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MSE for widening very narrow high palate

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june
 june
(@june)
Posts: 11
Topic starter
 

I (33F) just had the MSE installed yesterday to widen my palate (31mm intermolar width). The doctor is hopeful we can do at least 6mm growth though we will aim for the full 8. I’ll add progress photos/xrays here along with updates. This forum was really helpful in my decision to go for the device so hope this post can be of some help to others. 

 

Installation

The installation itself was not much worse than a filling. They applied a numbing gel to the roof of my mouth to prepare for the shots. The shots were the most unpleasant part as the needle seemed really large and somehow felt like it was expanding as the anesthetic went in. Not pain as much as really intense pressure. I couldn’t feel the screws go in at all even though I needed the 13mm which are supposed to be more difficult. The xrays showed the screws went in exactly as needed on either side of the suture and seem to be anchored as the doctor wanted. 

 

The pain started up about 30min after I left the office. It got to about an 7/10 by the time I was home so I took a couple ibuprofen and laid down until the pressure cleared. I’d recommend taking something as soon as you leave the ortho. I’ve had to re-up about every 2 hours yesterday and down to every 5 hours today. Pain is manageable at a 3/10, but I wouldn’t want to be at work today. Probably the most difficult parts are having to relearn how to say ‘k’, ‘g’, and ‘y’ sounds without sounding phlegmy and sticking with a liquid only diet for a few days. 

 

Treatment Plan

The doctor recommended we do 2 turns per day, 1 every 12hrs. The first two were done right after install and I did one this morning, causing some pressure in my nose that resolved within about an hour. 

We’re going to do 2 turns per day until the diastema forms, pause for 7 days, then start up again at 2 per day. The pause is part of a new treatment plan that’s seen a lot of success for adults, especially older women. It sounds like it decreases risk of issues and also allows for more overall expansion, but I’ll find out more details in the next visit. May also start the face mask next treatment too, though the doc wants to wait until making that call.

IMG 0128

 

 
Posted : 09/09/2020 6:16 pm
TheBeastPanda, Apollo, Agendum and 3 people reacted
Topic Tags
MSE
Sergio-OMS
(@sergio-oms)
Posts: 146
 
Posted by: @june

I (33F) just had the MSE installed yesterday to widen my palate (31mm intermolar width). The doctor is hopeful we can do at least 6mm growth though we will aim for the full 8. I’ll add progress photos/xrays here along with updates. This forum was really helpful in my decision to go for the device so hope this post can be of some help to others. 

 

Installation

The installation itself was not much worse than a filling. They applied a numbing gel to the roof of my mouth to prepare for the shots. The shots were the most unpleasant part as the needle seemed really large and somehow felt like it was expanding as the anesthetic went in. Not pain as much as really intense pressure. I couldn’t feel the screws go in at all even though I needed the 13mm which are supposed to be more difficult. The xrays showed the screws went in exactly as needed on either side of the suture and seem to be anchored as the doctor wanted. 

 

The pain started up about 30min after I left the office. It got to about an 7/10 by the time I was home so I took a couple ibuprofen and laid down until the pressure cleared. I’d recommend taking something as soon as you leave the ortho. I’ve had to re-up about every 2 hours yesterday and down to every 5 hours today. Pain is manageable at a 3/10, but I wouldn’t want to be at work today. Probably the most difficult parts are having to relearn how to say ‘k’, ‘g’, and ‘y’ sounds without sounding phlegmy and sticking with a liquid only diet for a few days. 

 

Treatment Plan

The doctor recommended we do 2 turns per day, 1 every 12hrs. The first two were done right after install and I did one this morning, causing some pressure in my nose that resolved within about an hour. 

We’re going to do 2 turns per day until the diastema forms, pause for 7 days, then start up again at 2 per day. The pause is part of a new treatment plan that’s seen a lot of success for adults, especially older women. It sounds like it decreases risk of issues and also allows for more overall expansion, but I’ll find out more details in the next visit. May also start the face mask next treatment too, though the doc wants to wait until making that call.

IMG 0128

 

Oh I never heard about that 7 days pause. Always good to learn what others are doing. Will try!

