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Is focusing on "the suture" looking at a tree and missing the forest? (alternate title: Is there such thing as a "non-growing" adult?)  

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toomer
Trusted Member

So obviously when it comes to adult cases, the traditional orthodontic community considers you "non-growing" ... i.e. the palatal suture is largely fused by your teens, and therefore the only way the maxilla (as a whole) will grow at all ... is by splitting it.  DOME, MSE, SARPE, etc.

Is this perhaps the wrong area of focus?  Well, I don't want to say entirely wrong since obviously those procedures deliver quantifiable results ... but is it missing a larger picture about bones as a whole?

I've been trying to develop an alternative talk-track when discussing potential treatments with orthodontists and oral surgeons (including one who is a family member) to try to shift the focus away from the suture (which they won't stop focusing on) and more to the bones as a whole.  Because unlike cartilage, bones are actually living things that adapt and change slowly over time.

So I'd love to vet some ideas out with the group here, on ways to try to drive the conversation into different territory?

Consider an example of some of the contestants you see on a show like The Biggest Loser.  Some of the dudes there go from like 500 pounds down to 200 pounds in half a year.  But did their ribcage stay the same size?  No, of course it didn't.  So some of the skeletal matter was resorbed naturally by the body, because it was no longer needed.  The body did that entirely on its own in response to changes in its environment.  

Here's a great example that you all know (but obviously not a great example of a human being):

Much smaller ribcage, yes?  And obviously lots of other bones as well, such as the pelvic bone.  I feel confident in saying that Jared there has less overall pelvic bone volume in the photo on the right than he did on the left.

Those same Biggest Loser contestants weren't always 500 pounds.  Maybe in their 20's they were closer to 200 pounds.  Are they "non-growing" adults, from a skeletal perspective?  If so, then when they get on the show why don't you see the lungs of a 500 pound person being squeezed through the much smaller ribcage of a 200 pound person?

When we stop and think about any other bones in the body, the whole idea of "non-growing" seems somewhat preposterous.

But for the maxilla, we seem to accept this line of reasoning because a traditional orthodontist said so?

So how is this adaptation happening - does the ribcage have sutures?

I don't think it does - but don't want to make a statement for certain.  But in reality either answer blows the "non-growing" theory out of the water:   

  • If the ribcage does have sutures, then that could be the mechanism by which new bone is being created ... because obviously those ribcages are changing in size.  So we have growth of bone in a "non-growing" adult, from a suture.
  • And if the ribcage doesn't have sutures ... then you have bones that are growing and shrinking without a suture at all.

So why can't the maxilla do that?  Yes, the maxilla has a suture ... but it's also bone.  And if it is truly the case that our body can remodel (create), resorb (destroy), or repair any bone in our body ... then why can't it widen the maxilla as a whole (including the suture) if the right outside forces are placed on it?

(Disclaimer:  My pet theory here is admittedly self-serving, in that it is largely based on the fact that I am looking into the Vivos DNA appliance, and this somewhat reflects the inventor's theory - and they claim to have documented the creation of over 2 cubic centimeters of new bone material in the maxilla as a whole during the course of their treatment protocol ... 2cc's is about the same volume as a pair of six-sided dice).

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Posted : 11/07/2020 10:41 am
Lawnmewer
Active Member

Isn't the skeleton unaffected by body fat?

But you might be right as your skeleton changes a lot as you age. CFD usually worsens, mandible shape and position changes, and the spine degenerates (kyphosis), none of which seem to be inevitable but rather caused by the modern lifestyles our bodies aren't adapted for.

So if these dramatic changes caused by bad posture happen throughout your entire life, it seems logical that your body could go through the same change in reverse through good posture.  

So while it is clear that with bad posture the most dramatic negative changes occur from birth to the start of puberty, and then throughout puberty it slows down, indicating that this is the time frame when the skeleton is most susceptible to change, it doesn't seem like after puberty significant change is impossible. 

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Posted : 11/07/2020 11:59 am
toomer
Trusted Member

@lawnmewer Yeah, this is what I am trying to get at.  

