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Possibly new "holy grail" for moving the maxilla up and forwards? [MSE + Facemask Therapy]  

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haza679
New Member

@varbrah

 

I'm currently 16 and got into this because I've had two teeth extracted which causes me to have a class III underbite. Also what elastics are you using to pull forward and do you keep the headgear on overnight?  

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Posted : 03/10/2018 2:41 pm
haza679
New Member

And what do you think I should use to hook onto the expander? I've done face pulling with braces before and used normal rubber bands and paperclips. Also, I have a helmet for face pulling but it's very uncomfortable to keep on overnight.

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Posted : 03/10/2018 2:47 pm
varbrah
Estimable Member

I thought you said your expander had hooks attached to it? I use a Petit facemask with heavy elastics. Yeah its a bit uncomfortable I usually end up ripping it off unconsciously halfway through the night haha

ReplyQuote
Posted : 03/10/2018 2:53 pm
haza679
New Member

I have this expander with headgear tubes. Don't know why I called them hooks tho

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Posted : 03/10/2018 3:01 pm
varbrah
Estimable Member

Ah i see, well you could do that paperclip thing or potentially hook around the tubes.

Also keep in mind there’s no bone anchorage so you’ll probably be getting more dental movement than youre probably comfortable with protracting with that unless you are younger.

ReplyQuote
Posted : 03/10/2018 3:05 pm
haza679
New Member

@varbrah

Also what rate do you think I should expand at and what do u think I should use to connect the elastics to the head gear tubes.

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Posted : 03/10/2018 3:06 pm
haza679
New Member

Right now i'm expanding at about 1-2mm a week but I feel I could go faster than this.

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Posted : 03/10/2018 3:06 pm
megamandude
Trusted Member

My maxilla is crooked (left dental arch is higher than the right) do you think its a good idea to still go ahead with mse first or get jaw surgery to straighten it out first?

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Posted : 03/10/2018 3:18 pm
varbrah
Estimable Member
Posted by: megamandude

My maxilla is crooked (left dental arch is higher than the right) do you think its a good idea to still go ahead with mse first or get jaw surgery to straighten it out first?

Go ahead with the MSE and then once its taken out you can get TADs installed on the “lower” side to pull the bone up slowly. Consult with an ortho though

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Posted : 03/10/2018 3:25 pm
Apollo
Reputable Member
Posted by: haza679

@varbrah

Also what rate do you think I should expand at and what do u think I should use to connect the elastics to the head gear tubes.

You can read the thread about my routine. I used the same type of removable expander for extra-oral traction by attaching a facebow to the headgear tubes with five elastics (2 posterior, and 3 anterior) like the Mewvector system shown in videos on the orthotropics youtube channel. Eventually I abandoned the "facepulling" because I felt like too much of the force was loaded onto my teeth rather than my palate. This is why the notion of applying traction to a bone-anchored expander is appealing. I advanced my expander screw at a rate of one 1/4mm turn every 2 to 5 days depending how tight it felt. Once you get to about 2-3mm of expansion, you'll find that you need to make adjustments to the acrylic to maintain proper fit. There is the potential for side effects like ulcers, gum recession, dental tipping, root resorption, etc. So you have to be very careful and listen to your body, and it is really advisable to find a like-minded professional to guide your therapy.

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Posted : 03/10/2018 3:25 pm
Apollo
Reputable Member
Posted by: varbrah
Posted by: megamandude

My maxilla is crooked (left dental arch is higher than the right) do you think its a good idea to still go ahead with mse first or get jaw surgery to straighten it out first?

Go ahead with the MSE and then once its taken out you can get TADs installed on the “lower” side to pull the bone up slowly. Consult with an ortho though

You might also find that some of your occlusal cant corrects itself through the course of expansion. I believe mine improved by about one degree as I expanded about 6mm. I'm still about 2 degrees higher on the left side.

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Posted : 03/10/2018 3:26 pm
kasey
Active Member

What did you expand with? What do you all think about facemax?

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Posted : 03/10/2018 4:17 pm
megamandude
Trusted Member

How many hours do you wear your fm every day @varbrah 

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Posted : 05/10/2018 10:46 am
varbrah
Estimable Member
Posted by: megamandude

How many hours do you wear your fm every day @varbrah 

Depends. As long as possible between getting home from work and waking up the next morning.

Somewhat unrelated but fun fact, I had to reconfigure the Face ID on my iphone xs today. I’ve been protracting heavily the past week and especially last night, I can definitely see subtle as well as not so subtle changes since starting, so I wonder if my facial biometrics had finally changed beyond what the software considers acceptable variance.

