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Relapse after Maxillary Expansion  

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letsgochamp
Active Member

Last week I went to an orthodontist to discuss the option of widening the maxilla with a R.M.E. First of all they were shocked that I would even consider that, since they didn't see any problem with my mouth. I guess that speaks more of their lack of understanding what a normal healthy palate should be. 

However they made the point that even if I were to widen the maxilla, it would ultimately relapse back, since the other cranial bones will not move. The Zygomat, Sphenoid, Ethmoid bone, etc. would be resisting and overtime push back on the maxilla, thus nullifying any expansion. 
Only way to keep the results won by an expansion,  is to wear a retainer in mouth practically for ever. 

What is the groups opinion on that? I mean, it is a valid point! Won't the rest of the facial bones adjust to maxilla pushing outwards, and if so, which force is greater. The inwards or the outwards? 

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Posted : 17/01/2019 1:09 pm
Freethemaxilla
Active Member

I'm seeing a ENT Dr and I plan on asking him this question.  

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Posted : 31/01/2019 10:07 am
Odys
 Odys
Trusted Member

I think he is right. I think dentists describe adult orthodontic treatment in cosmetic terms not only to market and not only because they understand the teeth primarily in aesthetic terms but because adult orthodontic results are temporary and it is more honest to describe them as cosmetic rather than medical. 

Both habits and structure go to create the forces of relapse. Tongue posture is important in the fight against both, and for this reason mewing is superior to orthodontic treatment. However the hope that expanding the palate and maintaining it by orthodontic retainers or tongue posture will result in sufficient facial restructuring to overcome the forces of relapse that have implanted in our faces seems over optimistic. I think it is even more difficult to move the bones of the face than expand the palate, but I think it is a good idea to try to reduce the forces of relapse in the face. In this attempt one should be addressing all one’s habits and posture throughout the body. I think that vibration is a useful tool in letting the body’s will to rightness reassert itself.

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Posted : 31/01/2019 10:52 am
varbrah
Estimable Member

Depends which form of RME we’re talking. Anything non-bone anchored in adults is a waste of time unless you are looking for dentoalveolar changes.

MSE on the other hand literally does move other cranial bones and in my case widened my midface/zygos by a little less than a cm. Retention with the MSE is six months in order for new bone to grow in and to allow for adequate remodeling to occur at the perimaxillary sutures and then there should be no relapse.

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Posted : 31/01/2019 1:36 pm
Abdulrahman
Reputable Member
Posted by: letsgochamp

What is the groups opinion on that? I mean, it is a valid point! Won't the rest of the facial bones adjust to maxilla pushing outwards, and if so, which force is greater. The inwards or the outwards? 

The point they bring up is valid, but depends on your situation. Some cases will respond well to skeletal expansion but others won't. I don't have enough information about the exact cause of this, but I think it comes down to the layout of the bones. I feel allot of doctors who engage in skeletal expansion are not doing enough analysis for their patients and that is causing inconsistency in results. 

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

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Posted : 02/02/2019 11:07 am
Abdulrahman
Reputable Member
Posted by: Varbrah

Depends which form of RME we’re talking. Anything non-bone anchored in adults is a waste of time unless you are looking for dentoalveolar changes.

If done correctly all forms of RME expand skeletal bones. It's just that mini-screw expanders, such as the one you have, are more stable and less prone to complications.

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

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Posted : 02/02/2019 11:11 am
James
Eminent Member
Posted by: Abdulrahman
Posted by: Varbrah

Depends which form of RME we’re talking. Anything non-bone anchored in adults is a waste of time unless you are looking for dentoalveolar changes.

If done correctly all forms of RME expand skeletal bones. It's just that mini-screw expanders, such as the one you have, are more stable and less prone to complications.

This matches what I have heard. I asked my osteopath about MARPE/MSE (she has lots of patients with appliances), and she said that it causes most of the expansion at the suture, while tooth-borne appliances cause changes throughout the palate in addition to the dentoalveolar area. 

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Posted : 02/02/2019 1:30 pm
varbrah
Estimable Member
Posted by: Abdulrahman
Posted by: Varbrah

Depends which form of RME we’re talking. Anything non-bone anchored in adults is a waste of time unless you are looking for dentoalveolar changes.

If done correctly all forms of RME expand skeletal bones. It's just that mini-screw expanders, such as the one you have, are more stable and less prone to complications.

If you are getting relapse after a sufficient retention period you have not achieved true skeletal expansion, just bone bending.

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Posted : 02/02/2019 1:58 pm
Apollo
Reputable Member
Posted by: Varbrah

If you are getting relapse after a sufficient retention period you have not achieved true skeletal expansion, just bone bending.

I read an article which suggested that even in cases with true skeletal expansion, compensatory dentoalveolar remodeling can occur during the retention phase. In other words some of the separation at the suture line is filled in with new growth, but some of it also comes from "bone bending" to back fill the gap, even if the appliance stabilizes all of the intermolar width gains. If this is true, it seems logical that bone-anchored retention would help prevent this from happening since it would hold the edges of the suture apart requiring actual growth to fill the gap.

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Posted : 02/02/2019 3:35 pm
varbrah
Estimable Member
Posted by: Apollo
Posted by: Varbrah

If you are getting relapse after a sufficient retention period you have not achieved true skeletal expansion, just bone bending.

I read an article which suggested that even in cases with true skeletal expansion, compensatory dentoalveolar remodeling can occur during the retention phase. In other words some of the separation at the suture line is filled in with new growth, but some of it also comes from "bone bending" to back fill the gap, even if the appliance stabilizes all of the intermolar width gains. If this is true, it seems logical that bone-anchored retention would help prevent this from happening since it would hold the edges of the suture apart requiring actual growth to fill the gap.

Possible, but that’s why I continue to shill specifically for MSE as opposed to MARPE in general as the answer. MSE is able to get more expansion in the superior maxilla which decreases the amount of bone bending occurring dramatically.

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Posted : 02/02/2019 4:09 pm