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How many turns/day for MSE in June 2020? Seems like the advice has changed - Is it just 1/day now? When did this new info come out?  

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MagnumOpus
Eminent Member

Hey everyone,

For people who have MSEs: Ron Ead posted in his most recent video, linked here , timestamp 4:30, that the best rate of expansion for MSE is 1 turn per day. (Following the Dr. Richard Ting protocol, a MSE orthodontist in California). But the previously used advice, from Dr. Moon's advice, is below (from the MSE brochure), which says around 4-6 turns per day before the diastema for most of us on the forum, age 20+. 

Ron followed the 4-6 turns per day or more routine but says that some of his asymmetric expansion and other side effects may be due to that rapid expansion. So my question is: When did the new advice of 1/day from Dr. Ting come out? Does anyone have a source for this? I've seen another user post about it as well (@entelechy) It sounds like 1/day is preferable based on Dr. Ting's experience.

-MO

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Posted : 18/06/2020 12:48 pm
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Apollo
Reputable Member
Posted by: @magnumopus

Hi, I also just got the MSE 2 installed last week. However I am following 1 turn per day, per my ortho, and which Ronny Ead suggests in his recent video "MSE Risks and Potential Complications" at 4:30. And this is the Ting Protocol which is 1 turn per day. Ron Ead says this slow rate is better for avoiding asymmetries.  And the corticopuncture won't heal soon enough that 1/day is a problem. What I mean is if the diastema usually happens from 20-40 turns, the corticopuncture won't be healed by this time so it's fine to do 1/day. Have you asked your ortho about this? Still, 2/day is fairly slow so it's probably fine.

-MO

Have you confirmed that Dr. Ting recommends 1 turn per day for adults even before the diastema? Dr. Moon's published protocol (which you posted above) calls for more turns before the diastema to overcome the resistance of mature sutures. I worry there's a greater risk for implant failure at this slower rate where the screws might move through the bone rather than pulling the suture apart. I remember a video where Dr. Moon compares this to the force required to pull apart a pair of wooden chopsticks. In the original MSE thread, Varbrah and I speculated that Dr. Mew's MSE case might have failed because he advanced too slowly. I guess this is all just based on clinical judgement since there's not enough published research on the topic. Gook luck and keep us posted!

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Posted : 25/06/2020 4:25 pm
MagnumOpus
Eminent Member

@apollo

Hi, thanks for the reply. I haven't confirmed that 1/day is what Dr. Ting recommends, I'm just basing it off Ron's video I linked above since he specifically said the name. And since he originally expanded at 4-6 per day, but now he's saying not to do that. But I guess it's not confirmed by Ting publicly yet that I know of at least. 
And could you link me the thread where you discuss Dr. Mew's MSE failure? Wondering if that was due to slow expansion, lack of corticopuncture, or both, or something else. Thank you.

-MO

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Posted : 25/06/2020 9:20 pm
Apollo
Reputable Member
Posted by: @magnumopus

@apollo

Hi, thanks for the reply. I haven't confirmed that 1/day is what Dr. Ting recommends, I'm just basing it off Ron's video I linked above since he specifically said the name. And since he originally expanded at 4-6 per day, but now he's saying not to do that. But I guess it's not confirmed by Ting publicly yet that I know of at least. 
And could you link me the thread where you discuss Dr. Mew's MSE failure? Wondering if that was due to slow expansion, lack of corticopuncture, or both, or something else. Thank you.

@ronaldead actually advanced 7 turns on 2 days and 6 turns on 2 days until his diastema and then switched to about 1 turn per day according to the calendar on his blog. He implicates this initial rapid rate for his asymmetric expansion. It sounds like he is referencing his personal consultation with Dr. Ting and not any published protocol recommending 1 turn per day. I wonder if he's sure Dr. Ting uses that rate throughout treatment regardless of the suture maturity staging or patient demographics.

I first mentioned Dr. Mew's failed MSE case here:

https://the-great-work.org/community/main-forum/possibly-new-holy-grail-for-moving-the-maxilla-up-and-forwards/paged/2/#post-9065

Varbrah and I discussed it in subsequent posts. To my recollection, corticopuncture wasn't used and he doesn't specify in the video what rate he expanded, but I speculated that it was about the same 1mm per week that he uses with removable appliances since he says rapid expansion is harmful. Something else that interested me with this case is his use of a "sonic device" to help mobilize the sutures. I still haven't figured out exactly what he meant. 

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Posted : 25/06/2020 10:06 pm
MagnumOpus
Eminent Member

@apollo interesting, thanks for the link. I'm not sure what's right. Corticopuncture (CP) definitely seems appropriate though to help split the suture, only minor downside is some pain/invasiveness. Sonic device seems like it may not be very effective versus CP imo. 

-MO

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Posted : 26/06/2020 12:22 pm
Apollo
Reputable Member
Posted by: @magnumopus

@apollo interesting, thanks for the link. I'm not sure what's right. Corticopuncture (CP) definitely seems appropriate though to help split the suture, only minor downside is some pain/invasiveness. Sonic device seems like it may not be very effective versus CP imo. 

