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Adult Jaw Expansion Showdown: AGGA vs DNA Appliance  

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Spygloblium
New Member

Hi all,

I recently did consultations two AGGA providers trained by the Las Vegas Institute and one DNA appliance provider trained by Vivos. I'm still trying to decide who I'm going to work with, and I thought I'd write up my thoughts in order to see what input you folks have.

First, a bit about me--I'm a 28 year old male who has never had orthodontics before. My teeth are significantly crowded and I think I suffer from some TMD / knots in my jaw muscles. I actually did visit a conventional ortho recently and he said he could fit all my teeth on my jaw without any expansion (or maybe after shaving a bit of tooth off). However, the improved sleep and aesthetics claimed by jaw expansion orthodontics has inspired me to investigate that option.  I also tried mewing for a while but using my tongue like that was giving me jaw issues.

I investigated many jaw expansion methodologies, even surgery. However, it seems like many, such as the orthotropics of Dr Mew, are targeted at children. Only a few, such as the ALF, AGGA, DNA appliance, and Homeoblock, are effective in adults. Of those four, the AGGA and the DNA appliance stand out for having some kind of company or professional organization which stands behind them. (For the AGGA, it's the Las Vegas Institute; for the DNA appliance, it's the Vivos corporation.) That appeals to me because I like the idea that the practitioner I'm working with is benefiting from the pooled wisdom and knowledge of every other practitioner who's making use of that appliance. Furthemore, both LVI and Vivos have methodologies which are focused on measuring many parameters of the head, face and jaw to deliver optimal results, whereas my impression is that practitioners of e.g. the ALF tend to play it by ear--since they operate as individuals, they don't have enough available data to get really scientific.

During my visits with the AGGA providers and the Vivos provider, I took extensive notes. Here is a point by point comparison of the claims made by each provider and other points of comparison I thought were relevant:

AGGA
Appliance type: Fixed
Radiation exposure: The AGGA provider I visited used a CT scanner [tk which according to this website releases nontrivial radiation]
Aesthetics: One of the two AGGA providers I visited mentioned that they work with the Facial Beauty Institute (?) to measure the aesthetic parameters of your face and deliver optimal aesthetics. Remodeling of the upper cheekbones was discussed
Growth type: Although the practitioners claimed the AGGA delivers both forward and lateral growth, the AGGA seems more focused on forward growth. If you have TMD because your mandible is in a very posterior position when you bite down, this could be helpful. (Try sticking a Q-tip between your top incisors and biting down. If it feels unexpectedly nice, that could indicate this is what's going on)
Time frame: One practitioner claimed a 1 year part 1 and 1-1.5 years for part 2 (braces, ideally done by an LVI doctor, "controlled arch" orthodontics?). Another said 6 months part 1 and 1.5-2 years part 2. It was claimed that AGGA is faster than the DNA.
Sleep: Sleep would only really start improving in part 2 when I got an appliance? Don't remember all the details here
Retainment: Lifetime retainment at night. One practitioner told me he'd me make me a sleep appliance that doubles as a retainer.
Cost: One practitioner quoted me $8K total (she was new and trying to get established), another practitioner quoted me $12-13K total--$16.5K is about as expensive as it ever gets for patients, he said.
Visit frequency: One practitioner said I'd come in every week during part 1 and every 3-4 weeks during part 2. Another said maybe twice a month but I also might be able to adjust remotely?
Periodontal: Since AGGA moves faster, it might be worse from a periodontal perspective? Additionally, I think somewhere I read that on/off appliances are better from the perspective of e.g. not resorbing roots.
Ease of transition: I was recommended to not switch between AGGA dentists--or if I did, at least do it in between part 1 and part 2.

