Notifications
Clear all

NOTICE:

DO NOT ATTEMPT TREATMENT WITHOUT LICENCED MEDICAL CONSULTATION AND SUPERVISION

This is a public discussion forum. The owners, staff, and users of this website are not engaged in rendering professional services to the individual reader. Do not use the content of this website as an alternative to personal examination and advice from licenced healthcare providers. Do not begin, delay, or discontinue treatments and/or exercises without licenced medical supervision.

Dr. Won Moon seemingly surprised to find out "Pneumopedics(TM)" is actually a thing.

29 Posts
7 Users
36 Likes
1,278 Views
toomer
(@toomer)
Posts: 275
Topic starter
 

Recently, Dr. Moon gave a very interesting presentation which was widely circulated among MSE patients, and patients considering MSE:

https://www.youtube.com/watch?v=LJ3H8eWbj1Q

All sorts of good stuff in here, and I commend Dr. Moon for all of the work he has done and all of the patients his protocol has helped.  I don’t really have anything against his protocol, when patients are properly assessed clinically and would have a high likelihood of success (i.e.: why some of the treating orthodontists are more leery about treating patients that are older).

At about the 2 hour and 14 minute mark, he begins to comment about how they were obviously seeing and documenting changes in the nasal cavity – that’s pretty straightforward, well-known results for MSE.  But he also began to comment about how they also were measuring statistically significant changes to the pharyngeal area (the remainder of the “upper airway” once air gets past the nasal cavity).  

As a means to demonstrate this, he rendered a 3D model of how it looks in patients pre- and post-treatment:

Screen Shot 2020 12 29 at 5.40.09 PM copy

Cool, right?  MSE makes changes to the nasal cavity … and in response to the increased volume of air flowing through the nasal cavity, the body is apparently smart enough to remodel the rest of the upper airway and widens it accordingly as a result.  You could call this a functional response, or a genetic response, I suppose.  

In any case, Dr. Moon is quite clear that his appliance is obviously not doing anything directly for the pharyngeal area … but the pharyngeal area in MSE patients is changing.  Awesome data for Dr. Moon to present for MSE.  He seemed to indicate that they were going to start investigating affects on sleep apnea soon, which I – as a sleep apnea patient – think is an awesome thing.

However, this concept of changes in the pharyngeal area due to remodeling of the nasal cavity … is something that Dr. Singh (Vivos / DNA) trademarked like a decade ago under the moniker of “Pneumopedics” (defined by him as “non-surgical airway remodeling.”)  More interestingly, this exact same kind of 3D modeling of the pharyngeal airway was done and presented by Dr. Singh and one of his early treating dentists (Dr. Liao) nearly a decade ago:

Screen Shot 2020 12 29 at 6.44.17 PM copy

Now, let’s put aside for a moment the fact that the inventor of DNA seems obsessed with buzzwords – epigenetic, pneuompedic, biomimetic.  I wish he would just call his appliances what they really are designed to be – “functional” appliances (more like an ALF), instead of mechanical appliances (more like a Hyrax).  If we can all just ignore the buzzwords for a minute and focus solely on the clinical changes being shown – gosh, those pharyngeal changes in a DNA patient post-treatment sure look similar to the changes Dr. Moon is just now presenting in 2020 (in fact, I would argue that at least for this specific patient example – the overall net changes look greater in DNA).

So I’m glad to see that Dr. Moon is getting onboard with something that Dr. Singh had noticed 10-20 years ago.  Dr. Moon doesn’t seem sure as to why this is happening, he just notices that it is … and then he ponders some possible reasons why in his video.  I have (very politely, of course) emailed Dr. Moon and suggested he make a professional reach-out to Dr. Singh to discuss why the body remodels the pharyngeal airway area on its own like this.  I think Dr. Moon could learn something from Dr. Sing’s 20-year history and research into the treatment of craniofacial structural issues, and the behavior of sutures in the body, and airway changes that result.

I’d be interesting in intelligent discussion on the following question:  If evidence of natural expansion of the pharyngeal area by the body is seen –  presumably in response to more airflow coming at it as it exits exiting the nasal cavity – then how do we assume that for MSE this is the obvious correlation of those two events, but the same pharyngeal result measured in DNA patients couldn’t possibly happen the same way simply because it’s not a bone-borne approach?

In other words – the increased pharyngeal area is the common denominator.  It is observed in both types of patients.  That is without question.  Could it somehow be due to increased nasal cavity space in one patient (MSE) but not with the other (DNA)?  

I’m not looking for a bumper sticker “anything tooth borne will just tilt your teeth!” argument I could get from watching no more than 5 minutes of any of Ronald Ead’s JawHacks videos.  I know that those interested in MSE will often believe everything that Ronald says 100% without question (and frequently parrot it everywhere).  But how could Dr. Singh be achieving these documented pharyngeal airway changes … if the nasal cavity in DNA patients is not expanding and allowing more air through?  

And just to be clear, I don’t discount what happens to Ronald’s case – but per his own blog post on the subject he was doing his treatment remotely which is an awful idea and borderline malpractice IMO, it was a 24-hour-a-day protocol giving absolutely no rest for oral structures or the possibility of intermittently cycling pressure on and off as a potential way to get more skeletal than dental changes, and the appliance was making full contact with the roof of the mouth which is absolutely not the DNA protocol – as a matter of fact, it’s even mentioned in Dr. Belfor and Dr. Singh’s 2004 patent that their appliance really only makes contact at the occlusal surfaces and the springs:

The [acrylic] body of [the] device, except for the [occlusal] overlay, is spaced from the patient’s tissues, including the palate and mandibular lingual areas. Therefore, the only portion of the [acrylic] body that touches the patient’s tissue is the [occlusal] overlay, which contacts the biting (occlusal) surface of at least one of the patient’s teeth in the space where that tooth would normally contact an opposing tooth from the opposite set of teeth, i.e., upper or lower jaw.”

Because prior split palate devices [like what Ronald had] contact the palate, they prevent the palate from descending as the palate is widened.

Thoughts?

 
Posted : 03/01/2021 1:22 pm
Thomas22, Fgsfds, Apollo and 5 people reacted
Apollo
(@apollo)
Posts: 1681
 
Posted by: @toomer

Cool, right?  MSE makes changes to the nasal cavity … and in response to the increased volume of air flowing through the nasal cavity, the body is apparently smart enough to remodel the rest of the upper airway and widens it accordingly as a result.  You could call this a functional response, or a genetic response, I suppose.  

In any case, Dr. Moon is quite clear that his appliance is obviously not doing anything directly for the pharyngeal area … but the pharyngeal area in MSE patients is changing.  