I definitely think corticopuncture is helpful to facilitate disarticulation, but you can't corticopuncture the perimaxillary sutures, only the midpalatal suture. So if the surrounding sutures on one side put up more resistance than the sutures on the other side you get asymmetric expansion, or if both sides put up too much resistance your maxilla fails to separate. I wonder if the "sonic device" Dr. Mew mentioned could help encourage symmetric expansion by mobilizing the perimaxillary sutures. Although, since his case was unsuccessful, maybe it doesn't help much.

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Posted : 26/06/2020 1:12 pm
MagnumOpus
Eminent Member
Posted by: @apollo

I definitely think corticopuncture is helpful to facilitate disarticulation, but you can't corticopuncture the perimaxillary sutures, only the midpalatal suture. So if the surrounding sutures on one side put up more resistance than the sutures on the other side you get asymmetric expansion, or if both sides put up too much resistance your maxilla fails to separate. I wonder if the "sonic device" Dr. Mew mentioned could help encourage symmetric expansion by mobilizing the perimaxillary sutures. Although, since his case was unsuccessful, maybe it doesn't help much.

Good thoughts Apollo. For now I'm just hoping 1. I get the suture split, 2. it's fairly symmetric expansion.

Personally I don't see much asymmetry in Ron's face, although he got 3mm and 7mm on his sides, so quite asymmetric expansion. But I think he looks good. Obviously the asymmetrical expansion caused bite problems but hopefully those will get resolved through his other treatments. So hoping even if I do get asymmetric expansion it won't be noticeable facially. 

-MO

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Posted : 26/06/2020 6:35 pm
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Apollo
Reputable Member

Here on the forum, I think @varbrah followed the Won Moon protocol of 4-6 turns per day until diastema and then 2 turns per day after diastema, and I think @noctilucentnikki made 2 turns per day throughout her expansion both before and after diastema.

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Posted : 26/06/2020 8:02 pm
MagnumOpus
Eminent Member

@apollo Thank you. Varbrah seems pretty busy recently, I don't think people have been able to get in touch with him. And I don't think @noctilucentnikki used the facemask. And Ron Ead didn't use the mask much either because of pain. I'll have to search around more..... looking for someone to ask questions, for example would a 30 degree upward protraction with FM maybe lead to an open bite? If the maxilla rotates CCW (Which is a huge if, I know) and the mandible can't follow it.

It makes sense to me that if protraction was done at 0 degrees, straight out, if then the mandible would be able to "slide" forward a couple mm and occlusion would be fine. But unsure about if mandible could match with a CCW rotation hypothetically.

 

-MO

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Posted : 26/06/2020 8:27 pm
Apollo
Reputable Member
Posted by: @magnumopus

@apollo Thank you. Varbrah seems pretty busy recently, I don't think people have been able to get in touch with him. And I don't think @noctilucentnikki used the facemask. And Ron Ead didn't use the mask much either because of pain. I'll have to search around more.... looking for someone to ask questions, for example would a 30 degree upward protraction with FM maybe lead to an open bite? If the maxilla rotates CCW (Which is a huge if, I know) and the mandible can't follow it.

It makes sense to me that if protraction was done at 0 degrees, straight out, if then the mandible would be able to "slide" forward a couple mm and occlusion would be fine. But unsure about if mandible could match with a CCW rotation hypothetically.

I'd like to have these questions answered before I start treatment myself. I don't know if an anterior open bite could result from upward protraction. I suppose that the hinging mandible might be able to swing up to meet the rotated maxilla. Ronald Ead said that his orthodontist recommended an upward vector for the facemask before he decided to discontinue using it. Varbrah elaborated on his decision to follow Won Moon's downward vector here:

https://the-great-work.org/community/main-forum/possibly-new-holy-grail-for-moving-the-maxilla-up-and-forwards/paged/8/#post-25883  

My maxilla is retruded but not really downswung. Personally, my limited upper incisor display and brachy/mesofacial structure makes me think a little downward growth might be worth the trade-off if it means I might get more forward growth, so I would probably use a downward vector (at least initially), but dolichofacial patients might be safer using an upward or neutral angle. I'm still not sure why that computer modeling article didn't test traction at 0 degrees to the occlusal plane. Maybe I would start with a downward vector for some weeks or months until I feel like I've gotten some suture separation and then switch to parallel with the occlusal plane or even a little upward.

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Posted : 26/06/2020 8:54 pm
MagnumOpus
Eminent Member
Posted by: @apollo

I'd like to have these questions answered before I start treatment myself. I don't know if an anterior open bite could result from upward protraction. I suppose that the hinging mandible might be able to swing up to meet the rotated maxilla. Ronald Ead said that his orthodontist recommended an upward vector for the facemask before he decided to discontinue using it. Varbrah elaborated on his decision to follow Won Moon's downward vector here:

https://the-great-work.org/community/main-forum/possibly-new-holy-grail-for-moving-the-maxilla-up-and-forwards/paged/8/#post-25883  

My maxilla is retruded but not really downswung. Personally, my limited upper incisor display and brachy/mesofacial structure makes me think a little downward growth might be worth the trade-off if it means I might get more forward growth, so I would probably use a downward vector (at least initially), but dolichofacial patients might be safer using an upward or neutral angle. I'm still not sure why that computer modeling article didn't test traction at 0 degrees to the occlusal plane. Maybe I would start with a downward vector for some weeks or months until I feel like I've gotten some suture separation and then switch to parallel with the occlusal plane or even a little upward.