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Posted : 05/10/2018 11:56 am
Apollo liked
megamandude
Trusted Member
Posted by: varbrah
Posted by: megamandude

How many hours do you wear your fm every day @varbrah 

Depends. As long as possible between getting home from work and waking up the next morning.

Somewhat unrelated but fun fact, I had to reconfigure the Face ID on my iphone xs today. I’ve been protracting heavily the past week and especially last night, I can definitely see subtle as well as not so subtle changes since starting, so I wonder if my facial biometrics had finally changed beyond what the software considers acceptable variance.

Thats great to hear. Anyone you know say you look different yet?

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Posted : 07/10/2018 2:04 am
varbrah
Estimable Member
Posted by: megamandude
Posted by: varbrah
Posted by: megamandude

How many hours do you wear your fm every day @varbrah 

Depends. As long as possible between getting home from work and waking up the next morning.

Somewhat unrelated but fun fact, I had to reconfigure the Face ID on my iphone xs today. I’ve been protracting heavily the past week and especially last night, I can definitely see subtle as well as not so subtle changes since starting, so I wonder if my facial biometrics had finally changed beyond what the software considers acceptable variance.

Thats great to hear. Anyone you know say you look different yet?

Not really and I’m not expecting any comments like that. I still very much look like “me” except my zygos and orbitals are more prominent, jawline is becoming sharper, etc. I look a lot better but the average person doesnt spend any appreciable amount of time analyzing faces. Also the gap tooth currently takes attention away from any improvements if that makes sense? lol

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Posted : 07/10/2018 11:45 am
EddieMoney
Reputable Member

You will never stop looking like yourself even with significant progress. A better version, yes. But a different one? Have yet to see such results .

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Posted : 07/10/2018 6:36 pm
varbrah
Estimable Member
Posted by: EddieMoney

You will never stop looking like yourself even with significant progress. A better version, yes. But a different one? Have yet to see such results .

Yup exactly

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Posted : 07/10/2018 6:52 pm
accnum2
Active Member

Will this appliance be able to fix asymmetry? As in one side is more expanded, forward and upswing than other? Also i have had 4 premolar extractions. Currently have 34mm upper palate and 29mm lower.

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Posted : 09/10/2018 1:56 am
Halti.H
Active Member

Hi! I was wondering if you can make just as much development with mewing than with the MSE method? I know that a guy named Jamo, who has posted his results on this site had insane results from hard mewing and chewing only. He completely lifted his maxilla and mandibular angle. I'm also 18, so does the MSE only make results easier but the same results can be achieved with mewing only? Thanks

ReplyQuote
Posted : 11/10/2018 6:10 am
varbrah
Estimable Member
Posted by: Halti.H

Hi! I was wondering if you can make just as much development with mewing than with the MSE method? I know that a guy named Jamo, who has posted his results on this site had insane results from hard mewing and chewing only. He completely lifted his maxilla and mandibular angle. I'm also 18, so does the MSE only make results easier but the same results can be achieved with mewing only? Thanks

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

ReplyQuote
Posted : 11/10/2018 11:19 am
alfio liked
Halti.H
Active Member
Posted by: varbrah
Posted by: Halti.H

Hi! I was wondering if you can make just as much development with mewing than with the MSE method? I know that a guy named Jamo, who has posted his results on this site had insane results from hard mewing and chewing only. He completely lifted his maxilla and mandibular angle. I'm also 18, so does the MSE only make results easier but the same results can be achieved with mewing only? Thanks

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

Yeah, those are definitely some amazing results man, congratulations. I'm only 18 though so I think that I'll be able to get great results from hard mewing and correcting my posture. Also I live in Finland and I don't think there are doctors who do operations like that here, unfortunately. Also aren't there any kind of risk factors in the method? Getting your palate drilled sounds pretty terrifying to me. I read somewhere that face pulling with hands every hour would greatly loosen the sutures, isn't that the main goal of MSE? I think I'll try that too.

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Posted : 11/10/2018 12:07 pm
varbrah
Estimable Member

@Halti.H

Yeah give hard mewing and all the other stuff a shot, you still have growth potential left. Personally this is something I wish I couldve done earlier because I would have had a better base for mewing.

And no not too risky at all. They don’t even have to put you on antibiotics or anything afterwards. Sounds terrifying but it isn’t bad, just some pain on day 1 that goes away completely by day 3. There are definitely orthos who use MSE or MARPE in finland, it’s a pretty common treatment. If not look to adjacent European countries.

