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Ronald Ead's critcisms of the Homeoblock and DNA appliances  

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WHCCARDIO
Active Member

Ronald Ead has recently uploaded https://www.youtube.com/watch?v=HQjH1uHjYx4 video to his YouTube channel in which he provides 4 problems with the Homeoblock. I myself am unsatisified with his conclusions and the works he draws upon in criticising *all* tooth born appliances.

For the most part I agree, tooth born appliances are almost all useless and will lead to damage to both the teeth and gums. However, I don't think these same assumptions can be made of the Homeoblock and DNA appliances as such a process of expansion is contested by these devices. The claims as made by these devices is that skeletal expansion is occuring and such claims are usually evidenced via 3d scans. Ead also claims that such devices do not open the airway when DNA is specifically marketed as a solution to sleep apnea and is currently seeking FDA approval to be registered as such. I think Ead does himself a disservice in neglecting the claims made by Homeoblock/DNA and instead lumping all tooth borne appliances together, essentially constructing a strawman and then tearing it down. An example of this can be found in around the 3:00 minute mark in which he poses the question "[do these appliances split the suture or do they just push on teeth?]" a question I think is made in bad faith. The homeoblock/dna appliances obviously put pressure on teeth and do not split the suture, however, that doesn't mean their use is obsolete and purely negative, as suggested by Ead. The Homeoblock/DNA seeks to create expansion via the suture, not through a splitting but a manipulation of the teeth, to my understanding. 

Again, I think Ead is doing a great disservice to these devices by not engaging with their claims and methods of expansion. I think to a large part his thinking is influenced in large part by his awful experience with AGGA, and I would agree on his assessment of AGGA in that it only moves teeth, however, I think such experience can't be used to frame all other teeth borne devices. 

I am not completley sold on the Homeoblock/DNA appliances. However, I don't think Ead's criticisms are well thought out. I would appreciate all your thoughts on this video and its claims?

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Posted : 25/09/2020 10:51 am
toomer
Trusted Member

I didn’t watch his video because I had already read the book, and I already knew what is foregone conclusion about DNA/Homeoblock would be.

But in regards to it not opening up the airway, he’s just simply wrong on that.  Watch YouTuber Jessaroo and her most recent video of treatment with DNA. She literally shows her starting sleep test (AHI of 11) and her current (AHI of 1). It cured her sleep apnea in under a year.  It’s actually also closing up an anterior open-bite she had.

She’s in a FB group I am in, and she is not the only one that has seen their AHI reduced. Another member has had their AHI go from 26 (borderline severe) to 6 (borderline “cured”) in about a year, and they’re not completely finished with treatment yet.

Ronald literally won’t do any work to understand if/how DNA and Homeoblock might be different.  He only sees the world through “splitting” the suture, not necessarily “stretching” the suture.  I doubt he actually even understands that in its default state, the acrylic actually isn’t even in contact with the roof of the mouth.

If he’d spent some time to dig into it, but still had criticisms - that would probably be worth considering.  But he simply won’t look into it.  So I don’t consider his opinion to be of much merit, because I doubt he’s done anything more than spend 1-2 minutes on Google image search to come to his conclusion.

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Posted : 25/09/2020 7:09 pm
greyham liked
Sergio-OMS
Trusted Member

@toomer

Dentoalveolar expansion also works for OSA, because it creates more space for the tongue. It also can create diastemas, even a midline diastema. Getting a diastema without a bone-borne appliance doesn't mean the suture has been opened.

But dentoalveolar expansion does not enlarge the nasal cavity. I do not know much about DNA but it looks to me like purely dentoalveolar. In my opinion getting an expansion by appliances that have dentoaveolar effects has the opportunity cost of not being able to get a true skeletal expansion. Dentoalveolar expansion has periodontal risks that must be taken into account when using it to correct a transverse skeletal discrepancy (so can skeletal overexpansion have periodontal risks due to the same problems, in the end one must get a healthy bite).

But the point is that dentoalveolar expansion can be achieved with other appliances including Invisalign, brackets... it really depends on how the treatment is planned. I am not saying that DNA is bad, just that I do not think it is something revolutionary at all, in my opinion.

Here my two extra cents.

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Posted : 26/09/2020 6:04 am
toomer
Trusted Member

@sergio-oms

So the fact that Dr. Singh has presented data showing post-treatment increases in distance between the inferior nasal chonchae and the septum, plus volume increases in overall maxillary sinus volume ... then those would be good things to see, right?  Because he has presented data of changes just like that in nasal structures.

