Share:

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.

Fixed Anterior Growth Guidance Appliance (FAGGA) - Holy Grail? Gonial angle change, maxilla movement forwards and palate widening. Without surgery.  

Page 10 / 11
  RSS
GoTTi
Trusted Member
Posted by: Abdulrahman
Posted by: Pedro_Napoleon

My question is, is there an appliance that gives both forward and wide expansion at the same time? *note* wide regarding the maxilla and mandible.

Sadly no, and note that all appliances such as Fagga, Alf, and DNA are mainly expanding your alveolar bone. Regarding your idea of expanding transverse then sagittal, normally its done the other way around with Fagga to stream line the process but you could still do it. It just that it would make your treatment time longer. I can see benefit to it in some situation though.

How about that appliance that was used and documented on a Brazilian journal that expanded the mandible, zygomatic arch, nasal bone and even improved nasal height? What is your opinion on that?  Wouldn't something like that cause some sort of upswing around the lower third after enough expansion?  

ReplyQuote
Posted : 16/06/2019 12:57 pm
Abdulrahman
Reputable Member
Posted by: GoTTi

How about that appliance that was used and documented on a Brazilian journal that expanded the mandible, zygomatic arch, nasal bone and even improved nasal height? What is your opinion on that?  Wouldn't something like that cause some sort of upswing around the lower third after enough expansion?  

Which one was that? I don't remember reading about any appliance that did all of that. Are you referring to the one that widened the upper arch by 2mm and the zygomatic arches by 1.5 mm? If so that did nothing in the sagittal direction, only transverse.

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

ReplyQuote
Posted : 16/06/2019 2:25 pm
GoTTi
Trusted Member
Posted by: Abdulrahman
Posted by: GoTTi

How about that appliance that was used and documented on a Brazilian journal that expanded the mandible, zygomatic arch, nasal bone and even improved nasal height? What is your opinion on that?  Wouldn't something like that cause some sort of upswing around the lower third after enough expansion?  

Which one was that? I don't remember reading about any appliance that did all of that. Are you referring to the one that widened the upper arch by 2mm and the zygomatic arches by 1.5 mm? If so that did nothing in the sagittal direction, only transverse.

Yes. Sorry for not clarifying... I was just wondering if you thought it would eventually cause some sort of forward action? I used to read about how the DNA appliance could cause the lower jaw to slide forward a bit after a sufficient amount of expansion. Is this not the case for really slow expansion in adults?

 

Also, maybe I misinterpreted the study, but didn’t the device also induce some sort of mandibular expansion? I did read that on the paper. Maybe they were referring to the arch or something? I’m not sure

 

This post was modified 4 months ago by GoTTi
ReplyQuote
Posted : 16/06/2019 2:48 pm
Pedro_Napoleon
New Member

Yes. Sorry for not clarifying... I was just wondering if you thought it would eventually cause some sort of forward action? I used to read about how the DNA appliance could cause the lower jaw to slide forward a bit after a sufficient amount of expansion. Is this not the case for really slow expansion in adults?

sorry for butting in but, doesnt the fagga in creating forward growth, the mandible comes forward because of decompression and because the mandible teeth likes to touch with the maxilla teeth so it follows it by also going forwarth ?!

 

if so, then i would assume that any appliance the cause forward growth in the maxilla would also cause the lower jaw to slide forth until good airway is achieved or maxilla stops growing.

 

If so, then FAGGA would be the best appliance thus far to achive forward growth and in consequence slide the mandible forwards. So then, what would be the best appliance to widen the palate for both upper and lower jaw after the FAGGA process?

 

ReplyQuote
Posted : 16/06/2019 5:44 pm
Abdulrahman
Reputable Member
Posted by: GoTTi

Yes. Sorry for not clarifying... I was just wondering if you thought it would eventually cause some sort of forward action? I used to read about how the DNA appliance could cause the lower jaw to slide forward a bit after a sufficient amount of expansion. Is this not the case for really slow expansion in adults?

 

Also, maybe I misinterpreted the study, but didn’t the device also induce some sort of mandibular expansion? I did read that on the paper. Maybe they were referring to the arch or something? I’m not sure

No it would not, what the DNA is referring to is something different. When the lower arch is trapped under a narrow upper arch and you expand the later the former gets the chance to slide forward. I had this effect early in my treatment with braces.

The report mentions that they were tracking any changes to those areas but only reported changes in the maxilla.

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

ReplyQuote
Posted : 16/06/2019 11:35 pm
Abdulrahman
Reputable Member
Posted by: Pedro_Napoleon

sorry for butting in but, doesnt the fagga in creating forward growth, the mandible comes forward because of decompression and because the mandible teeth likes to touch with the maxilla teeth so it follows it by also going forwarth ?!

 

if so, then i would assume that any appliance the cause forward growth in the maxilla would also cause the lower jaw to slide forth until good airway is achieved or maxilla stops growing.

 

If so, then FAGGA would be the best appliance thus far to achive forward growth and in consequence slide the mandible forwards. So then, what would be the best appliance to widen the palate for both upper and lower jaw after the FAGGA process?

 

It doesn't follow on its own. Molar pads are used to cause the mandible to auto rotation forward and upward. My previous post answers the second part of your question.

The best appliance for transverse expansion is debatable, because each has it's pluses and minuses. Combining two however might be the best. For example you can use self-ligating braces and an acrylic expander to achieve better results than either can acehive on its own. 

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

ReplyQuote
Posted : 16/06/2019 11:41 pm
GoTTi
Trusted Member
Posted by: Abdulrahman
Posted by: GoTTi

Yes. Sorry for not clarifying... I was just wondering if you thought it would eventually cause some sort of forward action? I used to read about how the DNA appliance could cause the lower jaw to slide forward a bit after a sufficient amount of expansion. Is this not the case for really slow expansion in adults?

 

Also, maybe I misinterpreted the study, but didn’t the device also induce some sort of mandibular expansion? I did read that on the paper. Maybe they were referring to the arch or something? I’m not sure

No it would not, what the DNA is referring to is something different. When the lower arch is trapped under a narrow upper arch and you expand the later the former gets the chance to slide forward. I had this effect early in my treatment with braces.

The report mentions that they were tracking any changes to those areas but only reported changes in the maxilla.

Thanks for clarifying. So what do you think about this study as a whole so far? I have to say,  I am most impressed with the increased nasal with & height. I haven’t really seen anything like that before . I’d really appreciate your input 

This post was modified 4 months ago 3 times by GoTTi
ReplyQuote
Posted : 17/06/2019 4:02 pm
Abdulrahman
Reputable Member
Posted by: GoTTi

Thanks for clarifying. So what do you think about this study as a whole so far? I have to say,  I am most impressed with the increased nasal with & height. I haven’t really seen anything like that before . I’d really appreciate your input 

Very promising, and seems consistent with the experience I had from expanding my dental arches.

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

ReplyQuote
Posted : 18/06/2019 12:58 am
GoTTi liked
ghrb6464
New Member
Posted by: Abdulrahman
Posted by: GoTTi

Thanks for clarifying. So what do you think about this study as a whole so far? I have to say,  I am most impressed with the increased nasal with & height. I haven’t really seen anything like that before . I’d really appreciate your input 

Very promising, and seems consistent with the experience I had from expanding my dental arches.

I also have tmj on both sides, and I think the conclusion that I got after a long time is that I can solve the tmj of the condyle only when the upper jaw space comes out.

Do you think you need any body preparation for treatment with FAGGA? For example, spine, pelvic symmetry and flexible muscle?

And I have a serious tmj, so the disk is broken a lot, so is the FAGGA safer than the surgery? 

I just want to know your experience and personal thoughts.I am an asian living in South Korea.

ReplyQuote
Posted : 20/06/2019 9:07 pm
Flashcam
New Member

Since Ronald Ead has recently come out with new opinions on AGGA, it would be great to hear the progress or thoughts and opinions from people that have had AGGA treatment or are undergoing AGGA treatment.  I'm scheduled for AGGA at the beginning of August, but I'm starting to have second thoughts.  I've scheduled another appointment with a different ortho, but I'm sure they are just going to recommend surgery.  Some encouraging words from people undergoing or having undergone AGGA would be great.  Thanks. 

