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

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Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: Sam

@Axilla Ronny explains in his blog that his face looks longer because of the molar build ups that will eventually be removed.

He also explains that his chin looks further back because of his new neck posture. His old neck posture compressed his vertebrae aggravating the nerves in his neck=migraines. His head posture made his head tilt back which in turn made his jaw position up and forward. Since his face has grown forward, his tongue is now in a more forward position and allows him to elongate his neck and tuck his chin somewhat, with out his tongue blocking his air passage. Most of this info is on his blog titled: Esther Gokhale’s One Mistake. He has worked very hard to achieve this neck posture and was the reason for his venture into AGGA.

Keep in mind, Ronny’s journey is about migraine cure. 

Just a note on forward head posture, such condition is usually accompanied with retruded lower jaw.  Military neck is the condition that causes the lower jaw to just forward.

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

 
Posted : 01/05/2018 6:00 am
Sam
 Sam
(@sam)
Eminent Member
 

@rogerramjet

Thanks for taking questions. It is so helpful. Here are some I am hoping you can answer:

1. Do you know the amount of time (a range) you would be wearing braces if you were not doing implants?. From your previous reply, it seems like it took 8 months for 1 set of teeth to be moved forward to close spaces. Does that mean it would take more then 24 months to move all teeth forward? I think the first sets of teeth to move would be the easiest since they are the smallest.

This seems like it could be a 3 year process for those who do not need/want implants.

2. Is there a lot of discomfort from wearing the braces? Do you remember if there is more or less discomfort from your original braces?

3. You said one of the facial changes you see is broader cheekbones. Do you mean wider sideways or do you see more forward projection of your front and lower cheekbones?

I know the first question maybe unanswerable. No worries. Just happy you are willing to do this.

 

 

 
Posted : 01/05/2018 6:00 am
Sam
 Sam
(@sam)
Eminent Member
 
Posted by: abdul
Posted by: Sam

@Axilla Ronny explains in his blog that his face looks longer because of the molar build ups that will eventually be removed.

He also explains that his chin looks further back because of his new neck posture. His old neck posture compressed his vertebrae aggravating the nerves in his neck=migraines. His head posture made his head tilt back which in turn made his jaw position up and forward. Since his face has grown forward, his tongue is now in a more forward position and allows him to elongate his neck and tuck his chin somewhat, with out his tongue blocking his air passage. Most of this info is on his blog titled: Esther Gokhale’s One Mistake. He has worked very hard to achieve this neck posture and was the reason for his venture into AGGA.

Keep in mind, Ronny’s journey is about migraine cure. 

Just a note on forward head posture, such condition is usually accompanied with retruded lower jaw.  Military neck is the condition that causes the lower jaw to just forward.

I don’t think Ronny’s aim is military posture. I have invited him on this forum to help clear up speculation on many subjects around his treatment. I hope he joins us!

 
Posted : 01/05/2018 6:00 am
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: Sam
Posted by: abdul
Posted by: Sam

@Axilla Ronny explains in his blog that his face looks longer because of the molar build ups that will eventually be removed.

He also explains that his chin looks further back because of his new neck posture. His old neck posture compressed his vertebrae aggravating the nerves in his neck=migraines. His head posture made his head tilt back which in turn made his jaw position up and forward. Since his face has grown forward, his tongue is now in a more forward position and allows him to elongate his neck and tuck his chin somewhat, with out his tongue blocking his air passage. Most of this info is on his blog titled: Esther Gokhale’s One Mistake. He has worked very hard to achieve this neck posture and was the reason for his venture into AGGA.

Keep in mind, Ronny’s journey is about migraine cure. 

Just a note on forward head posture, such condition is usually accompanied with retruded lower jaw.  Military neck is the condition that causes the lower jaw to just forward.

I don’t think Ronny’s aim is military posture. I have invited him on this forum to help clear up speculation on many subjects around his treatment. I hope he joins us!

I didn’t mean that. What I meant that since he had forward head posture in the previous picture normally his lower jaw would be retruded backward not jutted forward. When you fix forward head posture your lower moves forward. If you try the chin tuck exercise you will see how the lower front teeth move forward to push against the upper ones.

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

 
Posted : 01/05/2018 6:00 am
Sam
 Sam
(@sam)
Eminent Member
 
Posted by: abdul
Posted by: Sam
Posted by: abdul
Posted by: Sam

@Axilla Ronny explains in his blog that his face looks longer because of the molar build ups that will eventually be removed.

He also explains that his chin looks further back because of his new neck posture. His old neck posture compressed his vertebrae aggravating the nerves in his neck=migraines. His head posture made his head tilt back which in turn made his jaw position up and forward. Since his face has grown forward, his tongue is now in a more forward position and allows him to elongate his neck and tuck his chin somewhat, with out his tongue blocking his air passage. Most of this info is on his blog titled: Esther Gokhale’s One Mistake. He has worked very hard to achieve this neck posture and was the reason for his venture into AGGA.

Keep in mind, Ronny’s journey is about migraine cure. 

Just a note on forward head posture, such condition is usually accompanied with retruded lower jaw.  Military neck is the condition that causes the lower jaw to just forward.

I don’t think Ronny’s aim is military posture. I have invited him on this forum to help clear up speculation on many subjects around his treatment. I hope he joins us!

I didn’t mean that. What I meant that since he had forward head posture in the previous picture normally his lower jaw would be retruded backward not jutted forward. When you fix forward head posture your lower moves forward. If you try the chin tuck exercise you will see how the lower front teeth move forward to push against the upper ones.

My bad. I did not explain it clearly. Ronny did not have forward neck posture. He had compressed neck posture. You can see the difference in his before and after photos. He is aiming for primal posture. If you go to his blog, he explains it more clearly then I did.

Quoted from his blog:

“3) Neck Elongation – The neck is elongated rather than compressed, and an imaginary line from the center of the ear to the tip of the nose is angled downward.”

This would cause his chin to tuck.

Copied from Ronny’s blog:

 
Posted : 01/05/2018 6:00 am
test151515
(@test151515)
Eminent Member
 
Posted by: rogerramjet

 

Oh, I should say re: measurement of growth. My dentist didn’t measure the gaps created as such; particularly as these gaps seem to be created unevenly (similar to Ron) and it’s likely that your teeth will likely have to be slightly corrected back to midline anyway because of that uneven growth; mine certainly did. Measurements are rather taken from the base of the upper central incisors to the tip of your nose. I imagine there’s some sort of golden ratio that needed to be achieved. I feel like 38mm was mentioned as being ideal, but I can’t be remember with certainty?

 

Thanks again for answering!

I want to ask you regarding the text I quoted above. Are you saying that your doctor chose to expand with the AGGA until the sagittal distance between a certain point of the tip of your nose and your central incisors had decreased to about 38 mm?

I want to ask some questions regarding the blocks that are inserted on your rear lower molars. In your earlier comment you wrote: “initially the face is longer because blocks are inserted on your rear lower molars when the AGGA is installed so that your teeth can occlude forwards. These blocks are progressively ground down at each check up as the forward growth happens so that the teeth eventually meet again for the braces phase.”

What would happen if these blocks would not be present during the process? I am not as familiar with all the dentistry language as I should be by now (also I am not a native English speaker), so I want to ask you: What do you mean when you write “so that your teeth can occlude forwards”?

Is the job of the blocks to make it so that teeth can move forwards? Would teeth-to-teeth contact between upper and lower molars prevent such movement and do the blocks prevent such contact?

I want to ask you what happened as these blocks were taken out. Did you have an open anterior bite (meaning that you upper and lower molars did not make contact while you bite down) that needed to be addressed? Sorry if some of these questions are a bit stupid, but I simply don’t know a lot about this all yet.

You mentioned earlier that you had “inadvertent mewing/muscular development taught as part of the AGGA process. ” I wonder, what were you taught? Was it only things related to your tongue or did you for example also chew to develop your masseters or something of the sort?

Lastly, I want to ask regarding the “Controlled Arch” device you have used for your lower dental arch while expanding with the AGGA. What precisely was its purpose and how was it used in you? Did it push against certain teeth?

 
Posted : 01/05/2018 6:00 am
rogerramjet
(@rogerramjet)
Trusted Member
 
Posted by: Sam

1. Do you know the amount of time (a range) you would be wearing braces if you were not doing implants?. From your previous reply, it seems like it took 8 months for 1 set of teeth to be moved forward to close spaces. Does that mean it would take more then 24 months to move all teeth forward? I think the first sets of teeth to move would be the easiest since they are the smallest.

This seems like it could be a 3 year process for those who do not need/want implants.

This is good question and not one I can answer with certainty, simply because everyone’s rate of movement is different. I know other patients of my practitioner whose teeth have moved much faster than mine have.

