MSE vs. DNA appliace (which is better)

I agree with your overall conclusion (have seen those videos a long time ago).  The way I view it:

MSE Pro's:

• Faster - about 30-60 days time to get 10mm lateral width
• Probably near 100% skeletal growth, so chances of relapse in later years should be very low if not zero
• Should be zero risk of tipping teeth, pushing teeth out of alveolar process
• Definitely should increase nasal breathing capability

MSE Con's:

• Lateral expansion only (nothing for transverse expansion)
• Painful around the time of the suture split
• Very difficult to track down providers using it - emailing Dr. Moon just gets a response to email the manufacturer.
• Appliance in 24/7 for many months (initial months of treatment + retainer period) interfering with speech and eating
• Visible diastema for a period of time, until braces can move the teeth back into normal alignment
• Braces almost certainly (?) required - braces are an inflammatory/orthodontic movement, so risk of root resorption
• Some opinions from craniosacral therapists that splitting sutures may have some very negative effects on the body, flows of cerebral spinal fluid, etc.
• Risk of "cone shaped" expansion (wider towards front/anterior, narrower towards back/posterior)

DNA Pro's:

• Can achieve some measure of lateral and transverse expansion due to dual-expansion mechanism
• Doesn't need to be in-mouth 24h/day, so no interference with patients while eating or speaking
• Can potentially provide some improved nasal breathing capability (Dr. Singh has shown before-and-after CBCTs and data on nasal airway volume increases)
• Generally pain-free, as it is claimed this is "orthopedic" correction, not "orthodontic" (i.e.: inflammatory) correction
• Can be linked with lower appliance in various configurations, which is good for making sure both jaws expand/move/advance together - especially important to make sure that TMJ's align nicely
• Potential treatment for TMJ issues (although this is not their primary targeted case)
• Documented reductions in AHI for sleep apnea patients (MSE may have this as well, but I have not seen it).  Currently, they have submitted their data to FDA to be able to market as "a potential cure for mild to moderate sleep apnea" (and to gain that, you have to demonstrate clinical efficacy).

DNA Con's:

• Longer timeframe overall, average DNA time is 9-18 months, but there also may be a number of months of pre-treatment (such as an orthotic bite splint if significant TMJ issues exist) and some post-treatment finishing touches (braces, invisalign).  So total treatment time might be 2-3 years.
• Potentially less chances for lateral expansion - might top out at 5-8mm?  This is just a guess on my part, I did find one patient blog who indicated they'd gotten 9mm and were getting a new second appliance made to get them the last few mm they needed.
• Uncertain how much (if any?) expansion is skeletal vs. dentoalveolar.  Dr. Singh says some of it is skeletal, and his data seems convincing.  Some would almost certainly be dentoalveolar though, since you're expanding the arch.
• Potential need for lifetime use of the appliance as a retainer - Dr. Singh and every other Vivos employee is cautious in their statements about this.  They say in some patents, they won't need anything post treatment - and I have spoken to at least one patient for which this was true.  But for other patients - perhaps those of us whose tongues just aren't going to get up into proper resting position after years of not knowing how to do so - it might be required to wear permanently at nights as a retainer (some previous patients state that they just throw it in overnight for one week a month, just to make sure everything seems to be staying in-place).
• Dependent on patient compliance - don't skip/forget to wear, and also don't advance too quickly
• Risks of tilting/tipping teeth, dishescence, fenestration, pushing teeth out of the alveolar process, etc.

For me, the con's aren't really strong enough to deter me from seeking DNA treatment.  The longer timeframe is fine with me, and given that I do public speaking as a part of my career - not having my speech impaired (even minimally) is important to me.  As far as the risks of tilting teeth, etc. there are plenty of documented patient cases where this clearly did not happen - as Dr. Singh would indicate, since this is "orthopedic" correction to (in his eyes) to the maxilla, the body just knows how to move the teeth in response to that.  And for the potential lifetime use as a retainer ... well ... I am already diagnosed severe sleep apnea, so I already have a life sentence of CPAP ahead of me.  If I could just have a life sentence of an orthodontic retainer instead ... I would take that trade-off in a heartbeat!

@toomer

Thanks for listing it out so clearly. Since the DNA appliance is orthopaedic, would it be safe to assume that most dentists around the world have this treatment option?

Also, I read about the Y-palate expander elsewhere on this forum. It looks similar to the DNA appliance. Are they exactly the same?

Posted by: @mysterecessed

@toomer

Thanks for listing it out so clearly. Since the DNA appliance is orthopaedic, would it be safe to assume that most dentists around the world have this treatment option?

Also, I read about the Y-palate expander elsewhere on this forum. It looks similar to the DNA appliance. Are they exactly the same?