And those X-Rays are good (even though one of those is a 900lb person so a bit of an outlier) because it's not showing as much skeletal change in terms of in the ribcage following along with the body as I would have thought.  But unless we had an X-Ray of the same person when they were 200lbs vs. 500+lbs ... it's hard to be sure what happens skeletally when additional load/burden is added on.

So that forces me to rethink things a bit, but I still have to wonder if there is some amount of skeletal change going on ... given that "non-growing" sounds so absolute.

Additional data points:

So my bones aren't necessarily going to grow longer ... I am (probably) not going to get taller if you stretch me out on a rack every single day.  But my bones can increase their diameter via the osteoblasts at the surface, when stresses are placed on them.

And this may be why Dr. Singh (inventor of the DNA appliance) doesn't typically present his finding in terms of growth at the suture ... or number of millimeters added, etc.  He presents his findings as additional volumetric measurements of the maxilla as a whole (i.e.: creating 2 cubic centimeters of additional volume overall).  If appositional bone growth is happening via "osteoblasts at the bone surface secret[ing] bone matrix" then perhaps the growth is kind of happening everywhere in the maxilla.

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Posted : 11/07/2020 12:11 pm
Agendum
Active Member

There is very minor  but unnoticeable bone remodeling to be considered of the body of each facial bone without the need for distracting sutures but its hardly worth noting. The time it would take for treatment to affect this relies more on the bodies own bone/soft tissue tension forces to which a medical practitioner has no ability to affect this kind of growth (nor would they sit around long enough for its treatment.) Medical appliances can hardly imitate those kinds of forces because they act only as externalities.

 

The beauty of focusing on various sutures is that not only is it a source of expansion but slight articulation to shift the orientation of the bones in a hopefully habitually beneficial position thats more in line with the genetic potential. Sadly theres little one can do for underdeveloped bones like a mandible thats been under alot of bone re-absorption or maxilla thats squished. That kind of adaptive growth might as well be on geological time. Growth hormones are probably the only hope for the growth you're looking for in an adult in any reasonable way.

 

Sorry to say but DNA appliance is a meme. Just an overpriced shwartz expander with lots of marketing jargon.

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Posted : 11/07/2020 6:35 pm
Robbie343
Trusted Member

 

@agendum

Valid points. 

how would you rate bone resorption vs possible bone growth on geological timeline?

here’s a picture from a study I found of condylar regrowth over 8 months of splint therapy in a 30+ male.

 

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Posted : 11/07/2020 8:47 pm
Thomas22 liked
Thomas22
Trusted Member
 

Posted by: @agendum

Medical appliances can hardly imitate those kinds of forces because they act only as externalities.

I don’t know what you’re trying to say. You’re using indirect and flowery language. 

Sorry to say but DNA appliance is a meme.

https://m.youtube.com/watch?v=sYJBkX9FTLQ

This Homeoblock video is interesting because you can see the eyes move and change shape.  

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Posted : 12/07/2020 1:13 am
Agendum
Active Member

@thomas22 They can only act upon, not within the configuration of facial bones enact forces onto eachother.

 

The video has very alot of morphing, at best looks like its just the alveolar ridge moving, nothing of skeletal significance. Soft tissue appearance around the oribital rim can fluctuate with sleep, muscle tone and angle, even week to week.

 

If you cant fix a narrow palate with your tongue years within ossified adulthood, a non-skeletal appliance isnt really going to help much. I currently have MSE which has the most directional force and even I have to reinstall it again (with corticopuncture this time) because my bone is too dense (slight torus palatinus) and sutures too tightly ossified.

 

The only thing thats really going to move is the aveolar ridge with removable expanders, which with any type of expander will deliver some force to the zygomatic butress but will follow with the inevitable tipping and diminishing returns on the rest  the face if the midpalatal suture is unaffected. To grow or expand the parts of the face you'll even have to overcome many facial sutures which moving the aveolar ridge alone will have increasing difficulty in doing, if at all with removeable expanders at an adult age.

Ive tried upper and lower arch removable expanders (at age 27) and I wasted time and money on it, just tips teeth in my case. I was very hopeful about it but it was not what I imagined. 😕 

 

@Robbie343 I will have to take a look at that as it looks interesting. We'll have to see if its just the condyle growing or the ramus and/or body of the mandible. Maybe certain parts of bones have different growth properties, the mandible seems to differ from the other facial bones in that its mostly just a single piece with one area of articulation.