I’ve watched this lecture and posted a slide about slow vs. rapid MSE expansion protocols in another thread yesterday. I’d have to go back and rewatch the segment you’re referencing to see if it alludes to the kind of functional and/or genetic remodeling signals you’re crediting for the improvements to the pharyngeal airway. The way I understood it, in the nasopharynx, the MSE directly mechanically widens and displaces forward the anterior “wall” of this chamber by separating the posterior nasal spine and expanding the choanae. This might indirectly realign the sphenoid and cervical vertebrae constituting the other sides of the nasopharynx. In the oropharynx, the increased airflow reduces the collapsibility of soft tissue structures like the soft palate and epiglottis, and the increase in oral volume helps posture the tongue out of the throat. When I perform khechari mudra and put my tongue up into the nasopharynx above the soft palate, I think it does seem more spacious and easier to insert the tip of my tongue into the choanae since my MSE expansion.

 
Posted : 03/01/2021 2:31 pm
Fgsfds and Fgsfds reacted
toomer
(@toomer)
Posts: 275
Topic starter
 

@apollo

Dr. Moon ponders a number of different possible answers – somewhat along the lines of the ideas you have – but he does not seem to feel like he has an answer yet, and he has a lot of his treating orthodontists trying to help him figure it out.  He has considered that it might be solely mechanical – that was his first thought.  But then he has also pondered tongue position, and some other possibilities.  Seems like he paired up with Dr. Zaghi from the Breath Institute on the tongue position hypothesis to help try and figure that one out and start to do some analysis work.

On the point of slow v. rapid expansion – I went and re-watched one of Dr. Singh’s presentations from a couple years ago, and he makes an interesting statement that at some point I’m hoping to track down.  He claims he had read a passage in a medical journal from Dr. Schwartz – who obviously invented the Schwartz appliance – that had been translated from its original German and apparently said something to the effect of “I expanded this patient rapidly.”  And therefore, we’ve just always assumed that “rapid expansion” is a clinical concept.  But Dr. Singh claims that he researched the original clinical notes from Dr. Schwartz in their original German … and in the translation it was more along the lines of “I expanded this patient rapidly, because I was leaving for vacation.

I mean … I almost find that impossible to believe, that the “rapid” part of RPE maybe didn’t have anything to do with the patient at all.  But it could lend credibility to why when we see slow expansion attempted in adults we actually see things like the zygomas getting further apart from each other in space, and “without dental tilting” (as noted in the study).

 
Posted : 03/01/2021 3:00 pm
greyham
(@greyham)
Posts: 59
 

I have a different interpretation @toomer.

I think the reason why the pharyngeal area is expanding with MSE is because it rotates each side of the entire midface around a fulcrum up near the eyes, as shown in his improved method of measuring skeletal vs dental expansion in this bit: https://youtu.be/LJ3H8eWbj1Q?t=5922

image

The expansion rate typically used with MSE is far too fast for bone remodelling to accomodate, and the forces created by MSE aren’t distributed throughout the maxilla as they are with a tooth-borne expander according to the finite element analysis study he cites here: https://youtu.be/LJ3H8eWbj1Q?t=1457

image

He says at 24:22 that “you can see tremendous bone strain with the tooth borne expander”, which sounds like a bad thing, “… but with MSE all the strain or force is more localised internally near the mid-palatal suture and the internal structures”; but it’s the shear forces in the image on the right that trigger bone remodelling with a DNA Appliance. Desirable bone growth is one of the “side effects”; except that you’ve got to be patient and use slow palatal expansion, not Rapid Palatal Expansion as labelled in the image. A more objective comparison would be MSE vs SPE, as in the Brazillian study you cited. The intention of the FEM study was probably to show how bone-borne expansion is better than tooth-borne expansion, but it actually shows that tooth-borne expansion can potentially cause much more widely distributed remodelling throughout the maxilla… if you’re willing to wait for it.

However, at another point in the presentation he says that he’s impatient. My interpretation is that he and his patients don’t want to wait for remodelling so he’s using mechanical force to tear sutures apart instead, and the vertical V-shaped expansion around the fulcrums at the eyes is what leads to the increase in pharyngeal airway with MSE.

 
Posted : 03/01/2021 4:44 pm
Fgsfds, toomer, Apollo and 3 people reacted
toomer
(@toomer)
Posts: 275
Topic starter
 
Posted by: @greyham

bone-borne expansion is better than tooth-borne expansion, but it actually shows that tooth-borne expansion can potentially cause much more widely distributed remodelling throughout the maxilla… if you’re willing to wait for it.

I see.  So maybe the comparison of MSE vs. something like RPE is more accurate … and therefore comparing it to slow expansion (like DNA or ALF) is kind of apples and bananas?  Sure, they’re both fruits … but they’re not entirely the same.

However, at another point in the presentation he says that he’s impatient. My interpretation is that he and his patients don’t want to wait for remodelling so he’s using mechanical force to tear sutures apart instead, and the vertical V-shaped expansion around the fulcrums at the eyes is what leads to the increase in pharyngeal airway with MSE.

This is what I agree with – but I’d like someone to check me on my terminology here.  IMO, MSE is not triggering remodeling of the maxillary suture, it’s triggering repairing – exactly as you said, it’s tearing the suture apart.  For example, I had a stress fracture in my fibula last year from running too many miles too fast.  Working with my orthopedist, it took about 3 months to heal.  It seems like MSE takes about 2 months to cause the break/tear (hopefully in a somewhat controlled or parallel manner) and introduce however many mm’s of split are needed … then 3 months to heal, and then you’re done (other than any finishing orthodontic work that might still need to wrap up).  A 3 month time horizon between “split” and being done … absolutely aligns to a bone break process, not a slow remodeling process.

 

 

 

 
Posted : 03/01/2021 6:03 pm
greyham
(@greyham)
Posts: 59
 
 

 

Posted by: @toomer

This is what I agree with – but I’d like someone to check me on my terminology here.  IMO, MSE is not triggering remodeling of the maxillary suture, it’s triggering repairing – exactly as you said, it’s tearing the suture apart.

MSE does distraction osteogenesis at the suture, and DO appears to involve bone remodelling as part of the repair process according to this poster; it’s just a much more aggressive process involving macro-level fractures rather than microfractures, which remodel using the process described in this paper. The article Biomechanics of Rapid Tooth Movement by Dentoalveolar Distraction Osteogenesis may answer the question in a dental context; I can’t find it online but you could try asking the authors on ResearchGate.