Vivos has a provider directory on their website. If you don’t see someone close by, call their phone number, they may have someone who hasn’t been listed yet. 

You could also travel to see a provider, appointments are initially once every 30 days, but they will probably become once every 60 days once you get settled. 

@thomas22

Thanks. Have you tried the DNA appliance yourself? I'm curious if it increases under eye support as well.

Posted by: @mysterecessed

@thomas22

Thanks. Have you tried the DNA appliance yourself? I'm curious if it increases under eye support as well.

I have a DNA Appliance.

Look at the before or after photos, or the videos they’ve released. The changes can be substantial. 

In the moment though, you’re unlikely to notice. The growth is so slow.

One Homeoblock user did see an 8mm increase in facial width after 24 months. It appears the remodelling process may continue for some time, even after expansion is complete. The changes echo through your face. Growth in one area results in growth in other areas. Symmetry improves. 

Posted by: @mysterecessed

@toomer

Thanks for listing it out so clearly. Since the DNA appliance is orthopaedic, would it be safe to assume that most dentists around the world have this treatment option?

Also, I read about the Y-palate expander elsewhere on this forum. It looks similar to the DNA appliance. Are they exactly the same?

No, it would not be safe to assume that.  And in fact, last I heard there were only 450 dentists trained worldwide on the DNA Appliance - and that comes directly from a dentist I know who is providing it for patients and has been through Vivos' training.  Most of those 450 are US based.  There are a few in Europe, and few in Australia.  There are also only six labs in the world certified to make the appliance.

I would not assume that any other expanders are the same, even if visibly they look similar.  There are some things that the inventor of DNA patented which would be unique to his device (whether anyone actually believes that they work/make a difference ... is a separate discussion, one that I would not call myself qualified to discuss in detail).  Also, the way the DNA works, it's actually *not* supposed to be making contact with the roof of your mouth by default.  I think traditional expanders are generally designed to be touching.

Also, just so you understand - the concept of "orthopedic" correction ... is blazingly contentious in this field.  Dr. Singh thinks he has proved a certain percentage of orthopedic (skeletal) correction.  Many others will say that anything that is acrylic and touches the teeth is only doing 100% orthodontic (dentoalveolar) correction.  The drawbacks of dentoalveolar correction are more risk of tilting teeth/pushing them out of bone/dehiscence/fenestration ... and longer-term concerns of relapse since alveolar bone is more "spongey".  

(IIRC, even MSE apparently doesn't believe they're getting 100% skeletal correction - but it was pretty high, like 60-70%)

@toomer

Thanks for taking the time to explain this to me. Just wanted to ask, wouldn't an x-ray before and after be able to provide enough evidence that it is skeletal correction and not just pushing the teeth through the alveolar ridge?

Sad that the places that provide the DNA appliance is so limited. Any advise for someone not in the USA if they can't get MSE or DNA?

Also, may I ask what you're personally doing to fix your CFD? (I'm assuming you have it if you're here).

Thanks! 

Posted by: @mysterecessed

@toomer

Thanks for taking the time to explain this to me. Just wanted to ask, wouldn't an x-ray before and after be able to provide enough evidence that it is skeletal correction and not just pushing the teeth through the alveolar ridge?

Sad that the places that provide the DNA appliance is so limited. Any advise for someone not in the USA if they can't get MSE or DNA?

Also, may I ask what you're personally doing to fix your CFD? (I'm assuming you have it if you're here).

Thanks! 

So Dr. Singh does provide some of this detail in presentations they give to recruit new dentists to start providing the Vivos appliance.  He claims that via CBCT he has been able to measure just the maxilla, and that based on his measurements they are seeing the average patient ends up with 2 cubic centimeters of new bone volume.  That's about the same size as a pair of six-sided dice (not sure if it's Monopoly-sized dice, or Vegas-Craps-Table sized dice).

He did publish one study that goes through how they view things - pay attention to Figure 4 and Table 2: https://www.researchgate.net/publication/264298692_Changes_in_3D_Midfacial_Parameters_after_Biomimetic_Oral_Appliance_Therapy_in_Adults

Assuming his measurements are accurate, I am not sure how this could be explained as anything other than "skeletal" growth.

But the problem is that the entire industry is focusing on the mid-palatal suture, splitting it, how many mm's of space you can crank into there, etc. But he thinks he's seeing growth everywhere, not just at the mid-palatal suture.  He believes the periodontal ligaments for each tooth also function as sutures - since it has been seen that they have stem cells.  So I think he thinks some of the expansion is happening there too.  So having a discussion focused solely on the mid-palatal suture ends up a losing proposition for them, so they tend to avoid that.  

Of course, that makes people think it's just pushing teeth, and then they mentally dismiss it.