DNA Appliance
Appliance type: Removable, worn at night. Springs deliver gentle vibrations. It's not battery powered, it redirects the energy from the movements your mouth makes while sleeping or something like that.
Radiation exposure: I don't remember the details, but I believe Vivos is pretty careful about the radiation dose it delivers to patients, and their scan only uses as much radiation as 2 dental x-rays.  My friend claims there is no difference
Aesthetics: The DNA provider I visited seemed more focused on improving health issues than improving aesthetics--although that could more be a result of the way I presented my concerns than anything. He claimed I would get broader nostrils and a broader smile. I might get a fuller lip. My lower jaw might come forward. In any case, based on the few case studies I've seen, I actually think the DNA could deliver better aesthetics than the AGGA
Growth type: Although the practitioner claimed the DNA delivers both forward and lateral growth, the DNA seems more focused on lateral growth. One AGGA provider, when asked about the DNA, claimed the DNA would do 4mm of forward growth at most. I think that would be enough for me though.
Time frame: The practitioner I visited claimed that for my case, I would require 18-24 months of expansion with the Vivos appliance (he said my case is unusually bad and 12-18 months is more typical), followed by 9 months of braces to reposition my teeth post-expansion. Braces work could be done by any ortho
Sleep: Vivos is very focused on sleep. I believe the DNA doubles as a sleep appliance. The practitioner claimed that within the 1st week of wearing it, my sleep would improve, although in some cases it could take up to 3 months. By the way, family members have told me I don't snore, so I don't think I have sleep apnea, but I love the idea of sleeping deeper anyways--sleep is important! And the DNA practitioner seemed to think that even if I didn't have clinical sleep apnea my sleep would improve.
Retainment: The Vivos practitioner claimed that I wouldn't need any sort of retainer once the treatment was complete.
Cost: I was quoted $8500, plus another $1500 if I needed a second appliance, plus whatever ortho costs (maybe $6K?)
Visit frequency: I was told I'd have to come in after 1 week, then 3 weeks, then 6 weeks, then every 8 weeks thereafter. Apparently I would mostly be adjusting it myself. Supposedly some people will even fly out to see a DNA provider for each adjustment.
Periodontal: The forces delivered by the Vivos are lighter, which could contribute to slower treatment time, but is probably better from a periodontal perspective. The Vivos practitioner I visited was also a periodontal specialist. However, like the AGGA practitioner, he claimed that periodontal considerations weren't significant in my case--even though my old dentist said "any ortho worth their salt" would know perio was a consideration for me.
Ease of transition: A Vivos rep claimed that it's easy to switch between Vivos dentists if you move across the country.

Both methodologies are aware of the importance of myofunctional therapy (tongue posture etc.) and the importance of releasing a tongue tie (I guess my tongue tie is borderline, because the more experienced AGGA provider said it should be released, but the other 2 practitioners said it was fine. Amusingly, all 3 were rather confident in their assessment!)

Anyway, I think the AGGA seems better for those who want prominent cheekbones or are otherwise focused on aesthetics, those who need a lot of forward growth for e.g. TMD, and those who are in a hurry (and are willing to accept the possible increased periodontal damage that comes with that).

And the DNA seems better for those who are focused on sleep improvement, those who might be moving across the US within their treatment period, those would prefer not to wear a possibly weird looking fixed appliance for the first year, and those more concerned with health risks from gingivitis/periodontal disease or radiation (?)

Anyway I'm curious to hear any thoughts anyone has on any of the above--especially if your experience with either appliance was good/bad/contradicts practitioner claims, or if there are important factors I'm not accounting for.

One big question I forgot to ask is what exactly the theory is behind expansion of the mandible. I believe both AGGA and the DNA work on the maxilla only. The teeth on my mandible are quite crowded and I'm not clear if or how these appliances will create more room on my mandible.  ("Personally, I used the AGGA appliance and the experience was pretty horrific, leaving me with a 5mm overjet." - source)

Cheers!

Quote
Posted : 12/10/2019 4:04 pm
Achillespalate
Active Member

@Spygloblium

Very good and interesting comparison! 

I was at my first consultation ever at an orthotropic dentist and was recommended the DNA-appliance to help expand and grow my upper jaw that still is a bit too small to fit my lower jaw. Since this was my fist time ever meeting an orthotropic dentist it was very interesting to see a dentist talk so much about tongue and body posture and how it affects the growth of the face. This particular dentist did´t use AGGA at all so i guess that is why I was recommended the DNA appliance (only other option being the ALF which is working much slower to my understanding)

I also showed him some pictures that i took before I started practicing proper tongue posture and we compared them to my occlusion as it is today and he said that it definitely had been an improvment and even asked if i was considering to continiue with my own mewing routine instead of getting an appliance. 

