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Maxillary Hypoplasia caused by ortho + wisdom teeth removal TORONTO
I got braces and extracted 4 premolars to push all my teeth back in back in 2012. Then I got all 4 of my wisdom teeth taken out last year.
This is when my life changed. I faced so many health problems. I had a constant migrane, my neck and shoulder muscles were so tight that I couldn't breathe, and now I am living on painkillers and muscle relaxants.
I realized my jaw joints were compressed back into my skull severely. From just feeling where the pressure is relieved and my neck muscles are relieved, I found a comfortable position for my jaw. But the problem is that in this position, I have severe maxillary hypoplasia and a severe underbite.
I found a dentist that treats TMJ in Toronto who uses the RN Sagittal appliance to widen the jaw. But I think that in my case, forwards maxillary expansion is more critical. My face has flattened so much from all these tooth extractions. I can't live with having this kind of underbite..
I am looking for someone who does the FAGGA appliance in Toronto but I can't find any other than Susan Huxtable, but reviews say she may do more harm than good.
If my case is extremely severe, I feel like I will need surgery to bring the maxilla forward.
I am also considering flying to Dr.Buck in Seattle, Washington for my case.
I was modelling until I had these problems. It's changed my life. Please, anything you can tell me will help so much.
Your case is pretty severe and is causing you horrendous health problems so do not even [Rude Language or Insults are not tolerated] around with weak appliances, and especially don't blow your time and money on highly experimental and unproven treatments like FAGGA at this point in time.
You live in a big city so there will be plenty of qualified orthos in your area -- you need to look for orthodontists whose specialty is in dentofacial orthopedics ( http://bfy.tw/K1nz). You are class 3 as [Rude Language or Insults are not tolerated], a perfect candidate for a rapid maxillary expansion (using MARPE or preferably MSE) + facemask protraction, for reference: https://www.sciencedirect.com/science/article/pii/S1073874618300094
E-mail around to local orthodontists' offices (focus on rich areas/downtown Toronto, this is where the talented ones will tend to work), briefly present your case/circumstances and ask specifically about whether Dr. ____ has experience using Won Moon's MSE (this is a superior version of the standard MARPE, engages the maxilla bi-cortically, and results in full mid-facial expansion) -- if an ortho has experience using this device, then they probably know their [Rude Language or Insults are not tolerated] and care about staying on top of the research and innovations in their field, which is already a good sign. Go in and consult with a few orthos who have experience using the MSE and see what they recommend beyond it as far as treatment and fixing your jaws -- many will probably recommend combining MSE + facemask (standard for class 3 patients like yourself), which are highly synergistic due to the disruptive effect the MSE has on all perimaxillary sutures, and can result in a distraction osteogenesis-like effect on the entire midface.
Thanks a lot for your advice. So expansion with the RN-Sagittal is not going to be strong enough to push my teeth far enough to fix class III?
I'm having a hard time finding someone in Toronto who will do MSE and jaw expansion in general. I've consulted almost all orthos in the downtown area.
If anyone knows anything.. It would save my life.
How old are you?
If you are past puberty then RN-sagittal will probably not fix class 3 since your issue is fundamentally a skeletal problem and growth/bone remodeling is not on your side past a certain age -- all it would do is push/tip teeth further out, which might help marginally at best. You need to displace the maxilla forward, either through MSE + facemask protraction or through surgery (keep in mind surgery will not fix the structural problems with your face above the LeFort 1 fracture).
I have a hard time believing there are no orthodontists in a big city like Toronto who are willing to treat you with the MSE. Make sure when you ask that you are limiting what you are demanding out of treatment to conditions that the MARPE/MSE has proven efficacy in treating, such as: transverse maxillary deficiency (obvious one), narrow upper airway, etc -- even though MSE+FM will help immeasurably with many of the conditions you described, you have to remember that orthos like any other doctor have liability and cannot promise you too much outside of the scope of what is reasonable or legally justifiable and has research to back it up, and some (the ethical ones at least) might even turn down your business if they feel like they cannot help you to the extent that is necessary. It may also be that your case is too severe for orthopedic treatment, but I doubt it.
Have you hit up all of these practices at least (quick google)?
Dr. Fung: http://www.northyorkorthodontics.com/dentofacial-orthopedics
Dr. Trahatos: http://www.orthodonticsondanforth.com/dentofacial-orthopaedics.php
Dr. Nalbandian: https://www.wiredorthodontics.ca/treatment-options/dentofacial-orthopedics/
I'm not sure what you mean by "highly synergistic due to the disruptive effect the MSE has on all perimaxillary sutures, and can result in a distraction osteogenesis-like effect on the entire midface."
The MSE non-segmentally and non-surgically expands the maxilla, unlike SARPE, for example. The expansion of the maxilla with MSE causes the sutures connecting the maxilla to the other facial bones (perimaxillary sutures, peri- meaning next to) to loosen. Because these sutures have disarticulated to a degree due to expansion by MSE, bone-borne protraction with a facemask or similar appliance will cause more rapid sutural growth and sutural remodeling. Read the study I linked and google midfacial distraction osteogenesis if you are confused. No more spoonfeeding.
