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What are the pros and cons of bimax surgery?

FutureModel
(@futuremodel)
100+ Forum Posts

I talked to Derek Mahony, Bill Hang, Marianna Evans and a girl in Ontario who uses Won Moons MSE and they all said I should get a bimax done lol

Since this may be the only way to fix my sleep apnea I may just say screw it and get an online consultation from Mike Mew himself and see what he recommends.  https://youtu.be/OBVej45NXE4

I heard that he knows a surgeon who does some sort of lefort 3 to move the entire maxilla up and forwards but idk for sure

Anyway, what are the pros and cons of bimax? I heard somewhere that surgery is permanent and that the bones fuse or something and no amount of mewing will make it any better after, like the bones wont move at all after surgery. Is this true? I don't want claims I want a legit science article or something that confirms this

 

 

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Topic starter Posted : 12/12/2018 4:08 am
Abdulrahman
(@abdulrahman)
500+ Forum Posts

Save your money, Dr. Mew is going to start the interview by saying "YOU ARE AWARE EVERYTHING I AM GOING TO SAY TO YOU IS ALREADY IN THE CHANNEL". As if he is preparing you in advance to take in the disappointment. And beside all he is going to offer you at best is the Hybrid appliance therapy with absolutely no supporting facts that he used it successfully to fix sleep apnea for adults.

The doctor I referred to in your other MSE thread wanted me to do bimaxillary surgery, but I refused. It's a surgery in a very sensitive area so it carries risks. The recovery process is ****. It introduces significant bone scaring, so the bone is deformed. It still can remodel but in a disrupted way. 

Unlike Lefort 2, it only covers a small section of the maxilla, so the esthetic improvements are minimal. Plus most doctors performing this surgery will not give much attention to esthetics they will just look to achieving expansion. 

Since your main concern is esthetics, why bother with this when you can just have FAGGA plus MSE then followed by lower jaw surgery to expand it forward and sideways?    

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

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Posted : 12/12/2018 9:45 am
TheBeastPanda, Neigh, FutureModel and 2 people liked
varbrah
(@varbrah)
200+ Forum Posts

What @abdulrahman said basically. In addition to the bone being 'deformed', it will be in a mechanically disadvantageous position, so if you were to remove the miniplates which fix the maxilla together along the LeFort 1 fracture post-surgery (in hopes of positive remodeling), you would probably experience some relapse as your maxilla remodels closer to its previous configuration.

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Posted : 12/12/2018 11:01 am
FutureModel
(@futuremodel)
100+ Forum Posts

Yeeaaah, yall are right. Fk surgery.

I'm calling up a doc in Montreal who uses the mse her name is Dr Seguin. She asked to see pictures, I sent them last night and she has not gotten back to me. So, I'll call her up and if she suggests surgery I'll ask "Okay but how about we do the mse first and if that don't work we can always do surgery after"

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Topic starter Posted : 12/12/2018 11:08 pm
FutureModel
(@futuremodel)
100+ Forum Posts

@Varbrah @Abdulrahman

Heres the thing with me doing the mse appliance with protraction. If I'm going to do I want to go all the way, I might as well try and get the most out of it lol

I talked to some girl in ontario who uses the mse and we talked back forth, anyway, we were talking about expansion and I told her I wanted to expand to around 50mm because that is what our ancestors had, then she said she can only expand as wide as the mandible, so I told her that mandible expansion is a thing and people do it all the time and it's possible. She just stayed quiet and said no lolol

After that we talked about protraction and she said she can only protract the maxilla around 5mm, I asked her "Okay, but can you go further than 5mm? What would happen if you went over 5mm?" She couldn't give me a clear answer and all I remember her saying (she rambled) was that it would relapse. I asked her if the sutures or the fiburous tissues would tear and she said no.

She also said that they'ed have to do surgery on the mandible to pull it forward to meet the maxilla, I asked her "Okay, but I thought the mandible would just follow through? I thought the mandible joint would remodel itself so that the jaws would fit together?"