Thanks for your message

 
Posted : 10/09/2020 12:32 am
Agendum
(@agendum)
Posts: 71
 

@sergio-oms Funny thing occured to me, soon after my own suture split, I continued to expand at the prescribed 2/turns a day but found the arms digging into one side of the palate causing pain. I had to reverse a few turns (close to returning to the initial split) to stabilize it (at my own discretion and comfort) with pausing for a few days.

Ive arrived at this need to pause expansion independent of even knowing this pause method existed, I did it out of necessity. I was never prescribed to do this thats what makes it an interesting discovery. Only difference is that I only do about 1 turn a day now.

 
Posted : 10/09/2020 10:14 am
marp96
(@marp96)
Posts: 14
 

@Agendum @sergio-oms Hi, I’m really interested in learning about this therapy as my arches are very narrowed and I believe it would be a great help at expanding and allowing me to breathe better. I’m trying to plan out the cost of the therapy but haven’t been able to find much about it online. I was hoping you guys could fill me in on what I can expect to pay for the MSE treatment, on average. Also, how did you both find ortho/periodontists that provide this treatment? It seems they’re few and far between. Thank you in advance. 

 
Posted : 20/09/2020 8:47 am
Agendum
(@agendum)
Posts: 71
 

@marp96 The most expensive part are the braces/invisign that come after actually ($6K for me.) I think some orthos allow you to go through a couple or more MSE/MARPEs if needed within the set price (mine was $2K.) The actual appliances are cheaper to manufacture but I think that price range reflects the headroom for a possible failure rate and reinstallations.

These kinds of procedures are still very sparse, I have to drive nearly an hour away for the closest ortho that does MSE (that I know of in California.) I tried various search terms using quotation marks in search engines to specify the search. If your search terms relate to sleep apnea in relation to orthodontist you’ll probably come closer to finding an ortho that does procedures like MSE or DOME. Thats how I found my ortho.

 
Posted : 20/09/2020 5:18 pm
Silver
(@silver)
Posts: 173
 

Very cool! I’m about to get my own MSE in a few weeks. Can you update us when you find out the details of that turn protocol? I’ve heard a variety of different approaches ranging from 1 turn per day the entire time to 4 to 6 turns per day until a split and then 2 per day after that. What’s the idea behind the 7-day pause? Wouldn’t that be counterproductively long?

 
Posted : 25/09/2020 12:08 pm
june
 june
(@june)
Posts: 11
Topic starter
 

@marp96 My MSE ended up costing $10k (US), but there is a chance the first device won’t produce enough expansion so we’ll need to do a second round for an additional $1k. This is because of the high arched palate and that I’m older. There are some people who go through all the turns and only get the diastema right at the end so a second device can do the actual expansion. As @Agendum said, most of the cost is for the Invisalign. Finding a provider is challenging – I used the forums to find doctors in my area and spoke with nearly 10 before making my decision. I heard you can email Dr. Moon directly and he might send over a list of recommended providers in your area like in this post: https://the-great-work.org/community/main-forum/how-to-find-mse-providers/#post-35211

 
Posted : 27/09/2020 4:58 pm
Agendum, marp96, Agendum and 1 people reacted
june
 june
(@june)
Posts: 11
Topic starter
 

@silver Got some more info from the doctor on the pause and will try to describe it. The pause protocol is especially for people who have sutures that are less likely to open (older people or dense bone). As the device opens in the beginning before the suture splits, the screws may tip or even bend. This builds up pressure in the screws themselves and the pause gives time for that energy to be transferred into the palate. Once the turning starts again, it’s more likely for the pressurized suture to split. 

Good luck with your install!

 

 

 
Posted : 27/09/2020 5:07 pm
Apollo, Agendum, Apollo and 1 people reacted
june
 june
(@june)
Posts: 11
Topic starter
 

Update #1: 

I’ve been waiting (and waiting) for the diastema to form and finally, 42 turns later, I have a tiny hairline diastema between my front teeth. We knew that I was more at risk of not getting a suture split because of my anatomy + age, so feeling very relieved that it happened.

