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MSE (Maxillary Skeletal Expander) appliance effects on patients with good bite? Lower jaw?  

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DrMario
Eminent Member

Hi everyone,

I am a step closer to getting the Maxillary Skeletal Expander device, which is a form of MARPE. It's a device that uses TADs to be screwed into your upper palate for skeletal transverse expansion of the maxilla. I will also be combining this treatment with a face mask for maxillary protraction to accomplish some forward and upward movement.

 

My only concern at this point is...I know that if I do this, my upper palate will widen, but what about my lower dental arch? My bite is fine with no malocclusion but I fear that it will mess up my bite post treatment...

 

With my IMW only being at 33mm, I know I need transverse expansion from the mouth breathing when I was younger. I wish to do this treatment to have more room in my mouth for my tongue and breathe more efficiently at night. I already got my size +4 tonsils and adenoids out, and my turbinates reduced, so I'm breathing much much better than before but I do want to take advantage of the MSE appliance.

More info on this device:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398849/

 

Thanks in advance everyone.

Quote
Posted : 28/03/2019 10:30 am
entelechy liked
Abdulrahman
Reputable Member

MSE has no effect on the lower jaw, did your orthodontist discuss with you options to expand your lower jaw?

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

ReplyQuote
Posted : 28/03/2019 11:00 am
DrMario
Eminent Member

She said she isn't sure on how to accomplish that.

ReplyQuote
Posted : 28/03/2019 11:31 am
Abdulrahman
Reputable Member

Well from the x-ray it does not seem your lower jaw has much room for alveolar expansion, so your only option is probably surgery.

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

ReplyQuote
Posted : 28/03/2019 12:58 pm
snaaaaakes
Active Member

There are a dozen ways to widen the mandible with appliances (sagittal, ALF, etc) but I believe in some cases it just widens as a result of the improved tongue posture you get after maxillary expansion. 

Are you saying that the ortho who will be giving you the MSE has no idea how to widen her patients' mandibles after widening their maxillas with MSE? 

ReplyQuote
Posted : 28/03/2019 2:29 pm
DrMario
Eminent Member

Basically, I went to a holistic dentofacial ortho, she's great, educated in effects of the airway, sleep apnea, and is a firm believer in mewing, etc. But she is not familiar with MSE so she won't be installing it...

but there is another ortho who does MSE but is not familiar with sleep apnea, physiology of the airway, etc.

I just want to know if MSE + FM will expand my maxilla and not mess up my bite. I am hoping that post treatment my bite will be good and if I need an appliance for my lower jaw to correct the bite, I would like to know what would it be.

I'd rather not do orthognathic surgery because I'm hopeful in alternatives.

ReplyQuote
Posted : 28/03/2019 3:40 pm
megamandude
Trusted Member

Can you tell us the name of your holistic ortho? 

ReplyQuote
Posted : 28/03/2019 5:13 pm
ladida liked
snaaaaakes
Active Member

Okay but the one who DOES know how to install/apply MSE, surely they know how to resolve the occlusion afterward? Are you sure they're doing MSE and not SARPE? (MSE is very niche and its inventor is totally airway-oriented.) What is the exact treatment plan they proposed to you?

ReplyQuote
Posted : 29/03/2019 6:17 pm
DrMario
Eminent Member

I’ll find out next week if he does know. Because from the CBCT it’s clear more can be done airway wise

ReplyQuote
Posted : 29/03/2019 7:12 pm
DrMario
Eminent Member

I've got an update:

He said there is no way for him to skeletally expand the lower jaw. The only way he knows for sure is that there is an experimental surgery performed by a nearby University that skeletally expands the mandible by materializing a suture at the midline of the mandible and creating the transverse expansion there.

But as far as preventing the post-MSE malocclusion, in my photos you can see my teeth are lingually tipping (inwards) and I can correct that post-MSE bite by uprighting those teeth more. That's his immediate suggestion. He said he is absolutely not in tune with upper airway resistance, sleep apnea, etc...so he is going to contact my sleep doctor to get another (in-lab) sleep study done to determine the efficacy of this treatment and see how to proceed forward. The CBCT didn't help him out much.

 

He said orthognathic surgery can definitely help me but I don't want to do that. He is unsure about how MSE can advance my maxilla with maxillary protraction (face mask) because all the patients he actually uses MSE on are crossbite (class III malocclusion) patients. But @varbrah and i think @jimmy are saying they are reaping success of transverse and sagittal advancement. He also said he isn't confident in the mandible swinging forward from the maxillary protraction with MSE.