 
Posted : 03/01/2021 6:32 pm
Fgsfds, toomer, Fgsfds and 1 people reacted
Apollo
(@apollo)
Posts: 1681
 

In the lecture, Dr. Moon refers to a mechanical process and a biological process involved in suture disarticulation. Rapid expansion on the order of 4-6 turns per day relies more on the brunt mechanical force and either the suture will break or the appliance will. Whereas slow expansion on the order of 1 turn per day relies more on the biological process of osteoclasts being recruited to break down obstructions in response to tension between the interdigitations similar to the way braces move teeth through bone. So for any successful suture split, there will be some degree of traumatic breakage and some degree of controlled remodeling. 

MSE disarticulation
 
Posted : 03/01/2021 8:53 pm
Fgsfds and Fgsfds reacted
sinned
(@sinned)
Posts: 423
 

@greyham

“you can see tremendous bone strain with the tooth borne expander”, which sounds like a bad thing, “… but with MSE all the strain or force is more localised internally near the mid-palatal suture and the internal structures”; but it’s the shear forces in the image on the right that trigger bone remodelling with a DNA Appliance. Desirable bone growth is one of the “side effects”

Can someone elaborate on this, it sort of makes sense because the MSE is screwed right next to the suture and internal structures of the maxilla. I think the best structure to transfer the force is the alveolar bone that holds the teeth because it can take more force than the teeth themselves. You’ll still get the effect that’s described but without the downsides of using the teeth as an anchor.

 

 
Posted : 05/01/2021 9:00 am
toomer
(@toomer)
Posts: 275
Topic starter
 
Posted by: @apollo

In the lecture, Dr. Moon refers to a mechanical process and a biological process involved in suture disarticulation. Rapid expansion on the order of 4-6 turns per day relies more on the brunt mechanical force and either the suture will break or the appliance will. Whereas slow expansion on the order of 1 turn per day relies more on the biological process of osteoclasts being recruited to break down obstructions in response to tension between the interdigitations similar to the way braces move teeth through bone. So for any successful suture split, there will be some degree of traumatic breakage and some degree of controlled remodeling.

I guess the key question then is … why can’t the entire process just rely on “the biological process of osteoclasts being recruited to break down obstructions in response to tension“?  Why can’t that be good enough – if one is patient enough to have a longer time horizon of perhaps 1-2 years?  Especially if one is well past the “ideal” age range for a procedure like MSE?

Given that the MSE is actually screwed into the maxilla … I can see where the goal would be to get it out within a few months, so that you don’t have risk of infections or whatever.  So that justifies the use of brute mechanical force + a time horizon that prioritizes time-to-completion.  But if tension/strain is enough to also trigger remodeling in the body … just more slowly … then I’m not sure how that would be a bad thing?

To quote a section of the research paper that @greyham linked to above, “osteocytes are strain-sensitive cells and can transduce mechanical signals derived from mechanical loading into cues that ultimately result in reduced bone loss and enhanced bone gain.”

To me, that kind of sounds exactly like what Dr. Singh believes he is doing via the DNA Appliance (whether anyone agrees with him or not, is obviously debatable).

 
Posted : 05/01/2021 9:52 am
Apollo
(@apollo)
Posts: 1681
 
Posted by: @toomer
 
I guess the key question then is … why can’t the entire process just rely on “the biological process of osteoclasts being recruited to break down obstructions in response to tension“?  Why can’t that be good enough – if one is patient enough to have a longer time horizon of perhaps 1-2 years?  Especially if one is well past the “ideal” age range for a procedure like MSE?
@greyham posted the slide comparing where the tension is distributed in MSE vs. RPE without bone anchorage. So with MSE, the tension signal for remodeling (meaning osteoclasts and osteoblasts are recruited to breakdown and rebuild bone) is localized along the midpalatal suture. Remodeling has the limited role of breaking down the interdigitations locking the two halves of the maxilla together. Once disarticulation occurs, the two halves swing apart from one another and you get distraction-osteogenesis-type fill of the gap. During the stabilization phase and after, some remodeling might continue adjusting the contour of the palate, but the bone that filled in the suture should remain as long as the MSE isn’t removed too early.
Posted by: @greyham

The expansion rate typically used with MSE is far too fast for bone remodelling to accomodate, and the forces created by MSE aren’t distributed throughout the maxilla as they are with a tooth-borne expander according to the finite element analysis study he cites here: https://youtu.be/LJ3H8eWbj1Q?t=1457

image

He says at 24:22 that “you can see tremendous bone strain with the tooth borne expander”, which sounds like a bad thing, “… but with MSE all the strain or force is more localised internally near the mid-palatal suture and the internal structures”; but it’s the shear forces in the image on the right that trigger bone remodelling with a DNA Appliance. Desirable bone growth is one of the “side effects”; except that you’ve got to be patient and use slow palatal expansion, not Rapid Palatal Expansion as labelled in the image.

This is in contrast to tooth borne expanders that transfer the force across the whole maxilla so remodeling is triggered everywhere. The suture doesn’t separate and the shape of the maxilla bends and/or grows to adapt to the appliance. This might be “good enough” for some people. I’m willing to believe there might be some widening of the body of the maxilla, even extending into the nasal cavity, but the alveolar ridge seems to be the easiest/most likely to reshape. This type of expansion also seems to be more susceptible to relapse after the appliance is removed. Honestly, being “impatient” isn’t a bad thing. I was pretty desperate to get a good night’s sleep as soon as possible and I felt noticeably better rested the night after my suture split. My sleep still isn’t perfect, but it’s definitely better.

 
Posted : 05/01/2021 12:45 pm
Fgsfds and Fgsfds reacted
Apollo
(@apollo)
Posts: 1681
 
Posted by: @sinned

Can someone elaborate on this, it sort of makes sense because the MSE is screwed right next to the suture and internal structures of the maxilla. I think the best structure to transfer the force is the alveolar bone that holds the teeth because it can take more force than the teeth themselves. You’ll still get the effect that’s described but without the downsides of using the teeth as an anchor. 

There are MARPE appliances designed with TADs anchored into the alveolar ridge, or acrylic pads that transfer some of the force to the alveolar ridge. They might be more appropriate in some cases. I think the MSE design with the TADs along the suture and into the nasal cavity is designed to get more parallel expansion and better opening of the nasal passages. Placing the TADs farther from the suture might allow more room for bending/remodeling of the bone to occur rather than splitting the suture. TADs won’t get bicortical engagement on the alveolar ridge so this placement might be less stable. The MSE arms are designed to be offset from the alveolar ridge to avoid impinging the tissue. Anyway, there could be cases where the type of design you’re describing would be better, but I’m not sure when it would be indicated. For example the EASE procedure uses an expander anchored in the alveolar ridge, but in that case the suture is already surgically separated.

 
Posted : 05/01/2021 1:02 pm
toomer
(@toomer)
Posts: 275
Topic starter
 
Posted by: @apollo
This is in contrast to tooth borne expanders that transfer the force across the whole maxilla so remodeling is triggered everywhere. The suture doesn’t separate and the shape of the maxilla bends and/or grows to adapt to the appliance. This might be “good enough” for some people. 