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Posted : 12/07/2020 10:43 am
Thomas22
Trusted Member
Posted by: @agendum

They can only act upon, not within the configuration of facial bones enact forces onto eachother.

Agendum, I’m struggling with your English, this sentence doesn’t mean anything for example. 

It seems like you’re trying to say that the device applies pressure to the bones, but it’s not enough to change how the complex, the bones that make up the face, are structured. 

But I have no idea if that’s what you’re trying to say. 

If you look at the scans that Dr. Singh and Dr. Belfor have released, you’re incorrect, the devices can actually induce dramatic skeletal changes, including lengthening the ramus, widening the nose, higher cheekbones, and shifting the relative position of the eye orbits. One Homeoblock patent saw his face widen at the zygos by 6mm. What appears to happen is that force exerted on the alveolar ridge, it  expands the ridge, but it also results in a cascade of changes throughout the rest of the face. The rest of the face grows in proportion to the larger ridge. Interestingly, in cases of asymmetry, the resulting growth is largely on the less developed side. 

In my experience, six months into treatment, I do breathe more easily but the biggest change has actually been in my posture. Instead of craning my head forward, I stand very upright. 

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Posted : 12/07/2020 11:37 am
Agendum
Active Member

@thomas22 Yeah, basically. I was re-reading my comment now and I couldnt understand it too. Sorry about that.

Most removable devices mostly seem to distribute forces on the surface of bones whereas implants like palatal distractors or MSE implants can impact the bone complex further than the surface of where they were implanted.

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Posted : 12/07/2020 12:37 pm
toomer
Trusted Member

@Agendum : "DNA appliance is a meme" 

Well, except for the documented case studies of >50-60% reduction in AHI for those suffering from obstructive sleep apnea (without requiring a device to be in the mouth for post-treatment sleep studies).  Case studies which have been submitted to the FDA for approval to market as a potential cure for mild-to-moderate sleep apnea (known as "class II" approval, for which actual efficacy must be demonstrated).

Oh, and except for the 2 cubic centimeters of additional bone volume that they have measured across the entire maxillary structure via CBCTs (not just at the suture) post-treatment (that's the equivalent of two six-sided dice of additional bone material).

Oh, and except for the documented increases in nasal passageways - in some cases improving areas that were maybe less than 1mm wide in terms of allowing airflow ... and doubling them or more. But yeah, maybe that's coming from just pushing teeth?

Oh, and except for all those other mid-face changes that @Thomas22 already mentioned ... including sometimes seeing re-alignment of the eye sockets (if there was a reasonable amount of craniofacial imbalance).

Oh, and except for the fact that Stanford university is working with them on studying this mechanism of bone growth.

But yeah ... other than that ... "just a meme".

Look, I'm happy for you that you found a protocol you think will meet your needs.  That's great!  Good for you, and I hope it delivers all the results you need to have a happy and healthy life.  But that's not cause to [Rude Language or Insults are not tolerated] on other protocols, especially if you haven't done much research into them at all (which it would seem you have not, at least in the case of DNA - your analysis doesn't seem to amount to much more than "looks like that Schwartz expander I tried" and that's about it).

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Posted : 12/07/2020 1:43 pm
Agendum
Active Member

You are free to spend money and time as you wish.

 

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Posted : 12/07/2020 8:38 pm
toomer
Trusted Member
Posted by: @agendum

You are free to spend money and time as you wish.

 

Sorry it didn't work out for you.  But there is research indicating that it just might possible, albeit slow:

"the results of this study show that the use of maxillary expanders in adults allows for statistically significant expansion, observed by the average increase in the linear measures of facial width (1.41 mm), nasal width (1.92 mm), nasal height (2.5 mm), maxillary width (2.42 mm), jaw width (1.92 mm) and molar-maxillary width (2.0 mm) (Table 3Table 4Table 5Table 6Table 7Table 8), in an average time frame of 5 months (table 2)."