 

Guys I just wanna sleep better, lol. Please help! lol thanks 

ReplyQuote
Posted : 03/04/2019 4:45 pm
Abdulrahman
Reputable Member
Posted by: DrMario

He said there is no way for him to skeletally expand the lower jaw. The only way he knows for sure is that there is an experimental surgery performed by a nearby University that skeletally expands the mandible by materializing a suture at the midline of the mandible and creating the transverse expansion there.

It's cutting the mandible in half between the two bottom incisors. It's a surgery that's on my rader but that I have not gotten the time to research it enough yet. Two problems that first come to mind is that it can change the appearance of your chin quite a bit and can cause the tmj to shift position in a bad way. 

But as far as preventing the post-MSE malocclusion, in my photos you can see my teeth are lingually tipping (inwards) and I can correct that post-MSE bite by uprighting those teeth more. That's his immediate suggestion. He said he is absolutely not in tune with upper airway resistance, sleep apnea, etc...so he is going to contact my sleep doctor to get another (in-lab) sleep study done to determine the efficacy of this treatment and see how to proceed forward. The CBCT didn't help him out much.

The natural position of your lower teeth is to be slightly tipped lingually. If they are overly tipped he can tip them in other direction for a 3-5mm gain in width, but your occlusion won't be the greatest.

He said orthognathic surgery can definitely help me but I don't want to do that. He is unsure about how MSE can advance my maxilla with maxillary protraction (face mask) because all the patients he actually uses MSE on are crossbite (class III malocclusion) patients. But @varbrah and i think @jimmy are saying they are reaping success of transverse and sagittal advancement. He also said he isn't confident in the mandible swinging forward from the maxillary protraction with MSE.

Yes some of the details around those effects are sketchy. Dr. Woon Moon's PDF on MSE protraction with face mask does not go into detail on how to achieve all of that with adult patients, only children and teens.

The good part is that your orthodontist seems like an honest guy genuinely trying to find a solution.

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

ReplyQuote
Posted : 03/04/2019 11:33 pm
mr.mewing
Estimable Member

why do you don't go for the homeoblock

video : https://www.youtube.com/watch?feature=youtu.be&v=R5S5AZ50pAE&app=desktop

ReplyQuote
Posted : 04/04/2019 2:07 am
DrMario
Eminent Member

@Abdulrahman Thanks man, yes he was expecting around 3-5 mm of gain in width for the lower dental arch with orthodontics and I agree my bite won't be the best post-MSE.

 

@mr.mewing Thanks for sharing that video. It was interesting. I've heard about the Homeoblock but does it really create permanent growth in bone and not just dentoalveolar changes? Is there relapse if i stop using it? I need to look into it more it looks interesting. Kinda looks like a form of AGGA.

ReplyQuote
Posted : 04/04/2019 9:35 am
NoctilucentNikki
Eminent Member

@DrMario

Are you in the USA? I am in Michigan and go for my CBCT on the 23rd and am also considering the MSE.

Keep us updated!  I'm mostly afraid of the screws going in, and the cranking pre-tooth gap! Eekk. 

Everything I find online, published articles and peoples experience videos and blogs say it's worth it, but not too many adults have shared detailed experiences either. So thank you in advance 🙃 

 

ReplyQuote
Posted : 08/04/2019 7:46 pm
Abdulrahman
Reputable Member
Posted by: DrMario

@Abdulrahman Thanks man, yes he was expecting around 3-5 mm of gain in width for the lower dental arch with orthodontics and I agree my bite won't be the best post-MSE.

 

@mr.mewing Thanks for sharing that video. It was interesting. I've heard about the Homeoblock but does it really create permanent growth in bone and not just dentoalveolar changes? Is there relapse if i stop using it? I need to look into it more it looks interesting. Kinda looks like a form of AGGA.

Welcome.

The Homeoblock works just like self ligating braces, ALF, acrylic expanders, biobloc in that it promotes deto-alveolar remodeling through light forces. You will be able to keep all the expansion if you are able to posture your tongue correctly.

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

ReplyQuote
Posted : 09/04/2019 12:11 pm
GoTTi liked
mr.mewing
Estimable Member
Posted by: NoctilucentNikki

@DrMario

Are you in the USA? I am in Michigan and go for my CBCT on the 23rd and am also considering the MSE.

Keep us updated!  I'm mostly afraid of the screws going in, and the cranking pre-tooth gap! Eekk. 

