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Expander Treatment with Conventional Orthodontists for Facial Benefits?

PaperBag
(@paperbag)
200+ Forum Posts

There's been a lot of recent focus on this forum in regards to tongue ballooning, but my palate is too high arched to feel like this is going to do much, and if appliances work much faster, why bother? For those of us who don't live near a big city, our options are limited.

A removable expander is probably good enough, but I only have access to two nearby doctors. There's the orthodontist who did my previous treatment with headgear/braces/retainers over a decade ago, which I was constantly unsatisfied with even back then, and another one whose website proudly advocates cervical headgear, extractions, etc.. He also has the wrinkles of someone 20 years his senior, probably due to having every one of these treatments himself.

Even though orthos do all these damaging things, how could there be harm in having them monitor your expander usage? It's not like they don't already use them all the time as part of their other treatments. There seems to be a lack of posters doing this, so I was wondering if they're also afraid of orthodontists not understanding what you're trying to do, or projecting their dogma into the outcome like I am. As long as the expansion is slow enough to prevent tipping, there's probably nothing bad that can happen, but it just feels counterintuitive to return to the "enemy", if that makes sense. What do you think?

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Topic starter Posted : 27/12/2019 1:34 pm
PaperBag
(@paperbag)
200+ Forum Posts

Bump.
Still not getting this mentality. Are people thinking that any expansion would be flaring out teeth through the alveolar ridge and not true palate growth? I assume it's irrelevant, but my case probably calls for more intercanine width instead of IMW.

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Topic starter Posted : 02/01/2020 2:13 pm
qwerty135
(@qwerty135)
50+ Forum Posts
Posted by: @paperbag

Bump.
Still not getting this mentality. Are people thinking that any expansion would be flaring out teeth through the alveolar ridge and not true palate growth? I assume it's irrelevant, but my case probably calls for more intercanine width instead of IMW.

@paperbag I’ve gone through expander therapy and can confirm that, if you expand at precisely 1/8mm per day, the expansion is skeletal(I can explain the biological reason why if you want). For me, I expanded 6mm total, and after I was done and looked at my upper palate, there was a thin strip along my mid palate which was a lighter pink than the surrounding palate, confirming expansion from the suture. Also, my cheekbones noticeably became more prominent.

As for the intercanine width, so long as the expander doesn’t have wires holding the canines in place, then they’ll expand with the molars.

I think it’d be good to have an orthodontist/dentist to check in with, even if they’re conventional...just in case something goes wrong, or for peace of mind. But make sure the rate of expansion is 1/8mm per day, no less and no more, and you’ll achieve expansion from the suture and also soften the surrounding maxillary sutures.

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Posted : 03/01/2020 12:21 am
sinned
(@sinned)
200+ Forum Posts

@qwerty135

Could you explain why 1/8 mm a day? Does it relate to the rate of suture growth?

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Posted : 03/01/2020 1:14 am
PaperBag
(@paperbag)
200+ Forum Posts

@qwerty135 Excellent, thanks for the reply. Please go on about why 1/8mm a day is the optimal amount. I thought 1/4mm a week was the usual recommendation, and more than that would start to move teeth? Almost 4mm a month sounds like too much too soon. Did your treatment only last two months?

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Topic starter Posted : 03/01/2020 3:07 am
qwerty135
(@qwerty135)
50+ Forum Posts

Yeah, of course... John Mew talks about it in his book, and my experiences matched up with what he said. Basically, the periodontal membrane attaching the teeth to the alveolar bone is 1/16mm thick on each side, and regenerates that much every night as we sleep. Each of the 3 types of expansion(slow, semi-rapid, rapid) has different effects on the membrane and hence different effects on the bone.