Thumb-facepulling is probably useless by the way.

ReplyQuote
Posted : 11/10/2018 12:16 pm
megamandude
Trusted Member
Posted by: varbrah
Posted by: Halti.H

Hi! I was wondering if you can make just as much development with mewing than with the MSE method? I know that a guy named Jamo, who has posted his results on this site had insane results from hard mewing and chewing only. He completely lifted his maxilla and mandibular angle. I'm also 18, so does the MSE only make results easier but the same results can be achieved with mewing only? Thanks

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

Wow, that's insane. Can't wait to see the x-rays.

ReplyQuote
Posted : 11/10/2018 12:19 pm
alfio liked
varbrah
Estimable Member

@megamandude 😎 all in good time my man.

Excited to share once my treatment is done 🙂

ReplyQuote
Posted : 11/10/2018 12:23 pm
Halti.H
Active Member
Posted by: varbrah

@Halti.H

Yeah give hard mewing and all the other stuff a shot, you still have growth potential left. Personally this is something I wish I couldve done earlier because I would have had a better base for mewing.

And no not too risky at all. They don’t even have to put you on antibiotics or anything afterwards. Sounds terrifying but it isn’t bad, just some pain on day 1 that goes away completely by day 3. There are definitely orthos who use MSE or MARPE in finland, it’s a pretty common treatment. If not look to adjacent European countries.

Thumb-facepulling is probably useless by the way.

Thanks for all the advice man, I really appreciate it.   

 So the main goal of MSE is to widen the palate and once it's wide enough to properly fit your tongue mewing is supposed to do the work to push the maxilla upwards, not the MSE device?

Also do you think that by using all these methods it's possible to reach the potential face that I would have had if my face had developed properly from the beginning? 

ReplyQuote
Posted : 11/10/2018 2:30 pm
varbrah
Estimable Member
Posted by: Halti.H
Posted by: varbrah

@Halti.H

Yeah give hard mewing and all the other stuff a shot, you still have growth potential left. Personally this is something I wish I couldve done earlier because I would have had a better base for mewing.

And no not too risky at all. They don’t even have to put you on antibiotics or anything afterwards. Sounds terrifying but it isn’t bad, just some pain on day 1 that goes away completely by day 3. There are definitely orthos who use MSE or MARPE in finland, it’s a pretty common treatment. If not look to adjacent European countries.

Thumb-facepulling is probably useless by the way.

Thanks for all the advice man, I really appreciate it.   

 So the main goal of MSE is to widen the palate and once it's wide enough to properly fit your tongue mewing is supposed to do the work to push the maxilla upwards, not the MSE device?

Also do you think that by using all these methods it's possible to reach the potential face that I would have had if my face had developed properly from the beginning? 

MSE expands the maxilla and the entire midface to some degree, which disarticulates all perimaxillary sutures. I am protracting concurrently with a Petit facemask for best results, but yes afterwards my palate will be able to easily accomodate my tongue and allow for any further marginal gains.

We have no way of knowing what your face would look like if you developed properly, but results depend on how aggressive you decide to go with the MSE/FM. You’d be making signficant and positive improvements regardless, which for me was enough to pull the trigger and do the treatment.

 

ReplyQuote
Posted : 11/10/2018 2:47 pm
Halti.H liked
alfio
Active Member
Posted by: varbrah

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

 😯 Really?How'd you do that? I think everyone here should know your story!

But first of all, do you have any photos to prove it?

 

ReplyQuote
Posted : 11/10/2018 2:55 pm
varbrah
Estimable Member

@alfio

My ortho has all my x-rays and facial photos right now, and I’m leaning towards posting only the before and afters once I complete treatment and get the MSE removed, rather than incremental changes, so there can be no doubt.

Meanwhile there’s plenty of MARPE and/or protraction case studies you can check out showing results just as good if not even better.

If I have time after work today I’ll maybe grab a ruler and snap a pic showing the IMW on my pre-mse dental cast and my IMW now

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Posted : 11/10/2018 3:15 pm
GoTTi
Trusted Member
Posted by: varbrah
Posted by: Halti.H

Hi! I was wondering if you can make just as much development with mewing than with the MSE method? I know that a guy named Jamo, who has posted his results on this site had insane results from hard mewing and chewing only. He completely lifted his maxilla and mandibular angle. I'm also 18, so does the MSE only make results easier but the same results can be achieved with mewing only? Thanks

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

Nice results! Any forward movement/expansion of the mandible at all or is there any expected? This is my weak point, as I’ve stated before. So I’m really curious to see how this will work for forward and upward rotation of the mandible, not just the maxilla.