@apollo,

I understand varbrah's reasoning but I think pulling straight out for example would cause more tension/growth at one side of the suture than the other, possibly allowing a couple of degrees of rotation. Pure speculation.

Your facial shape, I agree it make sense to protract at 0 degrees or even a bit below at 15-30. I think there is not much risk in that since that is common for kids who do facemasks, usually to protract below 0 degrees so I don't think that would harm occlusion. 

-MO

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Posted : 26/06/2020 9:57 pm
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NoctilucentNikki
Eminent Member

@apollo Tru dat. 2 turns a day for me, no facemask. 

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Posted : 27/06/2020 10:11 am
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MagnumOpus
Eminent Member

@noctilucentnikki Thanks for the reply! I've been reading your blog which has been helpful. Happy to year you got some good results. Did you not get a corticopuncture? From your blog it looks like you did not.

-MO

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Posted : 27/06/2020 10:23 am
NoctilucentNikki
Eminent Member

@magnumopus I did not need the puncture. But, it did take 23 days to split. The expander kept doing it's thing as expected but I didn't have a diastema until day 23, then within an hour my front teeth went from pretty overlapped to a 1 to 2mm gap! 

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Posted : 28/06/2020 2:35 pm
MagnumOpus
Eminent Member

@noctilucentnikki Thanks for the reply! So just to confirm, you were at around 46 turns before the diastema? Just wondering around when I should expect/hope for my diastema! I'm sure it depends based on the patient, corticopuncture etc. Ron Ead got his at 26 turns, but maybe that's bc he had the puncture. 

-MO

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Posted : 28/06/2020 9:07 pm
NoctilucentNikki
Eminent Member

@magnumopus I was at 53 turns on day 26! And I was told it would likely split in 2 weeks, +/- a few days. I was about to lose hope than one morning it just did it's thing and it was sore and a warm tingling feeling but I was at work and was fine. Good luck :3

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Posted : 30/06/2020 7:50 am
MagnumOpus and Apollo liked
MagnumOpus
Eminent Member

@noctilucentnikki Thanks for the info! Happy you got some good results! and keep us updated on how things go!

-MO

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Posted : 30/06/2020 9:40 pm
NoctilucentNikki
Eminent Member

@magnumopus

Update- I am scheduled to have the MSE removed July 13th. I am not sure if I'll get a new scan or not, but I will update my page afterwards 😀

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Posted : 04/07/2020 12:20 pm
MagnumOpus
Eminent Member

@noctilucentnikki Thanks for the update!  I'll be sure to check out the blog.

-MO

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Posted : 05/07/2020 11:17 pm
Apollo
Reputable Member

It looks like a patient of Dr. Ting confirmed on the lookism forum that he does recommend 1 turn per day even before the suture split, at least for some cases. Although this guy says he went against that advice and turned 4 times per day until the split and 2 times per day afterward. However, like Ronald Ead, he now cautions everyone else to follow Dr. Ting's expertise. I'm a little frustrated by these cavalier guys who went fast and successfully split the suture admonishing everyone else to go slow, when there are several cases on this forum who went slower than the Moon protocol and failed to split. Another of Dr. Ting's patients on that forum said he recommended 4 turns on the day of installation and again the next day before switching to 1 turn per day even before the suture split. So maybe there's some case-by-case variability, but generally Dr. Ting seems to advocate a slower rate even before the diastema. I'm still not sure what I'm going to do. I guess I'll play it by ear and see how much resistance I feel when I advance.

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Posted : 11/07/2020 3:35 pm
MagnumOpus
Eminent Member

@apollo thanks for the info. I'm getting close to 25 turns now so hoping for split soon ( hopefully next 10 days?) . And from what i've heard Ting is one of the most experienced orthos so hoping that advice is right. Even if no suture split yet I am feeling better sleep already.

-MO

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Posted : 11/07/2020 9:19 pm
Apollo
Reputable Member
Posted by: @magnumopus

@apollo thanks for the info. I'm getting close to 25 turns now so hoping for split soon ( hopefully next 10 days?) . And from what i've heard Ting is one of the most experienced orthos so hoping that advice is right. Even if no suture split yet I am feeling better sleep already.

I'm glad to hear your sleep quality has improved since that is my main goal! Can you remind me exactly what schedule you're following? Did you start 1 turn per day on the day after installation? How old are you? When are you going to start using the FM?

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Posted : 12/07/2020 9:38 am
Apollo
Reputable Member

I read someone in the comments section on Ronald Ead's youtube report that they had corticopuncture and turned 4-6 times per day, but the suture failed to separate. So it's definitely not as simple as more force=better chances of success. I think you have to go fast enough to overcome the resistance of the suture without the implants tipping or dragging, but slow enough that it doesn't deform the framework of the appliance. This rate is probably case-dependent and more forgiving if all the implants have good bi-cortical engagement. This youtube commenter says he is now going back and having DOME instead.

