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AGGA or MSE? Ridding sleep apnea  

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DrMario
Eminent Member

Hey Everyone,

I want to start off by saying that this forum is amazing and interesting. Everyone is so passionate about orthotropics. Thank you all for your contribution in this community, for hosting this website, for everything. You're all amazing.

So my question is:

Should AGGA alone be good enough for all of my goals or would I need a Maxillary Skeletal expander before, during or maybe even after AGGA? I understand that AGGA is primarily praised for forward growth but will this device also widen my palate and broaden my dental arch?

 

I went to an orthodontist for questions about AGGA. This orthodonist is actually very much in tune with orthotropics. I would like to invite everyone in on their opinions for what might be best for what my goals are:

1. Improved nasal patency
2. Increase in airway size
3. Improve neck posture
4. More tongue room
5. Broader smile
6. Bringing maxilla and mandible forward
7. Annihilate my sleep apnea

 

My guess is that AGGA may broaden the dental arch via bone remodeling but it won't be as good as a traditional palate expander. Measured by my orthodontist, my IMW is 33 mm which I feel needs to be expanded for better tongue positioning as the sides of my tongue are in still contact with my molars. My dental arch is a "U" shape and needs to be broader. I definitely don't doubt that mewing works...but it will take a considerable amount of time to accomplish my goals with mewing alone, so I have decided I will pay for AGGA.

I have removed my tonsils, adenoids, reduced my turbinates and even checked to see if I needed a tongue-tie release surgery and I don't, so AGGA along with orthodontic treatment is next in line.

My biggest objective is totally get rid my OSA once and for all. I don't want to buy into a MAD (Mandibular Advancement Device) or a CPAP. My sleep has drastically improved after the T & A surgery but I can definitely tell there is still some work that need to be done and I feel that AGGA may help me out a lot.

 

Thank you all in advance...

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Posted : 23/01/2019 11:07 am
rogerramjet
Eminent Member

Glad to hear there is an ortho up to speed and on board with orthotropics.

FWIW, I know LVI (who train in AGGA device) have a strict 'we don't claim to fix OSA' policy.

That said, from my experience and from a lot of documented scan results on their Facebook group, there is genuine improvement in airway space after AGGA treatment.

You can do a search in the group at this URL:

https://www.facebook.com/groups/tmjtmdosa/

Also worth noting, that at the conclusion of AGGA treatment, LVI trained dentists will put their patients in a MicrO2 sleep appliance, which acts as both a retainer and TMJ/OSA sleep appliance in one.

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Posted : 23/01/2019 8:17 pm
Apollo
Reputable Member
Posted by: Apollo
Posted by: letsgochamp

@Apollo

What is your take on if one first does the Fagga and then afterwards MSE with FM to achieve the best result possible?
With that you get expansions in all the planes. Sagital with the fagga, horizontal with MSE and protrusion with FM.

Are you also on the anti-Fagga team? Some say it only pushes the theet and not creating new bone

Posted by: letsgochamp

@Apollo

The Fagga appliace is also accredited  to widen the airways or at least create more space. You think that the same effect is possible with MSE and FM as well? Or is that Fagga exclusive?

I think you would probably choose one or the other. The MSE would provide significant transverse expansion plus some forward expansion that could be increased by adding extra-oral traction (i.e. facemask, etc.). Most (if not all) of the forward expansion from this device would probably come from separation of circummaxillary sutures. In contrast, the FAGGA would provide significant forward expansion plus some transverse expansion. Most (if not all) of the forward expansion from this device would probably come from bone remodeling. I am not "anti-FAGGA," (in fact I'm considering it for myself) but I can understand the argument for why the results might be aesthetically, and or functionally better from translating the maxilla forward as a unit along sutures rather than relying on remodeling. Both strategies should increase airway to the extent that they increase tongue space. I suppose if you attempted MSE+FM and your maxilla was still retruded you could then try the FAGGA, but that sounds like a lot of effort and expense.

 

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Posted : 23/01/2019 10:02 pm
varbrah liked
DrMario
Eminent Member

@rogerramjet

Thank you very much for your feedback. I went ahead and sent my request to become a member for the Facebook group. Awaiting approval. And thank you I feel much better that FAGGA has supportive evidence that the appliance can greatly improve the airway. 

 

I had my turbinates surgically reduced and now I'm thinking...if I had used MSE or AGGA I may not have had to have them reduced...but either way I can finally nasal breathe without much issues. I am still noticing that even after turbinate reduction and T & A surgery, I am still mouth breathing a little at night and my nose is slightly congested upon awakening.