Semi-rapid expansion is at the biologically ideal rate of 1/16mm per day, intermittent movement. It ends up removing the bone salts from the midpalatal suture and surrounding maxillary sutures, causing expansion from the midpalatal suture without having to "split the suture", which can be very harmful - I'll describe below. This softening of the bone salts means softening of the surrounding sutures, which allows the maxilla to move forward 2-3 mm just by expanding...because the sutures in the back of the maxilla can't move backwards, the jaw moves/grows forwards 2-3mm, allowed through softening of the adjacent sutures. I can confirm my vertical indicator line decreased by 2mm, having compared pictures before and after.

Rapid expansion of more than 1/8mm per day damages the periodontal membrane which is very sensitive. By moving it more than 1/16 mm, the expander will cut off blood flow, causing lack of oxygen(anoxia) and death of many cells. But many orthodontists think this is preferable to slow expansion, and see it as the only way to get expansion at the suture, and so they crank out the expander, damaging the gum and periodontium, until the midpalatal suture splits.  Once the midpalatal suture splits, they expand it further by however many mm, and the suture fills with scar tissue, which takes many months to turn into alveolar bone, which is why the orthodontists "stabilize" the expansion by leaving the expander in place for many months after turning. Anyway, this is all very unnecessary as semi-rapid expansion gets good results without the stress on the body, and in much less time when considering the stabilization period. And also, this may explain why MSE patients who expand upwards of 10 mm don't have facial changes mirroring that dramatic level of expansion(their facial changes may not match the extreme amount of expansion they receive).

Slow expansion is fine, but to get the sutures to soften and allow for forward movement and less dental expansion, I'd recommend semi-rapid.

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Posted : 03/01/2020 4:23 am
qwerty135
(@qwerty135)
50+ Forum Posts

@paperbag

Yes, I wore the palate expanders(upper and lower) for slightly less than 2 months, as that’s all the expansion I needed. My occlusion changed, but by chewing gum afterwards, I reestablished proper occlusion and my teeth straightened out without need for braces or other fixed appliances. If you only expand the upper and not the lower, you may have improper occlusion for a bit afterwards while the lower jaw follows, but if you want to speed it up, you can use a lower expander.

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Posted : 03/01/2020 4:33 am
PaperBag
(@paperbag)
200+ Forum Posts

@qwerty135 Very interesting. Is your treatment fully done (in terms of facial results) or was expansion just phase one? I assume the type of expander and being fixed or removable ultimately doesn't matter a whole lot. Also, how does the mandible expand? Every expander I'm looking at seems to have wires holding most teeth in place, though Orthos can and do modify appliances to fit differently. Which one did you use, specifically? I think Schwarz or any removable expander is the best, since alternating usage would lead to the intermittent pressure you were talking about. Also, you can easily stop wearing it if things go wrong.

I wonder how this would go over when pitching it to an orthodontist who's already set in their ways of how quickly to expand. Did you see a regular orthodontist or did you just order a plate from bracesshop and self-treat?

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Topic starter Posted : 03/01/2020 5:53 am
PaperBag
(@paperbag)
200+ Forum Posts

The Orthotropics channel has a video from 2014 about adult palate expansion:
https://www.youtube.com/watch?v=QCNqbvOALZI

Shouldn't be a surprise, but nice to hear that the rate of expansion matches what you quoted from John's book.
Nice results on this one case (4 months expansion with removable appliance) aside from the very noticeable dental asymmetry it caused due to one side expanding more than the other.

Expansion
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Topic starter Posted : 04/01/2020 12:17 pm
niccistar
(@niccistar)
New Member
Posted by: @qwerty135

Yeah, of course... John Mew talks about it in his book, and my experiences matched up with what he said. Basically, the periodontal membrane attaching the teeth to the alveolar bone is 1/16mm thick on each side, and regenerates that much every night as we sleep. Each of the 3 types of expansion(slow, semi-rapid, rapid) has different effects on the membrane and hence different effects on the bone.