This fits in-line with Dr. Singh’s opinion.  Now, whether it’s better to get all the bone remodeling in the suture, or if it’s better to have it “everywhere” throughout the maxilla … is an interesting question to ponder.  If it’s happening “everywhere” throughout the maxilla, is the body also making changes to the zygomatic bones and sphenoid and ethmoid too in order to accommodate?  Obviously, Dr. Moon thinks getting bone in the suture is better, so that’s why his “success metric” would be # of mm of split they can measure there.  But that’s also the reason why you can’t just use what Dr. Moon chooses to use for a metric of success, and try to apply it elsewhere.

Dr. Singh measures total bone volume of the maxilla as a whole as I’ve noted before in this research paper – and assuming he is presenting honest data accurately measured, then they seem to grow the maxilla to have about 10% more net bone volume (about 2 cubic centimeters of new bone).  So he’ll never advocate trying to present DNA as “palatal expansion” (like an MSE or any of its predecessors) because he thinks he’s getting bone a different way, everywhere – not just localized to the suture. 

They also make it clear that they seem to be trying to avoid some of the alveolar region in their measurements (see the definition used for figure 4).

I’m willing to believe there might be some widening of the body of the maxilla, even extending into the nasal cavity, but the alveolar ridge seems to be the easiest/most likely to reshape. This type of expansion also seems to be more susceptible to relapse after the appliance is removed. 

Dr. Singh’s published data would also seem to support some of this – including data on overall nasal cavity volume increasing by about 3 cubic centimeters (Kasey Li seems to get about 5cc’s doing EASE for people), as well as maxillary air sinuses getting larger in volume.

Yes, relapse is a concern.  Heck, even the oral surgeon I consulted with about MMA for OSA said they add on “a couple millimeters for potential future relapse.”  But – if I think about it from my case, I am a severe sleep apnea patient.  I am sentenced to live the rest of my life on CPAP if I don’t want to die early or have a stroke and be a burden to my wife.  So even if Dr. Singh’s appliance only made alveolar changes … as long as they’re safe … if it cured my sleep apnea and I had to keep DNA as a retainer every night for the rest of my life, that would actually be a very welcome tradeoff!  Way easier than CPAP, and absolutely worth $10,000 IMO.  And on treating/curing sleep apnea, Dr. Singh definitely has the data to back that up – they’re about 70-80% effective in mild-to-moderate cases.

 
Posted : 05/01/2021 2:30 pm
greyham
(@greyham)
Posts: 59
 
Posted by: @sinned

@greyham

“you can see tremendous bone strain with the tooth borne expander”, which sounds like a bad thing, “… but with MSE all the strain or force is more localised internally near the mid-palatal suture and the internal structures”; but it’s the shear forces in the image on the right that trigger bone remodelling with a DNA Appliance. Desirable bone growth is one of the “side effects”

Can someone elaborate on this, it sort of makes sense because the MSE is screwed right next to the suture and internal structures of the maxilla. I think the best structure to transfer the force is the alveolar bone that holds the teeth because it can take more force than the teeth themselves. You’ll still get the effect that’s described but without the downsides of using the teeth as an anchor.

 

You’ll get the effect that Dr Moon seeks: bone growth at the inter-maxillary suture via distraction osteogenesis, but you won’t get the effect that Dr Singh seeks: bone growth throughout the entire maxilla (and mandible if you’re using an mRNA appliance, like me) via strain-induced remodelling.

 
Posted : 05/01/2021 4:07 pm
greyham
(@greyham)
Posts: 59
 
Posted by: @toomer

Dr. Singh measures total bone volume of the maxilla as a whole as I’ve noted before in this research paper – and assuming he is presenting honest data accurately measured, then they seem to grow the maxilla to have about 10% more net bone volume (about 2 cubic centimeters of new bone).  So he’ll never advocate trying to present DNA as “palatal expansion” (like an MSE or any of its predecessors) because he thinks he’s getting bone a different way, everywhere – not just localized to the suture. 

Dr. Singh made the comment that DNA doesn’t do palate expansion during his Sydney presentation in 2019 that I attended, and when I questioned him on it I didn’t understand his answer; it sounded like marketing bullshit to me. Your explanation makes more sense though if he’s trying to differentiate DNA from MSE.

Incidentally, I’ve also heard him say that the periodontal ligament is the source of the stem cells responsible for the new bone growth. I don’t know how he knows this and I’m planning to borrow my provider’s copy of his book Epigenetic Orthodontics in Adults to find out. According to Biomechanical and Molecular Regulation of Bone Remodeling though, stems cells from bone marrow can travel through the bloodstream through bone to the site where remodelling has been triggered by strain. They don’t just have to come from, or end up, near the periodontal ligament.

 
Posted : 05/01/2021 4:26 pm
Fgsfds and Fgsfds reacted
greyham
(@greyham)
Posts: 59
 
Posted by: @apollo
 
This is in contrast to tooth borne expanders that transfer the force across the whole maxilla so remodeling is triggered everywhere. The suture doesn’t separate and the shape of the maxilla bends and/or grows to adapt to the appliance. This might be “good enough” for some people. I’m willing to believe there might be some widening of the body of the maxilla, even extending into the nasal cavity, but the alveolar ridge seems to be the easiest/most likely to reshape. This type of expansion also seems to be more susceptible to relapse after the appliance is removed. Honestly, being “impatient” isn’t a bad thing. I was pretty desperate to get a good night’s sleep as soon as possible and I felt noticeably better rested the night after my suture split. My sleep still isn’t perfect, but it’s definitely better.

 

I totally hear where you’re coming from. I wouldn’t mind a faster solution myself, but I also wasn’t keen on needing braces again to fix the diastema MSE would give me, and upright my lower teeth; which I might be able to avoid with mRNA if I’m lucky. My sleep apnea was severe on my first sleep study, so I’m probably on the edge of whether DNA will be “good enough” for me. At the end of the day after a lot of analysis it came down to a bit of a coin flip. I’m glad that MSE exists as a fall-back plan for me if DNA doesn’t expand my airway sufficiently, and then there’s always MSDO and MMA.

 
Posted : 05/01/2021 4:34 pm
sinned
(@sinned)
Posts: 423
 

@apollo

@greyham

The image comparing MSE to RPE, is it before the suture split? Where does the force go when the suture splits and the other sutures disarticulate. I’d assume after the suture splits there’d be some bending and remodeling throughout the rest of the maxilla to accommodate the appliance. Or are the forces still mostly internalized? Furthermore, if I’m interpreting it correctly, the bending and remodeling doesn’t seem to reach the cheekbones, personally I don’t see an issue with tipping because if you’re chewing the teeth will upright themselves, bending actually seems appropriate. The maxilla should change shape, the bending I think causes tipping, but chewing should upright the teeth so it’s not a big deal. In fact I think this is how the maxilla remodels, the change in shape and widening seems like bending to me, not all part of the maxilla expand outwards equally. The strain seems mostly concentrated on the maxilla though.