I would agree, those would be hard to achieve if you’re only moving teeth.

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Posted : 26/09/2020 8:20 am
Sergio-OMS
Trusted Member

@toomer

Then maybe every person looking for DNA should be treated by Dr. Singh

One good thing about the scientific method is repeatability.

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Posted : 26/09/2020 9:41 am
brt0512 and Agendum liked
toomer
Trusted Member

@sergio-oms

Actually, he presents data from other Vivos providers.  He does not personally treat patients.  As far as I know, he never has in the US.

But now you’re clouding the question, mixing what the appliance can/can’t do ... in with what any individual provider can/can’t accomplish with it.  Each question must be considered individually, wholly separate from the other. If the appliance is really only doing dental movement, then no provider should be able to achieve increases in nasal airways or sinus cavity volume - not even Dr. Singh himself.

But yet, providers (other than Dr. Singh) are seeing just that.

 

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Posted : 26/09/2020 9:54 am
Sergio-OMS
Trusted Member

@toomer

 

ok then go get treated my friend!

 

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Posted : 26/09/2020 10:48 am
Roflcopters
Trusted Member

Ronald doesnt completely trash FAGGA or other acrylic appliances and say their use is obsolete.

He actually writes that they can be put to good use on his blog, depending on the case. 

He just states the obvious.. these appliances aren't revolutionary and the epigenetic foo foo talk allows them to charge ridiculous prices for acrylic/tooth borne appliances that, well.. they mostly only move teeth.

It works for OSA because usually theres bite planes relieving TMJ/Mandible and dentoalveolar expansion also allows for more tongue space. I doubt it opens the sinuses.

Overpriced trademarks for sure.. short of a scam in my opinion. Homeoblock is cheaper tho.

Im under the supervision of an ortho doing a treatment with an orthopedic appliance at the WSEI institute and an upper and lower acrylic cost me 700euros. Not 10 000. The appliance is very very similar to the DNA. (planes to relieve my TMJ, a little expansion to correct midline, its being quite effective for my body posture, and we're planning MSE after)

So my tl;dr is:

If you're going to put urself trough a treatment and your case truly needs a considerable amount of transverse expansion, why would you pay the same price for an inferior appliance that carries more periodontal risks? 

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Posted : 27/09/2020 7:37 am
brt0512 liked
Thomas22
Trusted Member
Posted by: @roflcopters

well.. they mostly only move teeth.

It works for OSA because usually theres bite planes relieving TMJ/Mandible and dentoalveolar expansion also allows for more tongue space. I doubt it opens the sinuses.

 You're wrong.

 Read the studies.

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Posted : 27/09/2020 9:19 pm
FloatingCloud
New Member

@thomas22

 

Their isn't good scientific evidence to back any claims of facial growth or remodeling from the DNA Appliance. There's no logical reason for that to happen. All the Vivos publications use very shady and non-standardized ways of showing "bone growth" If this appliance worked consistently it would be very easy to use CBCT overlays showing the level of the skeletal bone changing in X direction.

Most likely the best case scenario is you get some lateral expansion at the suture, otherwise you'd get dentoalveolar expansion / tooth tipping.

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Posted : 27/09/2020 11:18 pm
lavishroot
New Member
Posted by: @floatingcloud

@thomas22

 

Their isn't good scientific evidence to back any claims of facial growth or remodeling from the DNA Appliance. There's no logical reason for that to happen. All the Vivos publications use very shady and non-standardized ways of showing "bone growth" If this appliance worked consistently it would be very easy to use CBCT overlays showing the level of the skeletal bone changing in X direction.

Most likely the best case scenario is you get some lateral expansion at the suture, otherwise you'd get dentoalveolar expansion / tooth tipping.

Just because you do not understand the mechanisms taking place does not make it illogical. There are superimposed cbct models on the vivos vimeo page if you care to look. There are many variables at play, so predictability is out there, but no one that has gone through vivos/dna treatment and came out worse. Literally nobody. Everyone talks about teeth tipping blah blah, show me someone with it, just one person.

It requires a high degree of compliance on the user, proficient skill from the provider in making sure the contact is proper, and how your body responds. If one could "only" experience 5% subjective improvements in health for 10k, that could be worth the investment for them. But usually it is better than that from what I have seen. 

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Posted : 28/09/2020 12:35 am
toomer liked
Thomas22
Trusted Member

@floatingcloud

 That is something people on the forums repeat - but it’s not actually true. 