She said no of course lol

I don't know what else to say about that. That's pretty underwhelming to be honest, 5mm? Wow lol

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Topic starter Posted : 12/12/2018 11:21 pm
JimmyB
(@jimmyb)
10+ Forum Posts
Posted by: FutureModel

@Varbrah @Abdulrahman

Heres the thing with me doing the mse appliance with protraction. If I'm going to do I want to go all the way, I might as well try and get the most out of it lol

I talked to some girl in ontario who uses the mse and we talked back forth, anyway, we were talking about expansion and I told her I wanted to expand to around 50mm because that is what our ancestors had, then she said she can only expand as wide as the mandible, so I told her that mandible expansion is a thing and people do it all the time and it's possible. She just stayed quiet and said no lolol

After that we talked about protraction and she said she can only protract the maxilla around 5mm, I asked her "Okay, but can you go further than 5mm? What would happen if you went over 5mm?" She couldn't give me a clear answer and all I remember her saying (she rambled) was that it would relapse. I asked her if the sutures or the fiburous tissues would tear and she said no.

She also said that they'ed have to do surgery on the mandible to pull it forward to meet the maxilla, I asked her "Okay, but I thought the mandible would just follow through? I thought the mandible joint would remodel itself so that the jaws would fit together?"

She said no of course lol

I don't know what else to say about that. That's pretty underwhelming to be honest, 5mm? Wow lol

When you say mandible expansion, do you mean expanding solely the lower dental arch to match the expanded upper arch post-MSE, rather than widening the mandible itself? Or do you have plans to have a procedure like Mandibular Symphyseal Distraction Osteogenesis (MSDO) to expand the entire mandible itself?

"Luckily" in my case, my bottom molars tip inwards slightly and I have a far amount of crowding in the front teeth, so it seems like I can afford some lower arch expansion without actually expanding the mandible itself. Hopefully correcting that would compensate enough for the resulting upper arch expansion from MSE.

Also, is it a fact that the mandible would move forward with the maxilla's forward growth from MSE? I know Mew claims that the mandible swings forward with the maxilla from mewing, but if that was the case with MSE, then how would it treat varbrah's class 3 malocclusion?

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Posted : 13/12/2018 3:26 am
FutureModel
(@futuremodel)
100+ Forum Posts

@JimmyB I'm talking about expanding the entire mandible to match with the 53mm inter molar width of the maxilla with some sort of appliance that Mike Mew was talking about here  https://www.youtube.com/watch?v=j4sH7MVFmMQ

My bottom teeth are tipped inward too, but uprighting them wont be enough I don't think. I want my maxilla and mandible to be widened to what our ancestors had which was roughly 53mm, then I want to protract 20mm forward (upwards a little too) because Jonh Mew says that people maxillae are roughly 20mm back from ideal, really, all I want is to achieve the ideal place for my jaws, because this is optimal for health and looks.

 

I can't answer that last paragraph you have there, I have no idea

 

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Topic starter Posted : 13/12/2018 5:53 am
varbrah
(@varbrah)
200+ Forum Posts

@JimmyB

im class 1

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Posted : 13/12/2018 6:23 am
JimmyB
(@jimmyb)
10+ Forum Posts

@varbrah

I guess I assumed you were class 3 because you mentioned MSE is typically for class 3s cases in the other thread, my fault. Looking at your response you made today, in the other thread, it seems like your mandible is swinging forward though. I'm happy to hear that.

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Posted : 13/12/2018 6:45 am
varbrah liked
JimmyB
(@jimmyb)
10+ Forum Posts
Posted by: FutureModel

@JimmyB I'm talking about expanding the entire mandible to match with the 53mm inter molar width of the maxilla with some sort of appliance that Mike Mew was talking about here  https://www.youtube.com/watch?v=j4sH7MVFmMQ

My bottom teeth are tipped inward too, but uprighting them wont be enough I don't think. I want my maxilla and mandible to be widened to what our ancestors had which was roughly 53mm, then I want to protract 20mm forward (upwards a little too) because Jonh Mew says that people maxillae are roughly 20mm back from ideal, really, all I want is to achieve the ideal place for my jaws, because this is optimal for health and looks.