 
Posted : 05/01/2021 6:13 pm
toomer
(@toomer)
Posts: 275
Topic starter
 
Posted by: @greyham

Dr. Singh made the comment that DNA doesn’t do palate expansion during his Sydney presentation in 2019 that I attended, and when I questioned him on it I didn’t understand his answer; it sounded like marketing bullshit to me. Your explanation makes more sense though if he’s trying to differentiate DNA from MSE.

Incidentally, I’ve also heard him say that the periodontal ligament is the source of the stem cells responsible for the new bone growth. I don’t know how he knows this and I’m planning to borrow my provider’s copy of his book Epigenetic Orthodontics in Adults to find out. According to Biomechanical and Molecular Regulation of Bone Remodeling though, stems cells from bone marrow can travel through the bloodstream through bone to the site where remodelling has been triggered by strain. They don’t just have to come from, or end up, near the periodontal ligament.

He actually said in his 2019 Vivos presentation “this is not palatal expansion” and they showed data from a patient case where they got about +1mm of IMW, but they still dropped that patient’s AHI from 18 down to like 7.  I’ve even heard from a very well-known DNA provider that Dr. Singh wasn’t entirely a fan of making Sassouni analysis part of their reports they generate for patients – because it is all 2D measurements.  But breathing and airway is a 3D problem.

In terms of stem cells being in the periodontal ligaments, I don’t actually think that’s all that controversial – https://pubmed.ncbi.nlm.nih.gov/31215350/ – so I think he assumes new bone growth is likely a little bit at the perimeter of all of the sutures (mid-palatal, and pre-maxillary), at the PDLs, and then just general appositional bone growth/remodeling/reshaping.

 
Posted : 05/01/2021 8:10 pm
pizzaman500
(@pizzaman500)
Posts: 19
 
Posted by: @toomer
Posted by: @greyham

Dr. Singh made the comment that DNA doesn’t do palate expansion during his Sydney presentation in 2019 that I attended, and when I questioned him on it I didn’t understand his answer; it sounded like marketing bullshit to me. Your explanation makes more sense though if he’s trying to differentiate DNA from MSE.

Incidentally, I’ve also heard him say that the periodontal ligament is the source of the stem cells responsible for the new bone growth. I don’t know how he knows this and I’m planning to borrow my provider’s copy of his book Epigenetic Orthodontics in Adults to find out. According to Biomechanical and Molecular Regulation of Bone Remodeling though, stems cells from bone marrow can travel through the bloodstream through bone to the site where remodelling has been triggered by strain. They don’t just have to come from, or end up, near the periodontal ligament.

He actually said in his 2019 Vivos presentation “this is not palatal expansion” and they showed data from a patient case where they got about +1mm of IMW, but they still dropped that patient’s AHI from 18 down to like 7.  I’ve even heard from a very well-known DNA provider that Dr. Singh wasn’t entirely a fan of making Sassouni analysis part of their reports they generate for patients – because it is all 2D measurements.  But breathing and airway is a 3D problem.

In terms of stem cells being in the periodontal ligaments, I don’t actually think that’s all that controversial – https://pubmed.ncbi.nlm.nih.gov/31215350/ – so I think he assumes new bone growth is likely a little bit at the perimeter of all of the sutures (mid-palatal, and pre-maxillary), at the PDLs, and then just general appositional bone growth/remodeling/reshaping.

Hello again toomer! As you well know, I’m doing Homeoblock myself and have experienced some improvement for my UARS. But I am awfully sceptical of claims that 1mm expansion is enough for a big reduction in AHI since this is not just “palatal expansion”. Truthfully, I didn’t feel much of a difference at all at 1mm. AHI values vary from one night to the next, and I suspect the drop from 18 to 7 is just that – variance. Of course, variance can also work the other way, and I’m sure the people marketing DNA / Homeoblock conveniently leave that data out. I don’t fault them for their marketing tactics and all the mumbo jumbo about epigenetics. But in my experience, it seems to be regular palatal expansion with a focus on the underdeveloped side. I could be wrong of course.

 
Posted : 05/01/2021 11:26 pm
WHCCARDIO
(@whccardio)
Posts: 19
 

@pizzaman500 Hey Im thinking of getting Homeoblock. Hows it been so far for you? Also how long have you had it and whats your age?

 
Posted : 05/01/2021 11:31 pm
Sergio-OMS
(@sergio-oms)
Posts: 146
 

Please stop making health decisions based on conferences on YouTube and isolated studies that have not been reproduced by other teams.

These are the basic concepts to understand how these different approaches affect your breathing, should you be seeking to get a structural optimisation that helps you on breathing better, but please remember there are other structural (soft tissue volumen and funtion) for breathing disorders: loose weight, don’t drink alcohol, stop smoking, make some sports:

• Being unable to lift your tongue and keep it on the roof of your mouth affects the retroglossal airway. Treatment: myofuncional therapy ± functional fenuloplasty.

• Having a narrow palate affects the airway in two ways: it means that you also have a narrow nasal passage and it also implies that there is not much space for your tongue. Treatment: skeletal expansion ± dentoalveolar expansion. But don’t go for dentoalveolar first as you won’t probably be able to do much skeletal afterwards, as dentoalveolar is kind of camouflage. Means to get skeletal: the best one is MSE without surgery. You can use any MARPE appliances that are purely bone borne. This approach can fail, then you should add surgical assistance. Making a horizontal (no mater the name of the technique, SARPE, EASE, DOME…. really, it doesn’t really matter) will affect the amount of nasal expansion you can get, but it still helps. Maxillary expansion tents the soft palate. Increasing nasal airflow increases upper airway in general, as the more airflow you get, the more balloon-effect it produces in the lower parts of the upper airway. Regarding dentoalveolar, there are many ways to go for that, many appliances, braces and even aligners, and also some surgical assistance (corticotomies and bone regeneration techniques) can help overexpanding while reducing the periodontal and root resorption risks.

• Breathing through the nose is important as well! it you are a mouth breather your tongue falls back. If you have grown being a mouth breather you will probably have many structural problems.

• Bruxism also is associated with sleep apnea. It can be is a consequence of other structural and functional issues. The best way is to treat these first and also other factors (psychological, sleep hygiene, and treating the rest of the body) but also well designed splints will help.

