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Is there a 4th mechanism of adult palate expansion (aside from teeth tipping, alveolar remodeling, and splitting the intermaxillary suture)?  

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Mr_Man
Active Member

After absorbing lots of information, and some personal experience, it appears that many of us are aware of these mechanisms of adult palatal expansion (in increasing order of efficacy):  1) tipping of teeth, 2) stretching/remodeling of alveolar bone, and 3) skeletal expansion via separating the intermaxillary suture and allowing new bone to grow in between.  I understand that an adult that undergoes expansion often experiences some or all of these three to varying degrees.

I've heard that there might also be another expansion mechanism between #2 and #3, which is growth of new bone along the intermaxillary suture without actual separation of the suture itself.

I'm beginning to believe that this growth is possible with the appropriate forces.  In my case, following about 7 months of mewing and using a transverse expander, I decided to get another expander (same type).  Looking closely at the two plaster molds (created by the impressions, 7 months apart) and measuring, I found about 4 mm total expansion.  This is using the IMW of the first molars.  I'd say about 50-60% of this expansion was just molar tipping, but the rest appears to be the palate itself being wider without "dropping".  I figure this based on the increased width between molars where they meet the gums (i.e. the most "apical" points I can measure), and measuring horizontal increases between distinct points within the rugae (kind of like fingerprints).  Again, I see no vertical height difference at all between the two molds, meaning the highest point of the palate, in relation to the incisal edges of the teeth, remained the same.  That makes me believe that there was no "stretching" of the bone, which I would think would have caused the top of the palate to drop down.  I also see no evidence that the suture itself split in two.

Is there a consensus about whether it would be realistic to grow new bone along the intermaxillary suture, for adults, without splitting it, given the right amount of forces (such as hard mewing or acrylic expander) or not?

 

 

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Posted : 20/07/2020 4:46 pm
JordanR
Active Member

Yeah, general bone remodelling. Although probably the slowest, it could prove the most promising. Bone can change shape under force apparently.

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Posted : 20/07/2020 11:17 pm
Thomas22 liked
toomer
Trusted Member

This study shows an average of about 2mm of maxillary expansion across a batch of adult test patients, achieved in about 5 months with an acrylic palate expander.  Most importantly, the researchers were specifically looking for tilting of teeth and felt that they could find no evidence for that occurring:

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

They are clear that they didn't attempt to investigate whether the growth was skeletal (implying suture), or dentoalveolar.

Dr. Singh - the inventor of the DNA appliance - believes that if you create "stretching" signals to the sutures, that stem cells in the sutures will create new bone.  That a hard split (MSE, DOME) is not necessary (unless for some reason you want 10mm in 30-45 days).  This article - on experiments performed on rats, but they are apparently similar enough to humans in that regard - seems to show growth of the suture based on stretching forces alone:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/

There is also "appositional bone growth" which occurs throughout life, but as far as I understand it that's taking place at the outer layer of the bone and is more about altering its shape.  But I think that that's part of how your "plate drops" downward as you are growing up ... is through appositional remodeling.

And finally, Dr. Singh also believes that periodontal ligaments act as "modified sutures".  It has been shown that there are stem cells in the periodontal ligament - so that's not controversial - but he seems to theorize that the outward forces are creating new skeletal bone there (in addition to at the suture).  So that's one of the reason why when he shows before-and-after measurements, he tends to focus on overall bone volume of the maxilla (which he claims they get an average of 2 cubic centimeters of new bone, about the side of a pair of dice) instead of focusing on mm's split at the suture.

For all of these reasons, this is why I am only investigating DNA at this point.  I don't care if the treatment time is 18-24 months ... I'm patient, I can wait.

It's interesting that your palate didn't drop at all.  In a way, that reinforces your conclusion that you did get growth.  If you think about your mouth as a little tiny "Monopoly house" ... imagine you can stand inside of it, and with your hands push the inner walls outward.  If you keep the same amount of "roof material", then as the house walls move outward, the roof should drop a bit and be at a lower angle.  But if it doesn't, that would have to imply you've created new "roof" material somehow. 

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Posted : 21/07/2020 8:49 am
Thomas22 liked
Basim
Eminent Member
Posted by: @toomer

This study shows an average of about 2mm of maxillary expansion across a batch of adult test patients, achieved in about 5 months with an acrylic palate expander.  Most importantly, the researchers were specifically looking for tilting of teeth and felt that they could find no evidence for that occurring:

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

They are clear that they didn't attempt to investigate whether the growth was skeletal (implying suture), or dentoalveolar.