Semi-rapid expansion is at the biologically ideal rate of 1/16mm per day, intermittent movement. It ends up removing the bone salts from the midpalatal suture and surrounding maxillary sutures, causing expansion from the midpalatal suture without having to "split the suture", which can be very harmful - I'll describe below. This softening of the bone salts means softening of the surrounding sutures, which allows the maxilla to move forward 2-3 mm just by expanding...because the sutures in the back of the maxilla can't move backwards, the jaw moves/grows forwards 2-3mm, allowed through softening of the adjacent sutures. I can confirm my vertical indicator line decreased by 2mm, having compared pictures before and after.

Rapid expansion of more than 1/8mm per day damages the periodontal membrane which is very sensitive. By moving it more than 1/16 mm, the expander will cut off blood flow, causing lack of oxygen(anoxia) and death of many cells. But many orthodontists think this is preferable to slow expansion, and see it as the only way to get expansion at the suture, and so they crank out the expander, damaging the gum and periodontium, until the midpalatal suture splits.  Once the midpalatal suture splits, they expand it further by however many mm, and the suture fills with scar tissue, which takes many months to turn into alveolar bone, which is why the orthodontists "stabilize" the expansion by leaving the expander in place for many months after turning. Anyway, this is all very unnecessary as semi-rapid expansion gets good results without the stress on the body, and in much less time when considering the stabilization period. And also, this may explain why MSE patients who expand upwards of 10 mm don't have facial changes mirroring that dramatic level of expansion(their facial changes may not match the extreme amount of expansion they receive).

Slow expansion is fine, but to get the sutures to soften and allow for forward movement and less dental expansion, I'd recommend semi-rapid.

I'm a bit confused... First you said 1/8mm a day, then above you say 1/16mm-

"Semi-rapid expansion is at the biologically ideal rate of 1/16mm per day, intermittent movement."
And
"Rapid expansion of more than 1/8mm per day damages the periodontal membrane which is very sensitive. By moving it more than 1/16 mm, the expander will cut off blood flow".

Could you clarify? Sounds to me like 1/16 is ideal.

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Posted : 04/01/2020 2:24 pm
qwerty135
(@qwerty135)
50+ Forum Posts

@niccistar

1/16 is the amount the periodontal membrane on your tooth regenerates each day. Since you have teeth on the left and teeth on the right, you want to expand twice 1/16 each day, or 1/8 mm on your expander. Which ends up being 1/16 on each side

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Posted : 04/01/2020 11:24 pm
niccistar liked
sinned
(@sinned)
200+ Forum Posts

@qwerty135

Is this the same for the mandible as well? Or does it regenerate less than 1/16.

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Posted : 05/01/2020 3:19 am
PaperBag
(@paperbag)
200+ Forum Posts

@qwerty135 Another question; how does the mandible expand if there aren't any sutures in it to separate? It seems like flaring teeth would be inevitable if using a lower appliance.

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Topic starter Posted : 06/01/2020 11:49 am
qwerty135
(@qwerty135)
50+ Forum Posts

@sinned Mandible has no suture through its middle dividing it into 2 halves like the maxilla, so rate isn’t as important...You can either go at the same 1/8mm turn per day, or one 1/8 turn every 2 days...if your expansion is not an extremely large amount(10-15mm), to the point where your teeth can still contact each other after expanding just the upper arch, then the mandible will follow the maxilla even without expansion, though this will take a longer time. But most people need around 10-15mm of expansion to get to 44mm IMW, so lower arch expansion is usually wise. Just don’t expand faster than 1/8 mm a day because you’ll still risk the damage to the teeth.