• Retruded lower third of the face is to be treated by orthognathic/orthofacial surgery: MMA or preferably (in my opinion) IMDO + 2-3 piece Le Fort and orthodontics.

In most occasions many of these approaches should be combined. Of course, many patients do not want this, as it takes more time, willpower and money (and also procedures, postops, risks…)

Hope his helps! I wish you a happy 2021, healthy and full of wise decisions.

 
Posted : 06/01/2021 3:51 am
Fgsfds and Fgsfds reacted
greyham
(@greyham)
Posts: 59
 
Posted by: @sergio-oms

Please stop making health decisions based on conferences on YouTube and isolated studies that have not been reproduced by other teams.

I’m struck by the irony of you asking other people on an online forum not to make health decisions based on conference presentations from leading experts and published peer-reviewed journal articles… and then immediately going on to give health advice with no supporting references whatsoever.

 
Posted : 06/01/2021 4:27 am
Fgsfds and Fgsfds reacted
Apollo
(@apollo)
Posts: 1681
 
Posted by: @sinned

The image comparing MSE to RPE, is it before the suture split? Where does the force go when the suture splits and the other sutures disarticulate. I’d assume after the suture splits there’d be some bending and remodeling throughout the rest of the maxilla to accommodate the appliance. Or are the forces still mostly internalized? Furthermore, if I’m interpreting it correctly, the bending and remodeling doesn’t seem to reach the cheekbones, personally I don’t see an issue with tipping because if you’re chewing the teeth will upright themselves, bending actually seems appropriate. The maxilla should change shape, the bending I think causes tipping, but chewing should upright the teeth so it’s not a big deal. In fact I think this is how the maxilla remodels, the change in shape and widening seems like bending to me, not all part of the maxilla expand outwards equally. The strain seems mostly concentrated on the maxilla though.

In addition to the midpalatal suture, Dr. Moon and other MSE practitioners identify the zygomatic buttress and the pterygopalatine suture as centers of resistance against maxillary expansion. DOME, and what Dr. Moon is calling “SMARPE” (Surgical and Micro-implant Assisted Rapid Palatal Expansion) or what Dr. Ting calls “MSE with Surgical Assist” cut or score the buttress bone to release the zygomatic resistance. Cutting the pterygopalatine junction can’t be performed as an outpatient procedure because of the bleeding risk. The EASE procedure is done in hospital and separates the pterygopalatine and midpalatal sutures but doesn’t cut the buttress. So without surgical assist, after the midpalatal suture disarticulates, these other foci of resistance remain. I think a combination of bending/remodeling and suture disarticulation occurs in response to the tension in the zygomas and pterygopalatine junctions. The rate of expansion might impact this ratio, as Dr. Moon says rapid expansion gives more perimaxillary changes. I continued to feel significant resistance to turning even after my diastema appeared. 

 
Posted : 06/01/2021 12:51 pm
toomer
(@toomer)
Posts: 275
Topic starter
 
Posted by: @sergio-oms

Please stop making health decisions based on conferences on YouTube and isolated studies that have not been reproduced by other teams.

Doctor,

I am appreciative that you are here and part of this forum.  This was a “YouTube conference” in which Dr. Moon was presenting – are you saying I should not trust it?  Because you seem to be a fan of MSE as a procedure, so I’m confused.  Or is it ok if Orthodontists present their information on YouTube, but no one else?

I find it disappointing that you’ve skated entirely past the point of this post, which I wanted to encourage discussion about.  Dr. Moon sees pharyngeal volumetric changes in MSE patients – even though the pharyngeal area is not being touched – which is almost certainly validation that his appliance is creating better airflow through the nasal cavity.  From someone with your background and training, I’d be curious to get your thoughts — if an increased pharyngeal area is the common denominator between the two treatment protocols, why should I believe that one is increasing the nasal airway (MSE) but the other couldn’t possibly be? 

Putting the question to you in another way, if you just move the teeth or tilt the crowns – that’s not going to create a larger nasal airway.  So why is the pharyngeal area getting larger in DNA patients?  If not due to increased nasal airflow coming at it, then what would be possible alternate explanations for that?  Is there any other explanation you can come up with … other than implying that the data must have been faked, hasn’t had enough peer reviews, didn’t appear in the right journals, or shouldn’t be trusted because it was cited on YouTube?

And it’s worth pointing out, even Dr. Moon isn’t quite sure why this is happening … he is just observing that it is.  But are his observations of this development – even though he doesn’t have an explanation – somehow valid and trustable, and Dr. Singh’s are not?

In 1986, Orthodontist Dr. Vincent Kokich noted that adults “retain the capacity to regenerate and remodel bone at the craniofacial sutures” well into their late years – perhaps as late as 60’s or 70’s (you can read that in the textbook “Craniosynostosis: Diagnosis, Evaluation, and Management” in chapter 4 titled “The Biology of Sutures”).

MSE is not without risks.  And oral surgery – sorry, no offense – has a horrible efficacy rate at actually curing obstructive sleep apnea.  Since you seem to value data packaged up into studies, here’s a retrospective analysis of over 518 patients showing the MMA “cure” rate for sleep apnea is only 20-40% of patients.  Sorry, but I’ve got a huge chip on my shoulder over this point given that I’ve heard oral surgeons say over and over again that MMA has like a “90-95% success rate” … only to later find out it is a bit of a verbal “sleight of hand” in that oral surgeons apparently define “surgical success” as a >50% reduction in AHI and AHI below 10.  Which still leaves far too many with sleep apnea post-treatment.

Not to put too fine a point on it – you should honestly be ashamed of your profession for propagating that kind of misperception.  But I guess it’s the same as the misperception about wisdom teeth, which the American Association of Oral and Maxillofacial Surgeons eventually had to take down a statement off of their website when they were challenged on the statistic of 80% of young adults who retain their wisdom teeth develop problems within seven years … and couldn’t come up with any documentation to that effect.  

At one point in history about 40 years ago, CPAP was “unproven”.  It did not have studies that had been “reproduced by other teams”.  It was not the “gold standard” … the gold standard back then was they put a breathing tube in your throat, and it was proven to be 100% effective.  But some patients were willing to try something new, something that didn’t have a lot of background, or history, or double-bind peer-reviewed data.  And so a few tried it.  And then a few more.  And then a few hundred, and then a few thousand … and now 40 years later CPAP is the “gold standard.” But science had to move forward, one patient at a time.  If it did not, I would have a tube in my throat right now, and I’m glad I do not.

Once … just once … it would warm my heart to hear a traditional Orthodontist or Oral Surgeon say something as simple as “Well, if this data is all accurate and fairly represented – this does seem interesting” … but that literally never happens.  That’s what we’re all here to find out more about.