"our results do not support the hypothesis that maxillary expansion occurred due to dental tilting"

https://www.sciencedirect.com/science/article/pii/S1808869415300513

(worth noting, they intentionally stopped after 5 months because their intention was only to proceed long enough to try to achieve clinically-measurable results, so it should not be assumed that 2.42mm of maxillary width growth was necessarily the limit for the test patients)

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Posted : 12/07/2020 9:08 pm
Thomas22
Trusted Member
Posted by: @agendum

Most removable devices mostly seem to distribute forces on the surface of bones whereas implants like palatal distractors or MSE implants can impact the bone complex further than the surface of where they were implanted.

 From the papers I’ve read, and from looking at before and after photos, I believe palate expanders can achieve dramatic results - albeit slowly, over he course of several years. The light forces they exert are similar to what we should have experienced naturally, when we were growing. And they encourage what amounts to natural growth.

Belfor says the Homeoblock helps you achieve your genetic potential which is perhaps a good way to think of it.

I don’t think they can completely resolve the asymmetries with that patients have, based on looking at photos. Everyone shows improvement - but it’s not complete. Although they only track patients for two years - what do they look like after four, or five years?

MSE undoubtedly works much faster, my question is how it effects the rest of the facial structure.

A traditional palate expander can reshape your sphenoid (indirectly) if you undergo MSE does the same thing happen? Does MSE help resolve the structural asymmetries we see?

And if so, to what extent? And does it do so more quickly than with a palate expander?

 

 

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Posted : 13/07/2020 12:40 am
Thomas22
Trusted Member

@toomer

 One of my questions is long term follow up. At what point does the device induced growth stop?

 What do patients look like at the four year mark? The six year mark?

 I suspect that asymmetries would continue to correct themselves, if only because normal function has been restored. A correct bite would lead patients to chew with both sides of their mouth, for example. 

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Posted : 13/07/2020 1:17 am
Agendum
Active Member

@thomas22 Removable expanders are really only trying to imitate the tongue but do it less efficiently and with less force on the palate and more on the alveolar ridge and teeth. Maxillary expansion allows the tongue to expand more intelligently than any of the appliances or expanders. With proper space in the mouth, the tongue can do what removeable expanders want to do.They are good for avoiding relapse of an expanded jaw for those who cannot achieve a good sleeping tongue posture.

MSE and other maxillary expanders are shown to add force to the zygomatic buttress expanding laterally, break up the suture complex around the nasomaxillary area, break + expand midpalatal suture and nasal floor+opening with adiastema all relative the midpalatal suture. MSE only expands along the plane of the suture so it has no corrective effect on the maxillary cant which is a greater craniofacial issue that no oral appliance/implant can really fix. For some people the midline of the whole face is offset with the midline of the palatal suture. I dont think this can really be resolved but the expansion exceeds the downside of the asymmetry that was already present. MSE is not elegant, its a roided-up man moving furniture that has been nailed down to make room for the artisan (the tongue.)

I dont think any appliances or implants can affect the sphenoid to a significant degree. Thats probably more likely due to correcting neck posture as a consequence of fixing access to airways than by forces (dynamic or static) from the appliance/implant. To depend on a removable appliance for 2-5 years is better spent on more effective treatments. Bone borne treatments make more of a commitment to skeletal changes as its more visually apparent in scans and facial appearance.

 

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Posted : 13/07/2020 3:43 am
toomer
Trusted Member

@thomas22

Good question!

So, in a number of Dr. Singh's video lectures he notes how that early on they got in a number of test patients and ran them through a home sleep test clinically determining whether they had OSA or not.  Then, using x-rays/scans, they measured the maxillas of both groups ... specifically trying to account for factors like someone a football player who might be 6'5" and 280lb ... will naturally have a larger maxilla than a 5'2" woman who weighs 95lbs ... even if neither has OSA.  Normalizing the data for height/weight/gender, they found that OSA patients had a ~7-11% smaller maxilla in each dimension.

So I bet the first part of the Vivos protocol is probably to look at whatever you've got, and see if they can expand you 7%.