Also keep in mind that I don’t have exact records of dates; I’ve been looking back through my phone at pictures I took at various stages of treatment and looking at their dates to work out milestones. Once treatment is finished, I’ll be bugging my practitioner for a copy of all of the professional photos taken along the way, and x-rays, cone beams, etc.

That said, I had braces applied in July 2017, and both premolars had moved forward by March 2018. Interestingly, even though my left gap was larger and the premolar required more movement (in mm), it touched in January and my right premolar even though travelling less far (in mm) was the laggard. So there is definitely asymmetry in how these things grow and move!  

The decision about implants was easier for me because I wanted an entire complement of teeth again, but for those of you without extractions, yes I guess it could be a lengthy process moving each pair forward unless you’ve got fast moving teeth.

There are also other things you can do during treatment, like those teeth vibrator things, ozone and laser treatment to speed things up, the types of brackets used, etc. There are a lot of variables here.

But yes, could be a long slow process.

2. Is there a lot of discomfort from wearing the braces? Do you remember if there is more or less discomfort from your original braces?

I would say no more or less discomfort than any other type of braces. I’ve had braces on twice previously as a kid/adolescent and besides the usual post-adjustment pain there is nothing unusual about the braces phase of treatment to me.

See my previous post about those pesky gaps being a shitfight with crunchy foods though!

3. You said one of the facial changes you see is broader cheekbones. Do you mean wider sideways or do you see more forward projection of your front and lower cheekbones?

I would so more forward, and *slightly* broader.

I saw slightly broader because optically there have been changes to all of my face, particularly the lower jaw and this may be causing an optical illusion. That is, my lower jaw is now in it’s correct place allowing me to engage and train my jaw muscles properly. People now say I have a square jaw, and that certainly didn’t used to be the case. I had a very weak looking jaw.

Forward, I can definitely see it in profile photos.

I know the first question maybe unanswerable. No worries. Just happy you are willing to do this.

No worries, happy to answer questions. I wish this forum and this information had been available to me years ago. Trust me, I looked and looked hard! So more than happy to help others out there.

 
Posted : 01/05/2018 6:00 am
rogerramjet
(@rogerramjet)
Trusted Member
 

I want to ask you regarding the text I quoted above. Are you saying that your doctor chose to expand with the AGGA until the sagittal distance between a certain point of the tip of your nose and your central incisors had decreased to about 38 mm?

Don’t get hung up on the 38mm, because that was said with no certainty.

But yes, there seemed to be a goal to get advancement to a certain distance between teeth and nose tip. This may have just been in my circumstances though, or it could have just been done every adjustment to track progress. I don’t know with certainty.

I want to ask some questions regarding the blocks that are inserted on your rear lower molars. In your earlier comment you wrote: “initially the face is longer because blocks are inserted on your rear lower molars when the AGGA is installed so that your teeth can occlude forwards. These blocks are progressively ground down at each check up as the forward growth happens so that the teeth eventually meet again for the braces phase.”

What would happen if these blocks would not be present during the process? I am not as familiar with all the dentistry language as I should be by now (also I am not a native English speaker), so I want to ask you: What do you mean when you write “so that your teeth can occlude forwards”?

Is the job of the blocks to make it so that teeth can move forwards? Would teeth-to-teeth contact between upper and lower molars prevent such movement and do the blocks prevent such contact?

The blocks were put in place to eliminate any potential contact between the anterior 6 (I knew there was a phrase for these!) and any other teeth. That way they can move forward without any interference of the lower teeth.

This was a pretty rough time because you had to learn to chew on essentially your back pads only, and when your chewing has been reduced to around a third of what you’re used to, it makes eating a lot more time consuming.

It gets easier with each adjustment though. As I said, as the anterior 6 progress forward,  the lower jaw naturally seems to slide forward to meet them and the blocks are gradually reduced to more chewing surface area becomes available to you.

I want to ask you what happened as these blocks were taken out. Did you have an open anterior bite (meaning that you upper and lower molars did not make contact while you bite down) that needed to be addressed? Sorry if some of these questions are a bit stupid, but I simply don’t know a lot about this all yet.

I had very small stumps left of blocks at the start of the braces phase, and again these have been reduced to basically nil as the braces have progressed and teeth have been raised, corrected, etc.. My bite now meets together.

You mentioned earlier that you had “inadvertent mewing/muscular development taught as part of the AGGA process. ” I wonder, what were you taught? Was it only things related to your tongue or did you for example also chew to develop your masseters or something of the sort?

Wasn’t taught about chewing per say. The focus was on tongue posture, nose breathing, tapping the acrylic pad repeatedly, swallowing and opening your mouth with correct tongue posture, etc.

I was also recommended to tape my mouth shut at night and falling asleep in correct tongue posture. This has been great – I can’t recommend it enough.

My masseters seem to have grown largely through my jaw finally being engaged in the correct location for a change, and also chewing and swallowing with good tongue posture. I can feel them engaged when I swallow correctly.

Lastly, I want to ask regarding the “Controlled Arch” device you have used for your lower dental arch while expanding with the AGGA. What precisely was its purpose and how was it used in you? Did it push against certain teeth?

I also had the controlled arch on top; it too formed part of my braces with the tube on the sides.

This was much more important on top than it was on the bottom – it is designed to maintain the shape of your arch and forward growth you have achieved in the AGGA during the braces phase.

There’s a lot of metal in your mouth and it takes some getting used to.

 
Posted : 01/05/2018 6:00 am
Apollo, test151515, Apollo and 1 people reacted
rogerramjet
(@rogerramjet)
Trusted Member
 
Posted by: Sam

 

Copied from Ronny’s blog:

This is what I was referring to in one of my earlier posts. I’ve seen the same transition to the “ideal” neck posture.

 
Posted : 01/05/2018 6:00 am
EddieMoney
(@eddiemoney)
Noble Member
 
Posted by: test151515
Posted by: Allixa

It sounds like no one really knows for sure what’s going on. It would be nice if we could get some clear before/after x-rays to know for sure. I did my best to try and figure out what the FAGGA actually does based on the photos and x-rays we have in the other thread. I’m pretty confident that my analysis in the other thread is correct. If you go to that thread and read all of my posts in there carefully you will see my position on the device. Everyone is saying that it provides forward movement but based on the evidence, it looks like it actually creates BACKWARDS movement while flaring the teeth. I think there might be an illusion going on, and I’m basing that on the actual images and xrays that we have so far. But I want better and clearer proofs and xrays if we can get them. 

It certainly seems tricky to figure out what may have happened by looking at the photos in question. I suspect that it can be problematic to try to come to conclussions by looking at distances and angles between certain points in the photos. The red lines you have used to compare might for example not be of much use if the position of the eye sockets and the eyes themselves, and the position of the nose, have changed as a result of growth/remodeling and/or movement of bones in many areas of the skull (including the maxilla). I have noticed changes in myself in my 8 months of mewing/powermewing in areas such as my eye sockets, my nose and even my forehead (in addition to changes for my maxilla/mandible). I for example believe that my nose has moved to a more forwards position since I started. I have had to adjust my glasses by bending the very back part that goes above the ears. At a certain point my glasses started to tilt. I had to bend them by making them fit a longer distance. Given this it seems obvious to me that the distance from ears to nose has increased in me since I started. I started at a very collapsed/underdeveloped state which probably is a big reason as for why I have changed so much since then and in so many areas.

I do think it is a bit strange that his mandible does not seem to have come forward as much as his maxilla seems to have developed forwards (assuming this has happened, which I believe is the case). Perhaps this is a result of the mandible not catching up with his rapid maxilla growth. I wonder if he now has a distance between his lower incisors and his upper incisors. On the other hand, perhaps the mandible has come forward sufficiently but the pouting lips make it look like it has not. The pouting lips could possibly have a lot to do with his massive flaring. The pictures compared above are from 21 weeks into his treatment, he posted pictures from 20 weeks into his treatment where massive flaring can be seen. The way I see it such major flaring should alone be responsible for a significant amount of unwelcomed lip pouting.

I have asked many doctors about whether a lower device usually is needed or not when palatal expanders are used and they explain that “sometimes it is needed, sometimes it is not since the mandible and the lower dental arch for some seem to change to match the changes in the maxilla and the upper dental arch”.  One doctor explained that the younger the person the more likely a lower device is not needed. All in all I got the impression that it for adults was less common for the mandible to change to match the upper changes and that some intervention for the mandible/lower dental arch usually is needed. So if the case is so that Ronalds mandible/lower arch has not sufficiently developed to match the maxilla development then perhaps that could explain why his lower third of his side profile in the pictures above does not look quite right. If so then I wonder if things could have developed better had he done the process at a slower speed, or at a younger age. However, right now I do believe that the major reason as for why his lower third in the side profile looks the way it looks is because of major flaring (which can be seen in the pictures he shows from 20 weeks into treatment).