Everything I find online, published articles and peoples experience videos and blogs say it's worth it, but not too many adults have shared detailed experiences either. So thank you in advance 🙃 

 

are those screws really go in too the palate yikes how deep ? and do you have a video about it where they instal it?

don't know if btw their is any relapse after use of a homeobloc don't think so because it goes pretty slow and by holding proper posture nothing chances and skeletal changes i don't know by the video the man did develop more bone around that area so as you saw what nothing to special more dental changes , but that great for creating more space for the tongue

ReplyQuote
Posted : 09/04/2019 12:53 pm
DrMario
Eminent Member

Happy Friday, everyone. I am truly grateful for this community. 

So I have some updates. I switched to another sleep doctor. Very holistic, very investigative and thorough. After getting my turbinates reduced and my tonsils + adenoids removed, he wants to see how my sleep is and if it's inconclusive he will be sending me to an in-lab facility for my sleep study to be conducted there.

 

Both orthodontists in Florida are going to be attending the same conference held in Los Angeles, California this May. Won Moon himself will be there as he has been actively giving out presentations at different conferences. 

ReplyQuote
Posted : 12/04/2019 10:29 am
DrMario
Eminent Member

@noctilucentnikki The CBCT is actually not as helpful as I thought. The reason is because it captures a still, yet panoramic image. The problem is that since it's a still, it's only capturing that one instance and not taking a video motion of the physiology. For example, when I went in for my CBCT, I had my tongue at the roof of my mouth so that I can breathe during the exam. But 9/10 your tongue will not exhibit that physiology all the time, especially during your sleep. So the CBCT is not as helpful in that respect. However, you can determine the minimum airway sizes from coronal, axial and sagittal slices of the scan...but again, this calculation will be based off of only that single physiological instance. Depending where you get the scan from, you can obtain a diagnostic report to include the radiologists findings. Btw, try to claim it through medical and dental. You just have to obtain the codes from your ortho/dentist. Might end up getting more $$$ back than what you actually paid.

ReplyQuote
Posted : 12/04/2019 10:29 am
NoctilucentNikki
Eminent Member

@DrMario Yes, good point.

And I didn't even think to bring insurance into it. I assumed they don't cover anything -_-

 

ReplyQuote
Posted : 14/04/2019 12:16 pm
NoctilucentNikki
Eminent Member

Guys guy guys... see this article. Warning- yucky pictures. SFOT, a form of bone grafting to widen the lower arch.

https://www.perioimplantadvisory.com/clinical-tips/surgical-techniques/article/16411515/surgically-facilitated-orthodontic-therapy-sfot-maximizing-case-outcome

So, I am having the MSE put in in about 4 weeks! See my thread- https://the-great-work.org/community/case-discussions/my-story-20-years-of-tmjd-and-mse-at-35/

 

Once the MSE does it's thing, I will have braces. But, the periodontist who is installing the MSE for me says I will need this SFOT, more than likely, to make my lower arch as wide as my top. All of my teeth are super tipped in as well, so they will be uprighted, but will still need a wider arch. Apparently, you go in, take a nap, and wake up a little sore, you're a bit swollen for 2 days and then you're fine. After a few months your lower arch expands outward, with new bone growth so the teeth can move out into it. Problem solved.

Please discuss, I am new to all of this!

ReplyQuote
Posted : 06/06/2019 6:39 pm
GoTTi liked
GoTTi
Trusted Member
Posted by: NoctilucentNikki

Guys guy guys... see this article. Warning- yucky pictures. SFOT, a form of bone grafting to widen the lower arch.

https://www.perioimplantadvisory.com/clinical-tips/surgical-techniques/article/16411515/surgically-facilitated-orthodontic-therapy-sfot-maximizing-case-outcome

So, I am having the MSE put in in about 4 weeks! See my thread- https://the-great-work.org/community/case-discussions/my-story-20-years-of-tmjd-and-mse-at-35/

 

Once the MSE does it's thing, I will have braces. But, the periodontist who is installing the MSE for me says I will need this SFOT, more than likely, to make my lower arch as wide as my top. All of my teeth are super tipped in as well, so they will be uprighted, but will still need a wider arch. Apparently, you go in, take a nap, and wake up a little sore, you're a bit swollen for 2 days and then you're fine. After a few months your lower arch expands outward, with new bone growth so the teeth can move out into it. Problem solved.

Please discuss, I am new to all of this!

 Very interesting find! Is this what you would be undergoing in conjunction with your MSE procedure? What about protraction? 