 

I just really want an appliance that has enough evidence to say it can increase nasal airflow, allow more room for my tongue and decrease upper airway resistance. 

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Posted : 23/01/2019 10:48 pm
DrMario
Eminent Member

@Apollo

Thanks for replying. So to sum it up, whether I go with MSE or FAGGA, my ability nasal breathing will greatly increase. I notice that if I extend my lower jaw forward, my ability to breathe nasally is GREATLY improved. This is why I initially was all over AGGA but then after doing more research, MSE is also an option to consider as part of my treatment. I'm leaning towards MSE at this point since my cheekbones are weak and I'm not sure if AGGA will help with that.

All I know for sure is that I will be taking 10,000 IU of D3 with 200mcg K2 MK7 and I will be happy to share my progress.

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Posted : 23/01/2019 11:20 pm
Apollo liked
rogerramjet
Eminent Member
Posted by: DrMario

I had my turbinates surgically reduced and now I'm thinking...if I had used MSE or AGGA I may not have had to have them reduced...but either way I can finally nasal breathe without much issues. I am still noticing that even after turbinate reduction and T & A surgery, I am still mouth breathing a little at night and my nose is slightly congested upon awakening.

I had a septoplasty and UPPP, and then got even more space with AGGA so I wouldn't start regretting your previous surgery - it all helps!

Particularly if the surgery got you started on the path of the big three - it will make the rest of your treatment easier.

Also think about lip taping at night if you're worried about sleeping with an open mouth. Just make sure you are comfortable with your ability to breathe solely through the nose.

ReplyQuote
Posted : 23/01/2019 11:55 pm
Abdulrahman
Reputable Member

If you want a definitive answer as to which you can benefit from then you need a good quality CBCT scan. Based on your skeletal bones dimensions and the position of the alveolar bone relative to it, a doctor can tell you weather you would benefit more from MSE or FAGGA.

my story: http://www.aljabri.com/blog/my-story/

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Posted : 24/01/2019 2:17 am
DrMario
Eminent Member

Good Morning, Everyone...

@rogerramjet

Thanks for your reply. Oh yeah I do not regret my somnoplasty -not one bit. To finally be able to breathe exclusively through the nose during the day is a gift. After the surgery, I started to realize that my anxiety levels have gone down dramatically...perhaps due to the NO production and better regulation of O2 and CO2 levels.

I'm glad I said no to all of the doctors who tried to prescribe me things like Ambien and Paxil before finding a doctor that was willing to go the extra mile for my health.

@Abdulrahman

Thank you for your reply! My orthodontist already scheduled the CBCT and I am just waiting to hear back. That sounds like a great idea because with a CBCT I can analyze airway dimensions in the nasal cavity and upper airway and decide on which device to use first. 

From all the research I've done on this amazing forum and YouTube videos, Maxillary Skeletal Expansion/MARPE and AGGA are both great options and helpful for what my goals are. From what I understand, MSE is great at improving nasal patency due to its significantly noticeable transverse expansion, where as AGGA is better at improving upper airway dimensions due to noticeable sagittal movement from positioning the maxilla and mandible more forward. According to my results from the CBCT, we will determine which direction of expansion should be prioritized.

Btw, I enjoyed reading your story on your website. I'm happy for you.

ReplyQuote
Posted : 24/01/2019 9:52 am
Abdulrahman
Reputable Member
Posted by: DrMario

@Abdulrahman

Thank you for your reply! My orthodontist already scheduled the CBCT and I am just waiting to hear back. That sounds like a great idea because with a CBCT I can analyze airway dimensions in the nasal cavity and upper airway and decide on which device to use first. 

From all the research I've done on this amazing forum and YouTube videos, Maxillary Skeletal Expansion/MARPE and AGGA are both great options and helpful for what my goals are. From what I understand, MSE is great at improving nasal patency due to its significantly noticeable transverse expansion, where as AGGA is better at improving upper airway dimensions due to noticeable sagittal movement from positioning the maxilla and mandible more forward. According to my results from the CBCT, we will determine which direction of expansion should be prioritized.

Btw, I enjoyed reading your story on your website. I'm happy for you.

Thanks.

FAGGA affects the jaws in 4 ways, it expands the alveolar ridge sagittaly and transversely, remodels the mandibular condyles, and brings the roof of the palate down. The last part has a big impact on the nasal cavity. If you have seen some of the before and after x-rays of nasal cavities you will notice this improvement.

my story: http://www.aljabri.com/blog/my-story/

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Posted : 24/01/2019 10:35 am
DrMario
Eminent Member

@Abdulrahman

Thank you for your reply. That's very exciting to know. I'm still awaiting approval to be joined into the Facebook group. 