ReplyQuote
Posted : 09/07/2019 4:08 pm
entelechy
Active Member

Hello Flashcam---why would surgery be your only other alternative?   It seems people have had success with other appliances that do not flare out the teeth, and yet achieve expansion.  Have you checked out the MARPE procedure or the DNA?     The MARPE at least has some research studies behind it that have proven it opened sutures in the palate in adults. 

 

entelechy

ReplyQuote
Posted : 09/07/2019 4:31 pm
Le_Fort_or_Bust
Trusted Member

Yeah, FAGGA is not Holy Grail. I'm going to make a new thread focused on MSE+Facemask.

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

ReplyQuote
Posted : 09/07/2019 5:56 pm
Flashcam
New Member
Posted by: entelechy

Hello Flashcam---why would surgery be your only other alternative?   It seems people have had success with other appliances that do not flare out the teeth, and yet achieve expansion.  Have you checked out the MARPE procedure or the DNA?     The MARPE at least has some research studies behind it that have proven it opened sutures in the palate in adults. 

I don't think surgery is my only option, but I'm sure that's what the ortho is going to recommend.  I've been reading about MSE and DNA and I think I'd rather do MSE, but I can't find any practitioners for either to even get a consult. Trying to find practitioners for some of  this stuff has been like looking for unicorns.  

ReplyQuote
Posted : 09/07/2019 7:08 pm
BPlease
Active Member
Posted by: Flashcam

Since Ronald Ead has recently come out with new opinions on AGGA, it would be great to hear the progress or thoughts and opinions from people that have had AGGA treatment or are undergoing AGGA treatment.  I'm scheduled for AGGA at the beginning of August, but I'm starting to have second thoughts.  I've scheduled another appointment with a different ortho, but I'm sure they are just going to recommend surgery.  Some encouraging words from people undergoing or having undergone AGGA would be great.  Thanks. 

I'm also scheduled at the beginning of August to get the AGGA installed. Ronald said that it works for forward growth but to be careful to not overgrow. I'm only looking for forward growth so it will work fine on me (probably) i just need to take some regular x-rays to see that my teeth are not about to stick out of the bone and not to overgrow to the point where my lower jaw can not adapt.

I don't care much for widening, (just a little bit) but from what i understand AGGA does not give the amount of widening growth as it does forward growth so if that is your problem then maybe see if that same dentist does something else like DNA.

MSE seems to be better than DNA but i don't know of any dentists that does MSE and AGGA so i guess you would need to find out which is better to do fist.

ReplyQuote
Posted : 11/07/2019 5:21 pm
dajajde
New Member

 

I don't know if anyone ever talked about this obvious midface improvement here in this thread. What do you think about this?

Honestly, after carefully following Ronalds agga journey and reading his last post about agga not being a holy grail, this picture is the only thing that makes me want to get agga.

I don't know much about facial structure and ways of correcting malocclusion, but I've been mewing for almost 2 years now (since I was 19) and I've seen nice improvements on my face. Right now I'm 20, just about to hit 21 soon and I can finally get agga for myself. The only reason I want it because of lack of tongue space I have, obviously since I'm class 3, and for some midface improvement which I lack the most. If someone more knowledgable can give me his opinion on the above picture and if I should pursue agga since my midface is similar, if not worse than one in the above picture. 

ReplyQuote
Posted : 20/07/2019 9:33 am
seii
 seii
Active Member

Hi, haven't been too active in this forum for a while but back after exploring the world of orthotropics and orthopaedics a lil. 

There are so many appliances that work and obviously the Agga is not the answer for everyone because everyone is different. 

It's great that Ronald figured that out too! 

In regards to your tmd ghrb6464, find yourself someone that can decompress and treat your tmd - stabilise and heal your tmj and disc before changing your bite otherwise you will never know what your stable is if you keep moving things around.

At least that's the treatment that I myself am having after all this study 🙂 

This post was modified 3 months ago by seii
ReplyQuote
Posted : 20/07/2019 10:07 am
BPlease
Active Member

@dajajde

Wow this looks to good to be true almost, i know about the first two pictures but where did you find the last one (without the makeup)?

Is it just me or has her eyes moved further back in to her skull or maybe it's her nose and forhead that have moved forward, or is it the lack of makeup in her later picture that confuses me.

I've tried matching the before and after picture up by positioning the eyes in the same position but no matter how much i scale up or down the picture, it's like her entire face has moved forward.

Someone please do a before and after fade.

ReplyQuote
Posted : 21/07/2019 2:35 am
GoTTi liked
GoTTi
Trusted Member
Posted by: BPlease

@dajajde

Wow this looks to good to be true almost, i know about the first two pictures but where did you find the last one (without the makeup)?

Is it just me or has her eyes moved further back in to her skull or maybe it's her nose and forhead that have moved forward, or is it the lack of makeup in her later picture that confuses me.

I've tried matching the before and after picture up by positioning the eyes in the same position but no matter how much i scale up or down the picture, it's like her entire face has moved forward.

Someone please do a before and after fade.

These results look intriguing, however, her lower jaw seems to have recessed to me... or maybe the mid face grew out a ridiculous amount? I was under the impression that that type of stuff does not typically happen with this appliance? Or maybe this is one of those atypical cases where the person had good posture to begin with (imperative for optimal growth) and managed to achieve what the device was made essentially created for

Edit- damn, lmao... I thought that this was one of those "before and after" shots that are backwards with the "after" flick being on the left and opposed to the right. With that said though, these results do warrant some further analysis from knowledgeable members of this group

How old was she/is she on the pics?

Also, thanks for sharing!

This post was modified 3 months ago 4 times by GoTTi
ReplyQuote
Posted : 21/07/2019 3:16 am
BPlease
Active Member

She's a patient of dr Kundel i think (the same person who did AGGA on Ronald Ead)
Under her picture (which was only the first two where she has makeup) on the Dr's website i think it said that she was on AGGA for 5 or 7 months. On this last picture (without makeup) she must have either completed or been on the Controlled arch phase for a quite some time.
I'm planning on doing some facial surgery but before doing that I need to fix my biggest issue which is my deficient midface. The dentist that will be doing the AGGA on me said that i should wait with the surgery 6 month after the entire treatment (AGGA + Controlled arch) because of the facial muscles that should take their final position after 6 months. That would imply that the Controlled arch does more for the facial aesthetics than what we first thought ( i would assume)

I dont think her jaw looks recessed at all, not sure how you see that?

I think you are right in that the AGGA appliance works differently on people and in this case she was the perfect candidate. Hopefully it will have the same result on me 🙂

Edit: it says that she was 8 months on AGGA, does not say what her age is but she is under the "Adult" title.

https://stamforddentist.com/agga-examples/

This post was modified 3 months ago by BPlease
ReplyQuote
Posted : 21/07/2019 3:39 am
GoTTi
Trusted Member
Posted by: BPlease

She's a patient of dr Kundel i think (the same person who did AGGA on Ronald Ead)
Under her picture (which was only the first two where she has makeup) on the Dr's website i think it said that she was on AGGA for 5 or 7 months. On this last picture (without makeup) she must have either completed or been on the Controlled arch phase for a quite some time.
I'm planning on doing some facial surgery but before doing that I need to fix my biggest issue which is my deficient midface. The dentist that will be doing the AGGA on me said that i should wait with the surgery 6 month after the entire treatment (AGGA + Controlled arch) because of the facial muscles that should take their final position after 6 months. That would imply that the Controlled arch does more for the facial aesthetics than what we first thought ( i would assume)

I dont think her jaw looks recessed at all, not sure how you see that?