Also, how much protraction are you aiming for give or take & how many MM’s are you expanding laterally?

 

thanks, and again, congratulations bro 💪🏽

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Posted : 11/10/2018 7:08 pm
varbrah
Estimable Member

@GoTTi

So far my mandible been able to move forward/rotate with my maxilla. No expansion of the mandible and none planned, my mandibular arch was wider than my upper arch anyway.

Done expanding. No concrete goal with protraction, just going to try to max out forward displacement of the maxilla during this 6 month window while I have the MSE in. I’ll consider stopping if my mandible is no longer able to move any further forward or autorotate.

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Posted : 11/10/2018 7:31 pm
accnum2
Active Member

Hello. How do i pm you? Do u have discord? I have had extraction/34mm intermolar and one side morr forward upswung expanded maxilla than other. Can MSE fix my asymmetry widen and up and forward move maxilla. I think i may need 1 cm upward and 2 cm forward movement. (5mm probably from reversing extraction). 

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Posted : 12/10/2018 12:30 am
GoTTi
Trusted Member
Posted by: varbrah

@GoTTi

So far my mandible been able to move forward/rotate with my maxilla. No expansion of the mandible and none planned, my mandibular arch was wider than my upper arch anyway.

Done expanding. No concrete goal with protraction, just going to try to max out forward displacement of the maxilla during this 6 month window while I have the MSE in. I’ll consider stopping if my mandible is no longer able to move any further forward or autorotate.

Appreciate the reply, dude.

well, from what I’ve read about this all, I’ve learned that the mandible should always follow suit as the maxilla is displaced. Why do you entertain the concept of the mandible potentially refraining from autorotatibg any further eventually?

 

also, this is going to probably be a stupid [Rude Language will not be tolerated] question lol, but couldn’t there be a similar protocol for the mandible to emulate what we’re doing here with the maxilla? 

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Posted : 12/10/2018 11:11 am
varbrah
Estimable Member
Posted by: GoTTi
Posted by: varbrah

@GoTTi

So far my mandible been able to move forward/rotate with my maxilla. No expansion of the mandible and none planned, my mandibular arch was wider than my upper arch anyway.

Done expanding. No concrete goal with protraction, just going to try to max out forward displacement of the maxilla during this 6 month window while I have the MSE in. I’ll consider stopping if my mandible is no longer able to move any further forward or autorotate.

Appreciate the reply, dude.

well, from what I’ve read about this all, I’ve learned that the mandible should always follow suit as the maxilla is displaced. Why do you entertain the concept of the mandible potentially refraining from autorotatibg any further eventually?

 

also, this is going to probably be a stupid [Rude Language will not be tolerated] question lol, but couldn’t there be a similar protocol for the mandible to emulate what we’re doing here with the maxilla? 

If the component of forward displacement of the maxilla is too large then the mandible will not be able to rotate to form a proper bite — it will have to shift forward, and its ability to do so is limited. Basically it’s important to get upwards growth and good CCW rotation while protracting, and this requires you to choose the proper angle of force direction.

Yes there is, mandibular distraction osteogensis. Google it, not exactly something I want to do considering the hardware they have to install. My mandible has acceptable development with just minor crowding so no need to, at least for now.

@accnum2 no idea, I’m leaning towards no, it wont correct your assymetry. However it can widen your maxilla and FM can move it forward.

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Posted : 12/10/2018 4:15 pm
ImperialMajesty
Eminent Member

@varbrah 

What was the rate of expansion?  How often did you have to turn your screw?

Also, where is the anchorage point of your facemask?  Is it toothborne or is it anchored to a TAD/ the microscrews on the MSE?

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Posted : 12/10/2018 8:15 pm
megamandude
Trusted Member

has your face gotten any wider and/or shorter @varbrah 

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Posted : 12/10/2018 10:20 pm
varbrah
Estimable Member
Posted by: peterparker

@varbrah 

What was the rate of expansion?  How often did you have to turn your screw?

Also, where is the anchorage point of your facemask?  Is it toothborne or is it anchored to a TAD/ the microscrews on the MSE?

4 turns per day until suture opens and then 2 turns per day after until desired expansion

anchorage are the metal orthodontic bands on my 1st molars which direct the force to the MSE, so total bone anchored.