This dentist was very experienced and was also talking more about the health aspects than the aesthetics, however I believe this to go hand in hand to a large extent. I was also shown a patient that he had used the DNA-appliance on and the results were very impressive with the patient looking much healthier, more attractive and also happier. 

To my understanding the AGGA has the potential for more forward expansion but does less for the width of the jaw while the DNA does expands the jaw in both directions. The greatest benefits of the DNA for me personally is that it isn´t a fixed appliance and you don´t have to wear retainers when the treatment is finished instead that work is supposed to be done with your tongue which now hopefully has enough space to do what it´s supposed be doing. 

 

 

ReplyQuote
Posted : 14/10/2019 3:22 am
James
Eminent Member
Posted by: @spygloblium

Hi all,

I recently did consultations two AGGA providers trained by the Las Vegas Institute and one DNA appliance provider trained by Vivos. I'm still trying to decide who I'm going to work with, and I thought I'd write up my thoughts in order to see what input you folks have.

First, a bit about me--I'm a 28 year old male who has never had orthodontics before. My teeth are significantly crowded and I think I suffer from some TMD / knots in my jaw muscles. I actually did visit a conventional ortho recently and he said he could fit all my teeth on my jaw without any expansion (or maybe after shaving a bit of tooth off). However, the improved sleep and aesthetics claimed by jaw expansion orthodontics has inspired me to investigate that option.  I also tried mewing for a while but using my tongue like that was giving me jaw issues.

If you have significant crowding, you may not have room to do proper tongue posture. An appliance would fix this.

I investigated many jaw expansion methodologies, even surgery. However, it seems like many, such as the orthotropics of Dr Mew, are targeted at children. Only a few, such as the ALF, AGGA, DNA appliance, and Homeoblock, are effective in adults. Of those four, the AGGA and the DNA appliance stand out for having some kind of company or professional organization which stands behind them. (For the AGGA, it's the Las Vegas Institute; for the DNA appliance, it's the Vivos corporation.)

AGGA and Controlled Arch treatments created by Dr. Galella, who runs the Facial Beauty Institute. The Facial Beauty Institute trains dentists, and also does analysis of scans. The Las Vegas Institute (LVI) is another organization who uses AGGA and Controlled Arch. Their approach is to attempt to move the mandible to a physiological position. LVI's typical patient is a severe TMD case.

AGGA
Appliance type: Fixed
Radiation exposure: The AGGA provider I visited used a CT scanner [tk which according to this website releases nontrivial radiation]
Aesthetics: One of the two AGGA providers I visited mentioned that they work with the Facial Beauty Institute (?) to measure the aesthetic parameters of your face and deliver optimal aesthetics. Remodeling of the upper cheekbones was discussed

I had the Facial Beauty Institute report done, and it was pretty cool. As for remodeling the upper cheekbones, there is no good evidence (such as scans or case reports) of any tooth-borne appliance accomplishing this.

Time frame: One practitioner claimed a 1 year part 1 and 1-1.5 years for part 2 (braces, ideally done by an LVI doctor, "controlled arch" orthodontics?). Another said 6 months part 1 and 1.5-2 years part 2. It was claimed that AGGA is faster than the DNA.

The first answer is very odd. AGGA causes gaps to open up at 1mm / month in adults typically. This means that to get 5mm gaps, it would take 5 months. Spending a year in AGGA would imply 12mm gaps, or going slower than the typical protocol. The second answer makes a lot more sense: 6 months for AGGA, and 1.5-2 years for Controlled Arch Braces. That's a bit long for Controlled Arch, and mine will only be around 12 months. I guess you would need longer in braces due to having severe crowding.

Sleep: Sleep would only really start improving in part 2 when I got an appliance? Don't remember all the details here

Some patients have mentioned improved sleep during the AGGA phase, but it didn't happen for me. I have heard other claims that transverse expansion is more likely to improve sleep. Transverse expansion doesn't happen during AGGA treatment, only in Controlled Arch, for which you would need to wait 6 months. Whereas with the DNA appliance, transverse expansion would start immediately.