 

I can't answer that last paragraph you have there, I have no idea

 

Thanks, I hope you find a doc that can provide you with what you want!

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Posted : 13/12/2018 7:30 am
Abdulrahman
(@abdulrahman)
500+ Forum Posts
Posted by: FutureModel

@Varbrah @Abdulrahman

Heres the thing with me doing the mse appliance with protraction. If I'm going to do I want to go all the way, I might as well try and get the most out of it lol

I talked to some girl in ontario who uses the mse and we talked back forth, anyway, we were talking about expansion and I told her I wanted to expand to around 50mm because that is what our ancestors had, then she said she can only expand as wide as the mandible, so I told her that mandible expansion is a thing and people do it all the time and it's possible. She just stayed quiet and said no lolol

After that we talked about protraction and she said she can only protract the maxilla around 5mm, I asked her "Okay, but can you go further than 5mm? What would happen if you went over 5mm?" She couldn't give me a clear answer and all I remember her saying (she rambled) was that it would relapse. I asked her if the sutures or the fiburous tissues would tear and she said no.

She also said that they'ed have to do surgery on the mandible to pull it forward to meet the maxilla, I asked her "Okay, but I thought the mandible would just follow through? I thought the mandible joint would remodel itself so that the jaws would fit together?"

She said no of course lol

I don't know what else to say about that. That's pretty underwhelming to be honest, 5mm? Wow lol

I am assuming this "girl" is a doctor? If she can get you 5mm of maxilla protraction I would fly over right now to get her procedure done. But, I highly doubt that number is accurate.

By the way do not underestimate what few mm can do to improving facial harmony. 5mm of protraction can go a long way. The same goes for the inter molar width, you do not need to go as high as 50mm to look good.

In fact, I think it will look over. Keep in mind that there are allot of standards of measurements for the inter molar width. The one Dr. Mew uses is taken at the inner most spot between the upper first molars, basically narrowest spaces. According to him most people measure this space wrong.

Most of the doctors you are speaking are measuring between the middle of the molars or even the outer edge. So those difference can produce a wide range of numbers.

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

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Posted : 13/12/2018 9:50 am
FutureModel
(@futuremodel)
100+ Forum Posts

@Abdulrahman Yes the girl is a doc who uses the mse. Yes I understand maybe you don't need that much expansion and protraction to look good. But, 53mm of expansion would dramitcallyopen up my nasal passages, my nasal passages would be so open!! I'd be able to breathe so well through my nose that I would never have to mouth breathe again

And protracting 20mm forward would permanently get rid of any sort of sleep apnea, not only that, I would have so much room for my tongue! Just think of all the room for the activities if I pull my maxilla 20mm forward! Hhahahaha, I know I'm called future model, but I'm not all about looks lol

 

There is such a good functional and health change as well if you could expand and pull your maxilla that far forward, you'd become superman hahahahathe the nasal breathing king!

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Topic starter Posted : 13/12/2018 6:14 pm
varbrah
(@varbrah)
200+ Forum Posts

20mm of protraction into ‘ideal’ would be giga-chad mode. You’ll have to settle for the 5mm and chad-lite status  😀  

Trust me 5mm will look great. 3mm already in my case looks wonderful.

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Posted : 13/12/2018 7:57 pm
TheBeastPanda, DrMario, Mewb and 1 people liked
megamandude
(@megamandude)
100+ Forum Posts
Posted by: FutureModel

@Varbrah @Abdulrahman

Heres the thing with me doing the mse appliance with protraction. If I'm going to do I want to go all the way, I might as well try and get the most out of it lol

I talked to some girl in ontario who uses the mse and we talked back forth, anyway, we were talking about expansion and I told her I wanted to expand to around 50mm because that is what our ancestors had, then she said she can only expand as wide as the mandible, so I told her that mandible expansion is a thing and people do it all the time and it's possible. She just stayed quiet and said no lolol

After that we talked about protraction and she said she can only protract the maxilla around 5mm, I asked her "Okay, but can you go further than 5mm? What would happen if you went over 5mm?" She couldn't give me a clear answer and all I remember her saying (she rambled) was that it would relapse. I asked her if the sutures or the fiburous tissues would tear and she said no.

