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Considering AGGA+Controlled Arch or DNA

darby_jones
Active Member

Hello All.

I am finally getting some help with my CFD, since I found a dentist who does either DNA or AGGA and Controlled Arch Braces. There is so much conflicting information out there, and I am having trouble deciding which makes more sense. My IMW is only 32mm top and 31mm bottom. As a teenager I had retraction braces with 4 first molars removed. Now I am 37 and my maxilla is recessed 4.5mm with a narrow airway and flat face. I have been mewing for about 2 years with NO results because my palate is too damn narrow and I can't keep my tongue up there. 

The AGGA and CAB is very expensive, but the dentist thinks it will produce a better result.  DNA could take two rounds (doubling the cost), and there would be probably no forward growth. The DNA is still more attractive, because no one wants braces until they are almost 40!

I would love to hear from those with experience to help me decide which is right for me. 

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Topic starter Posted : 22/03/2021 9:57 am
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Apollo
Reputable Member
Posted by: @darby_jones

Hello All.

I am finally getting some help with my CFD, since I found a dentist who does either DNA or AGGA and Controlled Arch Braces. There is so much conflicting information out there, and I am having trouble deciding which makes more sense. My IMW is only 32mm top and 31mm bottom. As a teenager I had retraction braces with 4 first molars removed. Now I am 37 and my maxilla is recessed 4.5mm with a narrow airway and flat face. I have been mewing for about 2 years with NO results because my palate is too damn narrow and I can't keep my tongue up there. 

The AGGA and CAB is very expensive, but the dentist thinks it will produce a better result.  DNA could take two rounds (doubling the cost), and there would be probably no forward growth. The DNA is still more attractive, because no one wants braces until they are almost 40!

I would love to hear from those with experience to help me decide which is right for me. 

You could read @greyham's blog post on his decision here:

https://cfs-survivors.org/blog/2020/10/27/why-i-chose-dna-over-homeoblock-mse-dome-mma-and-agga/

He believes there is the potential for forward growth from the DNA anterior screw and he's added reverse-pull headgear hoping for additional forward growth. I'm not convinced that a removeable acrylic appliance can accomplish these goals in an adult, and I chose the MSE with reverse pull headgear. I'm definitely wary of the AGGA after reports of adverse outcomes like Ronald Ead's.

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Posted : 22/03/2021 12:56 pm
darby_jones
Active Member

Thank you for your answer. Personally when I look at a before and after x-ray of on my dentist's website that used the AGGA, their teeth look bucked outwards. But as plain old internet users we don't have access to people's photos and x-rays, so we have to just sift through what has been published and place a level of trust in our providers. My dentist is telling me he will do the DNA if I want, but he feels he gets better results with the AGGA. Then again, he also gets paid a lot better if I do AGGA, so....who knows. I don't have any alternatives in my area. 

Mike Mew suggests in a video with the creator of ALF applicance that first, get yourself some space, then do the work (mewing, myofunctional therapy, etc). This makes me think that the less risky method of DNA together with myofunctional therapy will give the best results in the long run. 

My dentist is also warning me that DNA alone makes spaces between the teeth and in 80% of cases he sees, further work is needed. I read a few different people's experience on here that said this wasn't a problem, but @greyham shows gaps! His look small, and might fill in when treatment is over. Anyone have thoughts on tooth gaps?

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Topic starter Posted : 23/03/2021 12:12 pm
greyham
Eminent Member

The progress photos I've seen online of AGGA+CAB show massive flaring of the teeth after AGGA, and then CAB pulling them back in. To me, this is a red flag that the appliance pushes too hard, too fast. I can't for the life of me understand why they would want to do this other than to reduce the treatment time; but it's still two multi-month phases. I suspect this is the reason why when AGGA fails, the results are catastrophic. I'd rather take longer, move everything slower and avoid putting my alveolar through all that trauma. I suspect this would shorten the CAB phase of treatment too because it wouldn't have to pull all the flared teeth back in so far.

As for my gaps, I notice Lauren from Airway Health Solutions is getting them too. In this video Dr Ben Miraglia suggests that they come and go, so it'll be interesting to see what happens with mine. I noticed yesterday that I can now use green picksters, up from the blue size, so the space between my teeth is indeed increasing all round. If they don't fill in themselves, I'll probably need clear aligners after DNA to close the gaps and reopen my extraction spaces.