Retainment: Lifetime retainment at night. One practitioner told me he'd me make me a sleep appliance that doubles as a retainer.

Both AGGA and DNA are dentoalveolar appliances. So retention is probably not that different, assume that the amount expanded is the same. AGGA might only have worse retention prospects if the amount of forward expansion is large, but it sounds like that isn't what you need.

Cost: One practitioner quoted me $8K total (she was new and trying to get established), another practitioner quoted me $12-13K total--$16.5K is about as expensive as it ever gets for patients, he said.

My AGGA treatment is closer to the $8K. But the treatment plan of the more experienced practitioner sounds more correct (if that was the person quoting you 6 months for AGGA).

Visit frequency: One practitioner said I'd come in every week during part 1 and every 3-4 weeks during part 2. Another said maybe twice a month but I also might be able to adjust remotely?

For me, it was once a month during the entirety of treatment.

Periodontal: Since AGGA moves faster, it might be worse from a periodontal perspective? Additionally, I think somewhere I read that on/off appliances are better from the perspective of e.g. not resorbing roots.

My top incisors and canines got pushed forward in the bone from AGGA, and I ended up with gum recession. Adjustments during Controlled Arch are painful due to sensitivity in those teeth. Note that gum recession can happen with any orthodontic treatment or appliance, though AGGA is on the more aggressive end.

Aesthetics: The DNA provider I visited seemed more focused on improving health issues than improving aesthetics--although that could more be a result of the way I presented my concerns than anything. He claimed I would get broader nostrils and a broader smile. I might get a fuller lip. My lower jaw might come forward. In any case, based on the few case studies I've seen, I actually think the DNA could deliver better aesthetics than the AGGA

This is just differences in marketing. Both of these appliances can result in aesthetic improvements, but it's going to be subtle. I've looked at a large number of AGGA and DNA appliance results. Both can create slightly improved lip support, and give a wider smile. From the profile, AGGA has larger aesthetic results than DNA, but this would require forward expansion of over 5mm, which carries more risk.

Although the practitioner claimed the DNA delivers both forward and lateral growth, the DNA seems more focused on lateral growth. One AGGA provider, when asked about the DNA, claimed the DNA would do 4mm of forward growth at most. I think that would be enough for me though.

Another difference between AGGA / Controlled Arch vs DNA appliance is that in the former, the transverse appliance is a light wire called a FRLA, which only attaches to the first molars. The rest of the teeth are pulled outwards by the braces, using a wire with shape memory. Whereas with the DNA appliance, is attaches to multiple teeth, and the acrylic pushes on the alveolar ridge.

FRLA appliance:

Time frame: The practitioner I visited claimed that for my case, I would require 18-24 months of expansion with the Vivos appliance (he said my case is unusually bad and 12-18 months is more typical), followed by 9 months of braces to reposition my teeth post-expansion. Braces work could be done by any ortho

It may be true that braces can be done by any ortho, but the risk might be a conventional orthodontist retracting the expansion you gained with DNA. It would be better to do the braces with the DNA provider, or with someone like a Damon Braces provider (because their philosophy is not retractive).

Sleep: Vivos is very focused on sleep. I believe the DNA doubles as a sleep appliance. The practitioner claimed that within the 1st week of wearing it, my sleep would improve, although in some cases it could take up to 3 months. By the way, family members have told me I don't snore, so I don't think I have sleep apnea, but I love the idea of sleeping deeper anyways--sleep is important! And the DNA practitioner seemed to think that even if I didn't have clinical sleep apnea my sleep would improve.

Dr. Singh has a bunch of publications on sleep, but publications on AGGA in adults are nonexistent. So unfortunately, we don't have a good comparison between these appliances on sleep.

Both methodologies are aware of the importance of myofunctional therapy (tongue posture etc.) and the importance of releasing a tongue tie (I guess my tongue tie is borderline, because the more experienced AGGA provider said it should be released, but the other 2 practitioners said it was fine. Amusingly, all 3 were rather confident in their assessment!)

You could also consult with a myofunctional therapist, in person or remotely. They will likely be more aggressive in diagnosing tongue-tie.

