Notifications
Clear all

NOTICE:

DO NOT ATTEMPT TREATMENT WITHOUT LICENCED MEDICAL CONSULTATION AND SUPERVISION

This is a public discussion forum. The owners, staff, and users of this website are not engaged in rendering professional services to the individual reader. Do not use the content of this website as an alternative to personal examination and advice from licenced healthcare providers. Do not begin, delay, or discontinue treatments and/or exercises without licenced medical supervision.

sagittal expander?  

  RSS
esh296
Active Member

I really need some advice -- I am thinking about getting a sagittal expander from Dr Hang in LA but I am worried about it just tipping my teeth and also the fact that I would have to wear a retainer the rest of my life.

I am told I need about 5mm of expansion. Others Drs have suggested AGGA for forward expansion as well because my lower jaw is trapped behind my tipped in upper teeth.

I am TMD and mild sleep apnea. I am doing myofunctional therapy currently to try to correct this.

Would prefer to do orthotropics but I am having a hard time finding someone who does biobloc for adults. I am 28.

Thank you

Quote
Posted : 01/09/2020 6:45 pm
FalseNegativeSleepStudy
Active Member

Are you doing it to reverse extractions? What are the mentioned risks?

Keep in mind sagittal expansion just moves the teeth forward so you're limited by the thickness of the alveolar bone and damage can happen if too much force is applied or if the teeth move too fast. Best case scenario is you're able to move the teeth forward 5mm with minimal tipping and alveolar bone loss, worst case scenario is the opposite + potential relapse.

Why mess with Biobloc when it's unproven to work on adults consistently and it's extremely rare to find someone who would use it on an adult, MSE seems like a much better and consistent option.

ReplyQuote
Posted : 01/09/2020 8:13 pm
Mieko
Active Member

How did you proceed?  I saw Dr. Hang a couple of weeks ago.  I am not sure if I am going forward with his recommendations.  I would love to discuss further if this thread can be revived.  

ReplyQuote
Posted : 01/09/2020 9:40 pm
esh296
Active Member

@mieko I am not sure I am either as I feel that I need saggital and lateral expansion - would prefer something like DNA 

I'm moving in a few months so my treatment will be remote somewhat which I am worried about as well but feel free to PM me about your experience 

ReplyQuote
Posted : 02/09/2020 10:30 am
esh296
Active Member

@falsenegativesleepstudy no reverse extractions. I am trying to find relief for my TMJ, however chiropractor work has helped me get out of pain even though my joint still clicks a lot. 

they said that this would help relieve tension (though I don't have tension headaches)...but not help with my sleep apnea or TMJ

ReplyQuote
Posted : 02/09/2020 10:32 am
toomer
Trusted Member
Posted by: @esh296

I really need some advice -- I am thinking about getting a sagittal expander from Dr Hang in LA but I am worried about it just tipping my teeth and also the fact that I would have to wear a retainer the rest of my life.

I am told I need about 5mm of expansion. Others Drs have suggested AGGA for forward expansion as well because my lower jaw is trapped behind my tipped in upper teeth.

I am TMD and mild sleep apnea. I am doing myofunctional therapy currently to try to correct this.

Would prefer to do orthotropics but I am having a hard time finding someone who does biobloc for adults. I am 28.

Thank you

I am TMD and sleep apnea as well.  Currently working with a DNA provider, should be getting my appliance in a couple months.  There are some patients on YouTube who have had their sleep apnea (validated via home sleep tests) resolved in under 1 year.

A lot of people will say things like "it's tooth borne" and "it will just tilt your teeth" - but these people look at it, see it's an acrylic appliance, and assume it works like a Haas or something else.  It's not like that, though - it's not meant to be a  mechanical appliance ... it's meant to be a functional appliance and emulate proper tongue/roof-of-mouth interactions.

15,000 people treated with it over the past decade.  I've spent the last 6 months trying to track down these "tipped teeth" cases, and I really can't find any.  Finding plenty of people with results they're satisfied with, though.

AGGA scares me.  I don't think it works.  There's a private FB group for these treatments (which IMO gets better discussion on this forum which is very focused on "mewing").  One of the things the AGGA providers say is that it won't distallize the molars (move them backwards) but we have one patient who - based on patterns we could see on photos of her gums - proved that's exactly what happened in her case.

ReplyQuote
Posted : 02/09/2020 10:52 pm
Mieko
Active Member

@esh296

ReplyQuote
Posted : 07/09/2020 7:48 pm
Mieko
Active Member

@toomer

I appreciate your comments and the work of you trying to track down the DNA tipped teeth cases. 