 
Posted : 06/01/2021 3:52 pm
Fgsfds and Fgsfds reacted
Sergio-OMS
(@sergio-oms)
Posts: 146
 
Posted by: @greyham
Posted by: @sergio-oms

Please stop making health decisions based on conferences on YouTube and isolated studies that have not been reproduced by other teams.

I’m struck by the irony of you asking other people on an online forum not to make health decisions based on conference presentations from leading experts and published peer-reviewed journal articles… and then immediately going on to give health advice with no supporting references whatsoever.

I am not giving health advice, I’m just explaining. 

 
Posted : 06/01/2021 4:02 pm
Sergio-OMS
(@sergio-oms)
Posts: 146
 
Posted by: @toomer
Posted by: @sergio-oms

Please stop making health decisions based on conferences on YouTube and isolated studies that have not been reproduced by other teams.

Doctor,

I am appreciative that you are here and part of this forum.  This was a “YouTube conference” in which Dr. Moon was presenting – are you saying I should not trust it?  Because you seem to be a fan of MSE as a procedure, so I’m confused.  Or is it ok if Orthodontists present their information on YouTube, but no one else?

I find it disappointing that you’ve skated entirely past the point of this post, which I wanted to encourage discussion about.  Dr. Moon sees pharyngeal volumetric changes in MSE patients – even though the pharyngeal area is not being touched – which is almost certainly validation that his appliance is creating better airflow through the nasal cavity.  From someone with your background and training, I’d be curious to get your thoughts — if an increased pharyngeal area is the common denominator between the two treatment protocols, why should I believe that one is increasing the nasal airway (MSE) but the other couldn’t possibly be? 

Putting the question to you in another way, if you just move the teeth or tilt the crowns – that’s not going to create a larger nasal airway.  So why is the pharyngeal area getting larger in DNA patients?  If not due to increased nasal airflow coming at it, then what would be possible alternate explanations for that?  Is there any other explanation you can come up with … other than implying that the data must have been faked, hasn’t had enough peer reviews, didn’t appear in the right journals, or shouldn’t be trusted because it was cited on YouTube?

And it’s worth pointing out, even Dr. Moon isn’t quite sure why this is happening … he is just observing that it is.  But are his observations of this development – even though he doesn’t have an explanation – somehow valid and trustable, and Dr. Singh’s are not?

In 1986, Orthodontist Dr. Vincent Kokich noted that adults “retain the capacity to regenerate and remodel bone at the craniofacial sutures” well into their late years – perhaps as late as 60’s or 70’s (you can read that in the textbook “Craniosynostosis: Diagnosis, Evaluation, and Management” in chapter 4 titled “The Biology of Sutures”).

MSE is not without risks.  And oral surgery – sorry, no offense – has a horrible efficacy rate at actually curing obstructive sleep apnea.  Since you seem to value data packaged up into studies, here’s a retrospective analysis of over 518 patients showing the MMA “cure” rate for sleep apnea is only 20-40% of patients.  Sorry, but I’ve got a huge chip on my shoulder over this point given that I’ve heard oral surgeons say over and over again that MMA has like a “90-95% success rate” … only to later find out it is a bit of a verbal “sleight of hand” in that oral surgeons apparently define “surgical success” as a >50% reduction in AHI and AHI below 10.  Which still leaves far too many with sleep apnea post-treatment.

Not to put too fine a point on it – you should honestly be ashamed of your profession for propagating that kind of misperception.  But I guess it’s the same as the misperception about wisdom teeth, which the American Association of Oral and Maxillofacial Surgeons eventually had to take down a statement off of their website when they were challenged on the statistic of 80% of young adults who retain their wisdom teeth develop problems within seven years … and couldn’t come up with any documentation to that effect.  

At one point in history about 40 years ago, CPAP was “unproven”.  It did not have studies that had been “reproduced by other teams”.  It was not the “gold standard” … the gold standard back then was they put a breathing tube in your throat, and it was proven to be 100% effective.  But some patients were willing to try something new, something that didn’t have a lot of background, or history, or double-bind peer-reviewed data.  And so a few tried it.  And then a few more.  And then a few hundred, and then a few thousand … and now 40 years later CPAP is the “gold standard.” But science had to move forward, one patient at a time.  If it did not, I would have a tube in my throat right now, and I’m glad I do not.

Once … just once … it would warm my heart to hear a traditional Orthodontist or Oral Surgeon say something as simple as “Well, if this data is all accurate and fairly represented – this does seem interesting” … but that literally never happens.  That’s what we’re all here to find out more about.

You can believe what you want to believe, as I said I do not intend to keep that away from you. But I think you logic might be suffering from some magical thinking. I am quite open to new treatments and protocols but they must sound logical to me. I’m confident that you do the same thing (not doing things that sound illogical to you) . I don’t really value many studies, most of them are poorly done and can’t really prove much.

I really apologise but I think this conversation could last forever and there is not much point on keeping it and further. I am glad that you are willing to share your experience with the rest of the world, honestly.

 
Posted : 06/01/2021 4:19 pm
toomer
(@toomer)
Posts: 275
Topic starter
 
Posted by: @sergio-oms

You can believe what you want to believe, as I said I do not intend to keep that away from you. But I think you logic might be suffering from some magical thinking. I am quite open to new treatments and protocols but they must sound logical to me. I’m confident that you do the same thing (not doing things that sound illogical to you) . I don’t really value many studies, most of them are poorly done and can’t really prove much.

I really apologise but I think this conversation could last forever and there is not much point on keeping it and further. I am glad that you are willing to share your experience with the rest of the world, honestly.

No worries – I’ve spent a year challenging my own assumptions on whether I am falling for magical thinking, or not.  I find the concept of “sutural homeostasis” to be somewhat logical, and I find plenty of research discussing stem cells in sutures, in the periodontal ligaments, etc. that does not come from Dr. Singh.  I find research of light stretch forces placed across the premaxillary sutures of rats (which are histologically apparently quite similar to humans) and they can see the sutures stretching and becoming wider when viewed under an electron microscope.

I shall continue my quest to try to find someone with your training that could say those magical words of “if this data is accurate, that looks kind of interesting.”   

Speaking of which, I am curious at your dismissal of studies – that takes me by surprise.  You had said earlier to be cautious about things that have not been “reproduced by other teams” — to which, I naturally assumed you meant independent studies.  I may have misunderstood you?  If you are discounting even those, then what do you mean exactly?  Do you mean results that Dr. Moon reports, based on what some of his trained orthodontists around the world are noticing in patients?  Because if so, we might have had a fundamental misunderstanding here – because most of Dr. Singh’s data about DNA outcomes does not come directly from him.  He is not (as far as I am aware) licensed to treat patients in the US (he has a DDSc in Orthodontics from the UK) so all of his data, or at least most of his recent data, comes from dentists trained in his techniques – some in the US, some in Canada, some in Korea (for example – Dr. Hee Nam Kim, who studied changes of the maxillary air sinuses in a set of patients he treated).