I think you are right in that the AGGA appliance works differently on people and in this case she was the perfect candidate. Hopefully it will have the same result on me 🙂

Edit: it says that she was 8 months on AGGA, does not say what her age is but she is under the "Adult" title.

https://stamforddentist.com/agga-examples/

I was actually referring to her first picture when I stated that her lower third looked like it was pushed back. Now I know which picture is which. Sorry for that. & yes, facial muscles dictate facial aesthetics a lot, even more then bone does imo but they work hand in hand and simultaneously compliment each other as muscle mass leads to bone deposition. For example sake, take forward head posture for instance... if you have forward head posture, your neck muscles etc. will literally change the position of the lower jaw and pull it back causing it to retrude. That's how important muscle function is

You should search up some before and after of people who undergo slow palatal expansion from things like the dna appliance (DNA Smiles Blog is a good reference)

I am currently on another device and can't cite Christie's blog article (who was in her mid 30's) but if you want to, you can link it on her to share with others. She looks a lot different from just the undergoing palette expansion and I honestly think the dna appliance was (I may be wrong about this) not optimized at the time that she underwent her treatment

ReplyQuote
Posted : 21/07/2019 5:22 am
GoTTi
Trusted Member

Also, that's pretty tough. Facial surgery? I would love to know why you are going for that option? Which surgery specifically, if you don't mind me asking??

This post was modified 3 months ago by GoTTi
ReplyQuote
Posted : 21/07/2019 5:24 am
BPlease
Active Member

I actually had facial surgery already with custom facial implants (jawline and cheeks) but my deficient mid-face would not allow for the changes that I wanted. That's the reason I'm trying AGGA. What AGGA needs to do at a bare minimum is to push my jaw forward and lips as well to eliminate my sunken mouth and pointy face look. I pretty much have the same problem as the woman had in her first picture.
I will be getting AGGA installed in about 2 weeks.

ReplyQuote
Posted : 21/07/2019 12:28 pm
GoTTi
Trusted Member
Posted by: BPlease

I actually had facial surgery already with custom facial implants (jawline and cheeks) but my deficient mid-face would not allow for the changes that I wanted. That's the reason I'm trying AGGA. What AGGA needs to do at a bare minimum is to push my jaw forward and lips as well to eliminate my sunken mouth and pointy face look. I pretty much have the same problem as the woman had in her first picture.
I will be getting AGGA installed in about 2 weeks.

I can see agga helping your case for sure. if the agga is good for anything at all it is for mandibular advancement, so you are in luck there my friend. I am hesitant to get the agga until I fix my my posture, which I am currently working on. But I am also looking into it as well, for my case! I wish you good luck and please keep us updated. Also, if you have any postural issues, look into optimizing your posture with something like bowen therapy or a really good chrio/pt and you will love your results even more.

ReplyQuote
Posted : 21/07/2019 5:07 pm
BPlease liked
danib
New Member

@schlachter

Hello! I'm interested in doing the same procedure in Heidelberg. Did you go through with in in the end? If yes, are you satisfied with the doctor and progress? And finally, how much did it cost? Thank you in advance!

ReplyQuote
Posted : 02/08/2019 12:06 pm
James
Eminent Member
Posted by: @bplease

I actually had facial surgery already with custom facial implants (jawline and cheeks) but my deficient mid-face would not allow for the changes that I wanted. That's the reason I'm trying AGGA. What AGGA needs to do at a bare minimum is to push my jaw forward and lips as well to eliminate my sunken mouth and pointy face look. I pretty much have the same problem as the woman had in her first picture.
I will be getting AGGA installed in about 2 weeks.

In setting your expectations, note that AGGA is a treatment for the lower third of the face, and it has never been proven to change the skeletal maxilla (none of the public cases show change to skeletal maxilla, only to the alveolar process and premaxilla).

In my case, 9 months in AGGA and 8mm gaps did not change my skeletal maxilla (the A-point moved by maybe 0.2mm at most). It tilted my top teeth out 9°, bringing the tips of my upper incisors forward 5mm, and my chin forward 5mm. So my lower third looks much better, my lip support is better, and my nasolabial angle is better, but my midface above the A-point is still flat. Maybe my skeletal maxilla will change over time as the AGGA proponents say, but I'm going to be waiting a while for this.

So if you have poor lip support, a retruded chin, a wide nasolabial angle, and retroclined incisors, then AGGA will help you even without altering your skeletal maxilla. Just don't expect your skeletal maxilla to change from AGGA, at least not in the near future, which means that your paranasal area and cheeklines are going to stay the same.

This is the alveolar ridge (the thing that AGGA changes):

This would be the best case of what AGGA an achieve (source: Abdulrahman's blog):  

 

This post was modified 2 months ago by James
ReplyQuote
Posted : 03/08/2019 12:57 pm
GoTTi liked
James
Eminent Member
Posted by: @gotti
Posted by: BPlease

@dajajde

Wow this looks to good to be true almost, i know about the first two pictures but where did you find the last one (without the makeup)?

Is it just me or has her eyes moved further back in to her skull or maybe it's her nose and forhead that have moved forward, or is it the lack of makeup in her later picture that confuses me.

I've tried matching the before and after picture up by positioning the eyes in the same position but no matter how much i scale up or down the picture, it's like her entire face has moved forward.

Someone please do a before and after fade.

These results look intriguing, however, her lower jaw seems to have recessed to me... or maybe the mid face grew out a ridiculous amount? I was under the impression that that type of stuff does not typically happen with this appliance? Or maybe this is one of those atypical cases where the person had good posture to begin with (imperative for optimal growth) and managed to achieve what the device was made essentially created for

Edit- damn, lmao... I thought that this was one of those "before and after" shots that are backwards with the "after" flick being on the left and opposed to the right. With that said though, these results do warrant some further analysis from knowledgeable members of this group

How old was she/is she on the pics?

Also, thanks for sharing!

Allow me to explain what is going on in this before/after comparison. First, this is a shamefully bad before/after comparison because the angle isn't the sample. In the after picture, she is turned my towards the camera, making her entire face including brow look more forward-grown. This is an illusion. The only real changes are the in the lower third. As for the appearance of a recessed chin, what is actually happening is that she is in Controlled Arch. The braces give extra lip support. So her lower lip is pushed forward, making the chin look backwards (even though I'm sure the chin is actually further forwards than her before picture).

I have the same issue. My chin came forward 5mm from AGGA (measured on CBCT), but my lower lip got pushed forward a couple mm by the braces wire. Therefore my chin is now an additional 2mm behind my lower lip even though both came forward a lot.

Remember folks, both AGGA and Controlled Arch give illusory lip support, giving mid-treatment patients the appearance of extra prognathism.

ReplyQuote
Posted : 03/08/2019 1:04 pm
entelechy
Active Member

@james

James!  What a clear and precise overview of what Fagga does: exactly what I thought.  

Here is a tricky question:  how and why does Fagga do this better than archwire?     I ask because I am in six months of archwire braces, and have gotten already some of the effects you described:  alvealor ridge growth and incisor movement.   It is just a couple mm but makes a huge difference.  Allows mandible to come forward as well.   

But apparently Fagga gets far MORE movement:  5 to 10 mm.   How and why?   What is actually happening that braces (which work on the same principle) does not do?

I chose to start with braces because my ortho said it was slower and less risk of root absorption.   

entelechy

ReplyQuote
Posted : 03/08/2019 1:16 pm
GoTTi liked
entelechy
Active Member

@james

one other question:  as I love your precision.    Even more than matching lips, I am concerned with how the upper and lower arches of teeth will match.    

As my mandible comes forward, the back teeth do not match the top at all. They only meet when I eat (and retrude my mandible to do so).   

What will happen when the treatment is finished and the bottom teeth are one "tooth" forward from before?   Fiddle with closing spaces forward on the top? 

entelechy

ReplyQuote
Posted : 03/08/2019 1:26 pm
BPlease
Active Member

@james

Yeah i eventually figured out that she had her head turned to the camera a bit but the result are still amazing. Also in the last picture she has apparently 13mm growth.