The first 5 days after getting the device were intensely painful, especially days 3-5. I was on a cocktail of prescription strength ibuprofen and hydrocodone/acetaminophen all day and waking up at least once each night due to the pain. Couldn’t eat more than broth and yogurt and after eating my palate would feel like it was on fire. I have an extremely high pain tolerance and have not taken painkillers after major surgeries, so this was unexpected. I had to take the full week off work and couldn’t talk more than a few sentences all day. The doc says it’s because of how narrow my palate was, causing the device to sit a few millimeters from the top and digging into the soft tissue around the sides. Luckily I woke up on Day 6 with pain back down to about a 3/10 and it was almost gone on Day 7. 

I did 2 turns per day for the first 16 days. Although there was no suture split, I gained about 1.5mm in intermolar width and my bite shifted. Most of the growth seems to be on the right side where I had a crossbite. The crossbite is gone now and my lower jaw has even shifted slightly to the right, helping with the TMJ too. I’m not too worried about the one-sided growth because my face is asymmetrical to begin with and this is helping even it out. During this time, I could feel/hear little popping sounds like tiny bubble wrap in my nose and it became slighly easier to breathe. I also had a few days of an extremely watery nose and sneezing a lot.

At my second check in appt, the xray showed that the screws were tipping slightly but not bending and that the suture had a very small split in it. The doctor said it was promising and we discussed options for moving forward. She recommended that we take a pause to let the pressure build up, but I hadn’t really felt much pressure. Ended up deciding to do 4 turns per day for 3 days, as long as I wasn’t getting any device warping. That would increase the pressure and then I do the week long pause after that. Luckily, on Day 20 I woke up with my front teeth feeling very sensitive and later in the day the diastema finally formed. I’ll check in with the doctor tomorrow about whether the pause is still necessary and how many turns to do from now on. 

 

 
Posted : 27/09/2020 5:37 pm
Apollo, Agendum, Apollo and 3 people reacted
marp96
(@marp96)
Posts: 14
 

@agendum Thank you for your helpful insight. I have found a couple of orthos in states near me that offer MSE. I’m still in the process of price comparing since the prices seem to differ at each practice. I was wondering what your plan is for your mandible once your maxillary expansion is done? I’m trying to look into MSDO and SFOT which are both supposed to help the teeth on the mandible meet a proper occlusion with the teeth in the maxilla, I’m curious to see if anyone else is looking into these procedures. 

 
Posted : 29/09/2020 9:44 am
Agendum and Agendum reacted
marp96
(@marp96)
Posts: 14
 

@june thank you for your response, I’ve been getting quotes from $7k to $12k so it seems to vary from one practice to another. I’ve actually been able to find several in the states around me using Dr. Moons locator but I’ll definitely look into that post to see if I missed any! I was wondering if you had any plans for mandibular expansion? 

 
Posted : 29/09/2020 9:49 am
Agendum and Agendum reacted
Agendum
(@agendum)
Posts: 71
 

@marp96 Every mouth is different, Ronald Ead would be better to ask about lower jaw since I havnt completed MSE or have plans for lower arch (run into some complications.) My lower dental arch looks narrow but thats because the jaw is recessed (but not undeveloped) and my upper jaw is limiting it from coming foreward a few MM including the front teeth and uprighting the lower teeth.

Lower jaw solutions are very individualistic unless you expand like 10mm+ then mandible alterations are needed.

 
Posted : 30/09/2020 2:45 am
marp96 and marp96 reacted
june
 june
(@june)
Posts: 11
Topic starter
 

@marp96 I’ve talked briefly with my doc about this as my lower teeth are only going to allow the upper to expand by 8mm without causing a significant cant of the upper teeth. Since I could have up to 14mm of expansion, we’ll need to do SFOT or surgery to expand the mandible. I’m likely to have to get a second MSE already, so we’re going to wait to see how the first one goes before deciding on the second phase. 

 
Posted : 30/09/2020 1:12 pm
Agendum, marp96, Agendum and 1 people reacted
marp96
(@marp96)
Posts: 14
 

@june thanks for the update, can I ask, do you have an estimate of what you expect the total cost to be? 

 
Posted : 04/11/2020 1:11 pm
Apollo
(@apollo)
Posts: 1664
 
Posted by: @june

Luckily, on Day 20 I woke up with my front teeth feeling very sensitive and later in the day the diastema finally formed. I’ll check in with the doctor tomorrow about whether the pause is still necessary and how many turns to do from now on. 

Did you end up doing the 7 day pause after your diastema formed? Has your diastema increased in size since it first appeared?