Anyway, I think the AGGA seems better for those who want prominent cheekbones or are otherwise focused on aesthetics, those who need a lot of forward growth for e.g. TMD, and those who are in a hurry (and are willing to accept the possible increased periodontal damage that comes with that).

AGGA is great for patients with compressed TMJs and weak chins.

One big question I forgot to ask is what exactly the theory is behind expansion of the mandible. I believe both AGGA and the DNA work on the maxilla only. The teeth on my mandible are quite crowded and I'm not clear if or how these appliances will create more room on my mandible.  ("Personally, I used the AGGA appliance and the experience was pretty horrific, leaving me with a 5mm overjet." - source)

Cheers!

In both AGGA and DNA treatment, there is expansion of the mandible, but this is dentoalveolar, not skeletal (the expansion of the maxilla is also dentoalveolar). In AGGA, there is a transverse FRLA wire which is used to push the mandibular first molars apart. My lower FRLA was installed during AGGA, and I got +3mm width on the mandible during that time. In DNA treatment, there will be a lower DNA appliance for your mandible.

As for AGGA and overjets, I have seen several complaints like this, including Ronald Ead's. One possible cause for this issue is that the bite pads on the molars were not adjusted correctly to allow the mandible to come forward. Another possibility is that the mandible in these patients was not compressed, meaning that there would be very little ability to move the mandible forward in the TMJ. AGGA—especially when expanding a large amount—will work best with patients who have compressed TMJs. My TMJs were compressed pre-treatment, and my mandible came forward 5mm no problem, and now feels great. You can use a CBCT scan to figure out if your TMJs are compressed. Here is the ideal condyle position in the TMJ

Posted by: @spygloblium

Although the practitioner claimed the DNA delivers both forward and lateral growth, the DNA seems more focused on lateral growth. One AGGA provider, when asked about the DNA, claimed the DNA would do 4mm of forward growth at most. I think that would be enough for me though.

 

:

My other closing comment will be on treatment times. AGGA is likely a shorter total treatment time, due to faster forward expansion, but the drawback is that the aggressive forward expansion poses greater risks. DNA appliance will be a longer treatment time, but there will be a shorter time when there is metal in your mouth during the day, because the DNA appliance is removable. In both cases, you will need braces, but the braces period will be shorter with DNA.

ReplyQuote
Posted : 17/10/2019 4:08 pm
Wellwellwell
Active Member

Thank you this is very helpful!

Is it possible to get the DNA appliance out of North America or is it only there?

- Age: 30
- Started soft mewing on 12 Feb 2019. Have not seen any real results or changes.
- Starting IMW: 35 mm
- Current IMW: 35 mm

ReplyQuote
Posted : 20/10/2019 6:11 am
Spygloblium
New Member

Thanks for the comments all!

@Wellwellwell sorry I don't know of any providers outside North America.

Some people I'd be interested to hear the opinions of, or get updates from, with regard to the DNA appliance and how it compares to AGGA: @Nomis @JuliusO @Abdulrahman @ancoratu @chickenita

ReplyQuote
Posted : 22/10/2019 11:57 pm
ancoratu
Active Member

I believe that the mentality in this forum of achieving aesthetics results is a bit over-pronounced. The DNA appliance will give you "optimal" growth where it is required. Just recently I saw Ronald Ead's result with MSE after AGGA I think the results are rather "overwhelming" and he looks quite odd. Vivos will not give you a weird face you're not supposed to have, it will give you the face you're supposed to have if you had grown under perfect conditions for proper airway growth. 

When I started my treatment 2 months ago (today it's 2 months) I looked like a boy, thin face, could not breathe, I had a weird hollowness to the midface due to the upper jaw being too far back. Today, I look almost like a full-grown man. I do get treated differently when I go outside. I get much more attention. I never had a problem beforehand with looks, I always managed to attract, but now I feel like they just don't think of me as "cute" but rather as how one would describe an attractive full-grown man. 

I think AGGA is very 1-Dimensional, unlike Vivos which expands 3-Dimensional. Vivos will also be cheaper. Agga doesn't seem to improve breathing or sleep which makes me wonder why would anyone consider it given that the aesthetics results are kinda negative. 