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Posted : 13/07/2020 10:59 am
MagnumOpus
Eminent Member

@apollo I'm similar to ron ead in age. Following 1/day. Still no split but I've been having a strange feeling when biting. @noctilucentnikki In the 1-2 days before your split, did you feel something like this? Basically it feels "unstable" when I bite/chew on something tough with my molars, but mostly in the area between my 2 front incisors where the suture is. It feels like the suture has almost split but not quite, so biting on 1 side puts stress on the suture to the point where it almost is going to split. But I've been avoiding doing that very much because my incisors are pretty weak from previous issues so hopefully it's not related to that lol.

That said, my bite alignment is totally fine right now so it's not that my bite is misaligned at all. Just feeling that sensation that i'm not sure what it is. 

-MO

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Posted : 16/07/2020 6:40 pm
Apollo
Reputable Member
Posted by: @magnumopus

@apollo I'm similar to ron ead in age. Following 1/day. Still no split but I've been having a strange feeling when biting. @noctilucentnikki In the 1-2 days before your split, did you feel something like this? Basically it feels "unstable" when I bite/chew on something tough with my molars, but mostly in the area between my 2 front incisors where the suture is. It feels like the suture has almost split but not quite, so biting on 1 side puts stress on the suture to the point where it almost is going to split. But I've been avoiding doing that very much because my incisors are pretty weak from previous issues so hopefully it's not related to that lol.

That said, my bite alignment is totally fine right now so it's not that my bite is misaligned at all. Just feeling that sensation that i'm not sure what it is. 

So you're a little younger than I am. If I remember right, noctilucentnikki was eating when she felt her split, so that could be a trigger. How many turns have you completed so far? I've contemplated before ( https://the-great-work.org/community/main-forum/extracorporeal-shock-wave-therapy/#post-29283 ) if you could provoke the split with those kinds of forces: 

Posted by: @apollo

MSE patients often describe a buildup of tension in the face and then a shooting sensation at the moment when the midpalatal suture splits and a diastema appears with the release of tension. I've heard a few reports of people for whom the split coincided with some trigger like taking a bite of food, or getting jostled playing basketball. Are these just happy accidents, or could similar forces be deliberately replicated to help facilitate suture disarticulation during MSE treatment? Once you advance the bone-anchored expander far enough to reasonably expect the split, could chewing, or physical exercise, or applying some kind of vibration help induce it to happen? I still don't know what the "sonic device" is that Dr. Mew mentions using with his MSE patient, but I wonder if it could help encourage more symmetrical separation of the perimaxillary sutures when the split occurs.

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Posted : 16/07/2020 8:57 pm
NoctilucentNikki
Eminent Member

@apollo @magnumopus

Yes I was eating actually when I split. I don't recall feeling much before hand. It was early in the day and I had only been awake a couple of hours tops. Perhaps I did have tension and unstable feelings but didn't realize it. I am so very very used to always having tension headaches and neck pain going into my jaw and shoulder every day. Pain from severe TMJ disorder and from a car accident when I was 19 got me down this path. I do remember feeling a hot/warm sensation behind my front teeth say the 30 minutes or so right before the split though. Then it was just enough to warrant 2 ibuprofen and just continuing to work that day. I bet I did have a lot of tension built up though because it took 23 days of 2 turns a day to split, but when it did, It seemed to go all at once. My 2 front teeth went from overlapped to 1 mm apart in an hour.

You sounds very close to splitting. Just keep doing what you were instructed to do! The pain is tolerable and short lived. It's so very worth it. 

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Posted : 17/07/2020 10:09 am
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MagnumOpus
Eminent Member
Posted by: @noctilucentnikki

@apollo @magnumopus

 Pain from severe TMJ disorder and from a car accident when I was 19 got me down this path. I do remember feeling a hot/warm sensation behind my front teeth say the 30 minutes or so right before the split though.

You sounds very close to splitting. Just keep doing what you were instructed to do! The pain is tolerable and short lived. It's so very worth it. 

 Sorry to hear about your previous pain, hope it's all improving now! You were right that I'm very close, I think maybe I just got it! I have the smallest little diastema right now that I didn't before, like .5mm. It's just slightly more than the space between all my other teeth so i'm confident that will enlarge in the next few days! It's not noticeable right now unless you're looking for it.  I'm at 35 turns today. Thanks for the advice!

-MO

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Posted : 18/07/2020 11:45 am
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MagnumOpus
Eminent Member

@apollo So I definitely got the diastema, happy to say. Going to continue at 1/day. My bite is still fine too so that supports Ting's protocol, since from looking at my bite it's still symmetric while also getting the split.

Now to try facemask, previously I avoided it since I have some other dental stuff I thought may not be good to wear the FM, and I wanted to ask my ortho about using FM before trying it but they said it's probably fine. Only thing is it's uncomfortable while trying to sleep so I haven't been able to wear it sleeping. Need to find some padding for my forehead since the reverse pressure is uncomfortable and I haven't been able to sleep at all wearing it. During the day it feels okay though.