Obviously, you can't do that indefinitely though - so you raise a good question on how do they know what your genetic potential is?  I have a feeling that for DNA, they're just trying to cure sleep apnea ... so maybe once you get your AHI below 5 they would end treatment?  I suspect that with having treated 15,000 patients now (far more than MSE, as far as I can tell) they have compiled a lot of live patient data on just how far they can probably push things.

As far as the long-term ... I've directly spoken via email or phone with some patients that are now 5+ years post-treatment.  Changes seem to be stable.  There isn't much published research on this yet, and for what little there is most of the research that has come out has been focused on long-term stability of changes in an OSA context.  I am finding a mixed bag of results of some patients that still wear the appliance nightly or maybe one week a month - but the expansion mechanism has been completely acrylic'd over so that it is no longer adjustable.  It's just a permanent upper retainer now.  But other patients I spoke with had some orthodontic work done after DNA, and therefore there's no way the appliance would fit any more.  Even they seem to be indicating the gains seem to be stable.

There is one example that Dr. Liao did an 18-month follow-up of a 60-year-old patient post-treatment ... they wanted to see if the reduced AHI held, and it actually got even better 18 months after treatment stopped, which would be indicative that changes were still going on.  Now, did this patient wear the appliance overnight as a fixed retainer?  It doesn't say.  But continuing changes do seem to happen.

https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A5533

In this long video from Dr. Liao, that patient's case is one of the ones he reviews - and if I remember correctly, the 36-month CBCT showed additional airway volume improvement ... which would be indicative of changes continuing in the body.  If I can attribute a theory to Dr. Singh on this (which he has not specifically stated), I believe it is due to the nasal breathing / tongue position issues being corrected enough so that the body can (in some cases) actually continue to improve/remodel towards genetic potential on it's own at that point.  You don't need mechanical forces anymore, the appliance got you "over the hump" you were stuck behind, and now the body can take over and finish things off a bit.  I don't know any other way to explain how a 60-year-old patient's airway gets even larger at a 36-month CBCT ... above and beyond the end-of-treatment CBCT taken at 18 months.

It's a long video, and I can't remember how far in it is - but it really is worth a watch, Dr. Liao was one of the early providers to get onboard with Vivos' approach ... and thus he has a lot of patient cases, and I like that he still draws up old-school ceph traces for his patient cases: https://vimeo.com/296965001

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Posted : 13/07/2020 8:16 am
Thomas22 liked
toomer
Trusted Member
Posted by: @agendum

@thomas22 Removable expanders are really only trying to imitate the tongue but do it less efficiently and with less force on the palate and more on the alveolar ridge and teeth. Maxillary expansion allows the tongue to expand more intelligently than any of the appliances or expanders. With proper space in the mouth, the tongue can do what removeable expanders want to do.They are good for avoiding relapse of an expanded jaw for those who cannot achieve a good sleeping tongue posture.

MSE and other maxillary expanders are shown to add force to the zygomatic buttress expanding laterally, break up the suture complex around the nasomaxillary area, break + expand midpalatal suture and nasal floor+opening with adiastema all relative the midpalatal suture. MSE only expands along the plane of the suture so it has no corrective effect on the maxillary cant which is a greater craniofacial issue that no oral appliance/implant can really fix. For some people the midline of the whole face is offset with the midline of the palatal suture. I dont think this can really be resolved but the expansion exceeds the downside of the asymmetry that was already present. MSE is not elegant, its a roided-up man moving furniture that has been nailed down to make room for the artisan (the tongue.)

I dont think any appliances or implants can affect the sphenoid to a significant degree. Thats probably more likely due to correcting neck posture as a consequence of fixing access to airways than by forces (dynamic or static) from the appliance/implant. To depend on a removable appliance for 2-5 years is better spent on more effective treatments. Bone borne treatments make more of a commitment to skeletal changes as its more visually apparent in scans and facial appearance.

 

So, to summarize ... is it safe to say you are now admitting that DNA can accomplish some growth/expansion, but perhaps "less efficiently" over "2-5 years"?

If so, what's the hurry?  Does MSE achieve overall more net growth?  Maybe.  And perhaps even likely -- although my DNA provider says he's gotten 7mm of expansion in the anterior-posterior domain for some patients, and MSE is mostly lateral.  That's not too bad IMO.  But I would grant that MSE can probably achieve more lateral expansion overall.  