@megamandude

wider, some upswing so minor shortening

ReplyQuote
Posted : 13/10/2018 12:57 am
Apollo
Reputable Member
Posted by: varbrah

4 turns per day until suture opens and then 2 turns per day after until desired expansion

How do you know when the suture opens?

Do you think it's possible Dr. Mike Mew reported disappointing results in one adult case treated with this type of appliance (   https://youtu.be/WqqirRw_8bw   ) because he wasn't advancing the screw fast enough to disarticulate the suture?

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Posted : 13/10/2018 1:06 am
varbrah
Estimable Member
Posted by: Apollo
Posted by: varbrah

4 turns per day until suture opens and then 2 turns per day after until desired expansion

How do you know when the suture opens?

Do you think it's possible Dr. Mike Mew reported disappointing results in one adult case treated with this type of appliance (   https://youtu.be/WqqirRw_8bw   ) because he wasn't advancing the screw fast enough to disarticulate the suture?

You know the suture is open when a diastema forms. Some people even feel a pop or a crack when it comes apart.

Sounds like Mike used a Hyrax expander and the expansion screw wasn’t generating enough force or the body of the appliance wasn’t rigid enough for use in adults. The Hyrax also relies on dental anchorage so that probably contributed. Interestingly enough he mentions that he’ll be using the MSE’s expansion screw.

ReplyQuote
Posted : 13/10/2018 10:56 am
ladida liked
MrMaxilla
Active Member

Somewhat jelly of the results that you are getting, not going to lie. I have a crozat appliance, which has expanded roughly 3mm over 3 months now, and I already notice significant benefits in my breathing, sleep, and face. I could only imagine what 7mm would do for me! I would have to expand my mandible if I went that far though, as 3mm has already elicited the use of a lower expander. I know of at least one dentist in my area that uses MARPE, but decided to see someone with an orthotropics background instead.

I've considered mk-667 also, but as of right now I'm just going the natural route (vitamin k2, trace minerals, cod liver oil, vit D, collagen, vitamin c, cissus quadrangularis, epimedium, etc.) + exercise. It seems to be helping.

 

ReplyQuote
Posted : 13/10/2018 1:36 pm
Sceriff
Eminent Member
Posted by: varbrah
Posted by: Halti.H

Hi! I was wondering if you can make just as much development with mewing than with the MSE method? I know that a guy named Jamo, who has posted his results on this site had insane results from hard mewing and chewing only. He completely lifted his maxilla and mandibular angle. I'm also 18, so does the MSE only make results easier but the same results can be achieved with mewing only? Thanks

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

Do you think the same results can be achieved with the mewing? Or does the expander use a force that tongue alone cannot impress on the palate? @varbrah

ReplyQuote
Posted : 13/10/2018 4:08 pm
ImperialMajesty
Eminent Member

@varbrah

Great to hear that it's all bone anchored.  How are you measuring forward displacement of the maxilla?  Is it through x-rays or simply by measuring the overjet?

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Posted : 13/10/2018 6:04 pm
varbrah
Estimable Member

@scerif Already answered this. Browse this thread.

@peterparker x-ray

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Posted : 13/10/2018 7:13 pm
megamandude
Trusted Member

Any changes to the forehead @varbrah 

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Posted : 13/10/2018 7:43 pm
varbrah
Estimable Member

@megamandude no

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Posted : 13/10/2018 8:03 pm
Sceriff
Eminent Member

@varbrah  My question is directed exactly to your answer:

Posted by: varbrah

*Technically* the same results can be achieved with mewing, I guess? Of course MSE makes the results easier but the rate at which you make progress sort of determines how much progress you make, given that we have a finite amount of time, right?

I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping -in just three weeks and I’m 24. Similar results might take someone my age a decade to achieve, if not more.

I just wanted to know why MSE makes expansion easier? Why would it take a decade of mewing instead?

ReplyQuote
Posted : 13/10/2018 8:14 pm
GoTTi
Trusted Member
Posted by: varbrah

@megamandude no

Orb changes equate to brow ridge changes, correct? I guess that wouldn’t dnt ve considered ones forehead though would it 

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Posted : 13/10/2018 9:50 pm
GoTTi
Trusted Member
Posted by: MrMaxilla

Somewhat jelly of the results that you are getting, not going to lie. I have a crozat appliance, which has expanded roughly 3mm over 3 months now, and I already notice significant benefits in my breathing, sleep, and face. I could only imagine what 7mm would do for me! I would have to expand my mandible if I went that far though, as 3mm has already elicited the use of a lower expander. I know of at least one dentist in my area that uses MARPE, but decided to see someone with an orthotropics background instead.