ReplyQuote
Posted : 07/06/2019 8:00 pm
NoctilucentNikki
Eminent Member
Posted by: GoTTi
Posted by: NoctilucentNikki

Guys guy guys... see this article. Warning- yucky pictures. SFOT, a form of bone grafting to widen the lower arch.

https://www.perioimplantadvisory.com/clinical-tips/surgical-techniques/article/16411515/surgically-facilitated-orthodontic-therapy-sfot-maximizing-case-outcome

So, I am having the MSE put in in about 4 weeks! See my thread- https://the-great-work.org/community/case-discussions/my-story-20-years-of-tmjd-and-mse-at-35/

 

Once the MSE does it's thing, I will have braces. But, the periodontist who is installing the MSE for me says I will need this SFOT, more than likely, to make my lower arch as wide as my top. All of my teeth are super tipped in as well, so they will be uprighted, but will still need a wider arch. Apparently, you go in, take a nap, and wake up a little sore, you're a bit swollen for 2 days and then you're fine. After a few months your lower arch expands outward, with new bone growth so the teeth can move out into it. Problem solved.

Please discuss, I am new to all of this!

 Very interesting find! Is this what you would be undergoing in conjunction with your MSE procedure? What about protraction? 

The braces will more than likely bring my jaw forward. So far, I haven't gotten overly technical at the office visits. But yes, I have a legit over bite. I will post updates in my thread though!

ReplyQuote
Posted : 07/06/2019 8:35 pm
GoTTi liked
darkindigo
Reputable Member
Posted by: DrMario

I've got an update:

He said there is no way for him to skeletally expand the lower jaw. The only way he knows for sure is that there is an experimental surgery performed by a nearby University that skeletally expands the mandible by materializing a suture at the midline of the mandible and creating the transverse expansion there.

But as far as preventing the post-MSE malocclusion, in my photos you can see my teeth are lingually tipping (inwards) and I can correct that post-MSE bite by uprighting those teeth more. That's his immediate suggestion. He said he is absolutely not in tune with upper airway resistance, sleep apnea, etc...so he is going to contact my sleep doctor to get another (in-lab) sleep study done to determine the efficacy of this treatment and see how to proceed forward. The CBCT didn't help him out much.

 

He said orthognathic surgery can definitely help me but I don't want to do that. He is unsure about how MSE can advance my maxilla with maxillary protraction (face mask) because all the patients he actually uses MSE on are crossbite (class III malocclusion) patients. But @varbrah and i think @jimmy are saying they are reaping success of transverse and sagittal advancement. He also said he isn't confident in the mandible swinging forward from the maxillary protraction with MSE.

 

Guys I just wanna sleep better, lol. Please help! lol thanks 

@drmario  Actually, Dr. Sue Lee skeletally expands lowers.  It is a new thing.  Her OSA patient is amazing!  It's in here slides.  I don't know if she used SLDA or what.  He could ask her if he was interested.  🙂  She'll work with Doctors who want to use her stuff.

ReplyQuote
Posted : 09/06/2019 6:49 pm
Mars321 liked
Peterpp
New Member

What is the price of mse treatment? 

ReplyQuote
Posted : 08/10/2019 9:12 am
Le_Fort_or_Bust
Trusted Member

Can't you do any of this? https://www.youtube.com/watch?v=n2SF23Mu3T8

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

ReplyQuote
Posted : 24/01/2020 10:55 am
entelechy
Trusted Member
Posted by: @gotti
Posted by: NoctilucentNikki

Guys guy guys... see this article. Warning- yucky pictures. SFOT, a form of bone grafting to widen the lower arch.

https://www.perioimplantadvisory.com/clinical-tips/surgical-techniques/article/16411515/surgically-facilitated-orthodontic-therapy-sfot-maximizing-case-outcome

So, I am having the MSE put in in about 4 weeks! See my thread- https://the-great-work.org/community/case-discussions/my-story-20-years-of-tmjd-and-mse-at-35/

 

Once the MSE does it's thing, I will have braces. But, the periodontist who is installing the MSE for me says I will need this SFOT, more than likely, to make my lower arch as wide as my top. All of my teeth are super tipped in as well, so they will be uprighted, but will still need a wider arch. Apparently, you go in, take a nap, and wake up a little sore, you're a bit swollen for 2 days and then you're fine. After a few months your lower arch expands outward, with new bone growth so the teeth can move out into it. Problem solved.

Please discuss, I am new to all of this!

 Very interesting find! Is this what you would be undergoing in conjunction with your MSE procedure? What about protraction? 

HI Nikki---  I just did MSE and got the split--and my vision seems to have changed.  Did you get this effect?  it is worrisome!

 

entelechy

ReplyQuote
Posted : 10/02/2020 3:22 pm
NoctilucentNikki
Eminent Member

@entelechy

No I have not had that change. And honestly, with all I've read about the MSE and MARPE in general, I have not heard of that happening. Have you ruled out every other cause? Was it instant at the same time as your split?