-MO

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Posted : 23/07/2020 5:44 pm
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Apollo
Reputable Member
Posted by: @magnumopus

@apollo So I definitely got the diastema, happy to say. Going to continue at 1/day. My bite is still fine too so that supports Ting's protocol, since from looking at my bite it's still symmetric while also getting the split.

Now to try facemask, previously I avoided it since I have some other dental stuff I thought may not be good to wear the FM, and I wanted to ask my ortho about using FM before trying it but they said it's probably fine. Only thing is it's uncomfortable while trying to sleep so I haven't been able to wear it sleeping. Need to find some padding for my forehead since the reverse pressure is uncomfortable and I haven't been able to sleep at all wearing it. During the day it feels okay though.

Congratulations! I'm 2 days after installation. Everything went smoothly, and I was instructed to turn 2x per day. So far, I only feel a slight tension right after advancing that goes away in about a minute. I think I might throw in an extra turn tomorrow just to see if I feel any more tension build up. I'm still worried at my age that I'll need more force to split the suture, but I guess time will tell. I haven't posted about it yet because of the uncertainty, but it's nice to hear a slower rate worked for you.

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Posted : 23/07/2020 9:04 pm
Lisichka
New Member

@apollo can you name the doctor who installed you MSE please?

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Posted : 24/07/2020 5:20 am
Apollo
Reputable Member
Posted by: @lisichka

@apollo can you name the doctor who installed you MSE please?

I don't want to dox my orthodontist during treatment so that I can be candid about how the process goes without any friction like Ronald Ead encountered when he tried to arrange his SFOT/tunnel graft. I might share more specifics afterward.

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Posted : 24/07/2020 9:49 am
Lisichka
New Member

@apollo

ok! By the way, what do you think about this: do we add extra volume of bone to our maxilla (doing MSE), because ideally we have to reshape our arch after it became higher then it is supposed to by nature? Or we just add the volume of bone that was lost? This bothers me and i cant understand how to find the answer, nothing is written about this

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Posted : 24/07/2020 12:24 pm
Apollo
Reputable Member
Posted by: @lisichka

@apollo

ok! By the way, what do you think about this: do we add extra volume of bone to our maxilla (doing MSE), because ideally we have to reshape our arch after it became higher then it is supposed to by nature? Or we just add the volume of bone that was lost? This bothers me and i cant understand how to find the answer, nothing is written about this

I'm not totally sure what you're asking. I think there is some distraction-like filling of new bone between the split sides of the midpalatal suture, but I think there is also some remodeling and bone bending that occurs during the expansion phase until the suture splits and probably some additional remodeling that occurs during the retention phase.

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Posted : 24/07/2020 6:10 pm
MagnumOpus
Eminent Member

@apollo  or @noctilucentnikki or anyone else with MSE - noticed any asymmetry? I am seeing expansion which is nice - but also some asymmetry - mostly expansion on the left. I know this is somewhat common with MSE. Anyone know ways to minimize this? For example - mewing or pushing with fingers only on the deficient side?

-MO

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Posted : 11/11/2020 3:10 pm
Apollo
Reputable Member
Posted by: @magnumopus

@apollo  or @noctilucentnikki or anyone else with MSE - noticed any asymmetry? I am seeing expansion which is nice - but also some asymmetry - mostly expansion on the left. I know this is somewhat common with MSE. Anyone know ways to minimize this? For example - mewing or pushing with fingers only on the deficient side?

You could try sleeping on your side with the side of your face that is expanding farther against the pillow. You might also consider osteopathic manipulation, and/or any exercises to get your whole body moving symmetrically.

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Posted : 11/11/2020 5:18 pm
NoctilucentNikki
Eminent Member

@apollo @magnumopus

If I have asymmetry I haven't noticed it and my doctor hasn't mentioned it.

I just did 2 turns a day and all is well. I haven't updated in awhile but I thought I'd be done with the Invisalign by the end of the year but it's now April 2021 🙁

 

 

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Posted : 11/11/2020 7:24 pm
Deebob
New Member

I just had MSE installed three days ago, and my orthodontist told me to do 1 turn every other day. I’m a 34 year old male.  She did say I have pretty thin bone and shallow palate (the TADS were left sticking out a bit because of this).

 

But I’m seeing this Won Moon protocol of 4-6 turns for people over 30. And many other people doing 1 or 2 turns per day.  I’m not sure what I should do. Should I ignore my orthodontist’s advice, or is it possible that she’s recommending that based on my anatomy specifically? I also saw another doctor on YouTube mention that it should be 2 or more turns per day for someone over 30, and it’s especially important in the beginning while the screws have their primary stability.  So now I’m worried about wasting time in the beginning by not turning more.  I ignored my orthodontist’s advice and did a turn today when I was supposed to wait until tomorrow.  I feel like 1 per day, as Dr. Ting suggests, is probably the very least I should do. What should I do? 

 

 

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Posted : 22/11/2020 8:33 pm
nakedespresso
New Member

Hello - new to this forum and am 14 turns into my MSE.  Where is the expansion going prior to breaking?  Clearly the anchors are moving out, I can the space in the device.  How are the anchors moving without the suture opening, is the back of the palate expanding with it and it just needs to get wide enough to break the front, or do the anchors just push through the bone until it finally breaks?  

