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Answer I received regarding palatal expansion & maxillary advancement in adults from highly renowned orthodontist in my country who also did my braces

Le_Fort_or_Bust
Trusted Member

I'm 30. I have perfect bite due to braces (no extractions). The braces were done by a very high standing orthodontist who is also a phd in my country.

 

I wanted to figure out if there is really some way to move my midface (maxilla) outward and upward with traction devices, FAGGA or something of that sort.

 

My bite is perfect, but my midface is clearly deficient in bone mass and upper jaw lags behind, despite teeth compensating for this effect.

 

I sent her all the devices I could find (FAGGA, Biobloc, etc...) and here is her answer:

_____

 

Unfortunately I am still not able to help you.

1) The devices are only tools which we use to exert forces on anatomical structures which in turn react to biological principles.

2) In your case the bone is only a matrix which teeth and muscles are connected to. The more you exercise your muscles - the more pronounced the connective areas will become (facial angle regions) and the stronger teeth connection will become.

In the region you want to change (maxilla) facial mimic muscles are connected. It is very hard to train them. But if you are interested - look in direction of Japan. I don't know anything about this.

All devices are fixed:
1) to the teeth and they move teeth (which has been proven that for patients after end of growth period the effect is only at the level of teeth). This is not the case for you, since you have a stable and correct bite (teeth configuration).

2) To the bone: skeletal fixation. And even here we won't see any success, since your bite force is much stronger than force which we can exert of any skeletal fixation. We have to understand saying "as nature has intended" as it is very correct and includes a long time evolutionary process. However, our lifestyle and perception of personal image has changed only in the last years and has not yet left a lasting effect. 

So: the nature has intended that human eats hard and dirty food.

So teeth have evolved to handle hard stress and they can only be destroyed by heavy trauma or microbes. Your bite will always try to maintain status quo.

And bone without pressure is absolute waste of resources which your body cannot handle.

This is why if your wish to increase bone volume in the midface you have to consider contour plastic surgery options (implants, etc...).

 

The translation is rough, but I suggest you guys read it, because the person who wrote this is one of the best docs in this area in my country and also an academic professor. 

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 5:45 am
EddieMoney
Reputable Member

If I read it correctly it just seems to maintain the status quo of "you're done growing; surgery is the only option now"

 

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Posted : 01/08/2018 7:46 am
Le_Fort_or_Bust
Trusted Member
Posted by: EddieMoney

If I read it correctly it just seems to maintain the status quo of "you're done growing; surgery is the only option now"

 

Correct. And surgery she said they won't perform on my since I'm not syndromic and they don't want lawsuits if something goes wrong.

 

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 9:05 am
EddieMoney
Reputable Member
Posted by: Le_Fort_or_Bust
Posted by: EddieMoney

If I read it correctly it just seems to maintain the status quo of "you're done growing; surgery is the only option now"

 

Correct. And surgery she said they won't perform on my since I'm not syndromic and they don't want lawsuits if something goes wrong.

 

Not surprised . It may take many years if not decades for this to change tbh. We are just in infancy regarding adult treatment regarding the expansion and forward movement of the maxilla. Don't be surprised if docs aren't convinced considering they have been told the opposite all their life. 

Plus, imagine being a doctor and thinking adult expansion and forward movement is possible knowing you treated adults with unnecessary extractions or maxillary narrowing procedures. I wouldn't feel good with this new information as it would mean I may have ruined people's faces rather than helped their case. 

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Posted : 01/08/2018 9:21 am
Le_Fort_or_Bust
Trusted Member

The problem is there is no hard scientific evidence this actually works. She works with patients every day and she says she can only use scientifically proven methods and can't "experiment". 

She agrees that extractions are not needed and is generally a really good doctor and fixed my bite issues without using extractions, just braces, but still, all of this is new and unproven. Mewing in adults is pretty much a broscience and extremely anecdotal.