ReplyQuote
Posted : 11/02/2020 8:00 am
Sergio-OMS
Trusted Member

@noctilucentnikki

@entelechy

It’s an infrequent side effect but it can happen and it is usually limited and will solve in a days/weeks. But I agree that it is a good idea to consult.

ReplyQuote
Posted : 11/02/2020 8:27 am
entelechy
Trusted Member
Posted by: @sergio-oms

@noctilucentnikki

@entelechy

It’s an infrequent side effect but it can happen and it is usually limited and will solve in a days/weeks. But I agree that it is a good idea to consult.

Dear Nikki---   I too will be getting SFOT.  Do you already have a provider?   I also have other worries about MSE:

--the facemask for sure gets results.  I have seen 4 mm expansion in a former patient. However, I worry about the chin cup and the fact that the mandible can retrude.

--with MSE, the expansion in the zigomats means the  cheekbones get wider.   Fine and good aesthetically. But I feel a strain in the bone by my TMJ and worry that the pressure will further exacerbate my extant TMD and tinnitus.   Any opinions?

Thanks for any responses!  

entelechy

ReplyQuote
Posted : 13/02/2020 7:04 am
NoctilucentNikki
Eminent Member

@entelechy

Hello-

Yes I had my SFOT in November. It went very very well. I am in the Detroit area of Michigan though.

I have not had any retrusion, and I originally started this whole process because 20 years of terrible TMJ disorder was enough for me.  My pain has not been worse, however throughout this process, no matter what you do, your bite will change. That is the whole point, some days are worse than others, but overall I am getting better. I do not expect 0 pain until my whole process here is complete, which will not be until at least December 2020.

So far, for me, MSE + SFOT + Invisalign is working just fine and I am happy with how things are going.

All pain has been very tolerable compared to my past.

 

 

ReplyQuote
Posted : 17/02/2020 9:09 am
mr.mewing
Estimable Member

@noctilucentnikki

how are you going to expand the mandible and do you think your mandible can shift forwards?

ReplyQuote
Posted : 17/02/2020 3:48 pm
max iller
Eminent Member

As long as you chew and have some level of molar contact during expansion wont the bottoms/tops tip to stay in contact? It's not ideal but better than ending up with a brody bite.

Good luck with your treatment

ReplyQuote
Posted : 17/02/2020 3:53 pm
WATCHINGAPIC
New Member

@noctilucentnikki

Random question, have you had any extractions done prior to MSE?

ReplyQuote
Posted : 18/02/2020 11:44 am
NoctilucentNikki
Eminent Member
Posted by: @noctilucentnikki

Guys guy guys... see this article. Warning- yucky pictures. SFOT, a form of bone grafting to widen the lower arch.

https://www.perioimplantadvisory.com/clinical-tips/surgical-techniques/article/16411515/surgically-facilitated-orthodontic-therapy-sfot-maximizing-case-outcome

So, I am having the MSE put in in about 4 weeks! See my thread- https://the-great-work.org/community/case-discussions/my-story-20-years-of-tmjd-and-mse-at-35/

 

Once the MSE does it's thing, I will have braces/invisalign. But, the periodontist who is installing the MSE for me says I will need this SFOT, more than likely, to make my lower arch as wide as my top. All of my teeth are super tipped in as well, so they will be uprighted, but will still need a wider arch. Apparently, you go in, take a nap, and wake up a little sore, you're a bit swollen for 2 days and then you're fine. After a few months your lower arch expands outward, with new bone growth so the teeth can move out into it. Problem solved.

 

@mr.mewing

I posted the above 06/06/2019 and had it done November 12th 2019. I gained a good 2+ mm all the way around.

I am now in invisalign moving my lower arch outward to match my newly widened upper. 

 

@WATCHINGAPIC No i have not had any extractions.

ReplyQuote
Posted : 18/02/2020 4:24 pm
FalseNegativeSleepStudy
Active Member
Posted by: @maxiller

As long as you chew and have some level of molar contact during expansion wont the bottoms/tops tip to stay in contact? It's not ideal but better than ending up with a brody bite.

Good luck with your treatment

I feel like that theory makes sense, but moreso in kids naturally during their growth period, or maybe even adults making small gains with correct oral habits alone. 

I don't think widening with something as quick as MSE would allow the lower arch to keep up even if you did a lot of chewing with molar contact.  I believe adults doing MSE will most likely require tooth-borne expansion (with or without SFOT) and/or MSDO.

ReplyQuote
Posted : 18/02/2020 4:26 pm
entelechy
Trusted Member
Posted by: @noctilucentnikki

@entelechy

Hello-

Yes I had my SFOT in November. It went very very well. I am in the Detroit area of Michigan though.