I'm not so certain that a lot of the lip movement is made by the braces. The before and after pictures of Ronald Ead after letting the gaps relapse to 5mm, he had pretty much the same amount of lip "fullness/angle" as when on controlled arch braces (assuming he was not on arch braces for that last picture that was going to show the final result of AGGA)

Anyways as long as i get the same type of change as the woman above i will be happy.
If it turns out i need my skeletal maxilla to move forward i can just get paranasal implants (which i already got to balance my jaw and cheek augmentation)

So basically a combination of AGGA and plastic surgery will change your entire midface.
This works for me because I'm only after the look and don't have any health issues.
If you need your skeletal maxilla to move forward (the A point) for health purposes, then maybe whait and see how it turns out for Ronald Ead with MSE and facemask.

Also it could be that the A point does move but takes a lot of time because it's not as soft as the alverior bone, thoughts on that?

This post was modified 2 months ago by BPlease
ReplyQuote
Posted : 03/08/2019 2:07 pm
James
Eminent Member

@entelechy, I don't know much about the capabilities of archwire vs AGGA. Archwire sounds like it would be fine to procline maxillary incisors. This also happens during Controlled Arch Braces after AGGA. I would guess that the main difference with AGGA is that it has the tongue-pad (technical term: "Nance button") and that the front six teeth are bonded together and move as a unit. This allows new alveolar bone to growth in the gaps, and then Controlled Arch protracts the premolars into this new bone. But since AGGA does not develop the maxilla in the short-term, a patient who just needs a few mm outward tilting of the incisors would probably be fine with just archwire.

As for the occlusion, I also have the same issue where in AGGA, my mandibular molars ended up moving forward until they were under my maxillary premolars. But now in Controlled Arch, the maxillary premolars and molars are being protracted, so the occlusion will eventually line up. As the archform changes from a V-shape to a U-shape, the back teeth are moved up.

ReplyQuote
Posted : 03/08/2019 2:18 pm
James
Eminent Member
Posted by: @bplease

@james

Yeah i eventually figured out that she had her head turned to the camera a bit but the result are still amazing. Also in the last picture she has apparently 13mm growth.

I'm not so certain that a lot of the lip movement is made by the braces. The before and after pictures of Ronald Ead after letting the gaps relapse to 5mm, he had pretty much the same amount of lip "fullness/angle" as when on controlled arch braces (assuming he was not on arch braces for that last picture that was going to show the final result of AGGA)

Anyways as long as i get the same type of change as the woman above i will be happy.
If it turns out i need my skeletal maxilla to move forward i can just get paranasal implants (which i already got to balance my jaw and cheek augmentation)

So basically a combination of AGGA and plastic surgery will change your entire midface.
This works for me because I'm only after the look and don't have any health issues.
If you need your skeletal maxilla to move forward (the A point) for health purposes, then maybe whait and see how it turns out for Ronald Ead with MSE and facemask.

Also it could be that the A point does move but takes a lot of time because it's not as soft as the alverior bone, thoughts on that?

Sure, from an aesthetic standpoint you can get paranasal implants.

I am following Ronald Ead's MSE/facemask case with interest.

It's possible that the A-point of the maxilla might move more slowly than the alveolar bone, and I will get a CBCT at 1 or 2 years to check. My dentist says that my maxilla may have grown like 0.2mm. But this was in 9 months, and I was Mewing the entire time. So where is my A-point going to be at the 2-year mark, maybe +0.4mm, or 0.5mm? (Keep in mind that there is no public proof of any dentoalveolar appliance like AGGA moving the A-point by any amount.) Even 1mm forward growth of the A-point of the maxilla in 2 years is not really very much. Any patient doing AGGA to grow their skeletal maxilla is going to be disappointed by a lack of results.

Right now, there is a lot of confusion among AGGA patients due to marketing claims of "3D growth" of the entire face, combined with the impression that Mewing can change the maxilla in adults. These patients need to lower their expectations and understand that their changes are going to be dentoalveolar. Of course, for the right patient, dentoalveolar changes can still be a big deal for both health and aesthetics.

ReplyQuote
Posted : 03/08/2019 2:34 pm
BPlease
Active Member

@james

yeah, i wonder whether the mis advertisement of AGGA has turned away more patients than gaining them?
I think that if they advertised AGGA as being a forward growth appliance that grows and or pushes the alverior bone resulting in lower third face improvement with some lateral expansion which helps with breathing and TMJ/TDM would have been a much better advertisement.

you said that you have been on AGGA for 9 months, have you notices any changes in the nasal breathing?
The only health issue i have is annoying nasal cognitions that i hope will get resolved but I'm not counting in it.

ReplyQuote
Posted : 03/08/2019 4:07 pm
GoTTi liked
Lee
 Lee
Eminent Member

@bplease

Have you had a cbct to see if there are obstructions?

 

ReplyQuote
Posted : 03/08/2019 6:24 pm
James
Eminent Member
Posted by: @bplease

@james

yeah, i wonder whether the mis advertisement of AGGA has turned away more patients than gaining them?
I think that if they advertised AGGA as being a forward growth appliance that grows and or pushes the alverior bone resulting in lower third face improvement with some lateral expansion which helps with breathing and TMJ/TDM would have been a much better advertisement.

you said that you have been on AGGA for 9 months, have you notices any changes in the nasal breathing?
The only health issue i have is annoying nasal cognitions that i hope will get resolved but I'm not counting in it.

Yes, AGGA is misadvertised, and especially people coming from a Mewing background will have excessive expectations about possible change to the maxilla in adults.

I have had zero changes to my nasal breathing or sleep from AGGA, which is frustrating because sleep (UARS) is my main issue. The CBCT scan showed that AGGA improved my pharyngeal airway, especially behind the tongue. This helps a lot of people with sleep, but not me. It's possible that Controlled Arch with transverse expansion might help my nasal breathing, but it is unclear whether the FRLA appliance used for transverse growth is able to create a true palatal change to the floor of the nose, or just more dentoalveolar changes.

I got tired of waiting for sleep improvement, and consulted with an ENT, who thinks that my nose is the main problem behind my sleep. This would explain why AGGA hasn't helped my sleep. I just did Vivaer nasal remodeling a few days ago, and I will feel the full results over the next 2-4 weeks. I am also considering septoplasty and turbinate reduction.

Getting a true palate expander after Controlled Arch like a MSE or even a Hyrax is another possibility to improve my nasal airway.

 

ReplyQuote
Posted : 03/08/2019 6:27 pm
BPlease
Active Member

@lee

Yes, my Dr took the usual x-rays one of them being cbct and said that i was 7mm behind (minimum) and that my airway (behind the tongue) was narrow. I cant remember if he mentioned anything wrong with my nose based on the x-rays but he did say that the nasal airways were a bit narrow when he blocked one of my nostrils and listened how i was breathing from my other nostril.

Also something showed up in the x-ray which i guess was bone that was "sticking" out a bit next to my nose close to my eye, he later felt it with his finger. Cant remember what he said about it but it was only on one of my side and it might have been a sign of undeveloped upper jaw because of using headgear as a kid to fix my overbite.

ReplyQuote
Posted : 03/08/2019 6:51 pm
GoTTi
Trusted Member
Posted by: @james
Posted by: @bplease

@james

yeah, i wonder whether the mis advertisement of AGGA has turned away more patients than gaining them?
I think that if they advertised AGGA as being a forward growth appliance that grows and or pushes the alverior bone resulting in lower third face improvement with some lateral expansion which helps with breathing and TMJ/TDM would have been a much better advertisement.

you said that you have been on AGGA for 9 months, have you notices any changes in the nasal breathing?
The only health issue i have is annoying nasal cognitions that i hope will get resolved but I'm not counting in it.

Yes, AGGA is misadvertised, and especially people coming from a Mewing background will have excessive expectations about possible change to the maxilla in adults.

I have had zero changes to my nasal breathing or sleep from AGGA, which is frustrating because sleep (UARS) is my main issue. The CBCT scan showed that AGGA improved my pharyngeal airway, especially behind the tongue. This helps a lot of people with sleep, but not me. It's possible that Controlled Arch with transverse expansion might help my nasal breathing, but it is unclear whether the FRLA appliance used for transverse growth is able to create a true palatal change to the floor of the nose, or just more dentoalveolar changes.

