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Invisalign???

lou188
New Member
Wow I wish this resource was available five years ago.  I've struggled with really poor systemic health involving things like migraines, vision problems, and not surprisingly lots of TMJ dysfunction.  I have a high narrow palate and a crossbite and my mandible is shifted half a tooth over to the right side.  I have a lot of jaw joint pain.
 
I was going to go down the ALF route, or maybe DNA appliance, but the doc who was going to do them has recommended invisalign instead.  Invisalign for a palate expansion?  It seems unlikely.  But he claims it will help with a lot of other parameters of proper occlusion and TMJ position, and it will functionally widen my arch even if that doesn't mean moving actual bone.  He said invisalign is making leaps and bounds how much you can customize it for specific jaw conditions.
 
So where I'm at is I might literally do invisalign, see what benefits I get from it, then do a DNA appliance to get widening, then I'd have to finish off with invisalign!  Sounds a bit hacky, but keep in mind I'm really ill, too ill to work.  So the argument is if invisalign can make some real changes with my occlusion maybe I can start to get better sooner.
 
Any thoughts on invisalign for those of us with narrow palates and if it can improve things some or does it only make things worse?

 

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Topic starter Posted : 18/06/2021 8:08 am
Agendum
Eminent Member

Invisilign mostly works to affect aveolar bone. Not gonna get much skeletal changes.

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Posted : 18/06/2021 10:49 am
Apollo
Reputable Member

The majority of the cost for my MSE treatment is the invisalign afterward to realign my bite. Invisalign, ALF, and DNA are all expensive treatments. Paying for two rounds of alignment seems unnecessary. If you move your teeth to the edge of your alveolar bone with invisalign, there will be a limit to how much farther you could safely push them with an expander. I think it makes much more sense to start with the expander and then use aligners to tidy up afterward. I would be worried that your provider might be recommending what will be most lucrative for them rather than what's best for you. I've been happy with the bone-anchored expansion of my MSE, but I can't comment on the efficacy of the ALF or DNA. I'd at least recommend getting a second opinion.

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Posted : 18/06/2021 5:01 pm
lou188
New Member

@apollo

Yes so I'm 100% sure then as I've seen no evidence and you folks agree - there is no way that invisalign can expand my palate.
 
There is definitely a voice in the back of my head saying the things you said with skepticism of this treatment plan.  However I do think it's dependent on whether the ALF/DNA move the alveolar tissue versus bone.  If they really are moving alveolar tissue and my invisalign in fact moves as much as possible within that tissue, then that in and of itself is a success and the ALF couldn't have done better!  If on the other hand the ALF actually does widen the maxilla then it shouldn't matter what order I do it.  I do hear the financial argument but to me this is my life at stake and I can't work so the #1 financial priority for me is to heal.
 
I do think relative to the average person I see on this forum, I do have more explicit TMJ problems and the idea is perhaps invisalign could help with that sooner rather than later.  That said, after thinking about all this I am 100% sure the ideal  way is to do DNA/ALF first and then invisalign.  But knowing this very specialized world, I could be searching around for months or years to find someone who thinks the same way as me about these things.  So perhaps doing invisalign, then seeing if I still need palatal expansion, and then worst case scenario doing an expander and finishing with invisalign would be fine by me.

 

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Topic starter Posted : 21/06/2021 2:24 pm
lou188
New Member
I think when I asked the dentist originally how a tooth-borne treatment would expand the palate, the argument was other devices press on the teeth and can still shape the palate but I don't think that's generally true, is it?  Most palate expanders push directly on the palate, not on the palate via the teeth.  For the very reason that the teeth will move more readily than the bone.  Also the argument was that invisalign is much more sophisticated in how you can apply forces than it used to be.
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Topic starter Posted : 21/06/2021 2:27 pm
mysterecessed
Active Member
Posted by: @lou188

@apollo

Yes so I'm 100% sure then as I've seen no evidence and you folks agree - there is no way that invisalign can expand my palate.
 