 
Posted : 30/11/2020 9:16 pm
june
 june
(@june)
Posts: 11
Topic starter
 

@marp96 since I had to get the second MSE, the total cost is $11k (typically $10k if you’re just getting one MSE).

 
Posted : 30/11/2020 10:41 pm
marp96 and marp96 reacted
june
 june
(@june)
Posts: 11
Topic starter
 

@apollo since the diastema formed without the pause, we ended up skipping it. I went back down to 2 turns per day after it formed and did that until the device maxed out.

 
Posted : 30/11/2020 10:43 pm
june
 june
(@june)
Posts: 11
Topic starter
 

Update #2: 

After the diastema formed, I did 2 turns a day until the full 60 turns. One of the tads started to drag, opening up a long sore on my palate that made it difficult to eat solid foods again. That lasted about a week until my final appt at which point I got to 40.5mm (3.5mm expansion).

 

At the appt the doc took out the MSE which hurt badly on the screw that dragged, as it had gotten a bit infected. The rest of the screws didn’t hurt much at all. They made a Invisalign like plastic retainer and sent me home for 3 weeks while the second MSE was made. I was worried the palate would fuse again but the doc said it wouldn’t be an issue. My teeth felt sore for a few days, but otherwise fine. The drag and infection healed within a few days too. 

When I came in 3 weeks later the expansion shrunk by about 1.5mm despite me wearing the retainer. They put in the MSE again which hurt about the same as the first time, manageable. The biggest surprise is how I felt the next day – no pain, no inflammation, eating solid food. It was night and day from the horror show of the first MSE. The doc says it’s because my palate widened enough to properly fit the MSE rather than it resting on (and pinching) soft tissue. 

I started turning again at 2 per day and the gap between my front teeth grew almost instantly. The hard part really is getting a diastema started, the rest is easy comparatively. At my 1/2 way checkup I was at 43mm (5.5mm expansion). 

About 1 week ago, my gap stopped expanding as quickly and my molars with the bands have tipped. On the right the molar is about 45 degrees tilted with its inner edge hitting the lower jar when I bite. There is still some gap growth but at a much slower rate. I’m hoping the arch can be expanded slightly with Invisalign as I wish it would have gotten wider rather than pushing out the molars. The gums around the molars have expanded with them rather so I’m not worried much about exposing the root at this point. I’ll max out the device tomorrow and will have my final checkup the day after. 

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Posted : 30/11/2020 11:01 pm
Apollo and Apollo reacted
june
 june
(@june)
Posts: 11
Topic starter
 

Forgot to mention, I also started forward pull headgear with the second MSE. I can only wear it about 8hrs per day due to work, but it’s given me at least 1-2mm and my lower jaw has swung forward enough to reduce TMJ. There is still a slight choppiness, but it no longer cracks when I open my mouth. I’ll likely wear it for another month while the suture is still open and things can move around. 

 
Posted : 30/11/2020 11:06 pm
Apollo and Apollo reacted
Apollo
(@apollo)
Posts: 1664
 

Do you feel better breathing and/or sleeping?

 
Posted : 30/11/2020 11:15 pm
june
 june
(@june)
Posts: 11
Topic starter
 

@apollo breathing through my nose is much easier. I used to only be able to take 5 breathes from my nose until I’d have to open my mouth as I wasn’t getting enough air. That issue is pretty much gone now.

Can’t really tell a difference for sleeping yet, but that might be because of the headgear which causes me to toss and turn all night. 

 
Posted : 01/12/2020 12:57 am
Apollo and Apollo reacted
Apollo
(@apollo)
Posts: 1664
 
Posted by: @june

@apollo since the diastema formed without the pause, we ended up skipping it. I went back down to 2 turns per day after it formed and did that until the device maxed out.

So is the 7 day pause meant to be before or after the diastema appears? I got the impression it was done after the diastema to maximize skeletal separation by giving the built up tension time to take effect, and limit tilting or dragging of the TADs from zygomatic resistance even after the midpalatal suture opens.

 
Posted : 04/12/2020 9:36 pm
Bogdar
(@bogdar)
Posts: 78
 

Interesting thread. Thank you for the pictures and documentation ! Keep us updated

 
Posted : 08/12/2020 9:59 am

THE GREAT WORK