I have not had any retrusion, and I originally started this whole process because 20 years of terrible TMJ disorder was enough for me.  My pain has not been worse, however throughout this process, no matter what you do, your bite will change. That is the whole point, some days are worse than others, but overall I am getting better. I do not expect 0 pain until my whole process here is complete, which will not be until at least December 2020.

So far, for me, MSE + SFOT + Invisalign is working just fine and I am happy with how things are going.

All pain has been very tolerable compared to my past.

 

 

Dear Nikki!   I am so grateful for your posts--and for your daring spirit with these innovative procedures!     I have a few questions if you do not mind.  But first thank you for your wise point that the sometimes reported vision change wears off after a couple of days with MSE.   Exactly what happened!

My first question concerns MSE and TMD:    a doctor scared me and said it was crazy that I was doing it because by expanding my zigomatic bones, its going to press against the fossa of the temporo-mandibular joint--and my TMD will soar!          I am highly sensitive (and give in to panic) so now I am worried that my TMD has been exacerbated by this collision course between bones, and hence my tinnitus is spiking

But I also think the TM might be the very off occlusion (only one tooth hits know).     

What did you think about MSe and TMD? Did you think the expanding bones could make it worse?  I stopped turning the screw out of fear!  And this after I already split.

And an even more important question!  I love that you posted so clearly about SFOT on your blog. First patient report I have read.    I am most likely getting it right after the MSE to expand both my lower and give forward movement to the upper.      So some questions!!

--did it HURT?    I see all those bloody pictures and I think this must sting like hell if you drink lemon juice!

--how long did it take to HEALy?

--and how long after  it did you get the invasalign?   I heard it has to be immediate as that is when the teeth are most mobile.

--and most impt question:  what bone did you use?   Did you use that cadaver bone allograft or your own bone?

I also wanted to ask if you liked your periodontist a lot!  And if so could you please give me her name?    I will go anywhere to do this... plus it seems she charged you a decent price.  I was quoted 8000 for two arches by Dr. Curry in arkansas.

All in all, do you recommend this SFOT?   To get 2 mm of bone sounds fantastic!

and there is the adv that the invasalign will go much more quickly no?

 

thanks for any feedback and advice!

 

 

 

entelechy

ReplyQuote
Posted : 19/02/2020 10:32 pm
NoctilucentNikki
Eminent Member
Posted by: @entelechy
Posted by: @noctilucentnikki

@entelechy

Hello-

Yes I had my SFOT in November. It went very very well. I am in the Detroit area of Michigan though.

I have not had any retrusion, and I originally started this whole process because 20 years of terrible TMJ disorder was enough for me.  My pain has not been worse, however throughout this process, no matter what you do, your bite will change. That is the whole point, some days are worse than others, but overall I am getting better. I do not expect 0 pain until my whole process here is complete, which will not be until at least December 2020.

So far, for me, MSE + SFOT + Invisalign is working just fine and I am happy with how things are going.

All pain has been very tolerable compared to my past.

 

 

Dear Nikki!   I am so grateful for your posts--and for your daring spirit with these innovative procedures!     I have a few questions if you do not mind.  But first thank you for your wise point that the sometimes reported vision change wears off after a couple of days with MSE.   Exactly what happened!

My first question concerns MSE and TMD:    a doctor scared me and said it was crazy that I was doing it because by expanding my zigomatic bones, its going to press against the fossa of the temporo-mandibular joint--and my TMD will soar!          I am highly sensitive (and give in to panic) so now I am worried that my TMD has been exacerbated by this collision course between bones, and hence my tinnitus is spiking

But I also think the TM might be the very off occlusion (only one tooth hits know).     

What did you think about MSe and TMD? Did you think the expanding bones could make it worse?  I stopped turning the screw out of fear!  And this after I already split.

-Again, I am going through with the MSE/SFOT/Invisalign to HELP my TMD. My ortho and perio can explain it better than myself, but expanding should NOT worsen TMD. At least it was not a concern in MY specific case. I recommend talking to them yourself.

And an even more important question!  I love that you posted so clearly about SFOT on your blog. First patient report I have read.    I am most likely getting it right after the MSE to expand both my lower and give forward movement to the upper.      So some questions!!

--did it HURT?    I see all those bloody pictures and I think this must sting like hell if you drink lemon juice!

-Day 1 and 2 was rough, not nothing a couple norcos couldn't handle. The pain was temporary and very manageable. Not nearly as bad as all of the headaches I've had over the years. Also just don't drink lemon juice! 

--how long did it take to HEALy?