All in all I ask myself the following: Why not aim for doing the same thing in half the time to see if things develop better/in a more stable way? For example, so that teeth flaring can be avoided/controlled for during the process. Ronald clearly has changed very fast, he recently wrote on his blog that he took the device out a bit since he had changed so rapidly.

Edit: I will copy paste a message I wrote on Ronalds blog below:

“I do believe you have gotten forward growth of your maxilla but I now believe that there is a third option that may need to be examined in order for you to conclude that you have gotten true maxillary forward growth without unwelcomed side effects.

What if the gaps to a certain degree have been created by the teeth moving forwards without sufficient amounts of additional bone growth?

That would mean that the frontal teeth would see more and more flaring while the premolars/canines/incisors push each other forwards. Perhaps the constant force of the plastic oval thing communicates to the body that “more space is needed for the tongue” and as such growth/remodeling takes place to make for more space. But what happens if not enough bone can be grown/remodeled at the rate the constant stimuli by the oval thing signals is necessary? Then perhaps teeth would move even when not sufficient bone mass is being created. Could this be the cause of the teeth flaring?

Perhaps teeth flaring during the process should be avoided at all costs for this reason. Perhaps you have gone about the process at too high of a speed. After all you can only grow so much bone in a certain amount of time.”

I am just brainstorming here, but I really do think that teeth flaring never is a good sign and I wonder why he has seen it during his FAGGA treatment.  I do believe it is the reason as for why his lips are pouting the way they pout right now.

 

If his maxilla really grew that much the mandible wouldn’t need to play catch up. Truthfully the wider maxilla can just allow the mandible to jut forward more to the new position. Ever since starting mewing my lip pout had only decreased but then again my teeth haven’t tipped at all.

A maxilla that grows allowed a mandible to come forward to meet it. Even if the mandible didn’t change at all. These lip pouts really make me believe this dude just had teeth tipping because it seems his mandible had no room to move forward. 

 
Posted : 01/05/2018 6:00 am
EddieMoney
(@eddiemoney)
Noble Member
 

When I say his chin looks worse I account for his chin tuck. I mean the lower lip pouts too much which creates a weak chin look. Almost as if the distance between lower incisors and chin decreased, which would make the chin poke out less.

 
Posted : 01/05/2018 6:00 am
Amber12
(@amber12)
Eminent Member
 

Does this facebook post by John Mew not essentially establish that he thinks that the FAGGA works:

Most of you appear to concentrate on moving the teeth , maxilla or mandible mechanically. Remember these are living structures. I am not saying that this approach does not work because it obviously does but it is not natural and will relapse within a few years if the cause of the problem (oral posture) is not corrected. Of more importance to me, the faces never quite look as good, look at the lips, cheeks chin shape, eyes etc:

I introduced this concept forty years ago making clear at the time that the posture HAD to be corrected describing appliances that I designed to do this..Yes they are difficult to use but posture is hard to change and as far as I know there are no alternatives.

I see many of you getting nice results by mechanical orthodontic means, but worry that your patients will face later relapse. In my view only Orthotropics or something similar which corrects posture will ultimately succeed.

So hes saying that it works, but will relapse/not be as good without proper oral posture.

But….does this not mean that it works? So…he’s agreeing that it works? I thought that they were in disagreement? Because if relapse is the only issue here I’d gladly pay for myofunctional therapy during and after in exchange for 1mm+ of forward growth per month!

 I may be reading this wrong. He’s very specifically discussing the FAGGA, and says that it obviously DOES restore the proper form of the skull/maxilla – just that it will relapse without tongue posture?

I found it posted 14weeks ago in their facebook group 

 
Posted : 01/05/2018 6:00 am
Apollo and Apollo reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

@amber12 Can you please post the link to this specific facebook topic?

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

 
Posted : 01/05/2018 6:00 am
Amber12
(@amber12)
Eminent Member
 
Posted by: Abdulrahman

@amber12 Can you please post the link to this specific facebook topic?

I can’t figure out how do do that. But if you got to the CFAG facebook page and copy paste this in the search bar:

“I’ve been looking at various appliances for a while now”

The thread will show up. The thread is started by Timothy McLachlan and shows a FAGGA before after that we’ve already seen here. If someone else could link the topic for others that would be nice

John Mew’s quote is the last comment in the thread 

 
Posted : 01/05/2018 6:00 am
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: Amber12
Posted by: Abdulrahman

@amber12 Can you please post the link to this specific facebook topic?

I can’t figure out how do do that. But if you got to the CFAG facebook page and copy paste this in the search bar:

“I’ve been looking at various appliances for a while now”

The thread will show up. The thread is started by Timothy McLachlan and shows a FAGGA before after that we’ve already seen here. If someone else could link the topic for others that would be nice

John Mew’s quote is the last comment in the thread 

What is the CFAG facebook page? I tired searching with that acronym but got nothing related.

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

 
Posted : 01/05/2018 6:00 am
TGW
 TGW
(@admin)
Prominent Member Admin
 

As promised, I went to discuss this device with an LVI dentist. The doctor was kind enough to give me an entire hour for questions and to show me before/afters free of charge.

1. The dentist has only been using this method/device for a relatively short period of time, and this was reflected in the amount of material that he had available to show me. A reluctance for older patients to seek treatment which requires braces tilted the sample heavily towards children; I did see results for a ~30 year old and a ~60 year old. This was mostly profile photographs and inter-oral photographs, showing proper development of the maxillary arch in all patients. There was definite increases in jawline definition, lip support, undereye support, decrease in nasolabial angle, more angular submentals, and more prominent cheekbones. 

2. For most cases that I saw, and all adult cases, the doctor said that he could have expanded much further if the patient had complied. Most patients wanted the treatment wrapped up as soon as symptoms (such as TMJ or Class I/II) went away, so the device was removed so that the smile could be aligned. He seemed to stress that very few patients were actually expanding their maxilla all the way to genetic potential. He also acknowledged that there is an epidemic of such craniofacial dystrophy, which is why people expand to “normal” instead of to their genetic blueprint. 

3. I saw ceph scans, but cannot comment on them positively or negatively without seeing a ceph trace. The maxilla appears to have moved forward in the scans, but I simply do not have the ability to look at side-by-side ceph scans and be able to accurately tell whether bones have moved. In completed cases there was no indications of teeth being flared or titled. 

4. Most importantly, the doctor confirmed to me that the FAGGA device stimulates bone formation both at the premaxilla as well as at the nasomaxillary sutures at the posterior of the maxilla. While this is only verbal confirmation rather than proof, it was a major concern for many here (including myself).

The doctor graciously discussed sharing some of these before/after cases with the community here, but we will have to take a rain-check on this until after a review of the local patient privacy laws. Hopefully in upcoming months. 

It was a very long discussion,  feel free to ask me questions because I have not covered everything that we talked about. But I should have been asleep 5+ hours earlier, so off to bed I go.

 
Posted : 01/05/2018 6:21 am
Makmama, Apollo, rogerramjet and 5 people reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

Awesome. I think it’s normal that you could not see much difference without cephalometric tracing, because as the doctor stated most patients did not undergo a major change. There was a case study linked several posts ago for a patient with class 3 that was treated to class 1 and her angle changed from 80° to 83°. Her before and after cephalometric scans did not show a significant difference to notice, but the tracings and more so the pictures did.

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

 
Posted : 01/05/2018 9:30 am
Sam
 Sam
(@sam)
Eminent Member
 
Posted by: TGW

 

1. The dentist has only been using this method/device for a relatively short period of time, and this was reflected in the amount of material that he had available to show me. A reluctance for older patients to seek treatment which requires braces tilted the sample heavily towards children; I did see results for a ~30 year old and a ~60 year old.

Thank you for sharing this info. You may not be able to answer some of my questions, but I am curious to know, if the adult cases the dentist showed you were his completed cases? I am also very interested in the completed dental aspect. The intraorals that you saw, did they include the front facing smile of the patient to see If the smile was widened and how the teeth looked in relation to the face? 

I am also interested to know what you thought of the facial aesthetics of the completed adult cases, comparing before and after. Was there a noticeable improvement or just a different appearance, good, bad or neutral?

Did these cases have implants after expansion or teeth all brought forward to close spaces? If so do you know the amount of time the patients were in braces for the latter? 

My concerns are mainly about dental safety and altered appearance.

Thanks again

 

 

 
Posted : 01/05/2018 7:33 pm
Amber12
(@amber12)
Eminent Member
 

New update from here

https://www.migrainehacks.com/new-blog-1/2018/5/5/25-weeks-with-agga

Thoughts? It’s very hard to put my finger on what changed, but it’s definitely better by a considerable margin. One thing: His masseter muscles look bigger

Looking at the side view, I cannot make sense of what is going on with the bones of the skull here. Ear position, head rotation changes not reflected in the frontal view.  Could this be an example of what Mew talked about with the before/after scans being unhelpful since everything moves in relationship with each other so it just looks…completely different?