I've considered mk-667 also, but as of right now I'm just going the natural route (vitamin k2, trace minerals, cod liver oil, vit D, collagen, vitamin c, cissus quadrangularis, epimedium, etc.) + exercise. It seems to be helping.

 

What lower expander would you go about utilizing to expand your mandible if you decided to take that route on expanding +7mm?

ReplyQuote
Posted : 13/10/2018 9:56 pm
varbrah
Estimable Member

@scerif I think the MSE vs mewing question kind of speaks for itself... Why wouldn’t MSE make expansion easier? Have you seen any adults achieve nearly a centimeter of pure osseous expansion by mewing in a reasonable amount of time?

@GoTTi I would consider most changes in the appearance of the forehead to actually be a result of changes in the midface, and specifically due to ccw rotation of the maxilla and orientation of the occlusal plane. The shape of my forehead has not changed whatsoever, but I am now naturally tilting it slighty clockwise, leading it to appear less backwards sloping. Naturally, my browridge also looks more prominent since more of my eye is “underneath” it now if that makes sense.

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Posted : 13/10/2018 10:24 pm
GoTTi and Sceriff liked
Apollo
Reputable Member
Posted by: varbrah
 
Sounds like Mike used a Hyrax expander and the expansion screw wasn’t generating enough force or the body of the appliance wasn’t rigid enough for use in adults. The Hyrax also relies on dental anchorage so that probably contributed. Interestingly enough he mentions that he’ll be using the MSE’s expansion screw.
No, he definitely isn't using a Hyrax expander anchored to the teeth in this case. He calls it a "TAD-based skeletal expansion device" and he is using extra-oral traction mounted to a neck brace. He introduces the device in video 2 of the series (  https://youtu.be/EqiTDLlP2fA ): 
We've put this framework in the roof of your mouth. We've put four screws up into either side... two into each maxillary half on either side of your midline suture following Won Moon's concept... And I'm bringing in the MewVector style headbrace. 
In installment 3 of the series with this patient (  https://youtu.be/XsJUwp8WzP4 ), he talks about it failing:
This was following Won Moon's expansion screw, and the screw widened but it didn't seem to have any skeletal effect. Now you're one in five people who have used Moon's appliance and didn't get any skeletal effect... Now I'm not knocking the appliance. I mean I haven't been on his course. I don't have the time to go and do a sort of four-part weekend course, one part in American, three parts in Spain, at the moment. So I don't know if I'm doing things wrong, but... we certainly put some good screws in you and we didn't get any change at all, and I was surprised by that... One thing that I've noticed is nearly all of these screws, these TADs, become loose fairly quickly.
This last point is why he decided to put the TADs in at an angle when they tried it a second time to help lock them in place citing Dr. Evans' method in video 4 (   https://youtu.be/WqqirRw_8bw ):
We're going to use the Moon expansion device... We'll use Marianna Evans' angulation screws, but I'll use the actual expansion screw of Won Moon because I was finding the hyrax expander wasn't really man enough for adults and was seizing up. 

They never give another update about this patient, so I presume it failed again.

 

 

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Posted : 13/10/2018 10:35 pm
Sceriff
Eminent Member

@varbrah I don't discuss  that MSE is faster, my question is about the mechanism that makes it faster.

For example, does MSE apply a type of force that the tongue cannot replicate? Does it directly move the bone?

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Posted : 13/10/2018 11:18 pm
varbrah
Estimable Member

@Apollo I feel like he isn’t being very clear at all... Unless I’m misunderstanding he was still using a Hyrax expander at some point, since he stated “that it wasn’t man enough for adults”. The fact that it was affixed with TADs technically makes it a ‘hybrid’ ( utilizes both bone- and tooth-borne forces) Hyrax, but a Hyrax nonetheless.

If that is the case, then like I said, the Hyrax screw isn’t as rigid or stable as you’d like it to be for transverse expansion in adults, despite the bone-anchorage, which probably exacerbated the problem. Cases where Hyrax screws were used in conjunction with TADs for expansion in adults have generally resulted in increased dento-alveolar tipping comparable to regular old tooth-anchored expanders, as well as increased stress concentration at the anchorage points (meaning the bone anchorage was basically redundant).

If he did use Won Moon’s expansion screw, then he either 100% messed something up (I keep hearing about ‘following a concept’ as opposed to 100% adhering to the concept, and modifications to established protocols and specialized devices that are engineered to be used in a VERY specific way), or Fred has the sutural interdigitation of the average baby boomer, which still couldve been overcome.