-Stitches were in for 2 weeks. I was fine after 1 week honestly. Just have to eat liquids only until the stitches come out as to not tear anything.

--and how long after  it did you get the invasalign?   I heard it has to be immediate as that is when the teeth are most mobile.

-3-4 weeks, because i healed quickly.

--and most impt question:  what bone did you use?   Did you use that cadaver bone allograft or your own bone?

-I believe for my specific case the perio chose a mix of synthetic and bovine.

I also wanted to ask if you liked your periodontist a lot!  And if so could you please give me her name?    I will go anywhere to do this... plus it seems she charged you a decent price.  I was quoted 8000 for two arches by Dr. Curry in arkansas.

-Where are you coming from? My doctor is in the metro-Detroit Area. I paid $3500 for the entire lower arch. I did not need it on the upper. 

All in all, do you recommend this SFOT?   To get 2 mm of bone sounds fantastic!

Yep I do. 

and there is the adv that the invasalign will go much more quickly no?

The invisalign was chosen over metal braces because it's a slow but constant force. Metal braces are a much stronger force once every few weeks with an adjustment. This was better suited for me because of the SFOT.

Best of luck to you 🙂

 

 

 

 

ReplyQuote
Posted : 21/02/2020 10:07 am
entelechy
Trusted Member

@noctilucentnikki

Dear Nikki!

Thank you so so much for so generously responding to each question!  

I am very relieved to know your TMD got better.   The logic one TMD specialist gave me about why it would get worse is that the zigomatic bones would push the condyle back.     Could I ask why you think it helped yours get better?    Sometimes when I turn the screw it DOES seem like a relief, so I am suspecitng the expert is wrong.

I would also much appreciate knowing your Michigan doctor's name.    I live in Paris, France and will have to fly to the states anyway to get the treatment, so Michigan would be fine (if near an airport!).  

I am so happy everything worked out for you, and you really are an inspiration to me!

If by chance you are ever open to a phone call, I would be very thankful.    It's hard to plan on doing something so "innovative" in another country too....

By the way, by any chance are you of Greek origin?  Most of my friends in Paris are Greek, and I am going to Greece next week to spend a week in Thessaloniki and then in Crete with a friend.

un grand merci

entelechy

ReplyQuote
Posted : 25/02/2020 5:48 pm
NoctilucentNikki
Eminent Member

@entelechy

No I am not Greek! I am Eastern Euro/Slav/Russian but 100% American 😛

My doctor is in the Detroit area. I would suggest talking to her directly before planning on anything outside your own country. 

ReplyQuote
Posted : 06/03/2020 9:30 am
entelechy
Trusted Member

Hi everyone--- 

It is not true that MSE has no effect on the lower jaw.   It has massive effects on the lower jaw---at least in my case.

Here's my upshot after two months of MSE:

1)  imw:  29 mm before, now  36 mm

2) tongue position: changed completely.  Now back of tongue flat on back of palate most of the time.  Could never before---after my teen extraction orthodontics--even get my tongue to sqeeze past my molars.

3)  zigormats cames forward at least 3 mm, and widened at least 3 mm (each side): high cheekbones, forward midface (which was deficient before due to extractions)

4) maxilla came forward 2 mm (with facemask too and facepulling)

5)  And here comes the mandible!    Because the whole face comes forward (standard with MSE), my tongue and mandible also came forward.   it's hard to explain, but I cannot physically keep my mandible back where it used to be.  I would have to force it there, and the muscles want it to be forward with the rest of the skull.   This makes it a bit uncomfortable actually as the front teeth still need 4 mm expansion (through braces or SFOT) and 4 mm expansion (through more MSE turns if I can risk it) to be able to not bite on my tongue with my second premolars and canines.    Am hopeful will get there step by step.

6)  One negative:  my tinnitus, which I had gotten rid of through massage and relaxation, came back.  I think it must be because of the strain on the jaw muscles now that the mandible is more forward.

 

It is noticeably more forward---ie. people who know me and have not seen me remark I do not look retruded anymore.  At the cost that my premolars cut inot the tongue (trade off as tongue can now fit--despite that premolar cut--on the palate).

Note that all MSE providers comment that the maxilla comes forward 1 mm with the expansion.  

They did not comment on how the whole face comes forward, and the mandible swings forward too.   

Again, it might be more striking in my case because the typical MSE patient is not both RETRUDED (from extractons) and  NARROW PALATED.  Usually the MSE patient just has the lateral problem--at least from what I learned by reviewing Won Moon's case studies.

One huge benefit I forgot:

no more neck pain.  