I have a good feeling about DNA and I wish you the best.  I hope you post about your progress.   I don't understand the purpose of the acrylic parts of the DNA covering the teeth.  Do you know the purpose of the acrylic part?  

I spoke with an osteopath who works with ALF patients and her concern with DNA is that you can't practice tongue posture and because of that, you don't articulate signalling to the other cranial bones.  HOWEVER, it seems DNA makes change possible so that at a future time, the tongue will better fit at the roof of the mouth AND the appliance is not worn all day, so there are other hours of the day for correct tongue posture.

 I saw Dr. Hang and also another DNA / ALF dentist.  That dentist said that ALF would be too slow and is keen on me starting with the DNA.  Dr. Hang has his own appliances (sagittal and transverse palette expander). He mentioned one DNA patient who lost 6 front teeth due to DNA.  He did not provide details.  Probably, the teeth were pushed too far forward in the gums. I also would not do AGGA. 

On another note, I had my first breakthrough with TMD last week; I started taping my mouth shut at night and I sleep better and have less TMJ pain in the morning.

 

ReplyQuote
Posted : 07/09/2020 8:14 pm
Mieko
Active Member

@esh296

I added comments to toomer, above.  I'm still deciding.  I'll stay in touch.  I'm just starting to understand what to be worried about.  So, I'm worried about tipped teeth and teeth moved too far into the alveolar bone, whereby they lose stability.  

ReplyQuote
Posted : 07/09/2020 8:19 pm
toomer
Trusted Member

@mieko

The acrylic over the teeth is for a few different things as best I can tell, one of which it acts as a bit of a bite splint and helps get pressure off the TMJ’s if you have a retruded jaw.  It’s also there to make sure you have proper occlusion from top to bottom as the bite is changed slowly over time.  That acrylic gets adjusted by the dentist during every monthly appointment - they will have you bite on bite papers, check where your bite is/isn’t registering, then grind a bit off to make any adjustments.

As a result of this, your bite and occlusion are guided all the way throughout treatment.

As for someone having their six front pushed out - can’t say I’ve ever come across that story.  However, it is very important for the patient to use the device correctly, and the dentist to know what they are doing.  The arcrylic should get ground down a bit every month so that the appliance is not touching the roof of the mouth. That little bit of space gives the palate a little room to drop.  If you don’t do that, then you would risk turning the appliance into just a standard rapid palatial expander and tilting teeth.

ReplyQuote
Posted : 08/09/2020 12:36 am
esh296
Active Member

@mieko @toomer

 

Thanks for your input and advice. 

Since I am moving - Dr Hang was going to give me the sagittal expander at a discount and then I would do everything myself...I wasn't super comfortable with that, so I decided just to stick to myofunctional therapy for the next year and see if I need expansion at a later date. I also wasn't wanting to wear a retainer the rest of my life to keep the sagittal expansion in place. 

Since I'm moving to Europe I will possibly be looking into the homeoblock appliance. I would like to do DNA but Do you know if you have to wear a retainer the rest of your life after DNA/homeoblock? 

 

ReplyQuote
Posted : 08/09/2020 1:23 pm
esh296
Active Member

Dr Hang also said that I would be a good candidate for putting another set of bicuspids into my mouth. i think this a radical treatment he offers, but it is also pretty prohibitively expensive. 

For my night mouth-breathing, I've began taping my mouth closed, however I often take it off in the middle of the night. I also have raised my bed with bricks to help with the sleep apnea. 

Chiropractor has basically cured me of the pain in my TMJ which was incredible and I wasn't expecting. 

ReplyQuote
Posted : 08/09/2020 1:59 pm
toomer
Trusted Member
Posted by: @esh296

@mieko @toomer

I would like to do DNA but Do you know if you have to wear a retainer the rest of your life after DNA/homeoblock? 

 

Vivos is quite careful in their language around this.  You can find hints of it on their website, and also when some of their executives speak.  Their conservative answer seems to be:  maybe.

Having seen enough of Dr. Singh's presentations, I think he kind of "fell into" this by accident - so even he's not sure how all of the dynamics are working.  As a result, he can't say if the changes in the body are 50% dental, 50% skeletal ... 100% dental, 0% skeletal ... so as a result, they leave the answer to be pretty neutral.  They say that for some patients, they don't think long-term retention use will be needed.