I got tired of waiting for sleep improvement, and consulted with an ENT, who thinks that my nose is the main problem behind my sleep. This would explain why AGGA hasn't helped my sleep. I just did Vivaer nasal remodeling a few days ago, and I will feel the full results over the next 2-4 weeks. I am also considering septoplasty and turbinate reduction.

Getting a true palate expander after Controlled Arch like a MSE or even a Hyrax is another possibility to improve my nasal airway.

 

Palate expansion done right (slowly) can widen the nasal bone and airway, too. Even the mandible can grow a bit as a result of true palate expansion.

ReplyQuote
Posted : 03/08/2019 11:00 pm
BPlease
Active Member

@gotti

What kind of palate expander would you suggest work? Aren't they doing the same thing as the second phase of AGGA which is widening the alverior bone?

The only one i can come up with is the MSE

This post was modified 2 months ago by BPlease
ReplyQuote
Posted : 03/08/2019 11:35 pm
Parks
Active Member

@allixa

do you know of anything that can reverse bimaxillary protrusion brought on by botched orthodontic work? Any idea at all?

This post was modified 2 months ago by Parks
ReplyQuote
Posted : 04/08/2019 1:34 am
BPlease
Active Member

@james

After going through some previous posts i came across your picture that said you had 3.9 mm of growth. I have to say, it looks like you barely had 1 mm of growth there.

How come it did not give you more facial change (compard to others) and how do you look now?

ReplyQuote
Posted : 26/08/2019 2:25 am
James
Eminent Member
Posted by: @bplease

@james

After going through some previous posts i came across your picture that said you had 3.9 mm of growth. I have to say, it looks like you barely had 1 mm of growth there.

How come it did not give you more facial change (compard to others) and how do you look now?

In that picture you see, I had around 4mm gaps. What I have learned from treatment is that the AGGA gaps and forward growth are not the same thing, due to distalization. I have my CBCT scans post-AGGA, I have the files, so I have been looking through them with the InVivo free viewer. I am not going to post my scans until I am done with Controlled Arch, because my impression of certain parts of my treatment may change depending on how the results turn out. But I will summarize some of the changes for you:

  • I had around 8mm gaps intraorally after 8 months of treatment and 1 month resting in AGGA
  • My maxillary incisors tilted outwards 9°
  • The tips of my maxillary incisors moved forward 5.5mm, either from the tilting or from translation forward
  • My premolars and molars distalized, by 2mm at the crown and 1mm at the root (will be fixed in Controlled Arch)
  • My mandible moved forward 5mm
  • TMJs decompressed
  • My maxillary incisors extruded 1mm (will be fixed in Controlled Arch)
  • The A-point at the bottom of the maxilla didn't move
  • My bottom IMW increased 3mm from the FRLA appliance
  • My top IMW increased 3mm in AGGA, which was surprising because AGGA doesn't exert transverse force (I was practicing tongue posture the entire time)
  • No changes to palatal width or nasal cavity width
  • I got 2mm gum recession on my maxillary canines, maybe 0.5mm on my incisors. The front six are pushed forward in the alveolar bone.

Out of 8mm gaps, only 5.5mm turned out to be real forward growth, and the rest was distalization or tipping backwards / sideways. This is definitely part of the story of why my results don't change my profile as much as you would expect. My profile improved a bit more by the end of AGGA, and I do look better, especially the nasolabial angle and submental area. It's subtle, though. My changes are nowhere near as pronounced as Ronald Ead or rogerramjet, though they were opening up premolar extraction sites (which might allow more forward growth) where I was not. Later during Controlled Arch, my mandibular incisors will be retracted, which will allow my retruded chin to come forward even more, changing my profile.

There were only dentoalveolar changes, no significant skeletal changes. AGGA proponents claim that it causes 3D modeling of the entire face for years after treatment. This has never been documented. Whether it's true or not, there is no skeletal remodeling as of 9 months. There is definitely growth of alveolar bone in the gaps, which will make it possible to give me a much wider smile without retraction. The dentoalveolar changes also allowed decompressing of the TMJ, which could be a big deal for someone with TMD as their main problem.

There is increased airway behind the mandible, but no changes to sleep or UARS, my main complaint. I am seeing an ENT who thinks that the problem is in my nose, so I'm going to do nasal procedures and not expect AGGA to fix my breathing.

A positive surprise was the +3mm upper IMW, which was not expected. This must have been from tongue posture. AGGA gave me a lot of tongue space and allowed me to swallow properly.

At this point, I really can't tell whether the treatment is going to have a satisfying result. I like the improvements to my face, but it's a bit tough to go through the trauma of a large expansion (e.g. recession to gum, teeth pushed forward in bone) when I don't get to keep all of that movement as forward growth, with some of it being distalization. The distalization, recession, extrusion of maxillary incisors, and intrusion of molars were all undesirable and unexpected effects, though all of them except the recession should be fixed in Controlled Arch.  AGGA is definitely not a perfect treatment, but it has still given me more changes to my profile than any other documented treatment would have. I'm going to have to wait to see the final result before I can know how to feel about it.

 

This post was modified 2 months ago by James
ReplyQuote
Posted : 26/08/2019 1:16 pm
minniesinatra
New Member
  1. @rogerramjet

Hi there! Gosh sorry it’s been a whole year, but I figured better late than never!

I’ve had my braces for over a year now and I’m loving the progress. My philtrum is a lot shorter with all the palatial expansion (I had a retroclined scalloped upper lip because of my small palate) and now I finally have space to leave my tongue touching the roof of my mouth as it should be. Most recent changes have been that my top and bottom teeth are closing in and everything’s kind of locking in so to speak. My mouth used to always be open and now it feels a lot more natural to keep it closed, although I’m not consistent all the time.

My jaw is a lot better when it’s adhering to the correct position, although I think it still falls back when I sleep. But I’m very very happy with the progress and with Dr. Cole. I did this treatment mostly out of vanity to be honest and I’m already ecstatic about the improvements in my lower face. 

ReplyQuote
Posted : 21/09/2019 12:56 am
entelechy
Active Member

This discussion of saggital/FAGGA or MSE first is of great use.

I interviewed Dr. William Hang (on Saggital) and  Dr.Won Moon (on MSE) and am still conflicted on which should come first. 

If the tongue has more forward space, but is still trapped on the sides, this will not allow for correct swallowing.

If it has more lateral space, and yet does not have enough room to lay flat as compromised by the front teeth, this will not allow for correct swallowing.

My intuition is that the lateral expansion will be a great relief, and I want it first.    The tongue not being able to reach the palate as blocked by the teeth means that speaking is a problem as is sleeping because the mandible naturally slides back to allow the tongue to go up on the palate.  With the expansion laterally, the the tongue will not feel so compromised.

The issue with MSE that I notice is that many doctors do not know how to use it effectively.   I've noted quite a few failed cases.  Any other opinions on this?

entelechy

ReplyQuote
Posted : 21/09/2019 8:45 pm
entelechy
Active Member

Please take this survey if you have had premolar extractions----and pass on!

https://forms.gle/E77UZK4BnqaaCDvY6

entelechy

ReplyQuote
Posted : 21/09/2019 8:46 pm
doncock
New Member

Hello, i have a question for the more advanced in the Agga treatment. How is your experience with mewing during the Controlled Arch phase? Is the any scratching etc. which may prohibit proper mewing? Thanks for your help!

ReplyQuote
Posted : 29/09/2019 2:06 pm
theadonisking
New Member
Posted by: @james
Posted by: @bplease

@james

After going through some previous posts i came across your picture that said you had 3.9 mm of growth. I have to say, it looks like you barely had 1 mm of growth there.

How come it did not give you more facial change (compard to others) and how do you look now?