There is definitely a voice in the back of my head saying the things you said with skepticism of this treatment plan.  However I do think it's dependent on whether the ALF/DNA move the alveolar tissue versus bone.  If they really are moving alveolar tissue and my invisalign in fact moves as much as possible within that tissue, then that in and of itself is a success and the ALF couldn't have done better!  If on the other hand the ALF actually does widen the maxilla then it shouldn't matter what order I do it.  I do hear the financial argument but to me this is my life at stake and I can't work so the #1 financial priority for me is to heal.
 
I do think relative to the average person I see on this forum, I do have more explicit TMJ problems and the idea is perhaps invisalign could help with that sooner rather than later.  That said, after thinking about all this I am 100% sure the ideal  way is to do DNA/ALF first and then invisalign.  But knowing this very specialized world, I could be searching around for months or years to find someone who thinks the same way as me about these things.  So perhaps doing invisalign, then seeing if I still need palatal expansion, and then worst case scenario doing an expander and finishing with invisalign would be fine by me.

 

 

Doesn't DNA do alveolar expansion only too? I'm not sure that it does actual maxilla expansion. What I read here was that only MSE is capable of doing maxilla expansion by splitting the mid suture. I'm not sure about ALF though. Do you have anymore info on it? 

I'm still deciding if I should go for invisalign or DNA too. It's extremely difficult to decide.

MSE would probably be better if you are aiming to get better cheekbones as well, in addition to solving all your health issues. Not too sure though. What's your current molar width?

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Posted : 17/07/2021 1:13 am
Apollo
Reputable Member
Posted by: @mysterecessed

Doesn't DNA do alveolar expansion only too? I'm not sure that it does actual maxilla expansion. What I read here was that only MSE is capable of doing maxilla expansion by splitting the mid suture. I'm not sure about ALF though. Do you have anymore info on it? 

I'm still deciding if I should go for invisalign or DNA too. It's extremely difficult to decide.

MSE would probably be better if you are aiming to get better cheekbones as well, in addition to solving all your health issues. Not too sure though. What's your current molar width?

My intermolar width went from around 36 to around 46mm with the MSE. A little of that increase might be tilting of the molars that will get corrected when we start invisalign. I don't think anyone has a definitive answer for you about the mechanisms of expansion for these different appliances or what percent of the expansion will come from the teeth, alveolar bone, maxillary body, or midpalatal suture. This probably varies from patient to patient depending on the maturity of their midpalatal suture and other factors. I guess it's possible that lightwire or removeable acrylic expanders induce some remodeling in the body of the maxilla or even stretching at the midpalatal suture, especially in less mature cases, since some people report opening of the nasal cavity with improvements in nasal breathing. However, if that's what you need, I still think the bone-anchored approach is probably significantly more reliable and stable, with the majority of the expansion coming at the suture.

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Posted : 17/07/2021 12:42 pm
mysterecessed
Active Member
Posted by: @apollo

My intermolar width went from around 36 to around 46mm with the MSE. A little of that increase might be tilting of the molars that will get corrected when we start invisalign. I don't think anyone has a definitive answer for you about the mechanisms of expansion for these different appliances or what percent of the expansion will come from the teeth, alveolar bone, maxillary body, or midpalatal suture. This probably varies from patient to patient depending on the maturity of their midpalatal suture and other factors. I guess it's possible that lightwire or removeable acrylic expanders induce some remodeling in the body of the maxilla or even stretching at the midpalatal suture, especially in less mature cases, since some people report opening of the nasal cavity with improvements in nasal breathing. However, if that's what you need, I still think the bone-anchored approach is probably significantly more reliable and stable, with the majority of the expansion coming at the suture.

May I know how old you are now? I'm 30 and my IMW is 42-44mm, that's why I'm not seriously considering an MSE, but my under eye support and cheekbones are almost non existent, so I might. I don't know what to do. I would also guess that my maxilla isn't flexible anymore as I have a ridge of tissue/bone popping up at where the mid palatal suture is supposed to be (forgot what this is called), instead of it being reasonably flat.

