It’s not even expanding or anything. Idk if it locks in or something once you get to 90 turns. So it was a waste I didn’t even get all the expansion out the stupid thing. Also does the palate shrink down ? Like does the palate length reduce the more your expand? It’s almost like the my front teeth and collapsing down shorten the palate length. Think of a U shape palate and then a C shape palate.

 

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Topic starter Posted : 04/07/2021 10:20 pm
Apollo
Reputable Member
Posted by: @chilly

@apollo I’ve noticed when I do a turn i don’t feel any pressure or anything. It’s like the turn is doing nothing. I think it started happening around 45-65 turns. So It’s not even expanding or anything. Idk if it locks in or something once you get to 90 turns. So it was a waste I didn’t even get all the expansion out the stupid thing. Also does the palate shrink down ? Like does the palate length reduce the more your expand? It’s almost like the my front teeth and collapsing down shorten the palate length. Think of a U shape palate and then a C shape palate.

I think when the MSE expansion screw completes all of the turns, it just rotates freely since there aren't any more threads. I speculate the threads were stripped on one side of your MSE so it was always turning freely on that side without advancing along the threads. So once it turned through all of the threads on the other side it's just been rotating without pushing the TADs any farther apart when you turn. I don't believe the palate gets shorter in the sagittal dimension as it expands in the transverse dimension. On the contrary, it typically very slightly displaces forward from the expansion alone even without adding protraction.

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Posted : 05/07/2021 12:04 pm
Chilly
Active Member

@apollo this study linked by @EddieMoney https://www.researchgate.net/figure/A-When-anterior-sweep-of-maxillary-arch-is-broadened-smile-arc-may-fl-atten-Trend-for_fig4_10609205  

The expansion really helped my overbite.my low is still trapped since my incisors are retro-inclined. I noticed my canines open up from the expansion. This falls in line with my title. It seems like the bite closes from lack of width. 
 
I agree with your speculation. I’m just hoping my orthodontist follow through and places another one in. If we go by orthodontist guidelines my IMW is well above average and is considered a broad palate. Yet, I still have buccal corridors plus my lower teeth are tipped inwards. Where does this ideal intermolar width come from? It makes much more sense to determine it by the width of the tongue.  

 

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Topic starter Posted : 05/07/2021 8:02 pm