In that picture you see, I had around 4mm gaps. What I have learned from treatment is that the AGGA gaps and forward growth are not the same thing, due to distalization. I have my CBCT scans post-AGGA, I have the files, so I have been looking through them with the InVivo free viewer. I am not going to post my scans until I am done with Controlled Arch, because my impression of certain parts of my treatment may change depending on how the results turn out. But I will summarize some of the changes for you:

  • I had around 8mm gaps intraorally after 8 months of treatment and 1 month resting in AGGA
  • My maxillary incisors tilted outwards 9°
  • The tips of my maxillary incisors moved forward 5.5mm, either from the tilting or from translation forward
  • My premolars and molars distalized, by 2mm at the crown and 1mm at the root (will be fixed in Controlled Arch)
  • My mandible moved forward 5mm
  • TMJs decompressed
  • My maxillary incisors extruded 1mm (will be fixed in Controlled Arch)
  • The A-point at the bottom of the maxilla didn't move
  • My bottom IMW increased 3mm from the FRLA appliance
  • My top IMW increased 3mm in AGGA, which was surprising because AGGA doesn't exert transverse force (I was practicing tongue posture the entire time)
  • No changes to palatal width or nasal cavity width
  • I got 2mm gum recession on my maxillary canines, maybe 0.5mm on my incisors. The front six are pushed forward in the alveolar bone.

Out of 8mm gaps, only 5.5mm turned out to be real forward growth, and the rest was distalization or tipping backwards / sideways. This is definitely part of the story of why my results don't change my profile as much as you would expect. My profile improved a bit more by the end of AGGA, and I do look better, especially the nasolabial angle and submental area. It's subtle, though. My changes are nowhere near as pronounced as Ronald Ead or rogerramjet, though they were opening up premolar extraction sites (which might allow more forward growth) where I was not. Later during Controlled Arch, my mandibular incisors will be retracted, which will allow my retruded chin to come forward even more, changing my profile.

There were only dentoalveolar changes, no significant skeletal changes. AGGA proponents claim that it causes 3D modeling of the entire face for years after treatment. This has never been documented. Whether it's true or not, there is no skeletal remodeling as of 9 months. There is definitely growth of alveolar bone in the gaps, which will make it possible to give me a much wider smile without retraction. The dentoalveolar changes also allowed decompressing of the TMJ, which could be a big deal for someone with TMD as their main problem.

There is increased airway behind the mandible, but no changes to sleep or UARS, my main complaint. I am seeing an ENT who thinks that the problem is in my nose, so I'm going to do nasal procedures and not expect AGGA to fix my breathing.

A positive surprise was the +3mm upper IMW, which was not expected. This must have been from tongue posture. AGGA gave me a lot of tongue space and allowed me to swallow properly.

At this point, I really can't tell whether the treatment is going to have a satisfying result. I like the improvements to my face, but it's a bit tough to go through the trauma of a large expansion (e.g. recession to gum, teeth pushed forward in bone) when I don't get to keep all of that movement as forward growth, with some of it being distalization. The distalization, recession, extrusion of maxillary incisors, and intrusion of molars were all undesirable and unexpected effects, though all of them except the recession should be fixed in Controlled Arch.  AGGA is definitely not a perfect treatment, but it has still given me more changes to my profile than any other documented treatment would have. I'm going to have to wait to see the final result before I can know how to feel about it.

 

Are you followed by an LVI dentist ?

My profile is similar but worse than yours : https://imgur.com/a/8BLDtOf

and i have a consultation in a couple weeks.

I have some UARS but no pain, sleep is main issue.

I was hoping AGGA would bring my mandible/maxilla forward at least 10-15 mm (mew indicator line 55mm), but youre telling me yours didn't change ? do you know if your mew line decreased ?

i would like to see a picture if possible since on your 4 months agga i barely see a difference

ReplyQuote
Posted : 30/09/2019 12:27 am
James
Eminent Member
Posted by: @theadonisking

Are you followed by an LVI dentist ?

Yes, I have a LVI dentist.

My profile is similar but worse than yours : https://imgur.com/a/8BLDtOf

and i have a consultation in a couple weeks.

I have some UARS but no pain, sleep is main issue.

I was hoping AGGA would bring my mandible/maxilla forward at least 10-15 mm (mew indicator line 55mm), but youre telling me yours didn't change ? do you know if your mew line decreased ?

My Mew Indicator Line definitely changed, but I'm not sure how much because I need to find what my pre-AGGA Mew Indicator Line was. It must have been at least 2-3mm less post-AGGA.

The thing which didn't change was my skeletal maxilla and A-point.

My mandible came forward 5mm, but I still look like I have a weak chin because my mandibular incisors are proclined (tipped forward, aka lower dental protrusion). They will be retracted in Controlled Arch, which will allow my mandible to come another couple mm forward and hopefully give me a stronger chin. If this all goes smoothly, then my mandible will have moved forward 7mm relative to pre-treatment (5mm AGGA + 2mm retraction of mandibular incisors).

Moving the mandible forward is definitely realistic. Moving the maxilla is harder. AGGA can remodel the alveolar ridge of the maxilla forward, but it's unproven that it can change the skeletal maxilla. And if it does, the skeletal maxilla is only going to change by like 0-2mm I'm guess; expecting the skeletal maxilla to grow forward 10mm in an adult is not realistic. 

Your nasolabial angle is wide, and it looks like your maxillary incisors are retroclined. This means that there is room for AGGA to develop your alveolar ridge, and make the nasolabial angle narrower. This would bring your whole mandible forward, and 5mm is definitely realistic because that's what I achieved. But your chin would still have the same "shape" and look weak. Retracting your lower incisors might be able to help get your chin a little further forward and change your profile.  When you get a consult, ask if your mandibular incisors are proclined and whether they can be retracted a bit.

i would like to see a picture if possible since on your 4 months agga i barely see a difference

I already discussed my 4-month profile above. The reason it doesn't looks like 4mm is probably due to distalization, along with small changes being hard to see in soft tissue. 

ReplyQuote
Posted : 30/09/2019 1:20 pm
theadonisking
New Member
Posted by: @james
Posted by: @theadonisking

Are you followed by an LVI dentist ?

Yes, I have a LVI dentist.

My profile is similar but worse than yours : https://imgur.com/a/8BLDtOf

and i have a consultation in a couple weeks.

I have some UARS but no pain, sleep is main issue.

I was hoping AGGA would bring my mandible/maxilla forward at least 10-15 mm (mew indicator line 55mm), but youre telling me yours didn't change ? do you know if your mew line decreased ?

My Mew Indicator Line definitely changed, but I'm not sure how much because I need to find what my pre-AGGA Mew Indicator Line was. It must have been at least 2-3mm less post-AGGA.

The thing which didn't change was my skeletal maxilla and A-point.

My mandible came forward 5mm, but I still look like I have a weak chin because my mandibular incisors are proclined (tipped forward, aka lower dental protrusion). They will be retracted in Controlled Arch, which will allow my mandible to come another couple mm forward and hopefully give me a stronger chin. If this all goes smoothly, then my mandible will have moved forward 7mm relative to pre-treatment (5mm AGGA + 2mm retraction of mandibular incisors).

Moving the mandible forward is definitely realistic. Moving the maxilla is harder. AGGA can remodel the alveolar ridge of the maxilla forward, but it's unproven that it can change the skeletal maxilla. And if it does, the skeletal maxilla is only going to change by like 0-2mm I'm guess; expecting the skeletal maxilla to grow forward 10mm in an adult is not realistic. 

Your nasolabial angle is wide, and it looks like your maxillary incisors are retroclined. This means that there is room for AGGA to develop your alveolar ridge, and make the nasolabial angle narrower. This would bring your whole mandible forward, and 5mm is definitely realistic because that's what I achieved. But your chin would still have the same "shape" and look weak. Retracting your lower incisors might be able to help get your chin a little further forward and change your profile.  When you get a consult, ask if your mandibular incisors are proclined and whether they can be retracted a bit.

i would like to see a picture if possible since on your 4 months agga i barely see a difference

I already discussed my 4-month profile above. The reason it doesn't looks like 4mm is probably due to distalization, along with small changes being hard to see in soft tissue. 

Hi James, thanks for your input.