 
Posted : 07/05/2018 4:22 am
EddieMoney
(@eddiemoney)
Noble Member
 

If his palate expanded then why does his mouth look more narrow? His lips became puffier too indicating that teeth tipping occurred. 

 
Posted : 07/05/2018 5:23 am
Allixa
(@allixa)
Reputable Member
 
Posted by: Amber12

 

His entire face got pushed down and backwards towards his ears which is why the pictures look so different. I predicted this would happen in my earlier posts. His lips puff out indicating teeth flaring. Jaw doesn’t look like it came forward much if any either.

My mind is made up about this device.

 
Posted : 07/05/2018 6:13 am
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: Allixa
 
His entire face got pushed down and backwards towards his ears which is why the pictures look so different. I predicted this would happen in my earlier posts. His lips puff out indicating teeth flaring. Jaw doesn’t look like it came forward much if any either.

My mind is made up about this device.

That’s because he corrected his head position. Correct anyone’s forward head posture and watch their face shrink down and backward and reveal its true cranial facial destrophy. The fact that this guy’s face is slightly forward in the after picture proves he had allot of forward movement. Match the head rotation of the before and after and then compare the faces and you will see this. If I had the time I would have done it but I am traveling on a project.  

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

 
Posted : 07/05/2018 9:44 am
EddieMoney
(@eddiemoney)
Noble Member
 
Posted by: Abdulrahman
Posted by: Allixa
 
His entire face got pushed down and backwards towards his ears which is why the pictures look so different. I predicted this would happen in my earlier posts. His lips puff out indicating teeth flaring. Jaw doesn’t look like it came forward much if any either.

My mind is made up about this device.

That’s because he corrected his head position. Correct anyone’s forward head posture and watch their face shrink down and backward and reveal its true cranial facial destrophy. The fact that this guy’s face is slightly forward in the after picture proves he had allot of forward movement. Match the head rotation of the before and after and then compare the faces and you will see this. If I had the time I would have done it but I am traveling on a project.  

But correcting forward head position would cause the mandible to come forward more. But his lips pout more indicating that teeth flaring occurred. When a chin tuck is done and the neck is elongated,  lips become less pouty due to the mandible coming forward 

 
Posted : 08/05/2018 12:01 am
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: EddieMoney
 
But correcting forward head position would cause the mandible to come forward more. But his lips pout more indicating that teeth flaring occurred. When a chin tuck is done and the neck is elongated,  lips become less pouty due to the mandible coming forward 

Yes doing that brings the mandible forward and brings the maxilla backward in relation. When I correct all of my 3cm forward head posture my lower jaw moves forward of my upper as if I changed from class 2 to class 3 malocclusion.

As for the lips I am not entirely sure about that part. I will try to make the tracing and post it in few days so you can see what I mean.

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

 
Posted : 08/05/2018 9:39 am
EddieMoney
(@eddiemoney)
Noble Member
 
Posted by: Abdulrahman
Posted by: EddieMoney
 
But correcting forward head position would cause the mandible to come forward more. But his lips pout more indicating that teeth flaring occurred. When a chin tuck is done and the neck is elongated,  lips become less pouty due to the mandible coming forward 

Yes doing that brings the mandible forward and brings the maxilla backward in relation. When I correct all of my 3cm forward head posture my lower jaw moves forward of my upper as if I changed from class 2 to class 3 malocclusion.

As for the lips I am not entirely sure about that part. I will try to make the tracing and post it in few days so you can see what I mean.

Realistically there is no reason why lips should pout MORE when forward head posture is fixed. When the chin gets stronger, lips pout less because the lower incisors coming forward make the soft tissue become more lax. Retract your mandible and see what I mean. This is also why women have fuller lips than men, because their narrower palate causes their mandible to sit further back inside their maxilla. 

 
Posted : 08/05/2018 9:29 pm
Keengo
(@keengo)
Estimable Member
 

This is questionable. The slight change it brings doesn’t seem to be worth $10,000 dollars.

I’ve achieved almost like 75% of what these before/afters have shown with a $0 grocery bag and face pulling for like 3 months now. Haven’t seen mandible CCW rotation much, but I’m patient for some things at least…. Anyways I wouldn’t consider this unless it wasn’t so damn expensive for results I’m not far off from myself spending nothing on.

** The face pulling “bag method” — https://the-great-work.org/community/main-forum/face-pulling/#post-3902 **
** Keengo Chin Tuck method w/force (WIP)– https://the-great-work.org/community/main-forum/chin-tuck-with-added-force-chin-tuck-2-0-new-theory-inside/ **

 
Posted : 09/05/2018 12:51 am
Makmama and Makmama reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

Here is the comparison I promised. Using the frankfort plane and the facial plane you can see how much forward growth Ronny achieved. In the before picture he had moderate forward head posture. That’s why the frankfort plane is tilting 6° upward but its still intersects with the facial plane at 90°.  In the after picture his forward head posture seems to be completely corrected so I placed the frankfort plane at 0° and intersected it with the facial plane at the same point. Note how much forward growth Ronny achieved. His entire face moved forward not just the teeth. That’s an impressive improvement but if I am not mistaken Ronny had extraction before, so big part of it can be due to regains.  

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

 
Posted : 10/05/2018 8:21 am
mewchell and mewchell reacted
Allixa
(@allixa)
Reputable Member
 

Those lines do prove that his jaw has come forward in relation to his forehead. Absolutely.

However, they don’t prove whether the jaw came forward compared to where it used to be, or if the forehead actually went backwards, or a combination of both, or if the flaring was the only reason the jaw came forward (meaning the face didn’t come forward too). The only way to do that is use actual measurements (in pixels, inches, mm, etc) to measure how much further the skull bones moved from the ears. We can try and approximate that by lining up his ears in photoshop and making sure they are the same size and same rotation, and then measuring in both photos from there.

Since you took the time to make this image, I will try and make the next one. We have to be really careful to get this right because there’s a lot of false claims about devices out there.

Another photo that could help is the fading from one photo to the other, but having both photos locked in at the ears.

 
Posted : 10/05/2018 8:32 am
EddieMoney
(@eddiemoney)
Noble Member
 

There still should be no reason for teeth flaring. His chin looks weaker. In most if not all cases of mewing, the chin looks stronger afterwards but that didn’t happen here. 

 
Posted : 10/05/2018 8:57 am
Allixa
(@allixa)
Reputable Member
 

I didn’t get the ears perfect but they are close enough. The ears being the same size and same rotation and in the same place makes the transformation in the photograph all about the skull bones only, and not about rotation or camera distance or whatever. Like I said it’s not perfect but it’s close enough for what we need.

If the before photo in the gif was actually the after photo, people would be lining up for miles to get the work done.

 
Posted : 10/05/2018 9:26 am
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: Allixa

I didn’t get the ears perfect but they are close enough. The ears being the same size and same rotation and in the same place makes the transformation in the photograph all about the skull bones only, and not about rotation or camera distance or whatever. Like I said it’s not perfect but it’s close enough for what we need.

If the before photo in the gif was actually the after photo, people would be lining up for miles to get the work done.

I looked at the individual layers of the gif. You basically tilted the before picture a little (1-2°) and moved it forward. This lined up the ears but placed the nose and face in the before picture ahead of the after picture. It also left the back of the head in the before picture ahead of the after picture, and there lays the problem.

 

The head (face) moved forward in the before picture at the expense of the back of the head. That’s why it appears to you that the face receded in the after picture. You also did not tilt the picture enough; this is because you depended on ear orientation. It seems reasonable to do that except that correcting the forward head posture in the before picture requires more tilting to achieve that.

 

I don’t think this is a reasonable comparison and I think soft tissue analysis gives a better view.

 

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

 
Posted : 10/05/2018 2:10 pm
TGW
 TGW
(@admin)
Prominent Member Admin
 
Posted by: Sam
Posted by: TGW

 

1. The dentist has only been using this method/device for a relatively short period of time, and this was reflected in the amount of material that he had available to show me. A reluctance for older patients to seek treatment which requires braces tilted the sample heavily towards children; I did see results for a ~30 year old and a ~60 year old.

Thank you for sharing this info. You may not be able to answer some of my questions, but I am curious to know, if the adult cases the dentist showed you were his completed cases? I am also very interested in the completed dental aspect. The intraorals that you saw, did they include the front facing smile of the patient to see If the smile was widened and how the teeth looked in relation to the face? 