@paperbag

I did lower arch expansion with the lower biobloc stage 1 appliance, 8 mm of expansion, as my upper started out wider. Yet my molars and other teeth actually uprighted themselves to some degree. Reason is that the lower arch expands through bone remodeling. The plastic of the appliance contacts the inside of the arch, and as you expand. The pressure from the plastic triggers the body to remove bone from the inside of the arch and deposit bone on the outside of the arch. This will widen the mandible itself. I believe it’s just Wolff’s Law in action 🙂

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Posted : 06/01/2020 12:31 pm
PaperBag liked
qwerty135
(@qwerty135)
50+ Forum Posts
Posted by: @paperbag

@qwerty135 Very interesting. Is your treatment fully done (in terms of facial results) or was expansion just phase one? I assume the type of expander and being fixed or removable ultimately doesn't matter a whole lot. Also, how does the mandible expand? Every expander I'm looking at seems to have wires holding most teeth in place, though Orthos can and do modify appliances to fit differently. Which one did you use, specifically? I think Schwarz or any removable expander is the best, since alternating usage would lead to the intermittent pressure you were talking about. Also, you can easily stop wearing it if things go wrong.

I wonder how this would go over when pitching it to an orthodontist who's already set in their ways of how quickly to expand. Did you see a regular orthodontist or did you just order a plate from bracesshop and self-treat?

For my details: I’m seeing an orthotropist near me, and the bulk of the treatment includes expansion with a Biobloc Stage 1 upper and lower appliance, outward tipping of my upper and lower incisors(which is part of orthotropics, the hope is that by establishing proper oral posture, the incisors will upright themselves in a more forward position), and facemask use. It’s very similar to Mike Mew’s adult treatment protocol, I believe.

For your appliances, depending on how open your local clinician is(and it could be a dentist that you find, doesn’t have to be an orthodontist necessarily if your local orthodontists end up being too closeminded), you could have them order Biobloc Stage 1 appliances(upper and lower) from the Myoresearch Company. But a Schwartz appliance should be fine too, if that doesn’t work out...it’s all good. For the lower appliance, another option is the Trombone appliance iirc, but I’ll need to verify if my memory’s correct.

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Posted : 06/01/2020 12:52 pm
PaperBag liked
qwerty135
(@qwerty135)
50+ Forum Posts

Oh - by intermittent pressure, I meant you turn the screw once a day, so in that sense it’s intermittent. The opposite would be gradual, where the appliance slowly and continuously expands over the course of a day so that in 24 hours it expands 1/8mm(but for that you’d probably need more advanced technology to be able to constantly be expanding the appliance by 0.0001mm per minute, for intermittent pressure all you need is a screw!)

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Posted : 06/01/2020 12:58 pm
PaperBag liked
PaperBag
(@paperbag)
200+ Forum Posts

@qwerty135 Your orthotropist sees value in pulling the maxilla forward with a mask? Perhaps the conflict on here about whether or not the maxilla can be rotated (instead of grown) is solely about whether or not the tongue is able to do it. I still have the Crane protraction device that I bought from someone on this forum and considered it irrelevant to use.

Wouldn't any doctor wanting to order a Biobloc have to attend a Myoresearch course to be able to treat with it? I emailed them about that but didn't get a reply yet, and they didn't answer the phone. Getting one to use a Biobloc is a pretty lofty goal for me, since I just called the dental lab that works with the local orthodontist and asked if they made a Schwarz appliance. The technician said they could probably make it or something similar, then started going on about how adults' palates are fused and the expander would either do nothing or move my teeth and I'd probably be wasting money. Of course, some random person on the phone saying others have expanded as adults wouldn't instantly change their mind, but they didn't really acknowledge that at all.

Mike made a video about the Trombone appliance in the lower arch, that must have been the one you were thinking of.

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Topic starter Posted : 07/01/2020 5:04 am
Mewed
(@mewed)
10+ Forum Posts

I began my expansion 2 months ago at 2mm / mo rate and i have 0 tipping so far and my palate is noticeably wider, which leads me to think that i got true expansion and not just flaring. It feels like expanding the palate is pretty easy in adults?? Where did this nonsense " if you are older thn 18 forget it " start.

Either way im also trying to protract my maxilla on my appliance with a facemask , but i have little hopes for that, even thou my ortho told me that she's routinely improving peoples maxilla(improved eye support, paranasal areas mostly) with this combination. She showed me pretty good before and afters , but untill i see some xrays im not buying it.