 

Also, per this thread, I'm doing 2x per day.

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Posted : 15/12/2020 3:36 pm
Apollo
Reputable Member
Posted by: @nakedespresso

Hello - new to this forum and am 14 turns into my MSE.  Where is the expansion going prior to breaking?  Clearly the anchors are moving out, I can the space in the device.  How are the anchors moving without the suture opening, is the back of the palate expanding with it and it just needs to get wide enough to break the front, or do the anchors just push through the bone until it finally breaks?  

 

Also, per this thread, I'm doing 2x per day.

Some fraction of the expansion will always go to tilting or dragging the TADs, bending or remodeling the bone, and tipping the banded molars, in addition to actual skeletal separation at the suture. There might be some stretching or prying apart of the suture that occurs as the interdigitations give way before the diastema eventually pops open. 14 turns is still early. Do you feel a lot of resistance when you advance the appliance? What is your age and gender? There's often more resistance in older men. I'm coming around to believing in Dr. Ting's 1 turn per day protocol, but you should discuss it with your orthodontist.

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Posted : 15/12/2020 10:55 pm
nakedespresso
New Member

Thanks @apollo  Definitely seeing some angle forming in the anchors, and the molars are tilting out, especially my right molar.  No change in the resistance of the turns, just pressure for a bit after the turns. 

 

I'm 45yo male.  Just did turn 21, so sounds like I'm just entering the window.   I guess all I want for Christmas is a gap between my two front teeth...  I feel like there isn't any good information on when splits happen, so I'll definitely share any updates here on what comes of 2x a day.

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Posted : 17/12/2020 9:20 pm
Apollo
Reputable Member
Posted by: @nakedespresso

I'm 45yo male.  Just did turn 21, so sounds like I'm just entering the window.   I guess all I want for Christmas is a gap between my two front teeth...  I feel like there isn't any good information on when splits happen, so I'll definitely share any updates here on what comes of 2x a day.

Good luck! I guess it might take longer for a man your age to separate the suture. Did you have cortipuncture? At first I accepted Dr. Moon's logic that more mature patients would need more aggressive turning to overcome the resistance, but now I think Dr. Ting makes sense in advocating slower turning to minimize bending of the appliance and tilting or dragging the TADs. Watch your molars to make sure they aren't getting compromised.

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Posted : 17/12/2020 9:39 pm
nakedespresso
New Member

Thanks @apollo, what are the signs my molars have are getting compromised?  I feel like the ortho and perio (who did the anchors and is advising the ortho) working with me are really infatuated about the mse procedure and the perio is over confident, imo, he's done "60+ and all were a success!".  I want to know when to raise the flag and push their attention to something.

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Posted : 17/12/2020 10:00 pm
Apollo
Reputable Member
Posted by: @nakedespresso

Thanks @apollo, what are the signs my molars have are getting compromised?  I feel like the ortho and perio (who did the anchors and is advising the ortho) working with me are really infatuated about the mse procedure and the perio is over confident, imo, he's done "60+ and all were a success!".  I want to know when to raise the flag and push their attention to something.

Just watch to see if the banded first molars start tilting out too far beyond the rest of the dental arch and make sure they don't start aching too much. A little torquing and tenderness when chewing is ok, but you don't want to cause root resorption or push the teeth out of the bone. My understanding is that Dr. Ting often cuts off the molar arms and bands pretty early, but I think it's best to wait until after the diastema if possible. That's great if your team has a 100% track record and are confident even for men your age! Keep us posted.

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Posted : 17/12/2020 10:35 pm
Apollo
Reputable Member

Dr. Won Moon claims the failure rate is lower with slow expansion, but rapid expansion is better to maximize perimaxillary changes including airway, facemask protraction, and cheekbones.

 

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Posted : 02/01/2021 2:42 pm
Apollo
Reputable Member

He later says the optimal protocol is case dependent. You want to go slow enough to give time for biological remodeling to release the suture interdigitations but fast enough to mechanically separate the suture and translate the expansion to perimaxillary structures. This rate would vary on an individual basis, so he suggests activating enough to feel resistance to turning and then a little more. Of course this is subjective because the patient doesn't have experience to compare if the resistance is relatively high or low.

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Posted : 03/01/2021 3:15 pm
nakedespresso
New Member

@apollo It's not looking good.  2 turns per day, I'm at turn 58.  I'm running out of threads on the device.  What have you and this group seen as potential options?  

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Posted : 04/01/2021 6:44 pm
Apollo
Reputable Member
Posted by: @nakedespresso

@apollo It's not looking good.  2 turns per day, I'm at turn 58.  I'm running out of threads on the device.  What have you and this group seen as potential options?  