I am also interested to know what you thought of the facial aesthetics of the completed adult cases, comparing before and after. Was there a noticeable improvement or just a different appearance, good, bad or neutral?

Did these cases have implants after expansion or teeth all brought forward to close spaces? If so do you know the amount of time the patients were in braces for the latter? 

My concerns are mainly about dental safety and altered appearance.

Thanks again

 

 

There was a good noticeable difference, but he repeated that for the adult cases they pulled the plug as soon as symptoms of TMJ stopped and so they were not as impressive as they should have been – only a few mm of expansion. I only saw completed cases.

The front facing photos of patients had more of the arch showing (wider smile). It was aesthetically pleasing compared to the before photos. But given the age of the patients the small changes were less noticeable due to either facial fat or looser skin. These were not the ideal candidates for before/after comparison, Ronny’s case (migrainehacks) is far more informative than the adults that I saw.

The children’s cases had very noticeable aesthetic improvements from all angles. Massive positive changes that were clearly a return to proper growth. 

There was a mix between people getting implants and those doing controlled arch – but both took between 6 months to a year depending on how much the AGGA had separated their eye/canine teeth from the premolars. 

 

 
Posted : 10/05/2018 5:22 pm
Sam and Sam reacted
TGW
 TGW
(@admin)
Prominent Member Admin
 

Another AGGA reponse. I asked:

 

When the maxilla normally grows (due to both displacement and active growth) it both moves forward and also seems to rotate counter-clockwise (anterior moves superiorly, posterior moves inferiorly).

As the goal of of the AGGA is 3D remodelling to proper growth, does it also cause this rotation? In cases such as that of Ronny Ead, is it a possibility that rather than incisors/front teeth tipping, the bone is actually moving into its proper superior position but tips in relation to the back molars which are fixed in place by the device? Are some posterior open bites caused by the maxilla not having fully rotated as it did not grow to its potential ?

In short: If the maxilla is deficient in growth, and counter clockwise rotation is part of that growth, then does restoring the growth include this rotation?

Doctor David Buck answered:

The face must grow out from underneath the cranium which is largely complete by around age 6 or so. The preferred path of growth of the Nasomaxillary complex would be 70% forward and 30% down. The net vector of growth is thus down, but more forward. When growth is corrupted there is some degree of excess vertical growth of the Nasomaxillary complex, and not enough forward growth. This is the norm for our society (85+%) due to a number of factors. Since the face has no direct genetic blueprint it is totally responsive to the soft tissues acting on it during breathing, swallowing, eating and resting, and so on. During stimulation from the AGGA the remodeling is 3 dimensional and may include forward and upward development that failed to develop during growth. The back molars are not fixed in place, and in fact the AGGA has no restrictive qualities about it other then to hold the front six teeth so that cortical drift can take place. The body is free to correct all kinds of distortions in the corrupted Maxilla including passive transverse molar width; yaw in the Maxilla; roll and pitch in the Maxilla; superior movements and so on. Further, while in AGGA treatment I have an osteopath/craniopath who works in my office to see patients who have cranial strain patterns which further reduces pain and symptoms I deal with in my patient population. The AGGA allows for profound cranial releases to occur. These strains impact the dura and create tension and inadequate movements of fluid around the brain and spinal cord creating a myriad of symptoms. The body knows where things are supposed to be, for example I often see impacted teeth drop into place after growth appliance treatment that creates room for them to erupt. This is unlike the results with any other type of “expansion” appliance. I say this because of the true growth/remodeling activity of the AGGA is superior. By the way,the actual terms we use are correct facial growth is counter clockwise and corrupted growth would be clockwise.

 

 
Posted : 13/05/2018 5:04 am
Apollo and Apollo reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

@admin This is really great feedback, thanks for sharing it. How are you asking questions, directly by email or through their Facebook page?

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

 
Posted : 13/05/2018 10:00 am
seii
 seii
(@seii)
Active Member
 

So guys a little bit of background here. 

I’m a general dentist, I’m occasionally symptomatic with my TMD, I have snoring issues and also post exo orthodontics…. and my dad has major OSA. I’ve been discussing having treatment with one of my best mates who is also a GP but practices the Gallela method… and I’m having treatment in the near future. I started reading up more on this because as you all know, a majority (not all) of the world does practice traditional orthodontics… and very recently my mate got into trouble because mid treatment this patient started doubting her FGGA and went for a 2nd opinion with a very famous and well known orthodontist, and he pretty much said its impossible to grow bone… so and so… 

Personally I have had a year experience working with a very talented but arrogant oral maxillofacial surgeon and I have seen what surgery can do… I did lots of photo editing while working there and I think I’m pretty handy with my self taught photoshop skills.  

I just could not bear seeing you guys misunderstand this treatment so I’ve taken it to myself and spent the past hour or so trying to get this image right. I had to alter the original photo because there was clearly a difference in angulation so it isn’t a completely accurate side profile, therefore I did stretch the image a little using the external ear point (porion – highest and frontmost position of the earhole) and the nasion which is the midpoint depression between the eyes as my landmarks. I also brightened up the image a little. It is by no means perfect, but it definitely shows a difference. You can clearly see the changes in the posture and the position of the top lip. The changes in the chin comes later in treatment. 

I hope this helps and I hope the patient doesn’t mind the editing 🙂

Photo credit to  https://www.migrainehacks.com/new-blog-1/2018/5/5/25-weeks-with-agga

Before_SideProfile.gif

 
Posted : 13/05/2018 4:23 pm
rogerramjet, paradise, Sam and 5 people reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

Thanks for sharing your input. Do you think you can share with us a sample from your friend of a completed case?

Posted by: seii

The changes in the chin comes later in treatment. 

 Can you explain what happens to the chin later in treatment and how?

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

 
Posted : 13/05/2018 6:08 pm
EddieMoney
(@eddiemoney)
Noble Member
 
Posted by: seii

So guys a little bit of background here. 

I’m a general dentist, I’m occasionally symptomatic with my TMD, I have snoring issues and also post exo orthodontics…. and my dad has major OSA. I’ve been discussing having treatment with one of my best mates who is also a GP but practices the Gallela method… and I’m having treatment in the near future. I started reading up more on this because as you all know, a majority (not all) of the world does practice traditional orthodontics… and very recently my mate got into trouble because mid treatment this patient started doubting her FGGA and went for a 2nd opinion with a very famous and well known orthodontist, and he pretty much said its impossible to grow bone… so and so… now my buddy is possibly facing legal actions and it’s just a shitshow.

Personally I have had a year experience working with a very talented but arrogant oral maxillofacial surgeon and I have seen what surgery can do… I did lots of photo editing while working there and I think I’m pretty handy with my self taught photoshop skills.  

I just could not bear seeing you guys misunderstand this treatment so I’ve taken it to myself and spent the past hour or so trying to get this image right. I had to alter the original photo because there was clearly a difference in angulation so it isn’t a completely accurate side profile, therefore I did stretch the image a little using the external ear point (porion – highest and frontmost position of the earhole) and the nasion which is the midpoint depression between the eyes as my landmarks. I also brightened up the image a little. It is by no means perfect, but it definitely shows a difference. You can clearly see the changes in the posture and the position of the top lip. The changes in the chin comes later in treatment. 

I hope this helps and I hope the patient doesn’t mind the editing 🙂

Photo credit to  https://www.migrainehacks.com/new-blog-1/2018/5/5/25-weeks-with-agga

Before_SideProfile.gif

Of course we can see the position of his top lip change. For worse. 

The lower part of the lips came forward indicating teeth flaring.

At the rate he was going I wouldn’t be surprised if he developed a bimax/alveolar prognathism profile. And how is that indicative of forward growth? 

This pic below shows the correct way of upper lip repositioning 

Yes the upper lip comes forward when the maxilla does. But all of it, not just the bottom part like in a pout. Prognathic profiles are NOT forward grown, they are what happens when the maxilla recesses and causes the teeth to flare out. Humans are not naturally prognathous. No infant is born with prognathism indicating it is a degeneration due to environment. Sorry but I am not convinced with this false “angularity” that masquerades as forward growth to the untrained eye. The maxilla isn’t suspended in thin air. If it moves, everything else does so there is no reason for a forward movement of the maxilla to affect the lower face this way and increase the lip pout/make the nasolabial angle smaller. Because if the maxilla grows outwards, the mandible will naturally follow/rotate to maintain occlusion . 

 
Posted : 14/05/2018 2:12 am
seii
 seii
(@seii)
Active Member
 
Posted by: Abdulrahman

Thanks for sharing your input. Do you think you can share with us a sample from your friend of a completed case?

Posted by: seii

The changes in the chin comes later in treatment. 

 Can you explain what happens to the chin later in treatment and how?

I’m sorry I don’t have completed photos as he only started doing this treatment about a year ago… lots of completed FGGAs but the pictures all just look the same like Ronalds on his blog.