I’m curious to see what initial expansion rate he used, since you need relatively strong forces to disarticulate the suture (4-6 turns per day or increases of .57mm to .83mm equivalent of expansive force per day) — slow expansion will simply not cut it. If Fred’s suture was highly interdigitated, the next step would’ve been to perform interpalatal cortipuncture to mechanically weaken the suture and allow it to open. It’s also possible, but unlikely, that his maxillary buttresses were overpowering the force of the expander — again, possible but highly unlikely, and the MSE is designed and placed specifically to most effectively counter the resistance of the maxillary buttress.

What is Dr. Evans’ angulation of screws supposed to be? Between 60 and 90 degrees parallel to the slope of the palate is standard for these types of things so not sure what he is talking about? Lol.

Also, [Rude Language or Insults are not tolerated] at the part about the miniscrews becoming loose quickly? Again either he is messing something up or Fred is osteoporotic. The miniscrews used with the MSE are specifically designed for increased osseointegration, with a higher surface area and even a reverse tapered internal chamber in the miniscrews so that bone can grow INSIDE of them.

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Posted : 13/10/2018 11:56 pm
varbrah
Estimable Member
Posted by: scerif

@varbrah I don't discuss  that MSE is faster, my question is about the mechanism that makes it faster.

For example, does MSE apply a type of force that the tongue cannot replicate? Does it directly move the bone?

Bro, yes. Read the whole thread.

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Posted : 13/10/2018 11:57 pm
MrMaxilla
Active Member
Posted by: GoTTi
Posted by: MrMaxilla

Somewhat jelly of the results that you are getting, not going to lie. I have a crozat appliance, which has expanded roughly 3mm over 3 months now, and I already notice significant benefits in my breathing, sleep, and face. I could only imagine what 7mm would do for me! I would have to expand my mandible if I went that far though, as 3mm has already elicited the use of a lower expander. I know of at least one dentist in my area that uses MARPE, but decided to see someone with an orthotropics background instead.

I've considered mk-667 also, but as of right now I'm just going the natural route (vitamin k2, trace minerals, cod liver oil, vit D, collagen, vitamin c, cissus quadrangularis, epimedium, etc.) + exercise. It seems to be helping.

 

What lower expander would you go about utilizing to expand your mandible if you decided to take that route on expanding +7mm?

Not sure, any generic expander would probably work. A lower schwartz or something like that. I don't really know what I'd do tbh, but it would be necessary as my teeth simply wouldn't be able to occlude properly if I didn't

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Posted : 14/10/2018 12:07 am
Apollo
Reputable Member
Posted by: varbrah

@Apollo I feel like he isn’t being very clear at all... Unless I’m misunderstanding he was still using a Hyrax expander at some point, since he stated “that it wasn’t man enough for adults”. The fact that it was affixed with TADs technically makes it a ‘hybrid’ ( utilizes both bone- and tooth-borne forces) Hyrax, but a Hyrax nonetheless.

To my understanding of the video series, he initially tried to follow Moon's published methods as closely as he could without having trained in the protocol directly. When that failed, he then tried to make some adjustments during their second attempt. He never talks about using a Hyrax with this patient. He just explains that this appliance is sturdier and better suited for adult cases than the Hyrax based on past experience.

Posted by: Apollo
 
Do you think it's possible Dr. Mike Mew reported disappointing results in one adult case treated with this type of appliance (   https://youtu.be/WqqirRw_8bw   ) because he wasn't advancing the screw fast enough to disarticulate the suture?
I speculated that he might have been advancing too slow since he says in this video about adult palate expansion (  https://youtu.be/QCNqbvOALZI ):
I will always aim to go at 1mm a week, which is very different from either conventional slow expansion or the rapid maxilla expansion sort of favored by Haas and really still quite common by many people that I actually think is quite damaging and I don't support rapid maxilla expansion.
I believe he's saying this in the context of removable expanders, but my guess is that he kept to the same rate with the bone-anchored expander.
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Posted : 14/10/2018 12:52 am
varbrah liked
varbrah
Estimable Member

@Apollo Okay so given that info your original hypothesis is potentially right then. If he actually kept the expansion rate at only 1mm per week... [Rude Language or Insults are not tolerated] lol. The MSE brochure is publicly available ( https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf) and lays the expansion rates out by stage and age group, so there isn’t an excuse for that kind of negligence. I feel like if you’re not even going to take the MSE course then you should resign yourself to at least follow the instructions to a T and not [Rude Language or Insults are not tolerated] around like that based on your own biases.