One thing that stands out when you look at the before and after scans are the fundamental changes in bone structure. 

Dr. Belfor for example has a dramatic before and after showing how one of his patients grew a much longer Ramus with treatment.

That’s not tooth tipping. 

In one of his Vimeo videos, a short faced patient shows the dramatic upward rotation of his maxilla. You can see his cheekbones rise too. 

 Thats has nothing to do with the dental ridge. 

 I haven’t finished treatment, but I have noticed interesting changes. I have good posture now, I stand straight up, and I no longer crane my neck forward like a chicken. I don’t snore anymore at all either - that’s new. My head tilt is gone. I breathe much more easily, from both nostrils.

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Posted : 28/09/2020 2:31 pm
greyham liked
FloatingCloud
New Member

@lavishroot

There aren't any mechanisms that take place. If you want to gain maxillary growth in an adult it would most likely take loosening of not just the midpalatal suture, but multiple sutures throughout the skull with a high amount of extraoral force to cause distraction-osteogenesis at the suture sites.

Any intraoral appliance that has a screw in the middle will be trying to spread the maxilla apart to gain width, any forward screw will be all dental movement of the front teeth.

 

@Thomas22

Just because you haven't spoken to people that have only had their teeth only move through these appliances doesn't mean it doesn't happen. There are patients that have had underwhelming results. I don't think it's fair at all for them to make these claims of facial growth when they can't back them up with a scientific statement on how it works or clearly show multiple cases where the skeletal bone had actually widened or grown forward (A Point) Patients should be told what is a reasonable outcome from the treatment.

Can you link the Ramus growing in an adult patient? I have yet to find any scans that prove the lower jaw can actually grow significantly in an adult.

I'm glad you're getting good results from your treatment, I don't doubt you feel better.

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Posted : 28/09/2020 6:34 pm
brt0512 liked
toomer
Trusted Member
Posted by: @roflcopters

I doubt it opens the sinuses.

So glad you mentioned that.  Because it's actually one of the things that nearly all patients comment about within the first few months of treatment - that they have markedly better nasal breathing.

I'll post some of this below ... not because I actually think you will be convinced.  Quite the opposite, actually.  You've made it clear, you think it's a bunch of marketing mumbo jumbo.  And sure, the inventor sure does seem fond of buzzwords ("biomimetic", "epigenetic", "penumopedic", etc.) - I'll grant you that.  But whether the inventor is personally enamored with trying to create a new industry buzzword or not ... still has to be considered separate from the core question of whether it creates skeletal expansion in the mid face, or just moves teeth.

These screen captures below weren't actually hard to find  ...  which tells me you haven't done much research into the inventor or his invention.  And that's your choice, certainly ... but you also seem to have some pretty definitive opinions, despite having not really tried to do much research.  So I share these, not with any expectation that I will convince you ... but for others that may be browsing this thread.

So, does it open the sinuses?  Well, it seems to open the nasal airways ... here's one patient case:

Think that's just one patient case?  They ran a study and published their results, average patient age was 38 years old - so definitely not kids:

For reference, that's about 3 cubic centimeters of additional nasal airway volume.  Last I knew, I believe Dr. Kasey Li was getting about 5cc's of additional airway volume on EASE patients.  So, is it as good as EASE?  Perhaps not.  Is it just "overpriced trademarks" and "short of a scam"?  Assuming these results are not faked, I don't see how that would be a fair description.

BTW, one of the actual patients in that result set shown above - is this lady below:

But sure, that's just lighting and makeup and clever camera angles and pushing teeth, right?

Anyway, that's just nasal airway.  You asked specifically about sinuses?  Yep.  Those get bigger in their published results/studies too:

I don't know how sinus cavity volume actually gets larger, without creation of new bone ... do you?  

New bone forming making maxillary sinus cavities larger, is not something that would show up on a top-down CBCT slice showing how many mm's there are between the molars.  That's a simplistic, 2D measurement.  This is one of the reasons why Dr. Singh does not focus on the suture or transpalatal width as the sole measurement of success.  As a matter of fact, they even have a patient case that they've shared where they only expanded IMW by 1mm, but still dropped a patient's sleep apnea AHI from 18 down to like 7.

And just to be totally clear - I focus on DNA, because it is currently the only treatment which seems to have moderate success in actually curing sleep apnea.  And I'm a sleep apnea case.  Dr. Moon and MSE?  Smart man, good protocol.  But as far as I know (and I looked around) he has not published before-and-after sleep test studies to determine whether he's addressing sleep apnea.  He just says his patients "breathe better".  MMA surgery has a 90+% "success" rate, but surgical "success" is usually defined by oral surgeons as a >50% reduction in AHI and/or AHI below 10.  But that still leaves many people with sleep apnea.