I'm sorry to hear this! I know from personal experience that failing to disarticulate the suture can be very demoralizing. In his recent lecture, Dr. Moon mentioned pausing for a while to allow the biological response to breakdown the interdigitations and then resuming expansion. It might be worth a shot. In my case, I needed a second MSE, but it's not worth trying the same methods over again and hoping they work the second time. You can adjust your strategy with cortipuncture or surgical assist to help facilitate separation, perhaps slowing to the more reliable 1 turn per day protocol, and reevaluate the position (which will have to be adjusted anterior or posterior to the previous TADs unless you wait several months for the bone to heal). I think a second attempt has a better chance if you can identify a possible reason why the first attempt failed and correct it. Did your TADs tilt or drag through the bone? For example, Evan Lavizadeh on youtube just posted that he's going to try another round after his first MSE failed. His palate is very thick and he didn't get bicortical engagement in the anterior TADs. He might have had more success if his MSE was placed a little more posteriorly and if he had 13mm long TADs in the front. Instead, his ortho is planning a custom MARPE with 6 TADs for his second round.  

 

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Posted : 04/01/2021 10:59 pm
WHCCARDIO
Active Member

Hi, sorry this is slightly off topic. But Ead says a plan is needed for the mandible if one is to expand the maxilla via MSE due to the rapid expansion provided by the device. The options he layed out were either SFOT or surgical assist in splitting the mandible. Do those of you with MSE have plans for your mandible as to ensure you have a comfortable bite post-treatment?

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Posted : 04/01/2021 11:36 pm
Apollo
Reputable Member
Posted by: @whccardio

Hi, sorry this is slightly off topic. But Ead says a plan is needed for the mandible if one is to expand the maxilla via MSE due to the rapid expansion provided by the device. The options he layed out were either SFOT or surgical assist in splitting the mandible. Do those of you with MSE have plans for your mandible as to ensure you have a comfortable bite post-treatment?

Unless you dramatically expand the maxilla wider than the mandible, the orthodontist can often tilt the lower teeth buccally and the upper teeth lingually enough to achieve good occlusion without more invasive procedures. Many people with narrow palates start with a wider mandible with cross bite or compensation, so there's room to expand the maxilla to be slightly wider than the mandible. If you require more expansion than orthodontic correction can accommodate, or if you get asymmetric expansion like Ronald Ead, you might need SFOT to add grafted bone to the mandible to move the teeth out into. Surgically cutting the mandible with distraction osteogenesis is another option but isn't required in most cases.

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Posted : 05/01/2021 12:20 pm
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MagnumOpus
Eminent Member
Posted by: @apollo
Posted by: @magnumopus

@apollo  or @noctilucentnikki or anyone else with MSE - noticed any asymmetry? I am seeing expansion which is nice - but also some asymmetry - mostly expansion on the left. I know this is somewhat common with MSE. Anyone know ways to minimize this? For example - mewing or pushing with fingers only on the deficient side?

You could try sleeping on your side with the side of your face that is expanding farther against the pillow. You might also consider osteopathic manipulation, and/or any exercises to get your whole body moving symmetrically.

@Apollo: I definitely see asymmetric expansion and am trying to prevent this further. I've slowed turning a lot for now (trying to fix the asymmetry early by doing the below)

I'll sleep on the Left as you said. Also I'll try using thumb-pulling on the R side of my palate only, trying to loosen the sutures on that side more so further expansion will be even. 

Anyone else have ideas to either prevent or minimize asymmetric expansion by loosening sutures on 1 side only? (But in a way that will still allow midface expansion?)

I see that DOME could be done, but this would prevent midface expansion. I know there's ways to fix the bite effects later (like SFOT you mentioned) but if we could actually make the expansion symmetric this would be the best way to avoid all of that, while still getting symmetric midface expansion. And I noticed my cheekbone very slightly increasing on the 1 side where more expansion is happening, so preventing asymmetric expansion would allow symmetric midfacial changes, whereas SFOT would only fix the bite.

 

-MO

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Posted : 19/01/2021 12:31 am
Apollo
Reputable Member
Posted by: @magnumopus
 
@Apollo: I definitely see asymmetric expansion and am trying to prevent this further. I've slowed turning a lot for now (trying to fix the asymmetry early by doing the below)

I'll sleep on the Left as you said. Also I'll try using thumb-pulling on the R side of my palate only, trying to loosen the sutures on that side more so further expansion will be even. 

Anyone else have ideas to either prevent or minimize asymmetric expansion by loosening sutures on 1 side only? (But in a way that will still allow midface expansion?)

I see that DOME could be done, but this would prevent midface expansion. I know there's ways to fix the bite effects later (like SFOT you mentioned) but if we could actually make the expansion symmetric this would be the best way to avoid all of that, while still getting symmetric midface expansion. And I noticed my cheekbone very slightly increasing on the 1 side where more expansion is happening, so preventing asymmetric expansion would allow symmetric midfacial changes, whereas SFOT would only fix the bite. 

 

I wrote about a technique with cross elastics to prevent/treat asymmetric expansion in this other thread:

https://the-great-work.org/community/main-forum/mse-asymmetry-and-protraction/

Osteopathic manipulation might be another strategy to try. The studies I quoted in that thread suggest asymmetric expansion is pretty common. In fact, the majority of cases have a discrepancy of more than a millimeter and see statistically significant soft tissue changes on only one side. Based on my bite, I might have expanded around a millimeter more on my right side that started out broader, which isn't too bad. Maybe my asymmetry would have been worse without my slow turn protocol and osteopathic treatment.