Myofunctional therapy is legit, but in children, not adults. I went to myofunctional clinic and they told me they have never had an adult expand via these methods.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 9:42 am
alfio
Active Member
Posted by: Le_Fort_or_Bust

The problem is there is no hard scientific evidence this actually works. She works with patients every day and she says she can only use scientifically proven methods and can't "experiment". 

She agrees that extractions are not needed and is generally a really good doctor and fixed my bite issues without using extractions, just braces, but still, all of this is new and unproven. Mewing in adults is pretty much a broscience and extremely anecdotal.

Myofunctional therapy is legit, but in children, not adults. I went to myofunctional clinic and they told me they have never had an adult expand via these methods.

Your reasoning would seem valid, but then how do you explain the successful cases on this and other forums? If I were you, I would show these cases to your orthodontist, just to see what he thinks.

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Posted : 01/08/2018 11:07 am
EddieMoney
Reputable Member
Posted by: Le_Fort_or_Bust

The problem is there is no hard scientific evidence this actually works. She works with patients every day and she says she can only use scientifically proven methods and can't "experiment". 

She agrees that extractions are not needed and is generally a really good doctor and fixed my bite issues without using extractions, just braces, but still, all of this is new and unproven. Mewing in adults is pretty much a broscience and extremely anecdotal.

Myofunctional therapy is legit, but in children, not adults. I went to myofunctional clinic and they told me they have never had an adult expand via these methods.

I literally expanded my palate like 6mm (last I measured). If this was broscience then that wouldn't have been possible. Keep in mind I am one of the oldest members here. 

Plus, migraine hacks shows that bone movement in adults still happens under constant force (Ronnie Ead with FAGGA).

If you want to continue in disbelief due to *current* lack of peer reviewed studies go ahead. But your appeals to authority aren't helping your case either way. 

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Posted : 01/08/2018 11:23 am
Le_Fort_or_Bust
Trusted Member

Your reasoning would seem valid, but then how do you explain the successful cases on this and other forums?

Well, can you link to some successful cases that are measured properly and are not anecdotal? There don't seem to actually be many. In adolescents - sure, but not in adults.

 

I literally expanded my palate like 6mm (last I measured). If this was broscience then that wouldn't have been possible. Keep in mind I am one of the oldest members here. 

Plus, migraine hacks shows that bone movement in adults still happens under constant force (Ronnie Ead with FAGGA).

If you want to continue in disbelief due to *current* lack of peer reviewed studies go ahead. But your appeals to authority aren't helping your case either way. 

 

Well, what methods did you use? Just mewing? Keeping tongue in place like Mew says? My ortho agrees that all of this is important, but she said it won't work in my case. Maybe because I already have a perfect bite, so there is no incentive for body to mould in a different way. I still breathe only through nose and keep my mouth taped shut at night. I still use chewies for back teeth as my ortho also confirmed it will help me build more angular jaw. 

 

How long time did it take you to expand 6 mm? Because that is quite a lot. 

 

I mean, there are a few rare cases like you and that guy, but it is super rare and have not been performed in peer reviewed study. I mean, even myofunctional clinic told me they have not managed to expand in adults.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 11:50 am
EddieMoney
Reputable Member
Posted by: Le_Fort_or_Bust

Your reasoning would seem valid, but then how do you explain the successful cases on this and other forums?

Well, can you link to some successful cases that are measured properly and are not anecdotal? There don't seem to actually be many. In adolescents - sure, but not in adults.

 

I literally expanded my palate like 6mm (last I measured). If this was broscience then that wouldn't have been possible. Keep in mind I am one of the oldest members here. 

Plus, migraine hacks shows that bone movement in adults still happens under constant force (Ronnie Ead with FAGGA).

If you want to continue in disbelief due to *current* lack of peer reviewed studies go ahead. But your appeals to authority aren't helping your case either way. 