Anyway, here's a last image ... again ... don't think you'll believe it, you'll just say it's photoshopped or whatever.  But these are before-and-after CBCT or MRI (not sure which) of one of his early patients that had significant asymmetry.  Notice how much new bone formed in a lot of different places, mostly on the right side of the patient's body.

 

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Posted : 28/09/2020 8:19 pm
toomer
Trusted Member
Posted by: @floatingcloud

All the Vivos publications use very shady and non-standardized ways of showing "bone growth"

This is a reasonable point of discussion.  Dr. Singh does not believe that his appliance is solely doing palatal expansion, therefore, he does not seem to believe in a simplistic top-of-head-down CBCT view showing inter molar width.  I think he assumes that 2D measurements like that are rather simplistic.

Although they do measure that during treatment.  I am in possession of two patient treatment progress reports that they (the patients) shared with me, which shows a lot of measurements (including comparison Sassouni diagrams and measurements).

Whether any of us agrees that IMW is the ultimate single measurement or not, is a separate discussion.  But if Dr. Singh thinks his invention is creating a lot of facial changes throughout the mid face, why would he want to stick to a single 2D measurement?

His paper from 2014 gets to the heart of what he thinks is happening, and at least part of how he thinks things should be measured:  

https://www.researchgate.net/publication/264298692_Changes_in_3D_Midfacial_Parameters_after_Biomimetic_Oral_Appliance_Therapy_in_Adults&source=gmail&ust=1601425448944000&usg=AFQjCNEnPrXxvC5CbxehDZi5atYPHwokK w"> https://www.researchgate.net/publication/264298692_Changes_in_3D_Midfacial_Parameters_after_Biomimetic_Oral_Appliance_Therapy_in_Adults

Pay attention to Figure 4 and Table 2, he's measuring total bone volume of the maxilla itself - and only the maxilla.  He isolates everything else out of the CBCT images except the maxilla ... and measures if there's additional bone volume there post-treatment.  And based on the published results ... there would appear to be.  About 2 cubic centimeters worth ... that's roughly the equivalent of a pair of six-sided dice.

Assuming he's not fabricating the results ... I'm not sure how else you account for that, other than to say that bone growth in the maxilla is possible as an adult.

And we can talk about splitting sutures (MSE) or "stretching" sutures (see this experiment in rats where new suture bone formation was seen after "light" and "intermittent" signaling: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/), and we can also talk about the periodontal ligament having stem cells (not controversial) and behaving like a suture too ... but the point is, Dr. Singh doesn't seem to think "the suture" is the right playing field for discussing what he and Dr. Belfor invented.

ReplyQuote
Posted : 28/09/2020 8:31 pm
toomer
Trusted Member

Posted by: @floatingcloud

Just because you haven't spoken to people that have only had their teeth only move through these appliances doesn't mean it doesn't happen. There are patients that have had underwhelming results.

Can you point me to some?  I'm being 100% serious.  I have spent the last 9 months tracking down every current and completed DNA patient I could find.  I've spoken with dozens of patients who are just fine whether they are mid-treatment right now, or finished 5 years ago.  And that includes my dentist, who treated himself years ago, published his case results, and there isn't anything wrong with his teeth that I can see.

(I added the dashed red line to his published case, to see if he was putting his head more forward to get a bigger airway reading, it might be a tiny amount, but not enough to account for a full doubling of the airway IMO).

I don't doubt there might be "underwhelming results" cases out there, but I really looked hard for those for all of the treatments I was considering to try to address my sleep apnea ... and I honestly couldn't come up with a serious failed case for DNA.  Sure, there's one crazy lady that made a ranty Youtube video ... but none of her complaints seemed to have any real substantive merit.  

And to add on the point previously raised by @lavishroot, the DNA appliance should be viewed like a hammer.  With the right design, and in the hands of a competent craftsman ... you can build something interesting with it.  But used incorrectly, you can also wreck things too.  A Vivos DNA dentist I routinely correspond with (not the one who is treating me) said that yes if you turn too quickly, if you don't grind down the acrylic to give the palate room to drop, you absolutely would end up just turning the DNA into a Rapid Palatal Expander and risk tilting teeth.

That's why Vivos requires either 9 or 12 full days of training, before they will allow dentists to treat with it.