 

It looks like FAGGA has a lot of benefits for me. I'm not even sure if FAGGA is truly considered a "palate expander" but will I still see a noticeable increase in broadening the dental arch to have a broader smile? I attached a photo of my upper dental arch and I'm not sure how well AGGA will do in broadening my smile.

ReplyQuote
Posted : 24/01/2019 4:37 pm
Abdulrahman
Reputable Member
Posted by: DrMario

@Abdulrahman

Thank you for your reply. That's very exciting to know. I'm still awaiting approval to be joined into the Facebook group. 

 

It looks like FAGGA has a lot of benefits for me. I'm not even sure if FAGGA is truly considered a "palate expander" but will I still see a noticeable increase in broadening the dental arch to have a broader smile? I attached a photo of my upper dental arch and I'm not sure how well AGGA will do in broadening my smile.

Welcome.

The FRLA/ALF, which comes after FAGGA is removed, achieves dental expansion, but unlike MSE, it does not widen your skeletal palate, just the dental/alveolar part of it. That will defiantly give you a wider smile and more importantly more space for your tongue to posture against the palate.

This last part is very important because in order for any expansion in the alveolar ridge to stay after treatment you have support it with your tongue. Did your doctor mention myfucntional therapy as a one competent of the FAGGA treatment he is offering you?

my story: http://www.aljabri.com/blog/my-story/

ReplyQuote
Posted : 24/01/2019 11:14 pm
ltj48
New Member
Posted by: Abdulrahman
Posted by: DrMario

@Abdulrahman

Thank you for your reply! My orthodontist already scheduled the CBCT and I am just waiting to hear back. That sounds like a great idea because with a CBCT I can analyze airway dimensions in the nasal cavity and upper airway and decide on which device to use first. 

From all the research I've done on this amazing forum and YouTube videos, Maxillary Skeletal Expansion/MARPE and AGGA are both great options and helpful for what my goals are. From what I understand, MSE is great at improving nasal patency due to its significantly noticeable transverse expansion, where as AGGA is better at improving upper airway dimensions due to noticeable sagittal movement from positioning the maxilla and mandible more forward. According to my results from the CBCT, we will determine which direction of expansion should be prioritized.

Btw, I enjoyed reading your story on your website. I'm happy for you.

Thanks.

FAGGA affects the jaws in 4 ways, it expands the alveolar ridge sagittaly and transversely, remodels the mandibular condyles, and brings the roof of the palate down. The last part has a big impact on the nasal cavity. If you have seen some of the before and after x-rays of nasal cavities you will notice this improvement.

Would the DNA appliance and other expanders do that last part (bringing down the roof of the palate as well) as well?

ReplyQuote
Posted : 25/01/2019 8:39 am
Abdulrahman
Reputable Member
Posted by: ltj48

Would the DNA appliance and other expanders do that last part (bringing down the roof of the palate as well) as well?

This depends on two factors, weather the DNA is accompanied by osteopathic cranial strain release treatment and weather there is enough space between the bottom of the palate and top of the expander to allow a drop to happen.

my story: http://www.aljabri.com/blog/my-story/

ReplyQuote
Posted : 25/01/2019 1:55 pm
Apollo
Reputable Member
Posted by: Abdulrahman

osteopathic cranial strain release treatment

@abdulrahman, I've done some research about cranial osteopathy, craniosacral therapy, etc. Is this what you are referring to? The Osteopathic Cranial Academy (  https://cranialacademy.org/find-a-physician/ ) doesn't list any practitioners within 100 miles of my home. I've watched some youtube videos of therapy sessions. Can you recommend any good resources to learn more?

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Posted : 25/01/2019 5:16 pm
Abdulrahman
Reputable Member
Posted by: Apollo
Posted by: Abdulrahman

osteopathic cranial strain release treatment

@abdulrahman, I've done some research about cranial osteopathy, craniosacral therapy, etc. Is this what you are referring to? The Osteopathic Cranial Academy (  https://cranialacademy.org/find-a-physician/ ) doesn't list any practitioners within 100 miles of my home. I've watched some youtube videos of therapy sessions. Can you recommend any good resources to learn more?