As a point of comparison, I think that MSE was believed to be about 70% skeletal in the changes (because you're effectively sticking a crowbar in the suture ... so of course there will be a lot that is skeletal).  Don't quote me on that, but I thought I heard that was a statistic attributed to Dr. Moon at one point (MSE inventor).

I've spoken with some patients that are 5 years post-treatment with DNA, who didn't continue wearing the device as a retainer, and they seem to think that what they gained has held about 85% (to use one patient's description).  Every patient will vary.  One of the early doctors who treated himself (Dr. Caulfield) says he still wears his 10-year old DNA appliance from time to time, just to make sure things are staying put.  I think that's what's worth considering - can you just wear it a couple nights a week or one week a month, and keep all the gains permanently?  To me, that would be an acceptable trade-off.  Heck, I'd even gladly take lifetime retainer use if it can actually cure my sleep apnea ... a retainer is way better than a CPAP.

Implants can potentially be one way to help ensure gains stay.  But I'm not a big fan of them, so I will likely not go down that path.  But apparently one way to develop a DNA protocol for a patient is to target re-opening spaces for previously-extracted bicuspids, to then put in implants.

There are also cases - although this is much more rare - where wisdom teeth suddenly erupted and came in just fine, once there was more room in the mouth.  I know at least one patient that that happened to.  So as long as the wisdom teeth come in ok and seat themselves nicely (not necessarily a guarantee), those would probably also help keep gains locked in.

ReplyQuote
Posted : 08/09/2020 3:15 pm
esh296
Active Member

@toomer

Oh wow that is all super interesting, especially about the wisdom teeth. I never had extractions but I did have my wisdom teeth pulled as a a teenager. 

That's good to know about DNA/retainer. I agree that it's better than CPAP. 

I'll keep you posted if I decide to expand with DNA/homeblock in 6 months or so. 

 

ReplyQuote
Posted : 08/09/2020 3:56 pm
Mieko
Active Member

@esh296 @toomer

So esh,  Dr. Hang said you are a candidate for opening bicuspid spaces for implants even though you never had bicuspids extracted?  You would have an extra set of bicuspids? Wow, did I get that right?   That's so great the chiropractor got you out of discomfort.  I was wondering if the goal for you is to move the mandible forward so there is more space between the epicondyle of the mandible and the joint?

Toomer, you did or did not have extractions?  I am asking because I did have a set of bicuspids extracted (that is the whole problem). 

I  appreciate your response about the acrylic over the teeth.  That makes sense.  I appreciate your insights in regards to how that is likely functioning.  Yes, MSE would be skeletal because there is a split and bone has to fill it in. 

Dr. Hang recommended opening up spaces for implants to replace the bicuspids.  I am hesitant to have 4 implants that may have their own issues over time.  Also, I am concerned about a lot of transverse palette expansion, without the mandible following.  Dr. Hang's treatment would allow the mandible to move forward because the upper teeth are holding it back, and he also uses a transverse expander for the mandible if necessary but there are no guarantees about how the mandible will remodel forward, much less widen (via teeth).  Clearly, he is an expert, I have to mention that.

As esh mentioned, the treatment is very expensive before the implants.  Sagittal expander, braces, transverse expander, then maybe mandible transverse expander.  Then, off to the implant specialist.  

The main issue I want to resolve is TMJ pain, not cosmetic.  So, if DNA could work for me, I would proceed with Vivos. Toomer, will you post about your progress?  On this thread or another?

Thanks!

ReplyQuote
Posted : 12/09/2020 12:08 am
Mieko
Active Member

@toomer

So, I just read your comments on Gather Questions for DNA Appliance.  That was super helpful!   I get what you mean how Vivos is looking at it differently than the mm's of expansion in a particular direction.  Very interesting.   I'm just trying to get a functional airway and stop TMJ pain and stop wearing down my teeth through clenching at night.  

Anyhow, much appreciation.

ReplyQuote
Posted : 12/09/2020 12:20 am
toomer
Trusted Member
Posted by: @mieko

Toomer, you did or did not have extractions?  I am asking because I did have a set of bicuspids extracted (that is the whole problem). 

I  appreciate your response about the acrylic over the teeth.  That makes sense.  I appreciate your insights in regards to how that is likely functioning.  Yes, MSE would be skeletal because there is a split and bone has to fill it in. 