ReplyQuote
Posted : 28/09/2020 8:44 pm
FloatingCloud
New Member

I wouldn't trust CBCT skeletal reconstructions or airway dimensions for proving much. also, the inside of the nasal passages constantly swell up and depending on where you scroll into the nasal passage, you will see different dimensions of room. It would be really nice to see that the skeletal base of the maxilla could widen X millimeters.

We can't see his bite, but it does look like his anterior teeth were dentally advanced forward, allowing for the lower jaw to come forward a bit.

 

I really don't see a good argument that DNA is somehow superior to MSE for sleep apnea. Ultimately you have (mostly) 2 lateral expanders that increase tongue space / nasal volume, however much they can. You're limited on how much this will help for sleep apnea if your jaws are still significantly recessed.

 

and I honestly couldn't come up with a serious failed case for DNA

Sagittal expansion is much more likely to destroy your teeth than lateral expansion. I suppose it depends on how you define failure/success.

Is it just "overpriced trademarks" and "short of a scam"? Assuming these results are not faked, I don't see how that would be a fair description.

Well, I would say until we have some third parties actually conduct a study on this, I wouldn't assume it works how they say it works (how does it work?) Proceed with caution and don't expect the appliance to completely change your face. I would go as far to say to expect dental compensations as part of the process.

palate room to drop

This is a concept that I've heard, but can't find airway focused orthodontists who think it means anything. Maybe it does work better if you leave some room on the palate, no idea.

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Posted : 29/09/2020 1:18 am
toomer
Trusted Member
Posted by: @floatingcloud

depending on where you scroll into the nasal passage

I don't disagree.  But this starts to delve into the "it's fabricated/photoshopped" realm of answers, saying "it's not the same slice of the CBCT", etc. If we believe that the measurements are being taken fairly and accurately, and represented honestly ... then they are finding the slice that has the minimum amount of distance between the conchae and the septum during the 1st scan, and then finding the minimum amount of distance in the same area in the 2nd scan and making the comparison.  But those might not be the same exact slices.  But if they are honestly comparing minimums seen anywhere from one scan to the next, the data would seem to be a positive indication of changes taking place in the nasal passages/airways.  And as I noted before, I don't know how you get that result if you just move the teeth further out on the alveolar ridge.

These measurements seem similar to how both Dr. Li (EASE) and Dr. Moon (MSE) publish some of their results showing increased overall nasal cavity area.

And the one image is just the nasal passages.  There's another image above which shows the results of volumetric analysis of the maxillary sinus space, and it's larger post-treatment.  Again, I don't know how you get more overall sinus volume ... without creation of new bone.

I could show you photos of patients that actually had their nostrils enlarge and become more symmetric from the start of the treatment to the end, but again ... one could always say something like "the guy is just flaring his nostrils in the 2nd photo!"  Also, it's not an uncommon result for patients undergoing DNA treatment to suddenly report that their sense of smell has suddenly gotten better.  Thomas here in the forum reported that a while back, there are other patients I've spoke with who said the same things.

So that's why I think it's plausible that there's a lot that the DNA Appliance is doing in terms of nasal airway / breathing / sinus volume.

I really don't see a good argument that DNA is somehow superior to MSE for sleep apnea.

I never said superior.  My point was about proven to have efficacy / published results.  Dr. Singh has published numerous studies of cases where mild and moderate levels of sleep apnea are completely cured, and even some severe cases (although it's less often).  I am in direct contact with at least 2 active patients that have had their OSA completely cured, validated via home sleep tests.  Dr. Moon has published no such research as far as I am aware.

I could also make an argument that MSE is only focusing on the mid-palatal suture, and Dr. Singh believes there are changes taking place in multiple locations throughout the mid face ... and that would potentially have a better chance of addressing sleep apnea for patients.  But that would require a belief that his appliance is actually affecting a lot of different changes throughout the mid face, which I know is obviously debated.

As substitute for Moon/MSE not publishing any sleep apnea results, there is a sleep apnea patient case that Dr. Kasey Li published for EASE recently ... which definitely showed improvement, but it only got the patients AHI down to 10.1, so not "cured".  I would be very eager to see Dr. Li publish some before-and-after sleep study results for his EASE patients, but much like Dr. Moon ... he does not seem to have chosen to do that either.  I really have a hard time understanding why neither of these leading practitioners aren't doing simple HSTs for patients if they are claiming their treatment protocols can help sleep apnea.  Home sleep tests cost a couple hundred bucks (the WatchPAT-1 single-use test is available on Amazon for like $200) and are super-easy to do at home.