 

Well, what methods did you use? Just mewing? Keeping tongue in place like Mew says? My ortho agrees that all of this is important, but she said it won't work in my case. Maybe because I already have a perfect bite, so there is no incentive for body to mould in a different way. I still breathe only through nose and keep my mouth taped shut at night. I still use chewies for back teeth as my ortho also confirmed it will help me build more angular jaw. 

 

How long time did it take you to expand 6 mm? Because that is quite a lot. 

 

I mean, there are a few rare cases like you and that guy, but it is super rare and have not been performed in peer reviewed study. I mean, even myofunctional clinic told me they have not managed to expand in adults.

Keep in mind I had ortho done just like you. My bite was also "perfect" as explained by many orthodontists.

I did mewing, some chewing, and high calorie consumption. I firmly believe my high calorie consumption has helped a lot in this journey . 

My expansion took 7 months. So about 1 mm a month. But I started with a wide palate as it is. So I know that contributes. But to say changes of bone aren't possible in adults is an absolutist statement that doesn't even make sense. If maxillary recession happens in adults as a consequence of aging that already bone does change .

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Posted : 01/08/2018 12:12 pm
Le_Fort_or_Bust
Trusted Member

Why do you believe high calorie consumption helps bone change better? It is expansion of palate, right? So what do calories have to do with it if pressure is exerted over time?

 

I have been mewing and chewing for about 6 month now and my palatal expansion is literally 0. It was 36 mm and still is.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 12:28 pm
EddieMoney
Reputable Member
Posted by: Le_Fort_or_Bust

Why do you believe high calorie consumption helps bone change better? It is expansion of palate, right? So what do calories have to do with it if pressure is exerted over time?

 

I have been mewing and chewing for about 6 month now and my palatal expansion is literally 0. It was 36 mm and still is.

The body requires extra energy to make any changes. When caloric consumption is at maintenance or lower, the body cannot create energy out of nothing. Without extra energy, everything remains. 

I am not saying changes aren't possible without high calories. But they certainly aren't going to come soon. The same way muscles need extra calories to grow so does bone. 

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Posted : 01/08/2018 12:36 pm
Le_Fort_or_Bust
Trusted Member

Is the calorie part based on any research? Because if you just exert pressure on bone, it will deform, calories or not. Same way those paralysed people get their bones deformed.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 12:52 pm
EddieMoney
Reputable Member

Calories just speed up the process. All metabolic processes occur faster in highly caloric environment. Hypocaloric environments slow metabolic processes down.

So in your post you seem to imply you do believe bones can change from pressure. Why is the palate different?

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Posted : 01/08/2018 1:17 pm
Le_Fort_or_Bust
Trusted Member
Posted by: EddieMoney

Calories just speed up the process. All metabolic processes occur faster in highly caloric environment. Hypocaloric environments slow metabolic processes down.

So in your post you seem to imply you do believe bones can change from pressure. Why is the palate different?

Because palate is kept in "status quo" by the teeth being in correct bite. The bite itself (teeth alignment) keeps the palate in place. Since teeth contact is so strong (bite force) it keeps the maxilla from expanding (teeth locked together). At least that is how I understood it. Maybe I misunderstood something.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 1:22 pm
EddieMoney
Reputable Member
Posted by: Le_Fort_or_Bust
Posted by: EddieMoney

Calories just speed up the process. All metabolic processes occur faster in highly caloric environment. Hypocaloric environments slow metabolic processes down.

So in your post you seem to imply you do believe bones can change from pressure. Why is the palate different?

Because palate is kept in "status quo" by the teeth being in correct bite. The bite itself (teeth alignment) keeps the palate in place. Since teeth contact is so strong (bite force) it keeps the maxilla from expanding (teeth locked together). At least that is how I understood it. Maybe I misunderstood something.

Wouldn't that also stop children from expanding then? They too also close their mouth.

The prevailing theory isn't to do with occlusion at all but with the idea that the suture fuses in adults.