Here is a video by an ALF expert on the subject:

https://www.youtube.com/watch?v=szjEKq2Ly7c&feature=youtu.be

my story: http://www.aljabri.com/blog/my-story/

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Posted : 25/01/2019 9:21 pm
Apollo liked
darkindigo
Reputable Member
Posted by: Abdulrahman
Posted by: ltj48

Would the DNA appliance and other expanders do that last part (bringing down the roof of the palate as well) as well?

This depends on two factors, weather the DNA is accompanied by osteopathic cranial strain release treatment and weather there is enough space between the bottom of the palate and top of the expander to allow a drop to happen.

DNA practitioners actually do shave down as they go.  Sure, the palate drops.  I know you can even get some arch expansion with Invisalign.  It takes a while and typically they won't have gaps between teeth.  I'm cool with gaps, because typically you expand more than you want then it kind of back-tracks a bit on its own.  I spoke with one who does both Y-shaped Schwartz and DNA. He said he sees more forward maxillary movement with DNA for some reason? 

Smart to get CBCT!  😀  Going from pano to 3D is illuminating!

I like having some arch support... and actually find that how to approach things typically would depend on how far you have to go (can only move so far without teeth leaving the bone)... vs. something like skeletal expansion.  I like self-ligating braces if done by someone airway aware... however I'm not sure how much foward movement they get.   Whoa wait!  I don't think self-ligating gets as much forward movement (won't create/control gaps) like regular braces.  It is lighter forces, though.  It totally depends on the patients, their aiway and what needs to be done.  In fact... if you go to a local orthodontic lab or search online... they're everywhere, right?  You can see what they use.  There's SO many ways.  So many things.  It's really cool to see.  And they'll say which doctors use what.  Then if you find something you like, you can see which doctors use it.  Check this out... http://www.orthotech.net/products-functional.html   (look at this split)... it looks like you can adjust it for a more natural curvature since there are 2 expander points.  This can be good for someone kind of V-shaped, though this person looks like they're missing incisors.  If they were trying to make room for those to drop, not sure I'd push out the #2 teeth.  Anyway.. I really think many orthos are sloppy.  I'm guessing these lab technicians are in the know.  They will get follow-up molds, I think.  They can see the before and after often.  So... they may suggest something to an orthodontist, but the orthodontist is too proud or arrogant.  These lab techs, I'm guessing, know the real deal.  I haven't actually spoken with one, but I bet they'd be happy to surmise about possible options.

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Posted : 26/01/2019 3:12 pm
darkindigo
Reputable Member

Keep in mind, they won't see the jaws or face.. just the dentition. 

I know if someone is lazy, they can really screw up someone's nose.  For example... if someone palatal expanded a teen just in the back... then they can end up getting LESS air as nose shrinks down.

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Posted : 26/01/2019 3:39 pm
DrMario
Eminent Member

@Apollo
@darkindigo
@AbdulRahman
@rogerramjet
@varbrah

Thank you all for your replies. It's nice to be a part of this community. I have decided to seek treatment with an orthodontist that uses Dr. Won Moon's Maxillary Skeletal Expander. There just isn't enough clinical data to substantiate FAGGA's efficacy. I am seeking true skeletal expansion and bone-anchored skeletal expansion of the maxilla makes more sense, especially since I am an adult.

 

In addition to MSE, I will be using a FM for maxillary projection. From my understanding, since the sutures will be opening during this treatment period, maxillary projection may be possible to establish better positioning of the maxilla and perhaps the mandible too? 

Does anyone know if doing the FM with MSE bring the mandible forward too?

I will be taking a CBCT scan to investigate the size of my airways prior to my treatment. I plan to take Vitamin D3, Vitamin K2 as MK7 and Calcium supplements during the course of my treatment. I'm very excited to put this in motion, as I sincerely strive for an improvement on the quality of my sleep. Sleep apnea has been with me since childhood and I don't believe removing my tonsils is enough to do the trick. I hope this will significantly improve the quality of my sleep after expansion of my maxilla. If I insert a nasal dilator like the one attached, my nasal breathing significantly improves. Hopefully MSE will permanently mimic the benefit this nasal dilator gives me where I can breathe in and out more air.

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Posted : 28/01/2019 5:02 pm
Apollo
Reputable Member
Posted by: DrMario

Does anyone know if doing the FM with MSE bring the mandible forward too?

Protruding the maxilla should create space for the mandible to swing forward to meet it. I like using those nasal dilators, but they quickly loose their elasticity, and they are expensive to keep replacing. The packaging recommends replacing them after 10 nights (that's $22 per month), but I sometimes found them falling out during sleep after a week or less of use. They work best for me when used together with mouth taping to ensure nasal breathing during sleep.