Dr. Hang recommended opening up spaces for implants to replace the bicuspids.  I am hesitant to have 4 implants that may have their own issues over time.  Also, I am concerned about a lot of transverse palette expansion, without the mandible following.  Dr. Hang's treatment would allow the mandible to move forward because the upper teeth are holding it back, and he also uses a transverse expander for the mandible if necessary but there are no guarantees about how the mandible will remodel forward, much less widen (via teeth).  Clearly, he is an expert, I have to mention that.

As esh mentioned, the treatment is very expensive before the implants.  Sagittal expander, braces, transverse expander, then maybe mandible transverse expander.  Then, off to the implant specialist.  

The main issue I want to resolve is TMJ pain, not cosmetic.  So, if DNA could work for me, I would proceed with Vivos. Toomer, will you post about your progress?  On this thread or another?

Thanks!

I did have childhood braces w/extractions due to crowding.  4 bicuspids removed, and then teeth retracted backwards.

My smile actually was pretty good for several decades, actually.  Pictures from 10 years ago when I was 40, I still had a nice 10-tooth smile.  But I've always had poor nasal breathing.  So more and more mouth breathing over time slowly wrecked the upper arch.  By age 50, I had basically a 6-tooth smile in photos.

It's not a vanity thing ... I didn't actually care about that (I hadn't actually even really noticed until I started learning about all of this).  But in terms of biological functionality ... yeah, I really want it fixed, and for my sleep apnea to be gone.

FYI - I have seen DNA Appliance design guidance for dentists, which specifically considers whether or not a patient wants to "re-open" extraction spaces for potential implants.  So it can be done with DNA in some cases if a patient wants.  I'm not really a big fan of implants, and even though they would probably help with retention ... I'm ok with it if lifetime retainer use would be necessary in my case (it's way better than CPAP!)

I will post about my progress here once I get started.  However, I participate more regularly in a private FB group titled "Adult non-surgical palate expansion ALF/AGGA/ControlledArch Ortho/Vivos/MSE" since there's too much mewing conversation here to wade through.

ReplyQuote
Posted : 12/09/2020 1:34 pm
Mieko
Active Member

@toomer

Wow.  I will have to look at photos over the years and see how my smile changed. 

Is the facebook page you are talking about still active?  I ask because I have attempted to join several times over the last month and have not been approved. I've even tried from different accounts.  It's really where I need to be looking for feedback. 

 

ReplyQuote
Posted : 17/09/2020 6:05 pm
toomer
Trusted Member

@mieko

Yes, it's very active.  There's about 1,000 members in there.  Many in-treatment members, and many in process of considering.  Zero mewers.  🙂

Not sure why you haven't been able to get in yet.  I think the mods aren't the quickest, but as long as you answered the questionnaire fully and honestly, I can't see why they wouldn't add you.  Feel free to PM me your FB name if you want, and I'll ping one of the mods and ask if they know why you haven't been approved.  As long as it's exactly the group name I mentioned above.

ReplyQuote
Posted : 18/09/2020 6:04 pm
Mieko
Active Member

@toomer

Thank you for the offer. How do I PM?

ReplyQuote
Posted : 19/09/2020 1:12 pm
Progress
Member Moderator
Posted by: @mieko

@toomer

Thank you for the offer. How do I PM?

Scroll up, click 'personal messages' and create a new message

ReplyQuote
Posted : 19/09/2020 3:13 pm
Mieko
Active Member

Toomer, thanks much.  I went to the site and I was IN!  It's the same site I went to before, so maybe the mod responded further after your request.  Or, maybe I had not visited it recently enough since my last application or WHATEVER!  The site is very, very helpful!  You are a valuable contributor.  I love this site as well but I'm not the best candidate for mew success at this point.

My situation is much like yours.  My inner voice (after lots of investigating) is directing me to do Vivos.  However, I like the idea of MSE because, OMG let's just get it over with!

  But, I'm concerned about widening my mid face.  I'm Asian so I have a wide face.   My concern would be MSE widening my mid face, but my mandible/ chin not matching.  Because my face is already wide, my small chin - lower jaw could wind up looking tiny instead of small.  And, occlusion is then questionable.  Also, I really wonder, since I'm older and have sensitive and worn down teeth, does moving them around and then braces, stress the roots out and make the teeth more vulnerable to fracturing.  Anyhow, I'm getting long winded and should probably post on the other site for feedback on all this.  

I just wanted to say that I'm leaning toward DNA, and MSE could be a later possibility.  Although, how much money can one throw at the problem.  Apparently, lots!  

Cheers!

ReplyQuote
Posted : 20/09/2020 2:25 pm