Dr. Singh - the inventor of the DNA appliance - believes that if you create "stretching" signals to the sutures, that stem cells in the sutures will create new bone.  That a hard split (MSE, DOME) is not necessary (unless for some reason you want 10mm in 30-45 days).  This article - on experiments performed on rats, but they are apparently similar enough to humans in that regard - seems to show growth of the suture based on stretching forces alone:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/

There is also "appositional bone growth" which occurs throughout life, but as far as I understand it that's taking place at the outer layer of the bone and is more about altering its shape.  But I think that that's part of how your "plate drops" downward as you are growing up ... is through appositional remodeling.

 

So effective hard Mewing or with a tooth borne appliance can give you the same expansion as MSE or DOME without splitting the suture?(Albiet on much longer time frame)

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Posted : 21/07/2020 10:59 am
Mr_Man
Active Member

@toomer

It's hard to say for sure, and quite hard to tell from the before (left) / after (right) picture here, but I don't see any "dropping".  I didn't have to do much in the way of shaving of acrylic.  There were certain spots that were causing mucosal irritation where I did shave the acrylic down but for the most part, the height stayed the same .

It's quite hard to do a rugae comparison but I tried my best with the orange dots here.  Also, the "after" mold is not quite as detailed as the first, but this should give a general idea of where some of the non-teeth-tipping expansion seemed to take place.

Obviously, the left side of the "before" is lined up with the right side of the "after" here in this picture.

 

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Posted : 21/07/2020 2:04 pm
Thomas22 liked
Mr_Man
Active Member

@basim

I also wonder if, for example, I need 10 mm expansion, and could get 2 mm in 6 months, if I could carry on 5 times as long to get there?  I have the patience; I just don't want the teeth to tip too far, but I would of course continue to monitor that.

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Posted : 21/07/2020 2:08 pm
Elwynn
Estimable Member

@toomer

I wonder how this mechanism of growth at the suture looks, visually. Over the course of using a removable palate expander (Schwartz), a reddish-pinkish line of about 1-1.5mm appeared over my maxillary suture. Initially, it was very red, but as it slowly expanded (fraction of a millimeter at a time), it became more pale. I suspect that this is new bone being laid down. Either the suture had split, and the material is being laid between the gap, or it is being laid around the suture. Do you think my suspicions are reasonable?

24 years old

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Posted : 21/07/2020 2:13 pm
Mr_Man
Active Member

@elwynn

Sounds reasonable to me.  Whether new bone is deposited alongside or between the suture, either way transverse growth would appear to be occurring, especially given your mucosal changes in hue.

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Posted : 21/07/2020 2:21 pm
Thomas22
Trusted Member

@mr_man

 I think eating and keeping your teeth in contact at rest prevents tipping. 

 My teeth haven’t tipped. 

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Posted : 21/07/2020 2:30 pm
Mr_Man
Active Member

This picture should indicate why I need such a massive increase in upper IMW.  My upper is now close to 40 mm but the lower is closer to 50 mm.  I know I need upper protraction too, which I've tried some and will probably resume (I've given it a rest for now).

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Posted : 21/07/2020 2:36 pm
Mr_Man
Active Member

FYI, this is what my palate looks like now.  Haven't worn expander in over a week, but have still been hardmewing

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Posted : 21/07/2020 2:46 pm
Mr_Man
Active Member

@thomas22

You can probably see from one of my above pictures that the molars barely touch at all; perhaps as I expand, such contact will improve 

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Posted : 21/07/2020 2:55 pm
Thomas22
Trusted Member

@mr_man My open bite closed in month five. 

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Posted : 21/07/2020 2:56 pm
Mr_Man
Active Member

@thomas22

Excellent!  I've got a long way to go but at least the discrepancy between upper and lower is slightly better now

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Posted : 21/07/2020 3:05 pm
toomer
Trusted Member

@mr_man

Well, knowing a bit of his history it's important to understand that @Thomas22 's open bite correction was via the DNA appliance.  There's often this assumption that any old roof-of-mouth acrylic appliance / transverse expander could do the same thing, but I don't know if that's an accurate assumption.  For example, I don't know if your appliance is making contact with the roof of your mouth at all times ... but the DNA does not, it's just a hair below ... which apparently causes a bit of "suction" pressure on the suture when you swallow and the appliance is briefly/temporarily pressed on the roof of the mouth.  So there could be subtle distinctions between what Thomas is doing via DNA vs. what you're trying to accomplish.