I wouldn't assume it works how they say it works (how does it work?)

So I think the core thing that people look past, is they immediately assume that the appliance is working as a mechanical appliance, like a MSE.  In reality, my personal opinion is I think it is working more as a functional appliance.  Sure, there obviously is a bit of a mechanical part to it given that it has the mid-line screw which is expanded slowly, but given that the acrylic is actually not making contact with the roof of the mouth by default most of the time, it's not constant outward pressure.

So - how on earth does it work?

Some researchers in Brazil proved (through a multi-patient study on adults, done with "blinded" ceph traces) that they were able to get 2mm of maxillary and mandibular expansion in patients in only 5 months, through the use of a slow, "functional" appliance only in the roof of the mouth, and with no evidence of "dental tilting": https://www.sciencedirect.com/science/article/pii/S1808869415300513

Now, they make the point in their study that they did not evaluate whether the changes were skeletal or dental, so I'll grant you that.  And it's clear that they were basically trying to prove "can it be done at all?" but not necessarily push the envelope to determine "how far can you go?" as that would likely increase patient risk.  But 2mm expansion of the maxilla and mandible through only a functional roof-of-mouth appliance ... is certainly interesting.  I mean, how did the mandible width grow, if nothing was "mechanically" acting on it at all?

The obvious answer - especially if the adaptations are purely dental - is through chewing/eating.  But I think Dr. Singh would theorize that there are also some genetic mechanisms at work, based on work he did early in his career where they were treating kids with prematurely fused cranial sutures elsewhere in the skull, and once they corrected those, they noticed the kids' airways got bigger.

Anyway ...I'm of the opinion that the appliance basically accomplishes the majority of what it does mostly through functional mechanisms, not mechanical.  It basically emulates the proper tongue/roof-of-mouth interactions a normal person might have ... but those of us with collapsed maxillary arches do not. In other words, you might think of it as an "auto-mewing" device, or basically a "prosthetic tongue".  But it just so happens that this prosthetic tongue keeps getting a tiny bit larger each week, over a 9-18 month period.  Can the roof of the mouth and the teeth detect this ever-increasing-tongue, and adapt itself accordingly?  Teeth do have proprioception/spatial awareness.

Heck, there's even a Vivos rep that said in an interview something to the effect of "well, you could do this yourself - you don't need the appliance ... just press the entirety of your tongue up on the roof of your mouth 1,000 times per day, and then 1,000 times per night while you are sleeping too"

Thus, functional changes brought about more by the body itself ... than mechanical forces.  The appliance is meant to nudge the body in this direction and then let it do the work on its own, not forcibly rip apart the mid-palatal suture.

Here's a couple questions I'll leave you with.

1) Do "mandibular tori" and "buccal extoses" happen in adults?  These are abnormal bony outgrowths, yes?  What is causing those, if the body can't "grow" additional bone past adulthood?

2) If you believe that the maxillary arch shape can collapse in adulthood (I don't think this is controversial), what causes that collapse?  Bone doesn't evaporate into thin air.  The most likely answer is that the body resorbed some of its own bone in the maxilla.  If that's true, then that begs the question - if my body can resorb its own bone, why can't it remodel it too if given the proper signaling/encouragement to do so?

3) Would you believe an appliance like this could close up a significant anterior open-bite in a patient, i.e. where when biting down on the molars there are a few mm's of open space between the upper and lower front incisors?  If you used MSE on a patient with an anterior open-bite, I think you'd just have a wider anterior open-bite at the end.  But yet, in a private FB group I'm in we have one patient who is having exactly that happen, her anterior open-bite is closing.  At the start of her treatment, she could clearly stick a bit of the front of her tongue out between her incisors while biting.  One year later, now she can't.  What on earth has bent the front of the maxilla back down to create that result, if not the body itself?  This is one you don't need x-rays or CBCTs to see, it's obvious.

Thanks for the back-and-forth!  It's very helpful, and I definitely do appreciate it.

 

ReplyQuote
Posted : 29/09/2020 10:56 am
Thomas22
Trusted Member
Posted by: @floatingcloud

Patients should be told what is a reasonable outcome from the treatment.

Yes - but i suspect it’s hard to make a uniform statement on outcomes. Everyone’s case is unique, and gains will be very specific to the person  

I started with an open bite on my left side for example (it’s gone now). 

 The DNA Appliance is also approved for sleep apnea. 