For your progress picture i meant a picture of now, since in the 4 months theres not much to see because of distalization as you mentioned. I would like to know the profile change possible.

My maxillary incisors seem retroclined and mandibular proclined.

How would retracting the mandibular incisors bring the mandible forward and change the chin ? Is the goal to have both incisors perfectly level to have a square chin ?

ReplyQuote
Posted : 30/09/2019 1:55 pm
James
Eminent Member
Posted by: @theadonisking

Hi James, thanks for your input.

For your progress picture i meant a picture of now, since in the 4 months theres not much to see because of distalization as you mentioned. I would like to know the profile change possible.

My maxillary incisors seem retroclined and mandibular proclined.

How would retracting the mandibular incisors bring the mandible forward and change the chin ? Is the goal to have both incisors perfectly level to have a square chin ?

I'm holding off on releasing photos until my case is finished. My profile is going to look weak-chinned until my mandibular incisors are retracted, which will hopefully improve it.

The maxillary and mandibular incisors aren't supposed to be "square," but in cephalometrics there are norms for their inclination (relative to each other, or to the maxillary/mandibular plane). 

Why would retracting the mandibular incisors bring the mandible forward? Think about it this way: what is stopping you from bringing your mandible more forward right now? Because your lower incisors hit the upper. If your lower incisors were tilted less forward, then you would be able to move your mandible forward further prior to hitting your top incisors. Why does the inclination of the incisors influence the position of the chin? Look at cases of bidental protrusion (aka bimaxillary protrusion) to visualize this: all such patients have weak chins. Another example:

ReplyQuote
Posted : 30/09/2019 5:11 pm
entelechy
Active Member

Hello James,

Thank you for your detailed overview of your treatment results.  Very helpful.

Does the 2 mm gum recession bother you?  Is it a cause for concern?  Similarly with the teeth being pushed out to the alvealor bone?

The 5 mm expansion of alvealor ridge sounds great.   Is there anyway you can see on your CT scan that it is alvealor ridge and not teeth?

I ask because my concern is tongue space.  If it is just the teeth moving forward, this--I would guess-- does not do much for the tongue space (unless one presses teeth on the tongue).

thanks for your feedback

entelechy

ReplyQuote
Posted : 30/09/2019 5:26 pm
theadonisking
New Member
Posted by: @james
Posted by: @theadonisking

Hi James, thanks for your input.

For your progress picture i meant a picture of now, since in the 4 months theres not much to see because of distalization as you mentioned. I would like to know the profile change possible.

My maxillary incisors seem retroclined and mandibular proclined.

How would retracting the mandibular incisors bring the mandible forward and change the chin ? Is the goal to have both incisors perfectly level to have a square chin ?

I'm holding off on releasing photos until my case is finished. My profile is going to look weak-chinned until my mandibular incisors are retracted, which will hopefully improve it.

The maxillary and mandibular incisors aren't supposed to be "square," but in cephalometrics there are norms for their inclination (relative to each other, or to the maxillary/mandibular plane). 

Why would retracting the mandibular incisors bring the mandible forward? Think about it this way: what is stopping you from bringing your mandible more forward right now? Because your lower incisors hit the upper. If your lower incisors were tilted less forward, then you would be able to move your mandible forward further prior to hitting your top incisors. Why does the inclination of the incisors influence the position of the chin? Look at cases of bidental protrusion (aka bimaxillary protrusion) to visualize this: all such patients have weak chins. Another example:

well i can bring my mandible forward because i have an open bite  ahah, so the incisors arent blocking eachother, but yeah i see how i understand how it could affect the chin, since when i contract my lower lip my chin is more prominent, and my lip looks bigger at the moment probably because of the proclined lower incisors.

and regarding the mew indicator line, if mine is 55mm do you know if that translates to the agga growth needed ? like if i want 40mm i need 15 mm of growth from agga ?

When i push my mandible forward 5 to 10 mm chin looks great ahah, wonder if i can attain that position with this

Thanks for your help

This post was modified 2 weeks ago 2 times by theadonisking
ReplyQuote
Posted : 30/09/2019 6:09 pm
James
Eminent Member
Posted by: @entelechy

Hello James,

Thank you for your detailed overview of your treatment results.  Very helpful.

Does the 2 mm gum recession bother you?  Is it a cause for concern?  Similarly with the teeth being pushed out to the alvealor bone?

The 5 mm expansion of alvealor ridge sounds great.   Is there anyway you can see on your CT scan that it is alvealor ridge and not teeth?

I ask because my concern is tongue space.  If it is just the teeth moving forward, this--I would guess-- does not do much for the tongue space (unless one presses teeth on the tongue).

thanks for your feedback

The 2mm gum recession does bother me, but I am waiting to see if it improves once my premolars are pulled up during Controlled Arch. The biggest recession is next to the gaps.

The 5mm forward expansion is measured from the tip of the incisors. I can't tell how much of this is due to alveolar expansion, vs how much of it is my teeth getting pushed forward the edge of the bone; probably both. It's hard to tell from a CBCT scan whether teeth are pushed out of the bone. My dentist says that they are not.

I did get a lot more tongue-space. As the teeth travel forward in the alveolar, the bone reabsorbs on the backside.

ReplyQuote
Posted : 30/09/2019 8:09 pm
James
Eminent Member
Posted by: @theadonisking

and regarding the mew indicator line, if mine is 55mm do you know if that translates to the agga growth needed ? like if i want 40mm i need 15 mm of growth from agga ?

When i push my mandible forward 5 to 10 mm chin looks great ahah, wonder if i can attain that position with this

Thanks for your help

AGGA has its limitations. So it's not realistic to plan treatment by deciding the Mew Indicator Line you want, or the amount of the growth you want, and then expect AGGA to deliver that. Remember that AGGA mostly grows out the alveolar ridge and the moves the teeth, and does not expand the skeletal maxilla (at least not that's documented, and if it does, is not likely to be by a large amount). The problem is that the alveolar ridge doesn't want to be pushed too far ahead of the rest of the maxilla, which means that the prospects of growth are limited to people with underdeveloped alveolar ridges.

Pushing out the alveolar ridge too far while leaving the skeletal maxilla behind would result in the body resisting, posing a risk for the various AGGA side effects people complain of, like pushing the incisors/canines through the alveolar bone causing sensitivity and gum recession, or distalizing the molars/premolars, or dislocation of the TMJ which Ronald Ead complained of.

The more you expand with AGGA, the more risks of your body fighting you and causing complications. I've heard other AGGA patients suggest that only 5-6mm is safe on a single appliance. It is possible to do AGGA, then go into Controlled Arch and close the gaps, then go into a 2nd AGGA. This would be a safer way to do a large amount of expansion.

If you start AGGA, be aware of the potential complications, and consider slowing treatment or going into Controlled Arch early if complications emerge (you could do a 2nd AGGA phase after Controlled Arch if necessary). The safe amount of growth that your body can handle from AGGA may not be as much as you want. Unfortunately there is no appliance that can provide a full fix to the entire maxilla for a highly retruded person.

In my case, by the end of treatment, I expect to have my mandible move forward around 7mm. This is not as much as I want, but I'm hoping it will be enough to improve my health and to look better than I did before.

ReplyQuote
Posted : 30/09/2019 8:29 pm
entelechy
Active Member

@james

Dear James,

I very much appreciate how thoughtfully you outline all the consequences of the Fagga experience.

Might I ask why you did not consider doing MSE first---and what you think about the prospect of doing it now?

I interviewed Dr. Won Moon in his office for a few hours a month ago, and he and his laboratory showed me many CT scans of patients treated with MSE whose nasal airways had been improved.    

This is not my issue, but it seems to be a main issue for his patients.

I also saw a fantastic ENT---Dr. Zaghi in California, expert on tongue issues--who confirmed that I (like you) have UARS.

Mine is caused not by airway but by the fact that the tongue does not go up on the soft palate.  The CT revealed it to rest low, which is because the mouth cavity does not allow it to extend.  Anyway who had headgear, retraction or maxillary deficiency might have the same issue.   If the tongue is pushed back and rests slow, it can block the trachea each time you swallow.   At night while sleeping, it can do the same.  An exam with a laser to check swallowing revealed that this is indeed my case.  