I probably shouldn’t have said changes to the chin. But as you grow the maxilla to its full genetic potential the mandible can then reposition forward to where it should ideally be), the condyle remodels – so you end up having a less steep mandibular angle and often times a more prominent jaw line (if i’m not mistaken, I haven’t actually done the course yet).

 
Posted : 14/05/2018 2:47 pm
seii
 seii
(@seii)
Active Member
 
Posted by: EddieMoney
 
Of course we can see the position of his top lip change. For worse. 

The lower part of the lips came forward indicating teeth flaring.

At the rate he was going I wouldn’t be surprised if he developed a bimax/alveolar prognathism profile. And how is that indicative of forward growth? 

This pic below shows the correct way of upper lip repositioning 

Yes the upper lip comes forward when the maxilla does. But all of it, not just the bottom part like in a pout. Prognathic profiles are NOT forward grown, they are what happens when the maxilla recesses and causes the teeth to flare out. Humans are not naturally prognathous. No infant is born with prognathism indicating it is a degeneration due to environment. Sorry but I am not convinced with this false “angularity” that masquerades as forward growth to the untrained eye. The maxilla isn’t suspended in thin air. If it moves, everything else does so there is no reason for a forward movement of the maxilla to affect the lower face this way and increase the lip pout/make the nasolabial angle smaller. Because if the maxilla grows outwards, the mandible will naturally follow/rotate to maintain occlusion . 

Hey buddy, (are you angry? you sound angry lol)

I was a little confused by some of your statements so hopefully I get it correct.

At this stage there is definitely some flaring but not created by the FGGA. The FGGA is meant to grow the A point forward, so as the maxilla grows forward his teeth have gone forward and and as the entire premaxilla moves forward obviously at this stage it props the lower part of the upper lip forward as well. You can probably see this clearer in the intraoral photos with his teeth showing on his blog. It will always look worse before it looks better. The FGGA’s main aim is to grow the A point forward. And when it has grown to its full genetic potential there will be more than enough space to just tuck those teeth back easily. So I reckon you just have to be a bit more patient and when he goes into the brackets and braces the lower part of his lip should look a little better. 

I truly don’t understand the photos you’ve posted tho, they do not look like they are taken in the correct angle and I do not understand what you are trying to get across? Sorry!

But rather than focus on the lips at this stage, I want you to try to see the difference in the base of the nose where you would measure your naso-labial angle and see how much the A point has changed – usually only a few mms but it makes so much difference.

You guys can also try watching Dr Anne-Maree Cole’s videos to get a better idea perhaps 🙂

 
Posted : 14/05/2018 3:00 pm
Makmama, Miandra, Makmama and 1 people reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: seii
 
I’m sorry I don’t have completed photos as he only started doing this treatment about a year ago… lots of completed FGGAs but the pictures all just look the same like Ronalds on his blog.

I probably shouldn’t have said changes to the chin. But as you grow the maxilla to its full genetic potential the mandible can then reposition forward to where it should ideally be), the condyle remodels – so you end up having a less steep mandibular angle and often times a more prominent jaw line (if i’m not mistaken, I haven’t actually done the course yet).

 

Thanks. I think I understand what you mean, as the maxilla moves up and forward the mandible follows by rotation.

I made this illustration using a cephalometric xray that I found online. I think it can illustrate what you are describing about the chin. In it’s default setting the POG point is a bit behind the ID point and the angle between them is 35°. By rotating the picture 15° the angle between them decreases and so does the space. This will make the chin appear larger. Does this match what you are describing? 

One more thing, you mentioned remolding taking place at the condyles, does this mean gonial angle of the mandible will decrease?

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

 
Posted : 14/05/2018 6:29 pm
starJammer
(@starjammer)
Eminent Member
 

Hey guys, the discussion is lively here and I thought I might be able to contribute a bit in a significant way.

I read through all 8 pages of this thread so far and hopefully I’ve got my ducks in a row.

First, regarding Ronny’s before and after pics and the lip flaring indicating teeth flaring. I want to point out that his before pic is, as I suspect, before his appliance was even installed. After the appliance is installed the top lips have two metal tips artificially pushing them further forward than they might otherwise be. This explains the puffiness that others have attributed to teeth flare. A more accurate comparison would be to compare a before pic when the appliance has just been installed and an after pic some time later like he has. However, the dental office he went to probably did not take a side profile picture after appliance installation. Why do I say this, because I went to the same place he did and after installation I had frontal pictures taken but no profile pics. 

 

That leads me to the second thing I wanted to contribute. I’m JUST starting my own treatment at the same location Ronny is going to. This is….day 4.

 

This being day 4, I didn’t feel any pressure at all after installation and I definitely don’t feel the same sort of discomfort that braces gave. I’ve been able to eat without much discomfort. Most of the discomfort is coming from an irritation on my tongue and the top lips that rest on the hooks of the appliance.

 Edit: If you go to Ronny’s page and exam the picture where he is smiling, you can see that there is a metal bracket around his bicuspids and those are the ones that have the metal tips protruding into the top lips. I’m on day 4 but the tips are highly annoying as they irritate the lip tissue.

 
Posted : 15/05/2018 1:30 am
Makmama, Apollo, Makmama and 1 people reacted
starJammer
(@starjammer)
Eminent Member
 
Posted by: Keengo

This is questionable. The slight change it brings doesn’t seem to be worth $10,000 dollars.

I’ve achieved almost like 75% of what these before/afters have shown with a $0 grocery bag and face pulling for like 3 months now. Haven’t seen mandible CCW rotation much, but I’m patient for some things at least…. Anyways I wouldn’t consider this unless it wasn’t so damn expensive for results I’m not far off from myself spending nothing on.

@Keengo, I’ve been asking the same question. I’ve started my own treatment, 4 days in, but am still wondering “Is it worth it?”. I’m curious about what you have been doing and how you have achieved good results. I’m not sure what you mean by 75% results achieved either. Any details or reference post? I read through all the pages but didn’t see any previous posts from you. 

I tried to improve posture myself for some time and I definitely achieved postural changes. Not sure I achieved structural changes, however. I definitely noticed a difference in my breathing as well as my swallow posture but I attributed that to just posture changes. I probably didn’t do the same things you have. My self help was just tongue/throat exercises and a persistent focus on my tongue posture. 

 
Posted : 15/05/2018 2:25 am
seii
 seii
(@seii)
Active Member
 

@abdulrahman yes to your picture! 🙂 as i replied on the other thread

When the maxilla is in its final position the mandible will rotate upwards and upright. As it slowly settles into its final position the gonial angle changes. It will decrease and get closer to a 90degree angulation due to remodelling – as all the muscles will be in a new position – especially the masseter. 

@starjammer

I reckon it is definitely worth it. the improvement you will get from an enlarged airway will help you sleep so much better, improve your quality of life… it should reduce your risk of developing OSA and with it the decrease in the risk of getting a stroke, heart attack etcetc… so much more.
I get depressed when I can tell someone has airway issues, can fix it and doesn’t 🙁

 
Posted : 15/05/2018 8:29 am
rogerramjet
(@rogerramjet)
Trusted Member
 
Posted by: seii

@abdulrahman yes to your picture! 🙂 as i replied on the other thread

When the maxilla is in its final position the mandible will rotate upwards and upright. As it slowly settles into its final position the gonial angle changes. It will decrease and get closer to a 90degree angulation due to remodelling – as all the muscles will be in a new position – especially the masseter. 

@starjammer

I reckon it is definitely worth it. the improvement you will get from an enlarged airway will help you sleep so much better, improve your quality of life… it should reduce your risk of developing OSA and with it the decrease in the risk of getting a stroke, heart attack etcetc… so much more.
I get depressed when I can tell someone has airway issues, can fix it and doesn’t 🙁

I’ve just had a controlled arch phase after approx 10 months of AGGA phase. I’m about to go into my second AGGA phase.

I’ll ask my dr at my next appointment for my latest ceph scan to seen what changes have come about now that tipping has been corrected in braces/CA phase.

 
Posted : 15/05/2018 8:42 am
Apollo, seii, Apollo and 1 people reacted
rogerramjet
(@rogerramjet)
Trusted Member
 
Posted by: EddieMoney

 

9 pages to get the answer. Better late than never 

I know you’re skeptical about this device, but do we need the negativity?

 
Posted : 15/05/2018 8:43 am
seii
 seii
(@seii)
Active Member
 

I would like to chip in that most practitioners you see providing this treatment would have likely had it themselves, are considering to, or have done it for a family member. And these are people who work in the industry. If i was trained in it already, the first thing I would try to do is pop this appliance in my dad and my two sisters mouth! XD At this stage I’m trying for find for a practitioner that does it where they live but it hasn’t gotten there yet :((

 
Posted : 15/05/2018 8:55 am
SUGR1
(@sugr1)
Eminent Member
 

Hi all, my friend Seii has brought me here. I am her friend she mentioned in earlier posts. 