@qwerty135 Are you sure adults are getting expansion of the maxilla (midface ( zygos ) ) and not just palate expansion? That would be really good news, my ortho also tells me she is able to widen peoples face routinely and that i could expect 3-4mm of increased facial width.

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Posted : 07/01/2020 7:52 am
PaperBag
(@paperbag)
200+ Forum Posts

@Mewed Which appliance are you expanding with? It seems like the arguments about suture fusion comes down to various studies claiming that some adults couldn't expand, even though there are other studies from decades ago that say the palate doesn't fuse until 30s at the minimum. A few attempts at transverse thumb pulling tonight have felt pretty good; wouldn't there be little to no sensation if the suture was fused? I was obsessive with it over a year ago, but was mostly pulling forward and that could be why results never came.

Are you also seeing an orthotropist or just a forward thinking orthodontist?

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Topic starter Posted : 07/01/2020 9:05 am
Mewed
(@mewed)
10+ Forum Posts

@paperbag

Something like this, im guessing the tubes are good and its what's preventing tipping. Also its not a removable expander , it says on 24/7, i think u need a non removable one if you want a shot of getting decent results in adults. She's very against extractions , etc etc has knowledge about orthotropics but relies on appliances alot aswell so its a mix of both. 

From what the info ive gathered , it looks like you can achieve expansion via growth ( where u need to split the suture ) and via remodeling ( where the split isnt necessary ) , do you think that's true? 

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992006000200004&lng=en&nrm=iso&tlng=en

Like here avg patient age was 27, no split occured yet they all gained maxillary expansion. My only doubt here is if the measurements are accurate.

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Posted : 07/01/2020 7:58 pm
PaperBag
(@paperbag)
200+ Forum Posts

@Mewed Oh, you're using the Hyrax? Not like I'd know, but I don't think the appliance being fixed or removable matters as long it doesn't overly compromise on function for being removable. I loathe the idea of being unable to immediately stop using one that isn't working or is causing damage. I have two consultations within the next month, and since neither doctor openly practices any of this stuff, it seems like preparing a script of what to say just to get them on my side is more important than pinpointing the best appliance. (it's a nearly forgone conclusion they haven't even heard of the cutting edge ones)

That study is promising, though they used slow expansion and you're doing 2mm/month. I don't understand how appliances signal remodelling to take place or how it happens when the suture isn't splitting. Didn't John Mew say the suture never fuses? He may have said the skull never fuses, since I can't find proof of anyone saying the former.

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Topic starter Posted : 09/01/2020 7:43 am
Ezcanor
(@ezcanor)
10+ Forum Posts

So since there are multiple appliances that expand the upper palate for improving airway and increasing oral space begs the question how is the mandible expanded? Do you tip the teeth to fit the new expanded upper palate? I know Ronald Ead is pursuing getting SFOT after MSE but is there any other way to get expansion by I don't know Jaw surgery or is it overkill? At the end of the day, you need to have a functional bite and you need to have the expansion of mandible to fit your expanded upper palate. 

If SFOT is the best option does anybody know of any providers in the NYC area?

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Posted : 11/01/2020 1:15 am
PaperBag
(@paperbag)
200+ Forum Posts

@ezcanor

Mandibular expansion was already answered above by @qwerty135. Whether it'll be done on purpose or not, most patients would probably get a bit of teeth tipping, but only a slight amount would be desired if their teeth were previously not proclined. I have no clue about SFOT but surgery is pretty disruptive since everything happens at once, so that should be considered a last resort unless you're desperate. (IMO, of course)

@qwerty135 It's only been like a week, but how's your treatment going?

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Topic starter Posted : 14/01/2020 12:55 am

THE GREAT WORK

Warning:
Your Cranial Sutures Need To Be open for CranioSacral / Jaw Development!