IMO, this is why the statements about "it's just an overpriced Schwartz/Hyrax/whatever expander" are missing the mark.  Dr. Singh has shown a few cases where they have closed open-bites that were quite notable.

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Posted : 21/07/2020 5:06 pm
toomer
Trusted Member
Posted by: @basim

So effective hard Mewing or with a tooth borne appliance can give you the same expansion as MSE or DOME without splitting the suture?(Albiet on much longer time frame)

So, I'm not really in the "Mewing" camp - since my estimated 34mm inter-molar width ... kind of makes it difficult if not impossible to really get my tongue properly on the roof of my mouth.  So I don't feel qualified to make any long-term statements about what mewing can/can't achieve.

There are some early DNA patients who claimed to get close to 10mm of lateral expansion ... but it seems like it's more rare to find.  This guy seemed like he got to about 9mm going from 25mm to 34mm, I think they were making a new appliance ... and unfortunately it seems like he stopped blogging: http://mydnaappliance.blogspot.com/

There's some stuff I read about splitting the sutures, and concerns from craniosacral therapists about it ... that make me cautious.  So that's why I view protocols in the order of risk/benefit/time involved ... and look at them not as a question of picking "this protocol'' or "that protocol", but which order would make the most sense?  So, maybe DNA to get 5-6mm in a year (which is what I probably need).  Maybe if that's not enough, then MSE after that - but perhaps less than 10mm now.  And then finally, MMA if all else fails.

The reason why considering the order is important, is some might preclude others.  For example, once you have the metal pins in your head from MMA ... you can't really do something like DNA unless you go in for a 2nd surgery to get them removed.

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Posted : 21/07/2020 5:20 pm
toomer
Trusted Member
Posted by: @elwynn

@toomer

I wonder how this mechanism of growth at the suture looks, visually. Over the course of using a removable palate expander (Schwartz), a reddish-pinkish line of about 1-1.5mm appeared over my maxillary suture. Initially, it was very red, but as it slowly expanded (fraction of a millimeter at a time), it became more pale. I suspect that this is new bone being laid down. Either the suture had split, and the material is being laid between the gap, or it is being laid around the suture. Do you think my suspicions are reasonable?

How often were you adjusting/how much were you adjusting each time?

It certainly seems plausible.  And some DNA patients do report getting a "diastema" between their front upper incisors.  Not the huge 10mm diastema that DOME gives you, but they definitely do start to see gaps form.

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Posted : 21/07/2020 5:24 pm
Mr_Man
Active Member

@toomer

I should point out that I do have plates and screws from a LeFort 1 done 23 years ago

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Posted : 21/07/2020 5:57 pm
sinned
Estimable Member

@toomer

I'm starting around your IMW, I was at 35 mm, not sure what I'm at now, but I've definitely expanded from mewing, you should stay tuned for pics, I'll probably post my palate expansion in a month or two when I see good change, I have slightly crooked teeth rn so when I get enough expansion that they straighten I'll post pics.

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Posted : 22/07/2020 12:53 am
Elwynn liked
toomer
Trusted Member
Posted by: @mr_man

@toomer

I should point out that I do have plates and screws from a LeFort 1 done 23 years ago

Hmmm.  And you're self-treating?  Hard to know how that might work out.  You're putting pressure on the bones and they want to adapt ... but those plates and screws are going to act as immovable objects.

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Posted : 22/07/2020 9:17 am
Mr_Man
Active Member

@toomer

I thought about that; there are 4 plates, with screws holding them in.  One pair are L-shaped, on the outer sides of the maxilla below the cheekbones.  The other pair curves around the outer and lower edges of each side of the nasal opening.

I'd been willing to try self-treating as any improvement is better than none.  I have noticed some improvement.  I do have an MSE consult coming up soon, though, and they'll give me the assessment I need for my specific case.

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Posted : 22/07/2020 11:33 am
Elwynn
Estimable Member

@sinned

I'd be very interested in seeing your photos as well.

I have two questions, if you don't mind:

1. Have you achieved palatal expansion exclusively through mewing, or have you used a device at some point?

2. Have you observed a line over your maxillary suture?

24 years old

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Posted : 23/07/2020 4:27 pm
sinned
Estimable Member

@elwynn

1. Mewing all day basically, using about a medium force. I was mewing at night but I stopped because it was affecting my sleep. So now I'm mewing during the day and doing a suction hold at night so I don't open my mouth. 

2. There's a line over my maxillary suture, it's always been there though.

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Posted : 23/07/2020 5:10 pm