The surgical options proposed by Varbah are sound. They are an option. And a very good one if you truly need like 1cm of distraction.
The picture you have provided is one taken of you with your mandible in a forward posture correct? This is not your post orthodontic articulated bite. If you could upload a normal photo of your mandible on bite it would be useful.
If however you simply need some mandibular decompression then I do not believe you neccesarily have to treat the maxilla to the Mandible position you have created. As often when you are in pain, you require excess anterior positioning to create a comfortable position, it does not mean you need to be permanently in this position. In this case other options cf surgery are possible.
Also, RN Sagital has no hope of developing your maxilla in an anterior position. I use sometimes for retrocline incisors as a work up towards orthodontics or clear aligners.... But not for true premaxilla development.
I am 24.
Some people have reversed extraction orthodontics by opening up space where the teeth were extracted and putting implants in them. What do you think about this for my case?
That is an option but only do it as icing on the cake, AFTER having maxed out growth and having your jaws corrected to a point where you are comfortable -- because they are implants in bone and not actually moveable dentition, they will limit growth potential.
I am personally considering reversing my wisdom teeth extractions. I'll see how I'm feeling in a few months after I'm done with my run with MSE + FM (getting the MSE in tomorrow!!!).
@sugr1 Thanks for your reply.
I think you are right. This is my post orthodontic articulated bite. (excuse the troubled skin.. I've been breaking out so badly from the stress this TMJ has caused)
After 4 wisdom teeth removal last year, I felt like my maxillary jaw started to collapse, and my mandible wanted to protract back. In this bite position shown in the picture, I can't straighten the back of my neck, my arms go numb, and my shoulders will roll forward to allow breathing.
I thought that the mandible position I've shown in the first picture was the 'correct' position of my jaw joints because I felt the tension in my neck and arms release and allowed abdominal breathing.
From the picture I've provided, do you think that my mandible needs to be in this forward posture? From what I feel this posture provides me with relief.. If this is the posture it needs to be in, then my upper arch must come forward at least 5mm and require skeletal expansion too.
That's disheartening to hear.. My dentist told me that the RN Sagittal will work better than the DNA appliance to promote forwards growth.
This is how the dentist I'm seeing treated open bite with the RN Sagittal.
I agree with varbrah and SUGR1 that a removable sagittal expander won't give you the kind of results you are looking for. Here is a good example of the potential side effects of these devices ( https://the-great-work.org/community/case-discussions/cautionary-palate-expander-case/# ). Personally, I still haven't decided if I want to try a device to help with my own forward expansion. I'm currently stabilizing my transverse expansion, and hoping that the increased tongue space will help me get some forward changes through oral posture alone. I'm definitely still struggling with airway resistance, sleep disturbances, and headaches, so I might need to try something soon. I think the strategy varbrah outlined above (bone-anchored palate expansion with extra-oral traction) could be a good option in your case. I'm also more impressed with the results from the few AGGA cases I've seen than varbrah is, and I think it is a treatment option you should seriously consider. Whatever method you choose, you want to be sure you trust your doctor and are conceptually on the same page before starting treatment. In the case I linked above, he gave up on the removable acrylic expanders and switched to AGGA ( https://ronaldead.com/ ).
Thanks for your advice. Do you need forward expansion due to orthodontic extractions as well? What kind of AGGA cases have you seen?
I've had my wisdom teeth extracted, and traditional orthodontics as a teen. The AGGA thread has several promising cases ( https://the-great-work.org/community/main-forum/fixed-anterior-growth-guidance-appliance-fagga-holy-grail-gonial-angle-change-maxilla-movement-forwards-and-palate-widening-without-surgery/# ) in addition to Ronny Ead's well-documented blog that I linked above.
Your new photo shows you may not need as much forward growth as you think.
Your symptoms are very typical of tmj compression post retraction orthodontics.
May I suggest before you have made a decision to consider a splint therapy to decompress the joint as often as you can.
The angulation of your incisors is good currently, I would not want it more flared than it is.
@sugr1 thanks so much. That’s really relieving. I believed my teeth were pushed so far back that my mandible had been pushed as far, and that forwards mandible position is the position that gives me the most relief. I thought this was the correct jaw position.
Instead of splints, my dentist is using the RN-sagittal.. I’m unsure if this is the right way to go. I’ve spent so much on trying to find the answer for my TMJ symptoms and post extraction symptoms, it’s really consumed me.
Do you know what the treatment process typically is like for tmj joint compression post retraction orthodontics? Is there a way to know through MRI/CT to establish a positioning of the bite that establishes the correct joint psition?
When you mention incisors being flared, do you mean that the RN sagittal will fan them out instead of pushing them out in a straight form?
Does this entail having to pull all the teeth forward/widen the jaw and establish a new bite - since it’s compressed?
That is the treatment process I’m going through.. I was worried that the RN sagittal wouldn’t pull my teeth far enough forwards to establish the right jaw position.
As you undergo correction in the near future, please consider keeping records for your own sake and for others. Pictures of dental impressions, scans, medical reports reports can be very helpful even with all personally identifying information blocked out.
Your input could help many, many people