So whether breathing issues are caused by airway OR tongue (or both) in cases of retruded maxilla is an interesting question.

On cramped tongue issues:   the reason an expanded palate with MSE would help breathing in my case, is that it would allow the tongue to be up on the palate and forward.  Right now my tongue instinctually flinches from the prospect of being up because it knows it's going to be sliced by teeth (narrow arch).

Curious about your thoughts on these issues.

And why is it not better to do the MSE before the FAGGA?

 

 

 

 

 

 

 

 

entelechy

ReplyQuote
Posted : 01/10/2019 4:33 am
James
Eminent Member

@entelechy

I was not aware of MSE when I started FAGGA, or I would have considered it. I am currently doing ENT procedures try to resolve my nasal obstruction and UARS. I am still considering MSE or EASE if the nasal procedures are not enough, but it has higher risks due to being more invasive. I'm also not thrilled about needing to do another round of braces if I did MSE. I want to give Controlled Arch a chance and see if it improves my nasal airway.

I am not taking any position on whether it is better to do FAGGA or MSE first. I wanted to do FAGGA because I am very retruded, and it has helped with this. My starting intermolar width was 34mm, and lack of forward space was my biggest constraint, not lack of width. AGGA allowed me to have better tongue posture, which expanded my upper intermolar width to 37mm before Controlled Arch.

There is a non-LVI dentist I've talked to in another country who does FAGGA and then follows up with a Hyrax expander, either after Controlled Arch or before. He says that this gives better transverse expansion than the usual FRLA appliance. He says that MSE could be used in place of the Hyrax for even better palatal expansion. This sequence is similar to what Ronald Ead ended up doing, except he had to allow partial relapse of his AGGA gaps.

This post was modified 2 weeks ago by James
This post was modified 6 days ago by James
ReplyQuote
Posted : 01/10/2019 1:23 pm
entelechy
Active Member

@james

Hello James,

Thanks for taking the time to give such a precise response.     A couple questions--

--what are the risks of MSE?    I have asked several doctors and they said "none" except that it does not work.  And yet I can't help thinking that playing around with breaking sutures in the skull might have its risk (especially as one cannot control which sutures split).    I checked online in research articles and could find no consequences.   Could I ask what you think they may be?

--with the greater tongue space with FAGGA.   I also needed that because I have a very retruded maxilla as well:  and accomplished 3 mm with arch-braces.  These 3 mm made for a great improvement (although still not enough).      Can I ask if you what I do?  Now that my tongue has space to actually be more on the palate, I use it minute-by-minute to press against the first molars to do my own expansion.  It seems to work as day by day I feel more comfortable (of course the flexible titannium arch wires help).    But it is certainly not palate but teeth I am trying to move.   My imw is only 28.5  so any push is helpful.

--can I ask how uncomfortable FAGGA is and whether it takes up tongue space or makes it difficult to talk?    I see your concern is braces, which is not mine as I don't find braces so uncomfortable (albeit yes will be nicer without).  But these palate expanders frighten me.  Doesn't it feel like your mouth is cramped with some bulky object that makes the lack of mouth space even worse?

--can you please tell me who the doctor in another country is?  I ask because I am in Europe and it is very hard to find anyone doing palate expanders here, and my most feasible option is to move to California and do it with Won Moon's students at UCLA.

Thanks for any insights.

 

 

 

entelechy

ReplyQuote
Posted : 01/10/2019 7:50 pm
theadonisking
New Member

Hey James and Entelechy, so is it normal with  retruded maxilla/mandible to not feel like being able to mew ?

If i do the mew swallow hold i cant breathe, and have difficulty getting the tongue up the whole palate since i have a steep hard palate, and soft palate i cant really feel the tongue

ReplyQuote
Posted : 01/10/2019 8:44 pm
entelechy
Active Member

@theadonisking

Impossible to Mew, in my opinion, with tongue not having enough space to lay flat on palate--- since retruded maxilla/mandible crams back the tongue.

Mike Mew also mentions that some cannot Mew due to lack of tongue space on some video.   

An ENT looked at my CT scan recently and saw my tongue laying low in the back where it should be on the soft palate.   It literally cannot reach the soft palate.  Only the middle of the palate.

You might want to try this an experiment.  relax your mouth and close it, and let your tongue go forward about 5-7 millimeters between your front teeth: so it is literally sticking out (but keep mouth closed).

Now swallow.    If you are like me, it should be easy to swallow, and you can even raise your tongue (with a tiny bit of practice) up on the soft palate and Mew.  

If this is the case, it means your tongue to be able to act normally needs further forward space.    This is my whole interest in doing Fagga or some other anterior epansion device.  

Or if I don't, I will need to get used to keeping my tongue a little outside my teeth (can't tell with mouth closed and it is not uncomfortable) and curling up against the back of the front teeth.    Makes breathing much better too, as the tongue is no longer so back that it is blocking the trachea (a major cause of sleep apnea/snoring)

Does that make sense?    It could be however that I am different because I am a case of premolar extraction/retraction:  which artificially retruded the maxilla and mandila, and my tongue just doesn't fit this abnormal "mutilation."

 

 

 

entelechy

ReplyQuote
Posted : 01/10/2019 9:04 pm
entelechy
Active Member

@james

This is fascinating James.  Right now as my mandible is more forward than before (due to the top anterior teeth having moved a few mm), nothing touches in my occlusion.   I am baffled how it will all come together.  I love your point about how when it goes from V to U, it will all line up.  Question: why is this?  and how long does it take for that V to become a U?    I think this is one of my main goals.

 

entelechy

ReplyQuote
Posted : 01/10/2019 9:12 pm
entelechy
Active Member

@amandaangrypanda

Can I ask what you did with the spaces that FAGGA produced? Wouldn't that have given you more tongue space? Did you close them with arch wire---could this too have contributed to getting the TMJ back, the fact that the archwires retracted the occlusion to close spaces?

entelechy

ReplyQuote
Posted : 01/10/2019 9:15 pm
theadonisking
New Member
Posted by: @entelechy

@theadonisking

Impossible to Mew, in my opinion, with tongue not having enough space to lay flat on palate--- since retruded maxilla/mandible crams back the tongue.

Mike Mew also mentions that some cannot Mew due to lack of tongue space on some video.   

An ENT looked at my CT scan recently and saw my tongue laying low in the back where it should be on the soft palate.   It literally cannot reach the soft palate.  Only the middle of the palate.

You might want to try this an experiment.  relax your mouth and close it, and let your tongue go forward about 5-7 millimeters between your front teeth: so it is literally sticking out (but keep mouth closed).

Now swallow.    If you are like me, it should be easy to swallow, and you can even raise your tongue (with a tiny bit of practice) up on the soft palate and Mew.  

If this is the case, it means your tongue to be able to act normally needs further forward space.    This is my whole interest in doing Fagga or some other anterior epansion device.  

Or if I don't, I will need to get used to keeping my tongue a little outside my teeth (can't tell with mouth closed and it is not uncomfortable) and curling up against the back of the front teeth.    Makes breathing much better too, as the tongue is no longer so back that it is blocking the trachea (a major cause of sleep apnea/snoring)

Does that make sense?    It could be however that I am different because I am a case of premolar extraction/retraction:  which artificially retruded the maxilla and mandila, and my tongue just doesn't fit this abnormal "mutilation."

 

 

 

I don't know, i don't feel anything different when i swallow like that, i don't know what it feels to mew i think lol.

Like when  i say singggg like people suggest to mew and open my mouth i can see the tongue going up but don't feel it touching the palate at all if that makes sense.

ReplyQuote
Posted : 01/10/2019 11:12 pm
Page 10 / 11
Share:

As you undergo correction in the near future, please consider keeping records for your own sake and for others. Pictures of dental impressions, scans, medical reports reports can be very helpful even with all personally identifying information blocked out.

Your input could help many, many people

Face Development

Please Login or Register