 If your vivos, I think it would be a mistake to over promise results, and what they’ve done is be very cautious and say, we can reliably reduce if not cure your apnea.

 Also, how do you measure improvements, like increased symmetry for study purposes? And how do you present them?

 Also, what is the point, to a degree, insurance isn’t going to cover improved facial structure  

 I think that explains the Vivos approach. Belfor, he is selling to an audience that is interested in cosmetic improvements, so his page had a lot of scans showing bone growth, and photos showing increased symmetry. 

 But at best, all he can say is that your face will be more symmetrical with treatment. And it will. But there’s no more scientific way to put it, or present it. 

In my first vivos report, they took a lot of measurements of my cranial structure, they outline which features are out of proportion. So my left nasal passages are 55% smaller than my right for example. 

Ill pull those links for you but it may be a day or two. I’m working 90 hour weeks right now. 

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Posted : 29/09/2020 7:39 pm
FloatingCloud
New Member

3) Would you believe an appliance like this could close up a significant anterior open-bite in a patient, i.e. where when biting down on the molars there are a few mm's of open space between the upper and lower front incisors?  If you used MSE on a patient with an anterior open-bite, I think you'd just have a wider anterior open-bite at the end.  But yet, in a private FB group I'm in we have one patient who is having exactly that happen, her anterior open-bite is closing.  At the start of her treatment, she could clearly stick a bit of the front of her tongue out between her incisors while biting.  One year later, now she can't.  What on earth has bent the front of the maxilla back down to create that result, if not the body itself?  This is one you don't need x-rays or CBCTs to see, it's obvious.

Thanks for the back-and-forth!  It's very helpful, and I definitely do appreciate it.

You can close an open bite dentally, if it's mostly a dental problem or not a huge skeletal discrepancy it's probably fine. If it's a huge skeletal discrepancy you should probably get a patients consent before trying something like that.

If your back teeth have contact or buildups, but not the front teeth from an appliance your back teeth will intrude and the front teeth will extrude.

If DNA could be proven to cause counterclockwise rotation of the jaws, that would be impressive and wouldn't be hard to prove. None of this stuff would actually be very hard to prove by any competent orthodontist who can read before and after CBCTs. I don't doubt this appliance can potentially widen the maxilla and cause dental changes, the more important question is if it legitimately can do more, which won't be proven until a third party researches it.

 

don't disagree.  But this starts to delve into the "it's fabricated/photoshopped" realm of answers, saying "it's not the same slice of the CBCT", etc. If we believe that the measurements are being taken fairly and accurately, and represented honestly ... then they are finding the slice that has the minimum amount of distance between the conchae and the septum during the 1st scan, and then finding the minimum amount of distance in the same area in the 2nd scan and making the comparison.  But those might not be the same exact slices.

Don't forget that there are other appliances out there that make similar claims to DNA which have been proven fraudulent in their claims and presentation. Until some third party orthodontist conducts a study looking at multiple before and after CBCTs and pictures, people should be cautious or have some reasonable level of expectation from the treatment.

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Posted : 30/09/2020 1:16 am
brt0512 liked
greyham
Active Member
Posted by: @floatingcloud

There aren't any mechanisms that take place. If you want to gain maxillary growth in an adult it would most likely take loosening of not just the midpalatal suture, but multiple sutures throughout the skull with a high amount of extraoral force to cause distraction-osteogenesis at the suture sites.

Your argument is not supported by the scientific literature on bone growth/remodelling. This is pure unfounded speculation, which takes us full-circle back to the problem with Ronald's assertions and the ensuing discussion in the comments below his videos. It is not supported by science.

The mechanisms are described in these texts, and I'm sure there are many others:

In Vitro Bone Cell Models: Impact of Fluid Stress on Bone Formation

Fundamentals of Biomechanics, Chapter 15: Mechanical Properties of Biological Tissues, Section 15.7: Biomechanics of Bone

Quantifying the effects of mechanical vibration on the volume of the midpalatal suture, Chapter 2: Bone, Section 2.4: Physical Properties of Bone, Subsection 2.4.4: Viscoelasticity

Biomechanical and Molecular Regulation of Bone Remodeling

I decided not to continue participating in this kind of debate with people who prefer to engage in unfounded speculation instead of taking the time to read references like these, but I'm posting this here so people exploring these appliances can appreciate that Ronald Ead's views are misinformed.

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Posted : 11/10/2020 8:14 am
toomer liked
toomer
Trusted Member

@greyham

Good additional info, thanks for adding it in.  