My bite is pretty banged up too. If I close my mouth with a relaxed jaw, the entire left side of my teeth do not touch from the 2nd incisors to the back molars. Only the right side of my premolars and back molars touch, that's why I'm considering invisalign more to fix my bite issues. Do you happen to know if DNA fixes bite issues too? I also have a "middle tooth" like Tom Cruise.

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Posted : 17/07/2021 10:09 pm
Apollo
Reputable Member
Posted by: @mysterecessed

May I know how old you are now? I'm 30 and my IMW is 42-44mm, that's why I'm not seriously considering an MSE, but my under eye support and cheekbones are almost non existent, so I might. I don't know what to do. I would also guess that my maxilla isn't flexible anymore as I have a ridge of tissue/bone popping up at where the mid palatal suture is supposed to be (forgot what this is called), instead of it being reasonably flat.

My bite is pretty banged up too. If I close my mouth with a relaxed jaw, the entire left side of my teeth do not touch from the 2nd incisors to the back molars. Only the right side of my premolars and back molars touch, that's why I'm considering invisalign more to fix my bite issues. Do you happen to know if DNA fixes bite issues too? I also have a "middle tooth" like Tom Cruise.

I'm in my late 30s. So I was lucky to have my suture open facilitated only by cortipuncture. Depending on the size and shape of your palatal torus, some providers might require you to have it surgically removed before attempting MSE. Any changes to my undereye and cheekbone areas are subtle. I wouldn't consider MSE just for the midface augmentation. Maybe if I had followed a more rapid turn protocol, the midface changes might have been more obvious, but I turned slowly to reduce my risk of failure. MSE can exacerbate existing asymmetries rather than correcting them. So there's a good chance your wider side (that is already farther from the midline) could move more than the narrower side. I think the vivos appliances like DNA can make some symmetry adjustments with the individual tooth springs, but I don't have any experience with them. If you need expansion for the tongue space, nasal airway, or dental crowding, I'd recommend MSE followed up by invisalign or some other realignment phase. If you're just looking for a straighter smile it's probably not necessary and might not work for a man your age with thick cortical bone along the midpalatal suture.

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Posted : 18/07/2021 12:20 pm
mysterecessed
Active Member
Posted by: @apollo

I'm in my late 30s. So I was lucky to have my suture open facilitated only by cortipuncture. Depending on the size and shape of your palatal torus, some providers might require you to have it surgically removed before attempting MSE. Any changes to my undereye and cheekbone areas are subtle. I wouldn't consider MSE just for the midface augmentation. Maybe if I had followed a more rapid turn protocol, the midface changes might have been more obvious, but I turned slowly to reduce my risk of failure. MSE can exacerbate existing asymmetries rather than correcting them. So there's a good chance your wider side (that is already farther from the midline) could move more than the narrower side. I think the vivos appliances like DNA can make some symmetry adjustments with the individual tooth springs, but I don't have any experience with them. If you need expansion for the tongue space, nasal airway, or dental crowding, I'd recommend MSE followed up by invisalign or some other realignment phase. If you're just looking for a straighter smile it's probably not necessary and might not work for a man your age with thick cortical bone along the midpalatal suture.

Thanks, I do have dental crowding but I think it's fixable with just braces or DNA. 

Do you know why the cortical bone can grow so thick in some people? Is there any explanation or theory?

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Posted : 19/07/2021 7:14 am
Apollo
Reputable Member
Posted by: @mysterecessed

Thanks, I do have dental crowding but I think it's fixable with just braces or DNA. 

Do you know why the cortical bone can grow so thick in some people? Is there any explanation or theory?

Some people theorize that clenching or bruxism causes palatal tori and buccal exostoses as an adaptive response to the high forces. There's a Weston A. Price Foundation article that suggests the palatal tori result when the nasal septum doesn't have adequate space in the nasal cavity and pushes down into the narrow palatal vault. I asked Dr. Mike Mew about tori and exostoses and their effect on expansion in one of the TGW Q&A videos.

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Posted : 19/07/2021 12:08 pm