And does MSE do it faster?  For sure.  No debates there (same for DOME, etc.)

But please keep in mind, some of us have been living with decades of sleep/breathing/TMJ problems.  1-2 years of treatment time is not off-putting.  I myself am one of those cases.  And given that I am in my 50's, my body probably isn't quite as adaptive as it was when I was in my 20's, so the idea of a "roided-up man moving furniture that has been nailed down" is actually not all that appealing.

Average case treatment time for DNA is 9-18 months, per investor literature they sent around earlier this year.  Some patients might need some pre-treatment work like an orthotic bite-splint (what my provider has me in right now) which could take months, and then some patients may want to do some post-treatment traditional orthodontics to get their teeth perfectly aligned (if DNA didn't do a good enough job aligning on its own).  But the average time a patient is using the appliance is 9-18 months.  From what we saw in the previous study I linked to, getting an average of 2mm of lateral expansion of the maxilla in 5 months is achievable and has been documented through traditional radiographs and ceph traces.

Whether long-term/lifetime use of the appliance as a permanent retainer might be necessary will vary from one patient case to the next (some might have slight tongue ties which would prevent the tongue from proper positioning even when there is space).  This may be a case where something like MSE might be superior as it's absolutely achieving probably close to 100% of its gains at the suture and likely next to nothing in the alveolus, but again - you have to consider where patients are coming from, they are not all in your specific circumstance.  I have been sentenced to spending 1/3rd of the rest of my lifetime on a CPAP machine if I want to avoid a whole host of cardiac problems, potential stroke, dementia (look up "CPAP apnea white matter brain"), etc.  The trade-off of a lifetime of permanent nighttime retainer use ... is trivial, and a huge trade-off in my favor (if DNA works for me).

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Posted : 13/07/2020 8:58 am
Thomas22
Trusted Member
Posted by: @agendum

Removable expanders are really only trying to imitate the tongue but do it less efficiently and with less force on the palate and more on the alveolar ridge and teeth. Maxillary expansion allows the tongue to expand more intelligently than any of the appliances or expanders.

The way you write is entirely your choice, and you don’t need to write in a way to make anyone else happy - myself included. 

But, and I say this as someone who spent too much time in school, and at university, the more words you use, and the longer the word you use, the less intelligible you are. 

In English, the best writing is usually clipped, and efficient.

Removable expanders are really only trying to imitate the tongue

This is what I’m getting at. You can eliminate the words in strike through without changing the meaning of the sentence, it’s more efficient, and it also makes your statement stronger and more assertive. Which is a good thing. 

I like some of Hemingway’s work, but not all of it, but he’s a good example of an efficient writer. 

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Posted : 13/07/2020 10:42 am
Thomas22
Trusted Member
Posted by: @toomer

You don't need mechanical forces anymore, the appliance got you "over the hump" you were stuck behind, and now the body can take over and finish things off a bit.

That’s exactly what I was pondering - thank you!

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Posted : 13/07/2020 10:46 am
Thomas22
Trusted Member
Posted by: @agendum

I dont think any appliances or implants can affect the sphenoid to a significant degree.

The CBCT scans show extensive remodelling.

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Posted : 13/07/2020 10:50 am
Agendum
Active Member

@thomas22 I do mean to say that the DNA appliance is only trying (but is much less sophisticated) to imitate the tongue. By your striking out my text you are changing the meaning of what I said. Im trying to highlight that the tongue with sufficient space does a better job than tooth borne removable appliances. I am satisfied with my own style of communication as I do not feel the need to conform.

 

 

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Posted : 13/07/2020 7:15 pm
Agendum
Active Member

@toomer Its mostly worn at night, acting as a retainer for poor tongue posture in sleep. When you move the aveolar ridge or teeth that gives more space for the tongue in the day time, how are we to know which is doing most of the expansion? Are we supposed to think its the "epigenetic" action that the marketing tells us its doing? Or is it that the beginner gains of added expansive forces allowed the tongue to expand?