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Posted : 23/03/2021 5:00 pm
ThaGangsta
Eminent Member

@darby_jones

@greyham

AGGA is based on a sound principle but in practice this is not carried out due to use of improper mechanics and rates of movement, as for adults these movements must be done much slower so that the bone and teeth aren't traumatized.  Allow for me to quote my comment from another part of the forum, this illustrates the purpose behind these movements.

 

h, the bit about Orthotropics is something I didn't know before. Interesting piece of information. As for helmutstrebl, he stated in his original 1-year update that his front teeth had tipped due to him deliberately pushing against them with his tongue. Like you said, he viewed this as an undesirable result and had stopped doing it by the time of his next update a few months later, in which he presented even greater, accelerated results. In this more recent update he revealed that his front teeth were now reverting back. Considering what you revealed about the Orthotropic preparation phase, it could indeed be that the forwardly tilted incisors acted as a catalyst to some kind of structural change in the jaws even after helmut had stopped actively pushing against his incisors.

If I recall right, tongue thrusters aren't just pushing against their teeth, but also placing their tongue in between the teeth. In this position the tongue isn't able to drive against the palate, neither are the teeth able to make contact, explaining the lack of palatal width and the wonky occlusion. What I am really interested in finding out is what happens when you are thrusting against teeth that are kept in firm contact with each other. It seems that this would not necessarily result in an open bite, and that instead the occlusion would conveniently maintain its integrity while the tongue is expanding the arches to every direction.

The preparation phase pushes both upper and lower incisors forward and up/down respectively.  The upper incisors are tipped forward to correct the "indicator line" and the lower incisors are tipped forward to correct the "lower indicator line".  Note that it is tipping and (not pushing like FAGGA, which can push the teeth out of bone).   The upper incisor movement is done to correct the position of the upper incisors relative to the cranial vault, and the lower incisors are done to help their position relative to the mandibular plane.  Both sets of incisors then upright in their forward position due to lip seal while the wires are behind them, forming new alveolar bone around them and thereby remodeling the Point A .  In a growing child this also gives the appearance of the the entire maxilla and mandible growing around these teeth.  In most cases of vertical growth, the lower incisors and upper incisors are retroclined and over erupted and this aims to correct this, because intruding the incisors alone would be orthodontically unstable and doesn't provide the needed movement.  Then the mandible is closed via intrusion or early extraction of deciduous teeth and advanced if needed.  Red lines in these pics are the wires tilting the teeth.  Green arrows. shows the movement vectors between stages.

 

Wires pushing on teeth in their original form, the case shown here is a hypothetical class 2 division 1 with a large overjet.

Incisal edges have now reached their ideal point relative to the cranial vault and mandibular plane respectively.

Forces now show the incisors must upright in a very particular fashion from lip seal in their forward position being held by the wires, so the center of rotation is at the apex of the incisors.

Incisors have now uprighted in the ideal position with new alveolar bone growing as they upright slowly.

The mandible must now close and move both up and forward.

The bite is now a class 1 good occlusion, the mandible has moved forward and up and the condyle has now remodeled in the new position.

 

Overlay between initial and final position, it resembles a moderate orthognathic surgery:

See these surgical pics for a similar effect illustrated, you can see how the distance between the lower incisors and bottom of the chin is actually lower in the postsurgical cases:

 

 
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Posted : 23/03/2021 11:09 pm
darby_jones
Active Member

@greyham

Thanks for the direct reply. I really appreciate all the research you compiled on your blog! Keep us updated on those gaps and the rest of your progress!

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Topic starter Posted : 24/03/2021 10:17 am
greyham liked
darby_jones
Active Member

@mafiagang

Thanks for all those diagrams. The transition between step 3, 4 and 5 is what makes me nervous. Does it just happen due to lip seal, or are the braces helping? 

I would be interested to know how this compares to the DNA appliance. 

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Topic starter Posted : 24/03/2021 10:22 am
ThaGangsta
Eminent Member

@darby_jones

AGGA tries to do this by pushing on teeth rather than tipping them and using controlled arch braces to try make them upright in that forward position (rather than lip seal).  This often just makes the teeth go back to their initial position and destroys bone and incisor roots.  If you rely on a lip seal with a wire supporting the teeth in the back, nature takes its course and these teeth upright as fast as the body allows new alveolar bone to be deposited, rather than tampering with this rate with artificial mechanics.  

AGGA is a flawed methodology to use on adults in my opinion, whose alveolar bone must be treated with extra care and caution.  Much of the treatment is done by dentists who've taken courses and certifications on this rather than orthodontists, many of whom may not understand the proper mechanics and rates that must be used.