The sustained slow expansion, which I assume happened over a period of weeks, probably also explains why the miniscrews came loose in the first place too. I imagine they became warped as the heads of the screws were torqued by the expanding body.

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Posted : 14/10/2018 1:22 am
GoTTi and Apollo liked
Apollo
Reputable Member
Posted by: varbrah

@Apollo Okay so given that info your original hypothesis is potentially right then. If he actually kept the expansion rate at only 1mm per week... [Rude Language or Insults are not tolerated] lol. The MSE brochure is publicly available ( https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf) and lays the expansion rates out by stage and age group, so there isn’t an excuse for that kind of negligence. I feel like if you’re not even going to take the MSE course then you should resign yourself to at least follow the instructions to a T and not [Rude Language or Insults are not tolerated] around like that based on your own biases.

The sustained slow expansion, which I assume happened over a period of weeks, probably also explains why the miniscrews came loose in the first place too. I imagine they became warped as the heads of the screws were torqued by the expanding body.

I'm not sure if this is relevant, but in the brochure you linked, under "Failed Case" it says:

When the implants are not engaged bi-cortically, they may tip laterally during the expansion, causing unwanted tissue impingements and implant failure

Does "bi-cortically" mean that the screw should extend the entire thickness of the bone from the surface of the palate through to the surface of the nasal cavity? There are also several contraindications listed. One of them is "Extremely thick/dense palatal bone and/or dense buttress bone." I wonder if my torus palatinus would prevent me from being a good candidate for this procedure.

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Posted : 14/10/2018 1:55 am
GoTTi liked
varbrah
Estimable Member

@Apollo Bi-cortical engagement essentially means that the miniscrew penetrates not only the hard, cortical surface of the maxilla on the underside (palate), but that it extends through the palate and engages the opposing cortical surface too, but without drilling all the way into the nasal cavity. This results in improved anchorage and more parallel expansion. One of my miniscrews isn't engaging bi-cortically, but this isn't a problem since the other three are. However, this is another reason why Dr. Mew should not be messing around with the MSE protocol, re: angulation of screws.

And yeah, you would probably have to get the torus palatinus removed if you want to use the MSE. There's the issue with achieving bi-cortical engagement of the miniscrews, as well as the angle of your palatal plane potentially being funky. Ultimately though, depends on the size and location of the growth.

EDIT: didn't see your edit until I posted. Yeah that's correct -- all the way through to the cortical surface of the nasal cavity, without actually penetrating it completely though.

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Posted : 14/10/2018 2:14 am
GoTTi and Apollo liked
GoTTi
Trusted Member
Posted by: varbrah

@Apollo Bi-cortical engagement essentially means that the miniscrew penetrates not only the hard, cortical surface of the maxilla on the underside (palate), but that it extends through the palate and engages the opposing cortical surface too, but without drilling all the way into the nasal cavity. This results in improved anchorage and more parallel expansion. One of my miniscrews isn't engaging bi-cortically, but this isn't a problem since the other three are. However, this is another reason why Dr. Mew should not be messing around with the MSE protocol, re: angulation of screws.

And yeah, you would probably have to get the torus palatinus removed if you want to use the MSE. There's the issue with achieving bi-cortical engagement of the miniscrews, as well as the angle of your palatal plane potentially being funky. Ultimately though, depends on the size and location of the growth.

EDIT: didn't see your edit until I posted. Yeah that's correct -- all the way through to the cortical surface of the nasal cavity, without actually penetrating it completely though.

Very nice information and well put information. My tortus platinus seems rather small and a bit less prominent than the default picture I see when I google tortus platinus. Maybe I won’t need to remove mine if I do decide to undergo this procedure because it’s not so big/thick (lol no h**o). I do, however, have a high palate. Do you think this will be a problem?

 

Also, feel free to drop a bitcoin link or something in my PM’s if you want to so I can compensate you for all of your answers. I know you may find some of these “basic questions” annoying. You just have to bear with me. I’m sort of new to this [Rude Language or Insults are not tolerated] I have been suffering from brain fog lately, so I’m kind of limited here for the time being.

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Posted : 14/10/2018 9:37 am
FutureModel
Trusted Member

Mike Mew talks about the MSE and MARPE in this video  https://www.youtube.com/watch?v=-pzL3ETuiKc

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Posted : 14/10/2018 11:30 am
Tiago liked
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