Notifications
Clear all

NOTICE:

DO NOT ATTEMPT TREATMENT WITHOUT LICENCED MEDICAL CONSULTATION AND SUPERVISION

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

Let's all argue about whether MSE is better than DNA

Page 2 / 2
toomer
Estimable Member
Posted by: @thomas22

I tripped over a comment by Ira Shapira.

 

He said that one of the reasons he likes the dna appliance is because it will drop the roof of your mouth, unlike MSE.

But what happens when you remove the appliance in MSE? It makes sense to me that the palate would start to drop once you did that. 

This was one of the criticisms that Ronald Ead eventually made for AGGA.  He noted that even if it was expanding things forward (which he was doubting) it wasn't doing anything to deal with the vaulting of the palate and drop it down.  

But the DNA/Homeoblock inventors specifically noted that in their patent in 2004, that that was one of the reasons why other split-palate acrylic appliances hadn't delivered results - because they were up against the top of the palate entirely, and thus there was no room for it to "drop" down as expansion occurred, and thus over a period of time too much force was imparted into the teeth.  That's why DNA providers grind down the top to make sure it's not making contact.  And then many patients eventually feel as though it's touching again - which is an indication that the palate has dropped down.

I have no idea if MSE creates that dynamic or not.  I don't think I've ever heard it mentioned, but I don't want to assume it doesn't happen.

ReplyQuote
Posted : 02/02/2021 4:01 pm
Thomas22 liked
greyham
Eminent Member
Posted by: @apollo

@greyham @toomer

Now that MSE has expanded my maxillary arch significantly wider than my mandibular arch, my orthodontist plans to use invisalign to bring my bite back together and close my diastema. I think this might include not only buccally tilting the lower teeth but also lingually tilting the upper teeth. I want to keep as much tongue space as possible. I know Dr. Ting sometimes uses a quad helix expander on the mandible. I have an old removeable acrylic expander that still fits my lower arch. I've debated trying to use it to get any potential bone bending or remodeling on the bottom during my MSE retention phase before I start the clear aligners to minimize the requirement for dental tilting. Given your experience, I wonder if you have any advice for using this kind of expander. How slowly would you recommend advancing turns? Should I make partial turns every few days when it doesn't feel as tight, or full 1/4mm turns all at once every week or more? If I want to try intermittent cycling, I should alternate on and off every hour during the day, and then use the expander throughout the whole night? Do you have any other recommendations? Is this a bad idea? Thanks for your help!

That's a really interesting question @apollo; I've always wondered what MSE users do about their mandible.

I turn my lower mRNA appliance one 1/4mm turn per week and cycle it hourly during the day as far as practical, plus using it throughout the night; all exactly as you describe. Sounds like a great idea to me, and I'd be keen to hear how it goes.

ReplyQuote
Topic starter Posted : 03/02/2021 4:43 am
Apollo liked
Apollo
Reputable Member
Posted by: @greyham

That's a really interesting question @apollo; I've always wondered what MSE users do about their mandible.

I turn my lower mRNA appliance one 1/4mm turn per week and cycle it hourly during the day as far as practical, plus using it throughout the night; all exactly as you describe. Sounds like a great idea to me, and I'd be keen to hear how it goes.

Thanks @greyham, I remember reading on your blog that you advanced farther with the upper while the lower was delayed for the dentist to make fit adjustments to avoid ulcerating your gums. Once those hotspots were filed down, have you been advancing the upper and the lower at the same rate, or do you sometimes subjectively feel that the lower is still tight while the upper is loose and decide to turn the upper before the lower? I guess what I'm asking is if you stick to the predetermined protocol of 1 turn per week top and bottom or if you adapt the schedule based on how it feels. One issue I've noticed with my lower schwartz-style expander is that the screw seems to wind itself backward, maybe when I pop the appliance in and out. So I'm not actually making the progress I think I am. I'll think that it is feeling less snug after about a week and decide to advance the screw, but if I wind it all the way closed and count the turns I find that it had reversed itself and advancing a turn would just put me back where I started. If I try to advance it another turn to where it should be based on the schedule, then it feels uncomfortably tight. This is probably an issue with my mechanism or how it was fabricated, so I've been trying to count the turns every day to make sure it is set where I want it to be and not gradually backtracking. I have 4 more days before I'm due to advance again if I follow the 1 turn per week schedule.