Like Seii I am a dentist who has a passion for airways health mainly due to my own experience with sleep apnoea and other issues. My personal journey has shaped how I now help many adults with their smiles and airways.

I have skimmed through the posts thus far and wanted to clarify this treatment. I am a student of Steve Galella and Anne Maree cole and my clinical protocols are shaped by their work. Most Lvi dental practitioners doing this treatment would have similar treatment protocols due to Anne Maree’s involvement in LVI. 

When you first start this treatment you have a fixed Agga cemented in. At this stage pads or placed on your lower molars to achieve two purposes…

1. disclusion of molars to allow for freedom of movement

2. Opening anterior bite to not bite on bonded on wire. (the wire behind front upper teeth must be bonded or else to brisk severe flaring which is not what the treatment is intended to do). 

 When you initially start with Agga it is developing the anterior maxilla through a remodelling process. Once you have reached your ideal position you will most likely have the following presentations 

1. Space between upper canine and first bicuspid 

2. Significant increased overjet, as you have simply translated the position of the upper incisors forward with growth guidance 

3. Maybe some forward sliding of discludes mandible (this does not always happen, especially if they do not have good lip/tongue posture and breathing habits). 

If yoy were to take a side profile photo now you would notice more lip support, possibly an appearance of bimax ptotrusive, and often lower lip posture is worse if the mandible has not come forward. This illusion is due to the large over jet and the change in lip shape to achieve lip competence. It may seem the dimple of the lower lip is exaggerated.

If you take a cbct at this stage it may also look quite strange. You might not see a huge difference radiographic ally because new bone remodelling is often not visible on cbct. Cbct are extremely low dose imaging which do not have a high affinity for non mineralised bony matrix. It is important to understand that the cells for bone development are all there and if you study dental bone biology you will understand the most important driver of alveolar bone (bone supporting teeth) is driven by the periodontal ligament which is also there. In fact for a cbct to illustrate true bony changes u would likely have to wait >3 month post Agga completion to see true changes… By this stage you will often have started controlled arch orthodontic therapy.

The real magic really only starts during orthodontic therapy… That is when you will correct upper lip angle by adjusting the incisors and slowly working to bring the upper posterior teeth forward one by one. This also greatly helps with mandibular repositioning in a forward position. The occkussal pads I spoke about earlier are still present and this means only the molars are biting. This opening of the other teeth causes muscle contractions to rotate the mandible forward giving it a more horizontal growth trajectory. With my personal experience for those with deep bites to begin with, this may often be unfavourable… 

I love the enthusiasm of this group, keep it going!

 
Posted : 15/05/2018 9:28 am
mewchell, Makmama, Apollo and 9 people reacted
starJammer
(@starjammer)
Eminent Member
 

@SUGR wow thank you for all that information. Since I’ve just started I’m excited to see the details you’ve added.

I hope my posture is good enough to begin mandibular repositioning earlier. Any advice there? Since it just got in installed my swallow has been affected due to an ulcer on my tongue and the discomfort but I maintain my tongue up and pressing against the pad on my palate. I’ve been mouth tapping successfully months before the installation and since the molar pads are there I’m letting my mandible advance forward to where it feels more comfortable.

I’m glad you shed light on the x-rays too. I did some reading on bone development but didn’t know that woven bone, or non-mineralized bone, won’t show up well in x-rays.

 

Once again, so excited you posted those details.

 
Posted : 15/05/2018 9:43 am
Makmama, seii, Makmama and 1 people reacted
SUGR1
(@sugr1)
Eminent Member
 

Congrats starjammer on starting this exciting journey.

Any ulcers etc make sure you tell your dentist as it can often be a sharp corner etc that can be permanently covered up. Of course you can also cover with wax temporarily. 

With agga the biggest factors are lip seal, tongue posture and of course nasal breathing. But you can speed up the signalling by tapping on the acrylic pad on your palate rather than just maintaining a constant pressure.  

The body is very good at ignoring constant pressure after a while, where as on/off stimulus causes more signalling potential. This is why for example you will hear the benefits of bone deposition when standing on vibration plates at certain frequencies(hertz) for osteoporosis etc.

As a side, I have plenty of patients who do not do the Big 3 and too commonly  after 3 months they have 1mm of agga growth only… So for me this alone shows the treatment is not simply about the appliance springs putting force on teeth.. Because if it was it would not matter the other factors…

As you attend your appointments the dentist will recontour your molar pads to adjust for your changes in mandibular position. Sometimes if the change is significant you may need new pads altogether!

 
Posted : 15/05/2018 10:06 am
Makmama, Apollo, starJammer and 3 people reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 
Posted by: SUGR

 

But you can speed up the signalling by tapping on the acrylic pad on your palate rather than just maintaining a constant pressure.  

How do you tap on the pad?

As a side, I have plenty of patients who do not do the Big 3 and too commonly  after 3 months they have 1mm of agga growth only…

Are the big 3 the ones you mention below?

With agga the biggest factors are lip seal, tongue posture and of course nasal breathing.

Regarding the comment below:

So for me this alone shows the treatment is not simply about the appliance springs putting force on teeth.. Because if it was it would not matter the other factors…

I thought the appliance springs placed the pressure on the pad which rested on the Palatal Rugae?

 

One last question at this point the fagga appliance procedure has been covered quite nicely, but there is one subject that I have never seen covered: inter-molar width. Is there a minimum width to starting this treatment and does it actually increase the width as an added benefit? It’s also important to ask how do you measure inter-molar width in the standard you use, just so we can understand your number better.

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

 
Posted : 15/05/2018 11:22 am
Greensmoothies
(@greensmoothies)
Reputable Member
 
Posted by: SUGR

Congrats starjammer on starting this exciting journey.

Any ulcers etc make sure you tell your dentist as it can often be a sharp corner etc that can be permanently covered up. Of course you can also cover with wax temporarily. 

With agga the biggest factors are lip seal, tongue posture and of course nasal breathing. But you can speed up the signalling by tapping on the acrylic pad on your palate rather than just maintaining a constant pressure.  

The body is very good at ignoring constant pressure after a while, where as on/off stimulus causes more signalling potential. This is why for example you will hear the benefits of bone deposition when standing on vibration plates at certain frequencies(hertz) for osteoporosis etc.

As a side, I have plenty of patients who do not do the Big 3 and too commonly  after 3 months they have 1mm of agga growth only… So for me this alone shows the treatment is not simply about the appliance springs putting force on teeth.. Because if it was it would not matter the other factors…

As you attend your appointments the dentist will recontour your molar pads to adjust for your changes in mandibular position. Sometimes if the change is significant you may need new pads altogether!

Very interesting, I’d been wondering about “pulsing” the tongue on the palate vs just applying constant pressure as is done with Mewing.

Thanks for sharing this information with us. I know skin is said to best remodel the same way as with LED light therapy, for example, so wondered if it worked likewise with bone.

Remember this pain… and let it activate you.

 
Posted : 15/05/2018 12:22 pm
SUGR1
(@sugr1)
Eminent Member
 

You use the tip of the tongue to tap the pad, like a pulsing action. I say to patients imagine you are doing gym work. Push the tongue into the pad and increase pressure and relax and repeat. I have patients who are fanatical about this advice and at the first month review you see already 2mm of remodelling!

But those who do not or have other pre-existing myology disorder which may have been missed (Eg tongue tie) present at 4-5 month into tx with minimal gains.

Yes big three are lip seal, tongue posture and nasal breathing. 

The appliance puts force you would imagine on rugae and teeth. Many skeptic say you are simply pushing the teeth through it or even out of bone… Does it happen? Yes I have definitely seen it. Do I think it’s a problem- no give it time and bone will come. But for me the fact that those without the big three fail to get growth shows it is obviously not just a force issue. No one is exactly sure of the histological process but those who do the procedure would probably agree there is some sort of force on the dental alveolar complex. I alluded it to this previously by saying teeth develop bone. In the absence of teeth the alveolar bone disappears Always… just matter of time. If you care to read into it a Japanese surgeon called Mitsuhiro Tsukiboshi is a leader in a procedure called auto transplantation. He essentially takes a took such as non functional wisdom teeth and put it into a site missing teeth, often into a site with no prior teeth and deficient bone. . Months to years later the tooth is completely encased in bone. If you ask him why this happens. He will tell you it’s the Periodontal Ligament Cells. 

For me it’s a a philosophic question of the chicken and the egg. Does the bone form continuously as you move the anterior maxilla forward or is it a bit of the teeth are being pushed forward and this result in new bone forming around it? I do not have the answer to this.  There is current research being undertaken by taking bone cores in the area of the new bone formed when they place Implants. 