Since mandible is more in the right relation to neck---

my extreme neck pain, which I had for the last three years, is completely gone.  And also standing up straight with no effort.  Note:  this is relevant to those who have had extractions with retracted jaws (but perhaps others naturally retruded), because the retraction orthodontics puts out skull-neck out of line--and narrows the palate so much the tongue cannot give muscle support to the spine--so the neck muscles often have to take extra work...

 

 

 

 

 

entelechy

ReplyQuote
Posted : 26/03/2020 3:31 am
kota liked
entelechy
Trusted Member

@noctilucentnikki  thank you for all your support re MSE and SFOT---  your comments were really so appreciated!    All on hold re the SFOT treatment due to Coronavirus...but it looks promising.    Hope you are doing well...and thanks again!

 

entelechy

ReplyQuote
Posted : 26/03/2020 3:33 am
entelechy
Trusted Member
Posted by: @drmario

Hi everyone,

I am a step closer to getting the Maxillary Skeletal Expander device, which is a form of MARPE. It's a device that uses TADs to be screwed into your upper palate for skeletal transverse expansion of the maxilla. I will also be combining this treatment with a face mask for maxillary protraction to accomplish some forward and upward movement.

 

My only concern at this point is...I know that if I do this, my upper palate will widen, but what about my lower dental arch? My bite is fine with no malocclusion but I fear that it will mess up my bite post treatment...

 

With my IMW only being at 33mm, I know I need transverse expansion from the mouth breathing when I was younger. I wish to do this treatment to have more room in my mouth for my tongue and breathe more efficiently at night. I already got my size +4 tonsils and adenoids out, and my turbinates reduced, so I'm breathing much much better than before but I do want to take advantage of the MSE appliance.

More info on this device:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398849/

 

Thanks in advance everyone.

can I please ask how you took that photo of your tongue???  It's really impt. Most orthos don't understand when I note that the tongue does not ft on the palate and hits teeth.   Note!  after MSE it is now getting closer to being there....  see my post.

 

As for your q about meeting the arches. My concern as well, but I still think--now expanded to 36 or 37, that  can either make it with braces or SFOT/.   Yes, I breathe better too-- helps to keep calm.

 

 

entelechy

ReplyQuote
Posted : 26/03/2020 3:36 am
kota
 kota
New Member

@entelechy

 

Thanks a lot for your update, very helpful! I have some questions if you don't mind, still trying to figure this out.

Do you know how it is that your zygomatic area expanded not only laterally but also in the forward direction?

Did you experience any changes in the eye area?

 

ReplyQuote
Posted : 29/03/2020 4:09 am
NoctilucentNikki
Eminent Member

@abdulrahman

@DrMario

@snaaaaakes

@megamandude

@mr.mewing

 

As I have posted several times before- please check this out. I had it done in November 2019 to WIDEN MY LOWER ARCH. It was an hour long process, and I started Invisaline less than 4 weeks later. Bonus, it can be done more than once if needed. I gained 2mm all the way around, so 4mm across the entire width and it's likely going to be enough to match the 11.8mm of expansion I got from the MSE. Also, it was so not that bad! Getting the MSE in was more painful!

Warning- yucky pictures. SFOT, a form of bone grafting to widen the lower arch.

https://www.perioimplantadvisory.com/clinical-tips/surgical-techniques/article/16411515/surgically-facilitated-orthodontic-therapy-sfot-maximizing-case-outcome

 

ReplyQuote
Posted : 03/04/2020 7:20 am
entelechy
Trusted Member

@noctilucentnikki   Thanks so so much for reposting!    I am thrilled to hear that you were able to match with 11 mm of MSE expansion.   It encourages me to keep turning my own MSE.

 

I had no idea you can do this procedure more than once!   A question, does it feel weird at all to have this transplanted bone in your gums?  I mean, do you notice or feel it?

And how close are you to matching now?   I will definitely do it on your recommendation.

 

 

 

 

entelechy

ReplyQuote
Posted : 03/04/2020 12:35 pm
NoctilucentNikki
Eminent Member

It really feels no different. And it's not noticable to anyone else. I'm not sure how exactly close I am because my teeth are moving every day. I imagine I'll be wearing Invisalign for the rest of the year. 

After I had it done, I had stitches all around for 2 weeks. That was the most annoying part but really, overall, it was a very easy procedure. 

ReplyQuote
Posted : 03/04/2020 1:06 pm
entelechy
Trusted Member

entelechy

ReplyQuote
Posted : 11/05/2020 1:00 am
Mars321
New Member

@darkindigo could I get more information on this doctor who has methods to widen mandibular bone? Appreciate your kindness 

ReplyQuote
Posted : 03/10/2020 6:15 am