ReplyQuote
Posted : 03/02/2021 12:28 pm
greyham
Eminent Member

@apollo

I generally stick to the one-turn-per-week schedule on both when I don't have an impingement, and my lower appliance is lagging behind the upper by 1.2 mm since I've had more lower impingements. But oddly enough I wound the lower appliance forward mid-week last week for the first time in 4 months because it was so loose. Thanks for the heads-up on the screw isn't winding itself back; I'm pretty sure that isn't happening for me because it's always at the start/end-of-turn position when I do an advance but I'll keep an eye on it to make sure it's in the end-of-turn position each day and isn't doing something sneaky behind my back; or jaw.

ReplyQuote
Topic starter Posted : 03/02/2021 2:55 pm
Apollo liked
Apollo
Reputable Member
Posted by: @greyham
Posted by: @apollo
 
One issue I've noticed with my lower schwartz-style expander is that the screw seems to wind itself backward, maybe when I pop the appliance in and out. So I'm not actually making the progress I think I am. I'll think that it is feeling less snug after about a week and decide to advance the screw, but if I wind it all the way closed and count the turns I find that it had reversed itself and advancing a turn would just put me back where I started. If I try to advance it another turn to where it should be based on the schedule, then it feels uncomfortably tight. This is probably an issue with my mechanism or how it was fabricated, so I've been trying to count the turns every day to make sure it is set where I want it to be and not gradually backtracking. I have 4 more days before I'm due to advance again if I follow the 1 turn per week schedule.

Thanks for the heads-up on the screw isn't winding itself back; I'm pretty sure that isn't happening for me because it's always at the start/end-of-turn position when I do an advance but I'll keep an eye on it to make sure it's in the end-of-turn position each day and isn't doing something sneaky behind my back; or jaw.

Hi @greyham, interesting to read on your blog post for this month that you encountered this same issue with the appliance surreptitiously winding itself backward. It's reassuring to know that it's not just an issue with my generic lower schwartz. I've been winding mine all the way closed and counting the turns forward every day. Now past 28 turns, it is troublesome and I worry that I might miscount. I also noticed on my expander that each turn advances less than 1/4mm. It seems to be about 5 turns per millimeter on mine, with 28 turns giving less than 6mm separation.

ReplyQuote
Posted : 01/08/2021 2:53 pm
greyham
Eminent Member
Posted by: @apollo
Posted by: @greyham
Posted by: @apollo
 
One issue I've noticed with my lower schwartz-style expander is that the screw seems to wind itself backward, maybe when I pop the appliance in and out. So I'm not actually making the progress I think I am. I'll think that it is feeling less snug after about a week and decide to advance the screw, but if I wind it all the way closed and count the turns I find that it had reversed itself and advancing a turn would just put me back where I started. If I try to advance it another turn to where it should be based on the schedule, then it feels uncomfortably tight. This is probably an issue with my mechanism or how it was fabricated, so I've been trying to count the turns every day to make sure it is set where I want it to be and not gradually backtracking. I have 4 more days before I'm due to advance again if I follow the 1 turn per week schedule.

Thanks for the heads-up on the screw isn't winding itself back; I'm pretty sure that isn't happening for me because it's always at the start/end-of-turn position when I do an advance but I'll keep an eye on it to make sure it's in the end-of-turn position each day and isn't doing something sneaky behind my back; or jaw.

Hi @greyham, interesting to read on your blog post for this month that you encountered this same issue with the appliance surreptitiously winding itself backward. It's reassuring to know that it's not just an issue with my generic lower schwartz. I've been winding mine all the way closed and counting the turns forward every day. Now past 28 turns, it is troublesome and I worry that I might miscount. I also noticed on my expander that each turn advances less than 1/4mm. It seems to be about 5 turns per millimeter on mine, with 28 turns giving less than 6mm separation.