I don't think Invisalign is a required part of the treatment for Vivos. My dentist had all her teeth straightened with Vivos alone.  When you're done with Vivos you'll be ready to move on with your life, better breath, better sleep, a much more attractive version of yourself.

 

ReplyQuote
Posted : 23/10/2019 8:36 pm
chickenita
Active Member

@spygloblium

My treatment with the upper DNA has been finished since the beginning of this year after about 18 months. I took measurements on the models. My IMW went from 34mm to 39mm. I also experienced some kind of forward growth and expansion in my mandibular arch. I am still using my lower DNA as a retainer.

The treatment has changed my life. Most of my TMJ symptoms have decreased a lot. This had been my goal. But: I can imagine that a normal acrylic expander would have done the same for me if correctly adjusted and would have been cheaper. My problem living in Europe was that no one else wanted to sell me any removable expander. I wish there would be more orthos knowing about Orthotropics and removable appliances here. I am so thankful that I could reduce my pain so much without bimax and without fixed appliances.

Today I am wearing the RAGGA appliance (a removable agga) hoping to see some more improvements.

ReplyQuote
Posted : 28/10/2019 3:50 pm
airleft
Active Member

@chickenita

Why did you stop at 39mm? What is the criteria of when to stop expanding? Mike Mew expands children up to 44 mm and I guess adults potentially even further. How do you decide from case to case?

ReplyQuote
Posted : 07/11/2019 9:47 am
airleft
Active Member
Posted by: @chickenita

 

The treatment has changed my life. Most of my TMJ symptoms have decreased a lot. This had been my goal. But: I can imagine that a normal acrylic expander would have done the same for me if correctly adjusted and would have been cheaper. My problem living in Europe was that no one else wanted to sell me any removable expander. I wish there would be more orthos knowing about Orthotropics and removable appliances here. I am so thankful that I could reduce my pain so much without bimax and without fixed appliances.

 

There is an online shop based in Germany that sells expanders. But you wouldn't get a practitioner with it. Where in Europe did you get your DNA treatment?

ReplyQuote
Posted : 07/11/2019 9:52 am
adam-gary
New Member

here is a link that may be helpful that specifically is reviewed on the Maryland Holistic Dentist site: https://marylandholisticdentist.com/agga-appliance-vs-dna/

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Posted : 23/11/2019 8:14 pm
toomer
Active Member

he claimed that periodontal considerations weren't significant in my case--even though my old dentist said "any ortho worth their salt" would know perio was a consideration for me.

What were/are your perio issues, if you don't mind my asking?  I'm due to talk to a Vivos DNA specialist next week, and I have experienced some degree of bone loss/gum recession - not so much that my dentist has referred me to a perio yet - so that is a bit of a concern for me.  I wouldn't want my teeth to get pushed forward through either bone structure, given that I now have a bit less than I did years ago.

ReplyQuote
Posted : 09/01/2020 4:54 pm
toomer
Active Member
Posted by: @james
In both AGGA and DNA treatment, there is expansion of the mandible, but this is dentoalveolar, not skeletal (the expansion of the maxilla is also dentoalveolar).

Hi!  Sorry to barge in here with a dumb question, I only just found this forum today - and I am having a consultation with a DNA specialist next week.

Does "dentoalveolar, not skeletal" basically mean - we're pushing the teeth through the bone, not expanding the bone?

ReplyQuote
Posted : 09/01/2020 5:50 pm
toomer
Active Member
Posted by: @ancoratu

When I started my treatment 2 months ago (today it's 2 months) I looked like a boy, thin face, could not breathe, I had a weird hollowness to the midface due to the upper jaw being too far back. Today, I look almost like a full-grown man. I do get treated differently when I go outside. I get much more attention. I never had a problem beforehand with looks, I always managed to attract, but now I feel like they just don't think of me as "cute" but rather as how one would describe an attractive full-grown man. 

It's been a few months since you made this post, how are things going?

I'm speaking with a TMJ/sleep/Vivos specialist next week, so I am trying to get all the input I can.  Some of the posts/comments on this forum have scared me a bit so far.

ReplyQuote
Posted : 09/01/2020 5:56 pm