 Is the DNA doing the skeletal expansion/remodeling or merely just saving the daily progress of the the remodeling effect of improved daytime tongue posture? It seems like tongue posture isnt being given credit it deserves. I find myself skeptical of 7mm of skeletal expansion especially if its from word of mouth. There doesnt seem to be many images of of these changes as well circulating through the internet.

I dont intend to make this about only about MSE, its just a good example of the effectiveness of bone borne options. What I mean about nailed down furniture is that for highly ossified faces it is needed to get reliable skeletal changes, I exaggerated it to make the point of just how stubborn sutures can be. There is little interpretation needed to see those changes. I do not know if theres a difference in bone strength/resistance of an adult vs an elderly person but it might be a factor in treatment options.

As for breathing the maxillary expanders expand the nasal floor, making even more air volume than shaving the nasal turbinates. This allows for better access to the airways which is a large reason (sometimes the primary reason) to breathing problems at night. The tongue can do the foreward remodeling with this new expanded oral volume as well which is the primary hurdle to tongue posture.

Its seems like the demographic target is much different between expanders. It appears that tooth borne acrylic removables are more suitable the very young/elderly and more bone-borne expanders for teens/adults.

I get some of my information from this presentation https://www.pathlms.com/pcso/events/1648/video_presentations/14383 (its 90 min long but does a good job of explaining the importance of being bone borne.)

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Posted : 13/07/2020 9:07 pm
toomer
Trusted Member
Posted by: @agendum

As for breathing the maxillary expanders expand the nasal floor, making even more air volume than shaving the nasal turbinates. This allows for better access to the airways which is a large reason (sometimes the primary reason) to breathing problems at night. 

I'm glad you mentioned that.  Because guess what?  There are other expansion protocols achieving the same thing.  Note the change in distances between the inferior conchae and the septum:

Was that just one patient though?  Nope.  Some adult patients are getting 1-2 cubic centimeters of additional maxillary sinus volume ... (in some cases, as much as 10 cubic centimeters if you look at patient 15-JWS who had the most significant results).

But yeah.  It's just pushing teeth, that's all.  Just a meme.

Except ... it's hard to call it a meme when an oral/maxillofacial surgeon measures a patient before and after treatment and in addition to noting there was no flaring of teeth, states: "I was going to expand your upper jaw, but that now been taken care of by your appliance" ... and also notes that increase between the canines was between 4-5mm, further commenting "wow, that's a lot" ... (all of this is at minutes 48-52 in the video)

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Posted : 14/07/2020 2:30 pm
Agendum
Active Member

Image appears to be taken at different depths. As usual one of the teeth are being pushed through the aveolar ridge on the right side. Not saying that doesnt help but it is what it is.

 

We can look at charts all day, Im only interested in seeing tangible changes instead of 2nd hand stories, the doctors says this and says that. Faces and mouths can show these but are few in number to see (always the same few sketchy patient photographs. Skepticism still remains high not just by me but other people.)

 

Again, how much credit is the tongue being given and are we supposed to believe in some 2010's trending marketing jargon like "epigenetics" is going to have weight for an acrylic expander with springs?

 

DNA appliance memed itself with its marketing.

 

 

 

 

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Posted : 14/07/2020 9:32 pm
toomer
Trusted Member
Posted by: @agendum

Image appears to be taken at different depths. As usual one of the teeth are being pushed through the aveolar ridge on the right side. Not saying that doesnt help but it is what it is.

 

You're funny.  So on the one hand, you say the images on the left and right can't be showing the exact same area ... because they must be making it up in terms of minimum distance between the nasal passages?  But then you turn right around, and you clearly think a tooth is "being pushed" on the right when you compare it to the left ... but that would necessitate the area shown on the right and the left is exactly the same to be sure.  Which you clearly believe it is not.

Sorry, if you can't actually bring honesty and logic to the discussion - I'm not sure there's a point in discussing it.  Either the depths are absolutely the same on the left and right, in which case we've increased airway ... but maybe we've pushed a tooth a bit.  Or they're not the same, and they are just measuring a larger spot in the second, but then you can't make comparative assessments about tooth position from one to the other.

You don't get to have it both ways.

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Posted : 15/07/2020 9:00 am