Hmmm... I don't know what's going on. I see my blog post from yesterday just contradicted my assertion from 5 months ago that my screw isn't winding itself back. And funnily enough I see I actually wrote "Thanks for the heads-up on the screw isn't winding itself back" here: I'm not making any sense there with that "isn't", and maybe I didn't pay as much attention to your observation as I should have. The idea of winding it all the way back to check is great, but the lip bar on my DNA (which I'm guessing your Schwarz doesn't have) makes that impractical. Maybe the screws in these appliances aren't 0.25 mm per quarter turn after all, or maybe it's winding itself back and I'm not noticing. All I know is I'll be keeping a closer eye on it from now on, so thanks again for your feedback @apollo.

ReplyQuote
Topic starter Posted : 01/08/2021 4:51 pm
Apollo liked
Apollo
Reputable Member
Posted by: @greyham

Hmmm... I don't know what's going on. I see my blog post from yesterday just contradicted my assertion from 5 months ago that my screw isn't winding itself back. And funnily enough I see I actually wrote "Thanks for the heads-up on the screw isn't winding itself back" here: I'm not making any sense there with that "isn't", and maybe I didn't pay as much attention to your observation as I should have. The idea of winding it all the way back to check is great, but the lip bar on my DNA (which I'm guessing your Schwarz doesn't have) makes that impractical. Maybe the screws in these appliances aren't 0.25 mm per quarter turn after all, or maybe it's winding itself back and I'm not noticing. All I know is I'll be keeping a closer eye on it from now on, so thanks again for your feedback @apollo.

These things are sneaky! My expander seems to have both issues, winding itself back and each turn reaching closer to 1/5 than 1/4 millimeter. The labial bow on my expander hasn't needed to be adjusted yet, and it's flexible enough to make all 28 turns backward and forward. If I advance much farther that could become an issue. I've also noticed that I can squeeze the distal molar ends of my expander together by a couple millimeters. The acrylic framework seems to flex at the front where the screw mechanism is on these lower appliances. So it's probably expanding the intercanine width more than the intermolar width.

ReplyQuote
Posted : 01/08/2021 7:28 pm
greyham liked
bdurwood
New Member

I had MSE w/ surgical assist 7 weeks ago with doctors Ting and Vaughan, and I really regret not going with the DNA instead.  My nasal breathing has not improved, and the recovery has been worse than expected.  I was very swollen for the  first 3 weeks and am still noticeably swollen after 7 weeks.  

I'm not clear on why my breathing didn't improve as I had a high arched narrow palate, standard for a long time mouth breather like me.  

I wasn't prepared for all the aesthetic changes, which I feel are overall negative.  Especially for my nose - my nose is wider, more crooked, and the front of my nose is upturned so that my nostrils are more visible.  Also, one nostril is noticeably larger than the other given the expansion was asymmetric.  

Also, I have not been impressed with Dr. Ting or Vaughan, and am regretful of trusting them so much.

I do still have a large diastema, which will likely not be fully closed for 4-5 months.  It's more socially embarrassing than I anticipated.  I'm less social now, and I feel like I need to explain all the background of the MSE to everyone I meet because the diastema looks so odd. 

ReplyQuote
Posted : 28/08/2021 11:28 am
Apollo
Reputable Member
Posted by: @bdurwood

Also, one nostril is noticeably larger than the other given the expansion was asymmetric.  

This is interesting since one of the advantages typically attributed to the surgical assist method is that it should result in symmetric expansion since it releases the resistance on both sides, whereas MSE without surgical assist can encounter more resistance from one side. I'm sorry to hear that you regret your treatment! Did you consider attempting MSE without surgery first, or did Dr. Ting discourage that because of your demographics?

ReplyQuote
Posted : 30/08/2021 2:44 pm
bdurwood
New Member

@Apollo, yes Dr. Ting said I would need the surgical assist since I'm 35 years old.  I also had a very narrow and high arched palate.  I did consult with Dr. Zaghi at The Breathe Institute too, and he confirmed I would need surgical assist.

As far as the expansion, the impact on my nose has definitely been asymmetrical.  My nose is now bent to one side and one nostril is larger than the other.