It's also why they focus more on sleep apnea improvement scores.  He's shown patients where they only gained 1mm of inter-molar width (39mm to 40mm, so already in a good position at the start) but they still managed to increase the airway and drop that sleep apnea's patient's AHI score by half.  So I think he intentionally tries to not have the discussion solely on a "palatal expansion" playing field ... and why they are focusing primarily on treating/curing OSA ... where they seem to have a good story.  In fact, they seem to think they have such a good story that they have submitted for FDA "class II" approval to market their device as a "potential cure" for mild to moderate sleep apnea.  In order to gain "class II" approval from the FDA, you must demonstrate clinical efficacy for the condition you claim to treat, and it must be independently reviewed.  So hopefully they get a favorable ruling on that in the near future.

And that's why I picked them, to hopefully cure my sleep apnea and try to correct decades of nasal congestion which has then led to mouth breathing too often (and all the problems that eventually generates).  So I should hopefully be starting in a DNA Appliance soon ... my provider needed to stabilize my mandible first because of some TMD before we could start considering expansion ... so I've had to go through several months of a "bite splint" first.  Fortunately my mandible seems to have stopped moving and found its preferred resting position, so now we'll just need to figure out how we adapt the maxilla to accommodate that.

If you don't have a DNA provider in your country, you may want to see if anyone is treating with Homeoblock.  Very similar device (they're based off of the same joint patent between Dr. Singh and Dr. Belfor) ... some subtle differences, but overall Homeoblock could also be effective for dealing with CFD issues.

@toomer

Hey, thanks for taking the time to explain this to me. I think I understand what to expect if using the DNA or Homeoblock. Sadly, I don't think I can get Homeoblock here (Singapore) too. 

I've only managed to find a few mentions of Maxillary Expanders (normal one, not MSE) by googling palate expander and my country and possibly only 1 mention of what I think might be something like Homeoblock or DNA but it's from a children's hospital they also only mention that it's for children (no mention of adults). 

That being said, may I ask your opinion on the normal maxillary expander that's not drilled into your palate? How is it better/worse than DNA and homeoblock or MSE?

This kind: ( http://drrafehelalam.com/34-Treatments-rapid%C2%A0palatal%C2%A0expander%C2%A0%C2%A0disjoncteur#.XzZKqi2d5QI)

Posted by: @mysterecessed

@toomer

That being said, may I ask your opinion on the normal maxillary expander that's not drilled into your palate? How is it better/worse than DNA and homeoblock or MSE?

 

I have not done enough research into MSE (or any "normal maxillary expander") to really say I could give you any sort of well-informed opinion ... above and beyond the brief strengths/weaknesses I listed above.

@mysterecessed

Those kind of expanders (RPE) are probably the worst. They only work on younger people, I'd guess the oldest that it would be effective is like 15. It's a rapid maxillary expander that is TOOTH-borne, not really a good idea, the forces it takes to split the palate are enough to damage the teeth permanently, the expansion is mainly anterior as well, very little posterior expansion (no cheekbone changes). It's also bulky and obstructive. 

Posted by: @sinned

@mysterecessed

Those kind of expanders (RPE) are probably the worst. They only work on younger people, I'd guess the oldest that it would be effective is like 15. It's a rapid maxillary expander that is TOOTH-borne, not really a good idea, the forces it takes to split the palate are enough to damage the teeth permanently, the expansion is mainly anterior as well, very little posterior expansion (no cheekbone changes). It's also bulky and obstructive. 

No, no, no.

Vivos has treated over 15,000 patients with their appliance.  Do you think they're all getting tipped teeth and just not speaking about it?  I've spoken with numerous patients that are multiple years post-treatment ... their teeth are all fine.

I've seen the mid-treatment and post-treatment scans and Sassouni reports of patients who have no detrimental change in angle from "upper incisor to optic plane" measurements.

There is a difference between a "mechanical" appliance, and a "functional" one.  You seem to think they're the same.

You can "stretch" the suture in rats, one of the keys is "intermittent" signaling (like what Vivos advises): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/

Histologically speaking, humans and rats are very similar, and there are researchers doing similar research on human sutures.

And researchers have been able to use "functional" appliances to get expansion of both the maxilla and mandible - without "dental tilting" - for over a decade: https://www.sciencedirect.com/science/article/pii/S1808869415300513

"There was a mean increase of 1.92 mm in nasal width and 2.5 mm in nasal height. As regards the linear measurements maxillary and mandibular width, the mean increase was 2.42 mm and 1.92 mm, respectively. A mean increase of 1.41 mm was found for facial width and 2.0 mm for maxillary molar width, alterations which were statistically significant, the mean time was 5.3 months ...

Our results do not support the hypothesis that maxillary expansion occurred due to dental tilting, as suggested in the literature.  If this hypothesis were right there should have been a decrease in molar-maxillary distance, which was not observed in our cases where, on the contrary, there was an average increase of 2.0 mm."