DNA might be more worthwhile or if you can find an extremely experienced biobloc provider that would do something similar.  With what I've seen, DNA respects the bone adaptation rate much more than AGGA.

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Posted : 24/03/2021 4:40 pm
eternally12
Eminent Member

You could also combine DNA with controlled arch braces which is what I'm currently doing. The DNA appliance made space and to close the gaps my dentist is using controlled arch so that we do not lose any space, which was my request. 

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Posted : 03/05/2021 11:50 pm
1EpicNinja
New Member

@eternally12 I am also undergoing the same process as you, after expansion in the DNA Appliance I am now in Controlled Arch Braces. My orthodontist has his own way of doing the CAB where only now has he put in the tools to actually start pushing teeth forward. He put me in normal braces at the start just to align things slightly and get my teeth used to movement (which I see is a way of taking extra precaution with the bone), and now he has put me in a square wire which allows torque of whatever tooth needs to be torqued, although the hasn’t started any major torquing or tipping of teeth yet, he has just got me used to a little bit at a time. I also want to note that in the DNA Treatment, I started at around 17y and 6m old and finished expanding and everything at 18y 11m old, and in the before and after xray there is a VISIBLE gap of the suture opening in the middle of my maxilla, which is quite amazing. I am by far his best result for a patient however.


 

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Posted : 05/06/2021 1:03 pm
auxiliary
Reputable Member

Problem with these appliances is there's no upward force, ideally you want everything to go up like the zygos, even the eyes, relative to the back of the head.

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Posted : 07/06/2021 12:20 pm
1EpicNinja
New Member

@auxiliarus I agree, I wanted a form of protrusion face mask like the face bow or something that is bone anchored and the subsequent reaction force being directed somewhere else ie. forehead or neck however this was far out of my orthodontists abilities, so I have just got the treatment I have gotten. Hopefully this arch development and proper alignment of bite will allow me to have this kind of change 5 years down the line if I perfectly mew, as the treatment should hopefully allow me to.

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Posted : 08/06/2021 4:34 pm
auxiliary
Reputable Member
Posted by: @1epicninja

@auxiliarus I agree, I wanted a form of protrusion face mask like the face bow or something that is bone anchored and the subsequent reaction force being directed somewhere else ie. forehead or neck however this was far out of my orthodontists abilities, so I have just got the treatment I have gotten. Hopefully this arch development and proper alignment of bite will allow me to have this kind of change 5 years down the line if I perfectly mew, as the treatment should hopefully allow me to.

What's exactly wrong with your arch right now? Why can't you mew? I might, in six months, make a proper guide on mewing. I feel the current instructions are either blatantly wrong or at best very vague.

 

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Posted : 09/06/2021 1:43 pm
greyham
Eminent Member

@blackbear I get that you're passionate about this cause and want orthodontists to change their behaviour. I want that too, so could you please stop leaving comments with fake names and invalid email addresses on my blog. I won't be approving them because I want a higher level of discourse that is more likely to effect change, and that means owning our opinions and backing them with solid evidence.

People in power aren't going to listen to us if we don't even have the courage of our convictions to put our name to our views. If we want to hold orthodontists accountable for their behaviour, we need to take the higher road and be ruthlessly scrupulous in ours, and that means being accountable for what we say and do too.

So no, at this point I don't think it's worth contacting Dr Jeffrey Miller; not until you can communicate with him honestly, without bias and in a manner he is likely to consider reasonable.

Thanks,
Graham

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Posted : 11/06/2021 5:11 pm
1EpicNinja
New Member

@auxiliarus

 

There is nothing really too wrong with my arch but in the stage of treatment I am in, which is CAB, I still feel that my bite is very uneven and unbalanced, as my teeth occlude differently every week which makes it hard to mew as there is no consistency, and this also doesn’t allow me to chew gum properly.

In addition to this my front 2 upper incisors still need to be torqued outwards and intruded a bit to allow my jaw to move forward, “unlocking” the forward POSITIONING of my jaw (not growth). Once my jaw moves forward my airway will be a lot less embarrassed allowing for proper body posture and then proper oral posture. When going for this treatment I don’t expect all my issues to be fixed but I just want enough fixed to the point where I can new for the rest of my life, hoping that fixes the rest of my problems. I just get a nice smile as a bonus I hope lol

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Posted : 24/06/2021 2:10 pm