Here's another one to add to your collection - they put mild "stretch" forces on the premaxillary sutures in rats, and sure enough, within a few days under an electron microscope they could see new bony formation.  Granted, it's rats ... not humans ... but they are believed to be biologically similar enough.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/

I still have yet to find an answer to the question I posted above (which was ignored/skipped over) ... if mandibular tori or buccal extoses can form as an adult ... that's new bone growth, is it not?  Granted, it's abnormal bony growth - we don't want it there ... but it's the body creating bone as a response to some sort of signal / stress / pressure.  So if we can get abnormal bone growth as adults, isn't it plausible that with a device that creates the right forces/pressures the right way ... we could get some more normal bone growth?

Another example.  I have a couple small, slight bony spurs on a few of my vertabrae.  Did I have those all my life, or did those form in later years as a response to pressures (likely from poor nasal breathing / too much mouth breathing)?  How did my body form "new" bone on my vertebrae if you can't grow bone as an adult?

There's another reference for you I need to find out of Dr. Liao's book (and Dr. Miraglia just cited recently), that the sutures in adults actually aren't fully fused until maybe about age 70.  Sure, they are more fused as adults than when someone is a teenager ... but the prevailing wisdom has been they're 100% fused after a certain age in mid-to-late teens ... and it seems as though maybe that's not actually the case. 

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Posted : 11/10/2020 9:46 am
FloatingCloud
New Member

@greyham

not supported by the scientific literature on bone growth/remodelling. This is pure unfounded speculation,

It's actually what is shown in orthodontic literature with proven results. I'm not saying the other theories on bone growth/remodeling are wrong, but it's absurd to believe that Vivos is any different to the other numerous "functional" appliances out there. Depending on your age, bone structure, appliance, and maybe some other factors you will get varying results.

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Posted : 17/10/2020 5:45 pm
greyham
Active Member

@floatingcloud

Orthodontic literature is not all it's cracked up to be, and what you call "other theories" are the in fact, the scientific consensus on how bone behaves; I've even cited the papers that demonstrate this whereas critics such as yourself have not cited any evidence whatsoever for your point of view.

This is the point I want other readers to get.

I am not participating in this debate for your benefit, I'm here so that other people in my position with a serious, life-threatening condition don't read your personal opinion, think that it's informed by scientific evidence, and end up being dissuaded from a potentially useful treatment as a result.

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Posted : 17/10/2020 5:56 pm
WHCCARDIO and toomer liked
sinned
Estimable Member

@toomer

I don't understand people who say adult sutures are fused, if they were being honest they would say they are more fused/ossified than a child, but the language seems very selective in supporting the idea that you can't get any change as an adult. The idea that sutures fuse as an adult is so laughably and blatantly untrue if one even understands what fusion means, fusion means the bones become one, yet you can easily see the sutures on an adult skull, it's clearly not just one bone, and even in the elderly you can still see the sutures. Just a quick image search of skulls of varying age and you can see for yourself that the sutures are obviously not fused.

 If you look closely you can definitely see the sutures, even in the elderly skulls. In regards to functional appliances, I think that chewing is critical for expansion and that the daily high cyclical load on the skull encourages sutural growth and prevents tipping. I've had interesting sensations in the maxilla when I'm chewing that makes me think that it's the combination of chewing and expansion that gets results. If you think about it for a moment, if you're chewing and your bite is slightly out of line and the teeth are slightly tipped, the forces of chewing should force the teeth upright, and I think this uprighting force is transferred into the whole maxilla/cheekbones forcing the roots of the teeth to also expand.

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Posted : 17/10/2020 11:27 pm
brt0512 liked
toomer
Trusted Member

@sinned

I'll try to dig it up at some point in the next week or so, but Dr. Liao (long standing Vivos DNA practitioner) published a book on a lot of this stuff.  And he found some citations from scientific literature that aligns directly to your point - sure, the sutures are more fused in adulthood than in childhood ... but they are not fully fused until maybe someone hits their 70's.  I'll dig up the citation when I get some time over the next few weeks and will post it back here.

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Posted : 18/10/2020 1:22 pm
FloatingCloud
New Member

@greyham

I'm here for the same reasons as you. The concept of sutural distraction works and there's a reason why it works.

 

https://pubmed.ncbi.nlm.nih.gov/25041370/

https://pubmed.ncbi.nlm.nih.gov/26111320/

https://pubmed.ncbi.nlm.nih.gov/16077296/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028474/

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Posted : 19/10/2020 12:00 am