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Posted : 01/08/2018 1:48 pm
Le_Fort_or_Bust
Trusted Member

Well, I don't really know who is right, because I don't disagree that you got results. But it is very hard to quantify how exactly. How old are you again? You say you chewed, mewed and ate caloric surplus, but there are different ways to mew. For example, how did you get tongue to stick at your palate when you were sleeping even with teeth together and lips shut? Because when I'm asleep my tongue never sticks there fully. Chewing - do you chew gum? On which teeth? For how long each day?

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 1:56 pm
EddieMoney
Reputable Member
Posted by: Le_Fort_or_Bust

Well, I don't really know who is right, because I don't disagree that you got results. But it is very hard to quantify how exactly. How old are you again? You say you chewed, mewed and ate caloric surplus, but there are different ways to mew. For example, how did you get tongue to stick at your palate when you were sleeping even with teeth together and lips shut? Because when I'm asleep my tongue never sticks there fully. Chewing - do you chew gum? On which teeth? For how long each day?

I barely chew. Average of 1 hour a week if that with Mastic. I constantly pulse my tongue on my palate when I mew to make sure it is in proper position. So at night it took me like 3 months to keep my tongue there. I would literally spend all my time driving somewhere just focusing on my tongue posture.

I am 32. I think the biggest proof my palate expanded is that my old retainer fit before I started and now it can't even be forced in without breaking. Keep in mind the retainer fit for maaaaany years prior even without me wearing it. 

Sleep mewing pretty much I think may separate me from others. But again, if I started at 38mm my advantage was already there. I know my genetic advantage cannot be ignored. Some people tell me 38mm is rare for a Westerner. I guess so, I have no idea. Maybe that is why I can sleep Mew and others can't . I have only had trouble the first 3 months but after that it was smooth sailing. 

Have you looked into a palate expander? 

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Posted : 01/08/2018 2:19 pm
gubbbbb
Eminent Member

OP I think most everyone on this forum understands mewing is a totally anecdotal hypothesis. We've all just decided to be guinea pigs because there's major holes in orthodontic science that don't make much sense or because plastic surgery is too risky/expensive. I'm sorry you haven't had much success with your maxilla but even still your jaw is probably sharper, you're breathing through your nose now, and maybe even have slightly better posture which are all net positives.

If you need help with the tongue at night then do tongue chewing exercises, and try falling asleep with something under your jaw(blanket,pillow,etc) so that it wont drop open at night.

In regards to bone remodeling at older ages I honestly wouldn't be surprised if it was all genetics more so than excess calories. Heck maybe even vitamin intake would probably help idk

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Posted : 01/08/2018 3:20 pm
Le_Fort_or_Bust
Trusted Member

Have you looked into a palate expander? 

 
 
The above response from my ortho was her response to me and palate expanders. She basically said the palate expander will tilt my teeth and bone won't expand.
 
 
Regarding night sleeping - I tape my mouth shut, so that is not an issue, but even with taped mouth tongue won't stick up palate, it just drops in mouth.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 01/08/2018 5:21 pm
Ayla31
Trusted Member

@Le_Fort_or_Bust, what about this lady? She's older than most of us (she's almost 50)

Here is an article about her:

http://www.happykansasfaces.com/uploads/2/9/2/7/29276427/cranio_uk_article.pdf

And more info on this thread:  

https://the-great-work.org/community/case-discussions/your-success-story/

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Posted : 01/08/2018 6:54 pm
SUGR1
Active Member

What your orthodontist says is correct in the realm of orthodontic core knowledge that is accepted by the orthodontic community. And in the orthodontic community they are the academics and truely knowledge full, no doubt about it. 

But what about people like John Mew, he is an orthodontist with great knowledge but the orthodontic community disapprove of him. In fact till today they still try to shame his twin studies. Yet his patients are the most healthy/beautiful faces you will ever see. 

You may have a perfect bite and that is what their tunnel visions leads them to. But if your goal is more pronounced cheek bone, forward growth and stronger genial angle then it is clearly a skeletal problem. Imagine your whole jaw upper and lower , moved forward with your current bite. If you compare the teeth by orthodontic viewpoint it is like you are the same dentally. 

