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24f, years of TMD with no improvement. Agga or MSE or Surgery?  

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beesforfrees
New Member

Hey y'all. I've had TMD in the right jaw for nearly 10 years. I have popping, clicking, cracking, pain, headaches, tinnitus, occasionally clogged nostrils, and facial asymmetry. The whole shebang. 

I previously had braces and impacted canines as a kid. 

I've seen different dentists, orthodontists, and specialists. I've been prescribed muscle relaxers, I had 1 front plate plate splint made, and 1 LVI dentist made orthotic. The orthotic worked for the right side, but started making the left side crack too. 

My jaw stops clicking and the pain stops if I jut my jaw out a few millimeters to give myself an underbite. I think I need to expand my maxilla or make it move forward. 

I've thought about Agga but I've read negative things about it and I don't want to risk wobbly teeth. I'm thinking about MSE and headgear.

Does anyone think this would help advance my maxilla? I've also thought about going to a dystonia clinic and seeing if it could be solved muscularly. Last resort is surgery. 

I will gladly accept any advice you all have!

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Posted : 20/05/2020 5:26 am
big_iron liked
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Tmd
Azrael
Estimable Member

As far as I know, MSE is an expansion appliance and going by the photos, your palate already seems pretty wide (have you measured your inter-molar width?). I don't think an MSE is strictly necessary in your case (it's also a bit too fast in its expansion, imo).

However, since your TMD symptoms stop when you jut the jaw, I think it's probably because your maxilla is recessed (most likely from the braces) like most CFD cases so you might indeed benefit from bringing it forward without any CCW rotation as it's already in such a position from what I can see in the x-ray.

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Posted : 20/05/2020 5:54 am
beesforfrees
New Member

@azrael I don't know the intermolar width at the moment. I've heard MSE and facepulling device might get you a few mm of maxillary advancement

I was also thinking a bit of expansion might help my canines fit in my mouth better. 

Do you know any other way to advance the maxilla besides surgery? 

 

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Posted : 20/05/2020 6:09 am
Azrael
Estimable Member
Posted by: @beesforfrees

I've heard MSE and facepulling device might get you a few mm of maxillary advancement

MSE splits the midpalatal suture and expands mostly laterally. I don't know if it's worth going through all that trouble just to advance your maxilla a few mm. Perhaps more experienced users here might provide you with better insight regarding the mattter.

Posted by: @beesforfrees

Do you know any other way to advance the maxilla besides surgery?

I wasn't recommending surgery as I believe it should be a last resort if no other alternative exists. I personally don't know about the capabilities of head gear when it comes to advancing the maxilla but I have heard about something similar called forwardontics. You should look into that. Also, mewing brings the maxilla forward as well, though it takes a significant amount of time to accomplish that.

 

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Posted : 20/05/2020 6:46 am
big_iron
New Member

I completely understand your problem since i have almost the same thing, clicking in the right side and all of that tmd stuff. I never had braces but i can tell that my canines are a tiny bit crowded.

Inter-molar width for me is about 45mm(I measured it myself so probably not 100% accurate), but still...I know I can't breath properly.

Maybe it's just me but I feel that forward expansion alone in the maxilla isn't enough, or maybe it's just my imagination.

I'm not a doctor but I know that MSE can give you 2mm forward expansion at best(with face mask). now the problem is that you said

Posted by: @beesforfrees

if I jut my jaw out a few millimeters to give myself an underbite

I think you should know how much exactly you will need. Although i have the same problem but i cannot measure it for me cause i still don't even have a splint to know where EXACTLY the ticking point is. (but if i could guess i'd say about 4 to 5mm to be in a good position)

 

But I would love to stay updated.

 

hope you find a solution

 

 

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Posted : 09/09/2020 11:37 pm
beesforfrees
New Member

@big_iron

 

Update-

I spoke with dr. Ting in LA via video chat, he said my mandible is recessed. Bottom teeth are currently pushed out too. Class 2 malloclusion. He recommended double jaw surgery. I feel like that might be too much, another ortho said that would be too much... she thinks that she can tip the lower teeth in, bring the upper teeth out, and then my jaw would be find. She thinks we're really just talking a few MM until it stops popping. I'm just nervous about bringing those teeth out without widening the maxilla, seems like it might look wonky. 

I'm going to see another orthodontist, in person this time, who does MSE. If she recommends double jaw surgery I might do it. I'm hoping she just says mse, move lower teeth in, upper teeth out, face pulling device. That would be ideal. 