I've been feeling pretty down and out about the whole procedure.  I'm in a worse spot now than when I started.  My plan is to wait until I'm fully healed (I'm guessing that takes approx. 6 months?) and to then get a septorhinoplasty to hopefully improve my breathing and undo some of the cosmetic damage caused by the MSE.

ReplyQuote
Posted : 31/08/2021 6:44 am
Apollo
Reputable Member
Posted by: @bdurwood

@Apollo, yes Dr. Ting said I would need the surgical assist since I'm 35 years old.  I also had a very narrow and high arched palate.  I did consult with Dr. Zaghi at The Breathe Institute too, and he confirmed I would need surgical assist.

As far as the expansion, the impact on my nose has definitely been asymmetrical.  My nose is now bent to one side and one nostril is larger than the other.

I've been feeling pretty down and out about the whole procedure.  I'm in a worse spot now than when I started.  My plan is to wait until I'm fully healed (I'm guessing that takes approx. 6 months?) and to then get a septorhinoplasty to hopefully improve my breathing and undo some of the cosmetic damage caused by the MSE.

I’m a male slightly older than you and my suture split with only cortipuncture facilitation, but I understand there’s a higher risk for failure in older men. I’ve seen this case of MSE-induced nose asymmetry on Reddit:

Did your nose expand more on the side your septum deviates toward or away? In my case, if anything my nose looks a little more symmetrical after expansion, although my dental arch expanded a little more on my wider side, which is the side my septum deviates away from. Still, I seemed to get enough expansion in the constricted nostril that my septum deviates toward to now breathe freely through it.

ReplyQuote
Posted : 31/08/2021 9:56 pm
bdurwood
New Member

@Apollo, my nose expanded more on the side my septum deviates away from.  It's an odd, unnatural look, and I'd rather not post my photos publicly, but it's a fairly similar result as the Reddit post you linked to, including the asymmetric nasal expansion and the eyes that are set further apart.  My overall result is I think worse  than his.  

I feel silly for not fully considering these risks beforehand.  If I had known there was a good chance my appearance would be worse after the procedure, I wouldn't have done it.  I have a follow up appt with Ting tomorrow, and I plan to give him a piece of my mind.  

ReplyQuote
Posted : 31/08/2021 11:12 pm
Apollo
Reputable Member
Posted by: @bdurwood

@Apollo, my nose expanded more on the side my septum deviates away from.  It's an odd, unnatural look, and I'd rather not post my photos publicly, but it's a fairly similar result as the Reddit post you linked to, including the asymmetric nasal expansion and the eyes that are set further apart.  My overall result is I think worse  than his.  

I feel silly for not fully considering these risks beforehand.  If I had known there was a good chance my appearance would be worse after the procedure, I wouldn't have done it.  I have a follow up appt with Ting tomorrow, and I plan to give him a piece of my mind.  

I am sorry to hear about your disappointing result! How rapidly did you advance the appliance? Is it worth considering turning backward at least part way? Let us know how Dr. Ting responds to your case. If I remember right, he suggests there is generally a positive or negligible change in facial form during his JawHacks interview, and aesthetic complaints are rare.

ReplyQuote
Posted : 01/09/2021 12:16 pm
bdurwood
New Member

@Apollo, thanks for the feedback, I appreciate your interest!  I met with Ting today and told him that I believe the expansion has had a negative aesthetic impact, especially my nose.  

We are going to back turn, like you suggested.  I initially did approx. 50 turns to expand (2 per day as recommended by Ting).  I plan to do approx. 12 back turns total.  I'm also getting a lower quad helix installed on Friday to help expand the lower jaw/ teeth.  

Tings concern with backturning is that it may not allow for enough space to complete his initial plan with the quad helix.  My concern is that the expansion seems to be damaging my nose, or at least causing serious discomfort and asymmetries.

The relationship with Ting is getting uncomfortable.  I'm frustrated with him, and he is frustrated with me.  From my perspective, this experience has been awful, and I wish I could turn back time and have never done this.  So, for any prospective patients out there, beware - this treatment is not all sunshine and roses for everyone.