Skeletal remodelling in adults isn’t a bro science. It is science . There is no need to argue about remodeling, they agree on remodeling. The orthodontist are just not on the same page because they are looking at things from a suture growth perspective, which in adults does not work. But from a growth remodelling perspective it does, the question is how much remodelling can you get? 

Look at the Harvold Monkey study. They seal the nose of the monkey, they are hence forced to mouth breath and then their whole skeletal shape changes, not just because of the mouth being open. But palate develops high vault, width of maxilla shrinks, gonial  angle changes, growth remodeling turns vertical... if only they had followed the experiment with unblocking nose and seeing if the change is reversible... that would be very helpful in these arguments. But if we can change for the worse... why not change for the better.  I have copy pasted an extract below. The main thing is there is a tooth force as any appliance but there is also a reaction to the sensory input. 

There are clinicians who have made it their whole practice just doing these reversal treatments and give you the results you seek. Day in day out hundred of cases/yr. And those same clinicians day in day out get slammed by the orthodontic community... why are they still doing it... because they are winning the legal battles. That is the truth. The more they win, the more the orthodontic community will and must change. 

By Harvold 

The experiments showed that the monkeys adapted to nasal obstruction in different ways. In general, the experimental animals maintained an open mouth. Some increased the oral airway rhythmically, while others maintained the mandible in a lower position with or without protruding the tongue. All experimental animals gradually acquired a facial appearance and dental occlusion different from those of the control animals. From these and the previously reported primate experiments in this laboratory, it can be deduced that orthodontic appliances in general affect the morphology of the orofacial structure in two ways: by direct force and by sensory stimulation. (1) The appliance exerts a direct physical force which alters the strain distribution in the bone and elicits bone remodeling and tooth movement. (2) The presence of the appliance initiates the sensory input which triggers a neuromuscular response. This change in neuromuscular activity, in turn, affects both muscle development and bone remodeling.

 

 

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Posted : 01/08/2018 9:36 pm
EddieMoney, rogerramjet, alfio and 1 people liked
SUGR1
Active Member

Also if you want to understand how remodelling can change the face so dramatically, simply read this book. Most orthodontists quote Don Enlow studies because his work was instrumental to orthodontic knowledge development, however what they did is they took bits and pieces of his work and disregarded the bits which they do not like. 

Don Enlow “essentials of facial growth” 1993. 

It is a very dry book, not many dentists or orthodontists read it. But if you truely are wanting to learn it holds all the secrets. 

The most interesting fact is he was dean of the Dental school and chair of the orthodontic department at Case Western Reserve University from 1977 yet he is NOT a dentist or an orthodontist. He was an anatomist.... now doesn’t that say it all.... 

and to make things worse, he himself is on record as saying the conclusions orthodontists have drawn from his research are incorrect, and more importantly in his later life he was critical of his own early research notable the reliability of sample size and skull ethnicity and it is his greatest regret that people still quote/reference them as the basis for their treatment philosophy and treatment norms. 

 

 

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Posted : 01/08/2018 9:47 pm
Dominik
Trusted Member

If your tongue is not mewing during sleep after so many months with 36 mm inter-molar, something must be wrong in how you are doing it. It took me under 1 month to mew during sleep and stop mouth breathing without tape. I'm 31 yo.

-not mewing at night

-not mewing during the day when you talk and eat

 

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Posted : 02/08/2018 3:42 am
Le_Fort_or_Bust
Trusted Member
Posted by: Ayla31

@Le_Fort_or_Bust, what about this lady? She's older than most of us (she's almost 50)

Here is an article about her:

http://www.happykansasfaces.com/uploads/2/9/2/7/29276427/cranio_uk_article.pdf

And more info on this thread:  

https://the-great-work.org/community/case-discussions/your-success-story/

That case seems anecdotal, created to promote a device and I don't really see hard evidence for the changes.

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Topic starter Posted : 06/08/2018 5:51 am