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Posted : 10/09/2020 12:59 am
big_iron liked
big_iron
New Member

Thanks a lot for the update,

Crazy, I was thinking exactly the same. MSE, lower teeth in, upper teeth out.

 

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Posted : 10/09/2020 7:41 am
toomer
Estimable Member

Best of luck to you!

Since you seem open to considering all options, I would also suggest maybe consulting with a Vivos DNA provider in your area (if there are any).  Although Vivos is clearly marketing towards obstructive sleep apnea cases, in reality they're trying to accomplish some of the same things that AGGA+CAB wants to do - get you both lateral and forward growth.  I've spoken with some post-treatment patients who were severe TMD cases, and they say their lives are way better now.

As you are no doubt aware, the topic of any growth of the maxilla - short of a "shove a crowbar into the palatal suture" procedure like MSE or similar - is highly contentious.  So I won't spend any time on that topic - if you've considered AGGA+CAB, you've considered the possibility that it might be possible without surgery.

What you will hear (over and over and over again) about Vivos DNA from people who have done nothing more than look at a picture in a Google image search ... might be something to the effect of "you can't open the suture by putting an acrylic appliance against it and creating outward lateral forces - the forces will just expel into the teeth" or "it's 'tooth-borne' and that will tilt your teeth".  I find these statements typically come from people who either have not undergone the treatment, and/or have not studied the appliance at any length.

What those individuals almost never understand (and thus, it comes as a surprise to them) is that the acrylic in the DNA Appliance is actually not supposed to be touching the roof of the mouth by default.  In it's normal state, it's just sitting there, a millimeter or so below the roof of your mouth.  In fact, one of the most critical parts of the protocol is to re-visit the dentist every month so they can shave a bit more of it down, so nothing is making contact by default.  

And the front springs are either not making contact in the default position, or only very light contact.

So how does it work then, if nothing is really touching anywhere by default?  When you bite or swallow - which we all do a few thousand times a day - the appliance presses up against the roof of your mouth, and puts a little bit of pressure there.  The front springs engage against the back of the teeth for a split second, and then release.  This is the "intermittent light forces" the inventors of that appliance say is part of how it's different.

When the acrylic does make contact on the roof of the mouth for a split second when you swallow, as it releases - because there is a gap there and saliva is in there, that creates downward suction pressure.  Very very slight.  But it's there.  And it gets repeated 1,000+ times a day ... little tiny bit of downward suction 1,000 times a day.  This is how the palate is able to drop, because there's actually room for it to drop into.  That's what other acrylic appliances don't provide, when they're right up against the roof of the mouth all the time.

And when the palate drops, even if there is no bone creation ... you should get more overall transpalatal width.  Imagine standing inside of a tiny "Monopoly" house that is just wide enough for you to stand at arm's length and touch both walls.  If you could tie a string to the center of the roofline and pull it down, the walls would want to move outward in order to maintain structure.  If you're also able to push out at the walls at the same time, you would make the overall square footage of the monopoly house wider, even without adding any new material to the roof, and the roof would be lower.  

When you add this in with the fact that the appliance is getting slightly wider every week ... the inventors say this causes new bone formation in the sutures from stem cells there, as the body is trying to maintain sutural homeostasis.  So they do believe they have created new bone material in the maxilla, and have published research to that effect.

Other scientists have also done studies in rats where they did intermittent stretching signaling on their palatal sutures and then examined them, and under an electron microscope they could see new bone formation as the suture got wider.  Rats are believe to be similar enough to humans in this regard that it's not impossible the same thing might be happening in humans (and I believe there are some scientists who have confirmed the same behavior in humans).

You can see a TMD testimonial at Vivos' conference here - this poor girl has had such a miserable life since her teenage years, and she said it really helped her: https://vimeo.com/297148624

Feel free to DM me if you have any other questions I can help with.

 

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Posted : 10/09/2020 1:59 pm
sinned
Estimable Member

@toomer

That sounds interesting, are there any resources you can link which discusses how the DNA works? Also, are you currently undergoing DNA treatment, if so, how much have you expanded so far and how much do you plan to expand? What's the time frame? The way DNA works is how I mew which is interesting, I'll push with the tongue and when saliva starts accumulating I'll intermittently switch to a suction hold so I can swallow the saliva then go back to pushing.

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Posted : 10/09/2020 4:43 pm
toomer
Estimable Member

@sinned

Even though it may not be the most accurate description, I have started referring to the DNA sometimes here as a "prosthetic tongue", or perhaps an "auto-mewing device" ... since some of us have narrow inter molar widths and we simply can't mew our way out of our problems at this point.