How did you locate an MSE provider in your area? I haven't been able to find one near me. 

ReplyQuote
Posted : 28/01/2019 5:30 pm
DrMario
Eminent Member

@Apollo

Yes that's my problem, too. They are mildly uncomfortable and keep falling out without fail.

I purchased this one. I suggest it if you can nasal breathe fine but have maxillary transverse deficiency, narrow palate etc. 
https://www.amazon.com/Dortz%C2%AE-Anti-Snoring-Devices-Solutions/dp/B07G5886WJ

Thank you for your reply. That's what I figured. I google searched "orthodontists" and called them one by one. Many in my area never heard of it so I got lucky on the few that know of it.

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Posted : 28/01/2019 5:40 pm
Apollo liked
Abdulrahman
Reputable Member
Posted by: DrMario

Thank you all for your replies. It's nice to be a part of this community. I have decided to seek treatment with an orthodontist that uses Dr. Won Moon's Maxillary Skeletal Expander. There just isn't enough clinical data to substantiate FAGGA's efficacy. I am seeking true skeletal expansion and bone-anchored skeletal expansion of the maxilla makes more sense, especially since I am an adult.

What is the clinical data that substantiates MSE? I have only seen one PDF specifically detailing the procedure, and it was by the maker of this treatment. Also, did you get a chance to research the negative side effects of rapid expansion? 

I suggest before deciding which rout you go to wait for the CBCT, it will be the best thing to answer this question. If you have recession in the skeletal part of the face MSE will probably be better but if your recession is coming from the alveolar ridge and wrong positioning of the facial bones FAGGA will be probably better. 

my story: http://www.aljabri.com/blog/my-story/

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Posted : 28/01/2019 9:54 pm
Mewb liked
Mewb
 Mewb
Active Member
Posted by: Abdulrahman
Posted by: DrMario

Thank you all for your replies. It's nice to be a part of this community. I have decided to seek treatment with an orthodontist that uses Dr. Won Moon's Maxillary Skeletal Expander. There just isn't enough clinical data to substantiate FAGGA's efficacy. I am seeking true skeletal expansion and bone-anchored skeletal expansion of the maxilla makes more sense, especially since I am an adult.

What is the clinical data that substantiates MSE? I have only seen one PDF specifically detailing the procedure, and it was by the maker of this treatment. Also, did you get a chance to research the negative side effects of rapid expansion? 

I suggest before deciding which rout you go to wait for the CBCT, it will be the best thing to answer this question. If you have recession in the skeletal part of the face MSE will probably be better but if your recession is coming from the alveolar ridge and wrong positioning of the facial bones FAGGA will be probably better. 

Great point, I would love to see more clinical data on MSE as well seeing as it's being paraded as the holy grail.

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Posted : 29/01/2019 8:21 am
darkindigo
Reputable Member

This is what I'd recommend to family:

My favorite for arch widening for Adults (age 23+) if not going far -

Self-ligating braces
If braces are hated,... then Invisalign by a TRUE orthodontist who does Invisalign. It can take a couple years to get some widening, though.

My favorite for arch widening for Adults if going a bit further -
Saggital with acrylic shaved down on palate and teeth during treatment.  No talking with it in as lips can get stretched.  Worn primarily at night... not during meals.  Kind of like DNA or this guy http://www.orthotech.net/products-functional.html possibly with Y-split, too.  I like this guy because you have ultimate control over the arch shape.

My favorite for arch widening if going far:

1)  The devices under "WOW - NEW STUFF!!!!!!" post for their facial effects.
2) Won Moon's Maxillary Skeletal Expander (I prefer #1 above in the anterior position for those with v-shaped arches to begin.  I also may prefer it overall, because there can sometimes be a vacated look or dropped nose from the anterior portion of the maxilla failing to release as well.)
3) DOME (I prefer #1 above for added support so that it doesn't put too much strain or cause the palatal vault to teepee)
4) SARPE

All of the above is subject to change and is of this date.

 

update:

Opps!  Also like alf and Crozat!  I personally wouldn't recommend skeletal drilling to family unless double crossbite.  Saggital can be paired with facemask... probably Crozat amd Alf as well.  Forwardontics people ars doing some really cool stuff.  If single crossbite.. a controlled Sagital with L & R separate controls may give better result than Won Moons... depending on distance.  So many factors.  Not a dentist!

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Posted : 29/01/2019 12:55 pm
darkindigo
Reputable Member