ReplyQuote
Posted : 02/09/2021 6:25 am
Apollo liked
toomer
Estimable Member
Posted by: @apollo

I’ve seen this case of MSE-induced nose asymmetry on Reddit:

 

Holy crap.

And all the MSE zealots give DNA a raft of [Rude Language or Insults are not tolerated]?  Sure, we can argue whether or not DNA actually gives you more room in the nasal cavity or not ... but I've never seen it wreck a face at all.

Do you have a link to that Reddit post?  I'd like to read the kid's story...

ReplyQuote
Posted : 10/09/2021 11:05 pm
ninjaB liked
Apollo
Reputable Member
Posted by: @toomer

Do you have a link to that Reddit post?  I'd like to read the kid's story...

https://www.reddit.com/r/orthotropics/comments/mfb196/me_before_and_after_mse_some_asymmetry_but_i_may/

ReplyQuote
Posted : 11/09/2021 11:22 am
Facetimeskink
Active Member

This story completely put MSE out of the running for me, so thanks y'all

ReplyQuote
Posted : 20/09/2021 5:25 pm
mr-sand-man123
Active Member

This is just negligence on the provider's part. They should be monitoring the expansion and making corrections if asymmetrical expansion is occurring. It looks like only one side of his maxilla mobilized, though photographs aren't very reliable. This doesn't make MSE look bad, it makes the provider look bad. Dr. Bockow talks about looking for this early on and aborting or correcting it.

You won't see DNA do something like this because DNA isn't expanding the maxilla.

ReplyQuote
Posted : 25/09/2021 7:21 pm
toomer
Estimable Member
Posted by: @mr-sand-man123

You won't see DNA do something like this because DNA isn't expanding the maxilla.

Except for those cases where the lower portion of the maxilla measure 10% more volume post-treatment: https://www.researchgate.net/publication/264298692_Changes_in_3D_Midfacial_Parameters_after_Biomimetic_Oral_Appliance_Therapy_in_Adults

 

 

ReplyQuote
Posted : 29/09/2021 6:02 pm
mr-sand-man123
Active Member

Ahh yes, how could I have forgotten about Dr. Singh's research (about his own product), that has never been replicated by anyone else.

ReplyQuote
Posted : 30/09/2021 12:36 am
toomer
Estimable Member
Posted by: @mr-sand-man123

Ahh yes, how could I have forgotten about Dr. Singh's research (about his own product), that has never been replicated by anyone else.

Actually, the work that goes into the reports comes from dentists in lots of different countries around the globe.  The study on maxillary air sinuses getting larger (that has been done more than once) was done on Korean patients not being treated by Dr. Singh.  They just send him the CBCTs, and he works on getting it in journals ... because your average dentist doesn't really want to spend time doing that.

It all is kind of logical ... if you don't look at it with a conspiracy frame of mind.

And then, of course, there's James Nestor's Homeoblock case which was analyzed by the Mayo Clinic.  But we'll just try to pretend that doesn't exist either.

For some ... none of this might be enough of an evidentiary bar ... and that is everyone's individual choice.  The Oxford Center for Evidence Based Medicine publishes level of evidence guidance for a reason - everyone can decide where they are (or aren't) comfortable hopping onboard with something.

My supine AHI has been cut by over 50% already - from 40 down to 18 - validated with in-lab PSG ... done in the same lab as my first sleep apnea test.  So I'm happy with the progress so far.

ReplyQuote
Posted : 08/10/2021 5:48 pm
ancoratu
Active Member

The DNA appliance works. It will expand the palate and move the maxilla forward, however, for certain patients, this is only one dimension and it might not even begin to resolve serious health problems. I will say that this device is good for sleep apnea but does not help to solve postural problems and doesn't change the position of the head nor increases the height of the molars. I finished my VIVOS treatment more than a year ago and I can confirm that this treatment is good for expanding the palate and improving the maxilla but that's about it. Not all cranial distortions will be fixed with the DNA appliance. I have attached my results with the VIVOS system and there's certainly an improvement but I'm simply not much healthier than when I started.