This knowledge comes from about 9 months of spending a good amount of my free time hunting down what I can ... tracking down in-treatment or previously treated patients online and asking questions ... even found a Vivos dentist in a FB group for these things, who has been very kind and willing to answer questions directly from her training she learned (it's suuuuuuper helpful to have a Vivos dentist on your FB messenger speed dial, who is willing to answer questions even though I'm not her patient).

It was not easy getting to this point.  It took a non-trivial investment of time.

I'm not in treatment yet, as my TMD had my jaw retruded and the discs/condyles out of position, so my provider insisted on fixing that first and then letting the jaw stabilize ... then working on expansion afterward.  We're about 2 out of 3 months of stabilization phase, so I'm hoping to get expansion started in the next 2 months.

Honestly, the best way to find out about how it works is to watch the two Dr. Singh videos on the Vimeo channel I linked in my previous post in this thread.  When Dr. Singh mentions a study on-screen, pause it and get the title and then go find it online and read it.  Watch some of the dentist videos (such as Liao, Cortes, Griffin, etc.) who actually share some of their patient cases with X-rays, ceph traces, etc. ... get screen shots of anything interesting they show, and study that too.  And then thoroughly review the patent that Dr. Singh and Dr. Belfor created. 

To be completely fair, if you read the Belfor/Singh patent, it become clear that at the time ... even they weren't sure about what may be causing the body to adapt in the way it does.  So it's kind of like the story of Post-It notes ... the inventor kind of fell into that by accident.  If you watch enough of Dr. Singh's videos and hear him go over his history, it goes back about 20 years treating kids with craniofacial suture problems, and when they fixed those ... he noticed their airways got bigger, even though the sutures they were fixing were nowhere near the airway.  So it seems like he became fascinated by cranial sutures and what you can convince the body to do.

That won't give you everything, but it will start giving you a lot of pieces of the puzzle.  And once you start doing all of these things, you start falling into other interesting adjacent research - such as, this research in Brazil where they used a "functional" appliance to get about 2mm of maxillary and mandibular expansion in about 5 months with a couple dozen patients ... and they "blinded" the radiologist that did the traces, so the radiologist wouldn't know which patient was which and could skew the results.  

https://www.sciencedirect.com/science/article/pii/S1808869415300513

Most important sentence in that entire report?  "No dental tilting".

So, if there's no suture in the mandible, and they got 2mm of growth there ... how did it happen?

(and keep in mind, for this study they were only trying to disprove the "null hypothesis" that you couldn't create bone ... they were not aiming to see how far they could push it, i.e.: getting 6mm, 8mm, 10mm ... that wasn't their goal ... and they are also clear that they did not investigate whether the changes were entirely dental, or entirely skeletal, or perhaps a mix of both)

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Posted : 10/09/2020 6:28 pm
sinned liked
big_iron
New Member

 

I just want to point out. As i'm looking at the pictures you uploaded I feel like i'm sure there is a lack of development on one side in the cheek bone and the maxilla and i think it's the right side where you have the clicking. And since you have the clicking on one side I think you have or had an unbalanced bite. If this is true and i don't know if MSE can grow cheek bone and the maxilla at the same time but if MSE gets focused on the less developed side(I'm sure this is possible cuz i've seen it done with MARPE) to balance both sides, then that will probably fix the bite, tmd, and the asymmetry. I think you can do a simple test by taking a picture of your face and cutting it vertically in the middle between the eyes, then mirror both sides(left with left, and right with right) to create 2 pictures of yourself. you probably can tell which picture is better just by looking at them.

 the white lines are equal in length and the black lines are also equal. I also can see that the chin i shifting to the left side of the picture.

this is just a nerdy analysis

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Posted : 11/09/2020 1:55 am
beesforfrees
New Member

@big_iron

My right side usually looks a little swollen. It sucks that just my everything being a few mm off  is causing me so much pain 😭.

Anyway, update for everyone... never saw that second orthodontist. She won't see me until I get a sleep study... and my insurance wont cover it 😑. 

Has anyone tried one of those online sleep studies?

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Posted : 27/12/2020 4:49 am
big_iron liked
auxiliary
Estimable Member
Posted by: @beesforfrees

@big_iron

My right side usually looks a little swollen. It sucks that just my everything being a few mm off  is causing me so much pain 😭.

Anyway, update for everyone... never saw that second orthodontist. She won't see me until I get a sleep study... and my insurance wont cover it 😑. 

Has anyone tried one of those online sleep studies?