Oh, and the inventor of the appliance has shown isolated measurements of just the maxilla taken via CBCT pre-treatment and post-treatment, and sees an average of 10-15% increase in overall bone volume in adult patients.  In some patients, it's an over 30% increase.  It's not just happening at the suture.  It's (likely) also happening via appositional bone growth, and also at the periodontal ligaments which are known to have stem cells.

Now, to be fair to the discussion - if you use a DNA appliance improperly by trying to advance it too far too fast, yes ... you can just turn it into a regular Rapid Palatal Expander at that point, and you may run into a dental tilting issue.  But that's improper use on the part of the patient that causes that.

But I really think you should do more research before throwing out such definitive opinions.

@toomer

I'm talking about the one  @mysterecessed linked

http://drrafehelalam.com/34-Treatments-rapid%C2%A0palatal%C2%A0expander%C2%A0%C2%A0disjoncteur#.XzZKqi2d5QI)

@sinned

Oh!  So sorry!!  Yes ... 100% agree, you can't use a traditional/mechanical appliance to do this, and that absolutely opens up risk of tilting teeth.

@toomer

@sinned

Okay, thanks for both of your advice! Hopefully Vivos expands its reach soon.

For aesthetics what's the better choice?

Guys there is no need to go and pay 10,000$ for the vivos appliance. You can just buy a Schwartz appliance online and turn at the same rate as the dna appliance. And if your very cautious  You can get a holistic dentist the watch you so there is no damage being done to your teeth and gums

Also, please don’t get the rapid maxillary expander. They are trying to split the suture with a dental appliance. And that will definitely cause damage to your teeth and gums and that’s not optimal for expansion. What we are trying to do with the dna appliance is stimulate the suture to create new bone.

I had a discussion with a prominent orthotropics professional here in L.A.  He did not like the DNA.  I can't tell exactly what his palette expander is, I can attach a photo.  He is talking about .1-.2 mm per week of expansion.  Is that a rapid maxillary expander? He opens up 4 spaces for my missing bicuspids, braces and implants follow. 

In any case, I'm still considering the DNA.  Thank you for the pros and cons.  I am going to visit a cranial sacral pro who works with adults using ALF and see what he says.  I'm new here, sorry about meandering considerations.  

I had a discussion with a prominent orthotropics professional here in L.A.  He did not like the DNA.  He starts with a saggital appliance, then a palette expander.  I can't tell exactly what his palette expander is, I can attach a photo.  He is talking about .1-.2 mm per week of expansion.  Is that an RME? He opens up 4 spaces for my missing bicuspids, braces and implants follow. 

In any case, I'm still considering the DNA.  Thank you for the pros and cons.  I am going to visit a cranial sacral pro who works with adults using ALF and see what he says.  I'm new here, sorry about meandering considerations.  

Posted by: @mewisit

Guys there is no need to go and pay 10,000$ for the vivos appliance. You can just buy a Schwartz appliance online and turn at the same rate as the dna appliance. And if your very cautious  You can get a holistic dentist the watch you so there is no damage being done to your teeth and gums

This tells me you don't understand anything about how the DNA appliance, and the entire Vivos approach to treatment, actually works.  There are actually monthly adjustments to a DNA appliance that the dentist makes - and no, they're not turning the screw for you (you do that at home).  But there is an extremely important part of the process that must be adjusted monthly ... that you simply won't be able to do.

But by all means, go ahead ... be cheap, buy a Schwartz and see how it goes.

Posted by: @mieko

He is talking about .1-.2 mm per week of expansion.

That's about the rate you aim for with DNA.  Generally, you're doing 1 turn of the screw maybe every 4-7 days, and each turn is 0.25mm.  You can, obviously, go slower than that if you want.

@toomer Have you gotten results with the dna appliance.

Posted by: @mewisit

@toomer Have you gotten results with the dna appliance.

I'm not in my appliance yet.  There were some other TMJ issues my doc needed to get stable first.

@toomeryou dont get a v shaped split w MSE 🤣 🤣 🤣 🤣 . Its fully parallel my guy. MSE is 97% skeletal while Homeoblock, unless you're like 8 or less wont be skeletal. MSE is WAYYYY BETTER and thats why I have it.

@toomer, that is a very thorough list of the Pros and Cons!  I wish I had seen this thread two months ago.  I got the MSE w/surgical assist with Dr. Ting and Vaughan 7 weeks ago, and I'm regretful I didn't do the DNA instead.  My nasal breathing has not improved, and I feel my overall aesthetics are worse.  The large diastema plus braces are also a pain and socially embarrassing.  Wish I had researched more thoroughly before going with MSE.