Isn’t that what we see happening with Dr. Moon and MSE providers/patients around the world?  He designs the appliance, licenses it out to be manufactured, trains providers in his treatment protocol … and then leverages his network of providers trained in his protocols for research on changes observed?  Like he was doing here with these changes noted in the pharyngeal area?  Because that’s what Dr. Singh has done.  Just trying to figure out if there’s a double-standard being applied because one is an orthodontist pitching to orthodontists, and one only has a DDSc in Orthodontics but is pitching to dentists.

 
Posted : 06/01/2021 5:00 pm
greyham
(@greyham)
Posts: 59
 
Posted by: @apollo

In addition to the midpalatal suture, Dr. Moon and other MSE practitioners identify the zygomatic buttress and the pterygopalatine suture as centers of resistance against maxillary expansion. DOME, and what Dr. Moon is calling “SMARPE” (Surgical and Micro-implant Assisted Rapid Palatal Expansion) or what Dr. Ting calls “MSE with Surgical Assist” cut or score the buttress bone to release the zygomatic resistance. Cutting the pterygopalatine junction can’t be performed as an outpatient procedure because of the bleeding risk. The EASE procedure is done in hospital and separates the pterygopalatine and midpalatal sutures but doesn’t cut the buttress. So without surgical assist, after the midpalatal suture disarticulates, these other foci of resistance remain. I think a combination of bending/remodeling and suture disarticulation occurs in response to the tension in the zygomas and pterygopalatine junctions. The rate of expansion might impact this ratio, as Dr. Moon says rapid expansion gives more perimaxillary changes. I continued to feel significant resistance to turning even after my diastema appeared. 

I’m curious about one thing here: while DOME/SMARPE/MSE-with-Surgical-Assist reduces the risk of expander failure, I wonder if it also reduces the potential for midfacial growth with the appliance when it is successful, because releasing the zygomatic resistance will also reduce the strain available to trigger bone remodelling. What do you think? Did you have surgical assist with your MSE? (And do you want fries with that?)

 
Posted : 06/01/2021 5:14 pm
Apollo
(@apollo)
Posts: 1681
 
Posted by: @greyham
 
I’m curious about one thing here: while DOME/SMARPE/MSE-with-Surgical-Assist reduces the risk of expander failure, I wonder if it also reduces the potential for midfacial growth with the appliance when it is successful, because releasing the zygomatic resistance will also reduce the strain available to trigger bone remodelling. What do you think? Did you have surgical assist with your MSE? (And do you want fries with that?)

I agree that cutting or even scoring the buttress reduces the tension translated to the upper maxilla and zygoma. The palatal tongue space and floor of the nasal cavity would still expand, but there would likely be less increase in the total volume of the nasal cavity and midface. This is one reason I insisted on only cortipuncture despite the higher failure risk for a man my age. EASE seems like a good option for older men with airway/sleep issues because it releases the midpalatal and pterygopalatine sutures but doesn’t cut the buttress. Here’s a slide Dr. Rebecca Bockow shared when @ronaldead asked her about this issue.

Bockow Slide

Her answer was a little vague, but I think the imaging confirms our suspicions that changes are limited to the Lefort 1 area with procedures like SMARPE, DOME, or SARPE while MARPE without surgical assist has the potential to change an area analogous to Lefort 3 cuts, although the midpalatal suture separation will probably be less because of the increased resistance, as illustrated in this slide from Dr. Marianna Evans.

MARPE SARPE DOME

 

 
Posted : 06/01/2021 9:37 pm
Fgsfds, greyham, Fgsfds and 1 people reacted
Sergio-OMS
(@sergio-oms)
Posts: 146
 
Posted by: @toomer
Posted by: @sergio-oms

You can believe what you want to believe, as I said I do not intend to keep that away from you. But I think you logic might be suffering from some magical thinking. I am quite open to new treatments and protocols but they must sound logical to me. I’m confident that you do the same thing (not doing things that sound illogical to you) . I don’t really value many studies, most of them are poorly done and can’t really prove much.

I really apologise but I think this conversation could last forever and there is not much point on keeping it and further. I am glad that you are willing to share your experience with the rest of the world, honestly.

No worries – I’ve spent a year challenging my own assumptions on whether I am falling for magical thinking, or not.  I find the concept of “sutural homeostasis” to be somewhat logical, and I find plenty of research discussing stem cells in sutures, in the periodontal ligaments, etc. that does not come from Dr. Singh.  I find research of light stretch forces placed across the premaxillary sutures of rats (which are histologically apparently quite similar to humans) and they can see the sutures stretching and becoming wider when viewed under an electron microscope.

I shall continue my quest to try to find someone with your training that could say those magical words of “if this data is accurate, that looks kind of interesting.”   

Speaking of which, I am curious at your dismissal of studies – that takes me by surprise.  You had said earlier to be cautious about things that have not been “reproduced by other teams” — to which, I naturally assumed you meant independent studies.  I may have misunderstood you?  If you are discounting even those, then what do you mean exactly?  Do you mean results that Dr. Moon reports, based on what some of his trained orthodontists around the world are noticing in patients?  Because if so, we might have had a fundamental misunderstanding here – because most of Dr. Singh’s data about DNA outcomes does not come directly from him.  He is not (as far as I am aware) licensed to treat patients in the US (he has a DDSc in Orthodontics from the UK) so all of his data, or at least most of his recent data, comes from dentists trained in his techniques – some in the US, some in Canada, some in Korea (for example – Dr. Hee Nam Kim, who studied changes of the maxillary air sinuses in a set of patients he treated).

Isn’t that what we see happening with Dr. Moon and MSE providers/patients around the world?  He designs the appliance, licenses it out to be manufactured, trains providers in his treatment protocol … and then leverages his network of providers trained in his protocols for research on changes observed?  Like he was doing here with these changes noted in the pharyngeal area?  Because that’s what Dr. Singh has done.  Just trying to figure out if there’s a double-standard being applied because one is an orthodontist pitching to orthodontists, and one only has a DDSc in Orthodontics but is pitching to dentists.

If you re read my previous long message you will see that I said that you could use any MARPE appliance (as long as it follows the same principles) there are quite case reports around with same results. More importantly, basic anatomical and physiological knowledge matches with the principles of treatment and expected behaviour. I’ve used MSE and never attended a course (of course I am not an orthodontist seeking to do some surgery). I like MSE because it’s cheaper than others but it is not the best for everybody.

 
Posted : 10/01/2021 3:09 pm

THE GREAT WORK