You have the same issue some other posted had, your teeth are protruding, so your mandible is retruding to maintain occlusion. This jams the mandible bone against the TMJ joint.

Your maxilla moving forward relative to your face and your lower teeth moving backward relative to the mandible should be your goal. Your posterior teeth moving downward should also help relieve tension.

Out of natural things that could help would be just resting your tongue on your palate to move it forward. Strengthening your orbicularis muscle should help in pulling the teeth backward, but it's only theory.

 

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Posted : 12/01/2021 2:13 pm
retroclined_incisors
New Member

@toomer

 

How does the DNA appliance achieve forward expansion of the maxilla?

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Posted : 19/01/2021 9:52 pm
JordanR
Active Member

@beesforfrees

 

I dunno if you're still around, but I have the same problem as you, on the same side. My problems started after having adult braces.

I figured out: My face is recessed more on the right side. My palate is smaller that side and so is my jaw. In order to make up for this, my body had made perfect adjustments to my teeth - they were crowded on the right side, but fit together perfectly. When the braces straightened them all out, it bulldozed over those compensations, and now forces my jaw to close in an unnatural way. Like you, it is only a few millimetres but enough to cause clicking and popping etc.

At least you got an orthodontist to admit to your problem, people I visited flat out denied braces can cause tmj. THey are protecting their own profession obviously.

But I convinced a second ortho to treat me, and I got my new braces on last week. Soon I will have elastics. The goal will be to push my top teeth forward, and lower teeth backwards, and also improve the way teeth meet on the right side. Right now, my mandible has to swing up and backwards to the right in order to get occlusion.

The goal of the elastics will be to hopefully fix that. Its really troublesome when people in the industry will not admit these things.

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Posted : 19/01/2021 10:13 pm
beesforfrees
New Member

@jordanr

Keep me updated! I found an ortho who said she would do the same thing, but I'm getting some more input before I go that route.

Also, I got botox yesterday to (hopefully) temporarily alleviate pain. And I'm seeing a jaw/tmj surgeon on Friday to make sure it's not actually something else. I'll let you know how it goes. 

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Posted : 19/01/2021 11:39 pm
JordanR
Active Member

@beesforfrees

Cool I will keep you updated. I forgot to mention, I have a tongue tie which an oral maxillofacial surgeon is removing for me in about 2 weeks. It might be worth getting your surgeon to check on that when you see them. But your face looks fairly well developed so this may not be your problem, but for me, it was the origin of all these issues with my face/teeth. It can be hard to tell if you have one without a professional to check.

A tongue tie causes a lot of tension in the jaws, neck, and shoulders, so obviously can be a contributing factor to TMJ. I am wondering if mine is release, the clicking will be reduced even before the braces treatment is finished.

If you want to look further in to tongue tie and check if you have one, check out this channel on Youtube. This surgeon is a world leader on the subject.

https://www.youtube.com/c/TheBreatheInstitute/videos

I will be subscribed to this thread if you want to update in future. Good luck with your treatment.

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Posted : 20/01/2021 12:56 am
toomer
Estimable Member
Posted by: @retroclined_incisors

@toomer

 

How does the DNA appliance achieve forward expansion of the maxilla?

If I have interpreted the inventor's presentations properly - it's likely a few things.  First, there should be a distinction between forward expansion of the maxilla, and forward movement of the maxilla.  Both can help, in terms of getting the lower jaw untapped and the TMJs into their correct position.

But aside from movement (potentially helped by facilitating better nasal breathing) I believe the inventor's theories are that stem cells in the premaxillary sutures and the mid-palatal suture, and in the periodontal ligaments around each tooth, respond to the signaling the appliance gives (basically, emulating the tongue fully in the roof of the mouth) and generate new bone through what the inventor calls "sutural homeostasis".  In a nutshell, the osteoclasts and osteoblasts at the boundaries of a suture have the ability to absorb bone or create bone.  The inventor believes that the body wants to keep a suture to be roughly 0.25mm and will react accordingly to either stretching or compressive forces pushing the suture outside of that target range.

The fact that there are stem cells in the maxillary sutures and periodontal ligaments is not terribly controversial.  Whether the DNA Appliance is truly "activating" them into action, however, is.  But if you watch this video from a Homeoblock patient (roughly the same appliance as the DNA) it seems plausible that the periodontal ligaments are helping with the expansion of the jaws at each tooth: https://www.youtube.com/watch?v=R5S5AZ50pAE&t=15m24s

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Posted : 20/01/2021 10:14 am