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Posted : 19/01/2021 1:18 pm
MagnumOpus
Eminent Member
Posted by: @apollo

I wrote about a technique with cross elastics to prevent/treat asymmetric expansion in this other thread:

https://the-great-work.org/community/main-forum/mse-asymmetry-and-protraction/

Osteopathic manipulation might be another strategy to try. The studies I quoted in that thread suggest asymmetric expansion is pretty common. In fact, the majority of cases have a discrepancy of more than a millimeter and see statistically significant soft tissue changes on only one side. Based on my bite, I might have expanded around a millimeter more on my right side that started out broader, which isn't too bad. Maybe my asymmetry would have been worse without my slow turn protocol and osteopathic treatment.

Thanks for the info @Apollo, great contribution as usual! Yeah, 1mm difference isn't so bad, happy to hear that for you! My goal is soft tissue changes on both sides. 

The elastic treatment sounds interesting! But, I'm worried that this will cause a cant for me, or pull down the L side of my maxilla since the elastics attach it to the L mandibular molar as you've said elsewhere-- "Adding an elastic from the buccal side of the maxillary molars to the lingual side of the mandibular molars on the externally rotated quadrant that is expanding farther". I know these elastics would be appropriate if one has a cant, so one side is higher, and that side is also expanding faster, then these elastics would correct both of those.

For me though, I don't have a cant, just 1 side that's expanding faster. Undecided on these bands. Wondering if I should stick to pushing on the slow side. What did they do at your osteopathic treatment-- aka anything you think I could try at home? Many thanks.

 

-MO

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Posted : 12/02/2021 12:55 am
Apollo
Reputable Member
Posted by: @magnumopus

Wondering if I should stick to pushing on the slow side. What did they do at your osteopathic treatment-- aka anything you think I could try at home? Many thanks.

My osteopath recognized that I had less mobility or more resistance in the zygomatic buttress on the side that started narrower and expanded less. Over the course of several appointments, he says that side now feels less stuck. He does do some cranial and intraoral manipulation, but he also works on my body (legs, pelvis, spine, ribs, shoulders, etc.). The process seems to involve applying pressure toward better alignment while I breathe deeply and diaphragmatically. I haven't felt anything as dramatic as some people report, but maybe it's helping. @Robbie343 @Silver and @greensmoothies all recommended osteopathy to me. You could try some self manipulation/massage/myofascial release, but I think you'd have to be pretty attune to your body to achieve much effect. Any activity that gets your body moving symmetrically might also help like walking, yoga, qigong, etc. Mostly I think these interventions have a better chance of guiding expansion to be more symmetrical during the process than correcting expansion that is already asymmetrical, if they are doing anything at all.

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Posted : 12/02/2021 11:37 am
Silver
Trusted Member
Posted by: @apollo
Posted by: @magnumopus

Wondering if I should stick to pushing on the slow side. What did they do at your osteopathic treatment-- aka anything you think I could try at home? Many thanks.

My osteopath recognized that I had less mobility or more resistance in the zygomatic buttress on the side that started narrower and expanded less. Over the course of several appointments, he says that side now feels less stuck. He does do some cranial and intraoral manipulation, but he also works on my body (legs, pelvis, spine, ribs, shoulders, etc.). The process seems to involve applying pressure toward better alignment while I breathe deeply and diaphragmatically. I haven't felt anything as dramatic as some people report, but maybe it's helping. @Robbie343 @Silver and @greensmoothies all recommended osteopathy to me. You could try some self manipulation/massage/myofascial release, but I think you'd have to be pretty attune to your body to achieve much effect. Any activity that gets your body moving symmetrically might also help like walking, yoga, qigong, etc. Mostly I think these interventions have a better chance of guiding expansion to be more symmetrical during the process than correcting expansion that is already asymmetrical, if they are doing anything at all.

I would travel to see a skilled osteopath. To be completely honest, I don't think it's even remotely possible to DIY cranial osteopathy (and my own very highly skilled osteopath told me about the adjustments she and another one routinely give each other monthly and how even after years and years they're still both discovering and resolving small assymmetries or birth trauma or what have you as they continue to get more and more aligned, if you will), but then again, people said the same thing about mewing. I am no expert!

Even after all that, though, I still ended up with minor assymmetric expansion, but here's the thing—I didn't end up with any new assymetry, in a relative sense. I've scrutinized pictures from before and after expansion and I can clearly see that my face was always a little assymetrical in the way that it is now, but would you rather have a perfectly symmetrical face or one that's sort of typical, but with a palate wide enough to breathe efficiently and fit your tongue up against to mew properly (which may fix those assymmetries in and of itself, eventually)? My unqualified opinion based on observation, study, and thinking about all of this very deeply way too much is that you don't really have a choice as an adult. There's no way to truly resolve the assymmetries without mewing, and there's no way to mew without a fully un-tied tongue and a palate wide enough to accommodate it, so you can either be a cowboy and get an MSE before it's very, very well-understand, or wait maybe a few years, get a little older, with a stiffer suture, and probably end up with the same result lol

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Posted : 12/02/2021 3:28 pm
Apollo liked