 In my opinion, there's nothing magical about DNA/Vivos in comparison to other appliances. A lot has to do with who is in charge of the treatment. In my case, I will be starting treatment soon with the Starecta method which claims to solve a lot of the things that the VIVOS treatment could not. The best thing is that this treatment is done by myself at home with an appliance that costs $79 or merely $500 for an upgraded version. I get the idea that a lot of dentists don't understand how the entire facial structure should work in relation to everything else in the body. This is evident in that even after undergoing treatment with one appliance, a lot of people keep looking to get more appliances to fix what the previous appliance couldn't do. If the lower jaw is unable to support the skull due to lack of dental height then no real healing can be achieved. 

ReplyQuote
Posted : 13/10/2021 9:08 am
toomer liked
toomer
Estimable Member
Posted by: @ancoratu

In my opinion, there's nothing magical about DNA/Vivos in comparison to other appliances. A lot has to do with who is in charge of the treatment.

It's worth noting that Dr. Liao - who was a long-time provider of Vivos, and actually was co-author on some of the earliest clinical reports Dr. Singh published - is now using his own appliance, which does not have the front springs.  Likewise, Dr. Miraglia in NYC is a Vivos provider but he is also treating some patients with modified Schwarz appliances and in some cases apparently clear aligners.

So I'm not sure the "springs" are what makes Vivos do what it does.  But I think Dr. Singh has done a good job of standardizing an approach/technique ... most important, the on-and-off wear time, unlike 24x7 wear which is what Ronald Ead had.  Occlusal coverage and addressing the vertical domain of occlusion as well is also an important part.

Glad it worked well enough for you ... if you've got more you can share about your case, that would be great to know.  Good luck on the Starecta treatment.  Are you working with a good Atlas or Nucca chiro, or a osteopath, while you are doing that?  I can't imagine trying something like Starecta without someone else focusing on the rest of the body.

ReplyQuote
Posted : 16/10/2021 8:25 pm
ancoratu
Active Member

@toomer

When I first started seeing the dentist who oversaw my Vivos treatment I was referred first to a Physical Therapist for myofunctional therapy. The therapist gave me some exercises to strengthen the tongue for a tongue-tie release. The tongue tie release was successful in that my tongue mobility greatly increased. The physical therapist was perplexed with my case, he kept checking my heart rate and at one point told me that my heart was overworking. I then went to a chiropractor that performed a full-body x-ray on me and I had scoliosis. I suffer from horrendous upper back pain and an asymmetric body and face. Whenever I try to do any type of physical exercise I'm literally obliterated for 5 days following in that I even struggle to think from my exhaustion. 

As for sleep apnea, I would say I never really had it. The sleep study I did for Vivos put me at 5 incidents per night and after Vivos I was at 4; the results are inconclusive and could be margins of errors. For the Vivos treatment, I had two appliances (the bottom one wasn't very impressive/interesting). I also wore the face mask religiously. Based on my research, doing the Vivos treatment before correcting the bite height through Starecta was a mistake. One needs proper body posture to maintain the results achieved by Vivos (and improve upon them). I would also add that Vivos is not the best device out there for the upper jaw simply because it doesn't facilitate proper tongue posture. 

Starecta works by itself as it makes use of an orthopedic "lever" activated by the splint. It's a very natural treatment as it works based on Newtonian mechanics. If the starecta splint is used alone it can create a space between the dental arches (this depends on the severity of the assymetries), however, this space can be corrected by proper tongue posture (mewing) or devices that can mimic mewing. The starecta tailored rectifier can be used along with the ALF appliance. If you're interested in understanding how Starecta works I recommend the following blog post:

https://tooth-for-a-tooth.com/starecta/rectifier/

From what I have read, Mewing or Maxilla development is only one part of the equation, complete body symmetry using a method such as Starecta is also necessary to get the most optimal results for our genetic potential. Mewing does work past puberty, but if you have asymmetries that don't even allow you to rest your tongue evenly on your palate you're wasting your time and maybe even making things worse. There's more to Starecta than everything I've mentioned above so if you're interested there's a lot of information on the blog I linked as well as the Starecta website. 

ReplyQuote
Posted : 16/10/2021 9:31 pm
Page 2 / 2