Intermolar width is an interesting concept with respect to Agga treatment. Professor Timothy Bromage who is behind much of the science behind this approach to bone remodelling believes the body has preset ratios which are physiologically maintained… Or you might even look at it as genetic mathematical programming. And that there is a relationship between molar width and anterior posterior dimension. He believes that anterior posterior is the true driver of the size of jaw, ie correct this and the width will auto correct to a degree. I have seen this happen a few times but would not say currently in my experience it is definite.  So they argue if you are doing more traditional maxillary expansion often there is high relapse because you have not changed anterior posterior dimension so the maths is off… And the body fights you.. 

There is no minimum or maximum Intermolar or intercanine width to do Agga. The controlled arch technique can easily control inter molar width as it has a lingual arch with strong steel wire that can easily push the molars our wider if need be. 

In controlled arch mechanics we aim for 56-60mm of maxilla Intermolar width. We measure from buccal to buccal. Hence lower molar widths are 52-56mm. Other techniques use different reference points. 

 

 Included an image of a auto transplant case from his book. 

 
Posted : 15/05/2018 3:21 pm
paradise, seii, paradise and 1 people reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

Thank you very much for this detailed and through explanation. It really sheds light on the very interesting concepts behind the fagga treatment. There are few points I would like to better understand.

Posted by: SUGR

 

No one is exactly sure of the histological process but those who do the procedure would probably agree there is some sort of force on the dental alveolar complex. I alluded it to th is previously by saying teeth develop bone. In the absence of teeth the alveolar bone disappears Always just matter of time. If you care to read into it a Japanese surgeon called Mitsuhiro Tsukiboshi is a leader in a procedure called auto transplantation. He essentially takes a took such as non functional wisdom teeth and put it into a site missing teeth, often into a site with no prior teeth and deficient bone. . Months to years later the tooth is completely in cased in bone. If you ask him why this happens. He will tell you it’s the Periodontal Ligament Cells.

I agree with your comment but have to wonder how placing a none functioning tooth in the alveeolar bone can lead to bone growth if the nerve is not connected? After all, how does the body know a tooth exist without a nerve connection?

 

Posted by: SUGR

Intermolar width is an interesting concept with respect to Agga treatment. Professor Timothy Bromage who is behind much of the science behind this approach to bone remodelling believes the body has preset ratios which are physiologically maintained… Or you might even look at it as genetic mathematical programming. And that there is a relationship between molar width and anterior posterior dimension.

Can you please explain what is the anterior posterior dimension?

 

Posted by: SUGR

He believes that anterior posterior is the true driver of the size of jaw, ie correct this and the width will auto correct to a degree. I have seen this happen a few times but would not say currently in my experience it is definite.  So they argue if you are doing more traditional maxillary expansion often there is high relapse because you have not changed anterior posterior dimension so the maths is off… And the body fights you..

This is interesting. What is your thoughts on Dr John Mew Orthotrpic theory that facial muscle function and posture, primary of the tongue, determines the width and depth of the arch? And that people are growing with smaller jaws because they are not learning to use their facial muscles correctly by replacing breast feeding with bottles and replacing a hard diet with a soft one.

 

Posted by: SUGR

In controlled arch mechanics we aim for 56-60mm of maxilla Intermolar width. We measure from buccal to buccal. Hence lower molar widths are 52-56mm. Other techniques use different reference points. 

Is this measurement done on the first molars? The measurement standard we are following here in the forum is the one developed by Dr. Mew. It’s made between the lingual sides of the first upper molars, hence the ideal width is 44mm and the minimum is 38mm. Most people in developed countries have 29-34mm width according to Dr. Mew. I wounder how those figures compare to your method if they were taken from the same position.

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

 
Posted : 15/05/2018 3:58 pm
SUGR1
(@sugr1)
Eminent Member
 

We are really getting into deep and nittey dentistry but I’ll try to explain in short.

Your teeth has a nerve which detects hot and cold and direct dental stimulus. The actual proprioception of a tooth is in fact via the periodontal ligaments. This can be proved due to different nerves pathways having different sensory functions. So a tooth without a nerve still gives the body proprioception. In embryology as your teeth is developing the different cells also talk to each other to let each other (induction) know what to do next in a very clear sequence of steps to build teeth structure and periodontium. So when you transplant a tooth with live cells to a new site the cells actually speak and signal the surrounding cells to do stuff – lay down bone, lay down blood vessels etc. Teeth have nerves and blood vessels which enter at the apex. There are plenty of teeth in people’s mouth which have the nerve severed but blood supply is intact. So that is why sometimes testing a tooth to see if it dead or alive with cold tests etc do not work. If you want to be sure if there is blood vessels you need to take a Doppler imaging, much like how the pulse oximeters work. With mitsuhiro’s cases many will need root canal treatment after transplantation.

I am a big fan of the Mew and orthotropic movement. It is also in my to do list of training and I want to do ALF. Steve galella is also a huge fan of Mew and has personally been tutored by him.

The concept of the big three is pretty much similar to Mews beliefs. As part of all my orthodontic consults especially with children I often spend an hour tracing all the way back to infantile diet and behaviour. I ask about breast feeding, childhood illnesses, speech problems and much more and assess tongue posture and habits and I even observe their gait because I believe it is all related. I am a strong believer that a lot of the poor myology results in underdeveloped Jaws which then causes airway compromise. This then causes adaptation which further worsens muscle, posture and habits such as mouth breathing. This is a topic that we could discuss for days and I would recommend some great work by Dr German Ramirez. Just YouTube his work especially on mouth breathing in children..  

The measurements are of first molars. As galella learnt a lot from Dr Mew I would say the numbers we are referencing are essentially the same, just different reference points. Sometimes I find different professionals want their own famous references so might come up with their own numbers to reference. I use the Mew indicator line ruler for every patient I see who needs treatment to help determine where I need to treat to.

A dental cotton roll is exactly 38mm wide… I use it all the time to check the width of first upper molars if it fits loosely then its a good sign. If I have to bend it then I know we need to look more closely at the problems at hand. 

 Photo shows a poor paint job of a dental roll in the mouth… 

 
Posted : 15/05/2018 4:32 pm
seii and seii reacted
Abdulrahman
(@abdulrahman)
Prominent Member
 

Thanks @sugr

There is just one part that I think you missed. I know I asked allot of questions.

Posted by: SUGR

Intermolar width is an interesting concept with respect to Agga treatment. Professor Timothy Bromage who is behind much of the science behind this approach to bone remodelling believes the body has preset ratios which are physiologically maintained… Or you might even look at it as genetic mathematical programming. And that there is a relationship between molar width and anterior posterior dimension.

Can you please explain what is the anterior posterior dimension?

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

 
Posted : 15/05/2018 4:55 pm
seii
 seii
(@seii)
Active Member
 

The spatial dimension of the maxilla from front to back 🙂 

 
Posted : 15/05/2018 6:03 pm
Sam
 Sam
(@sam)
Eminent Member
 

SUGR, seii

I have sent you a private message. You can make it public if you wish. 

 
Posted : 15/05/2018 11:31 pm
starJammer
(@starjammer)
Eminent Member
 
Posted by: Sam

SUGR, seii

I have sent you a private message. You can make it public if you wish. 

I’m curious about it.

 
Posted : 15/05/2018 11:58 pm
starJammer
(@starjammer)
Eminent Member
 
Posted by: seii

The spatial dimension of the maxilla from front to back 🙂 

@seii thanks for being a resource here on the forum. Given that you seem to have the most knowledge about how this device functions and I just started my treatment, how long before I start to see/feel some difference? 

I suppose I’m anxious to see the spaces developing between incisor and bicuspids even though it’s the first week. I’ve been “pulsing” as you suggested and when drinking liquids I’m taking small sips so I can increase the frequency of my swallows and use them to push forward on the plastic during each swallow. 

 

I should just be patient. It’s JUST week 1 right?

 
Posted : 17/05/2018 5:34 am
Makmama and Makmama reacted
starJammer
(@starjammer)
Eminent Member
 
Posted by: seii

The spatial dimension of the maxilla from front to back 🙂 

@seii thanks for being a resource here on the forum. Given that you seem to have the most knowledge about how this device functions and I just started my treatment, how long before I start to see/feel some difference? 

I suppose I’m anxious to see the spaces developing between incisor and bicuspids even though it’s the first week. I’ve been “pulsing” as you suggested and when drinking liquids I’m taking small sips so I can increase the frequency of my swallows and use them to push forward on the plastic during each swallow. 

 

I should just be patient. It’s JUST week 1 right?

 
Posted : 17/05/2018 5:34 am
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