She also said that they'ed have to do surgery on the mandible to pull it forward to meet the maxilla, I asked her "Okay, but I thought the mandible would just follow through? I thought the mandible joint would remodel itself so that the jaws would fit together?"

She said no of course lol

I don't know what else to say about that. That's pretty underwhelming to be honest, 5mm? Wow lol

Can you tell me the name of the ortho girl from Ontario either here or through pm please 

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Posted : 13/12/2018 10:50 pm
FutureModel
(@futuremodel)
100+ Forum Posts

Exactly bro, gigachad hahahahahaha but I'm not settling for 5mm, I'm not wired like that haha

20mm of protraction would make me so happy I could cry just thinking about it lol

I'm going to try my hardest to get there, I will sit down with my ortho and talk to her about this, I mean, I don't know a whole lot about protracting the maxilla but I mean what's wrong about 20mm of protraction? I mean, if you can pull 5mm with no problems and you can keep going 15mm more without tearing or anything really bad happening than why stop at 5mm? There is no reason to stop at 5mm unless something catastrophic is bound to happen if you go further.

I talked to an ortho from ontario who uses the mse and I asked her what would happen if you pulled past 5mm and like I said she didn't tell me anything bad would happen, I remember that she just said it might relapse and won't be stable. But, if that's the reason why they don't go that far than why stop at 5mm? It's "only" 15mm more, I don't care if it takes longer to pull that far, I really am going to try to get there. 20mm is life altering, literally life changing, it's amazing how much the maxilla can affect your face and health as a whole, I'm going to really try and get there

If my doc tells me she wont pull that far, then when she tells me to stop the protraction phase I will just ignore her and keep pulling, I don't care bro, I really don't, 20mm is life changing like I said lol

I would eat my own waste to get the ideal maxilla, y'all don't understand how important this $h!t is to me

Anyway, what happens to the mandible when the maxilla upswings forwards from mse? Does the mandible go along with it? How does that work? I have not got a clear answer from people, does anyone else have an explanation? The ortho from ontario said that if you pull too far than they will have to do surgery on the mandible to advance it forward to meet the maxilla, is this true? Why doesn't the mandible just swing along with it?

Heres my ortho btw, shes in montreal and uses mse https://www.orthodrseguin.com/en/equipe/dr-johanne-seguin/

 

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Topic starter Posted : 13/12/2018 10:56 pm
varbrah
(@varbrah)
200+ Forum Posts
Posted by: FutureModel

Exactly bro, gigachad hahahahahaha but I'm not settling for 5mm, I'm not wired like that haha

20mm of protraction would make me so happy I could cry just thinking about it lol

I'm going to try my hardest to get there, I will sit down with my ortho and talk to her about this, I mean, I don't know a whole lot about protracting the maxilla but I mean what's wrong about 20mm of protraction? I mean, if you can pull 5mm with no problems and you can keep going 15mm more without tearing or anything really bad happening than why stop at 5mm? There is no reason to stop at 5mm unless something catastrophic is bound to happen if you go further.

I talked to an ortho from ontario who uses the mse and I asked her what would happen if you pulled past 5mm and like I said she didn't tell me anything bad would happen, I remember that she just said it might relapse and won't be stable. But, if that's the reason why they don't go that far than why stop at 5mm? It's "only" 15mm more, I don't care if it takes longer to pull that far, I really am going to try to get there. 20mm is life altering, literally life changing, it's amazing how much the maxilla can affect your face and health as a whole, I'm going to really try and get there

If my doc tells me she wont pull that far, then when she tells me to stop the protraction phase I will just ignore her and keep pulling, I don't care bro, I really don't, 20mm is life changing like I said lol

I would eat my own waste to get the ideal maxilla, y'all don't understand how important this $h!t is to me

Anyway, what happens to the mandible when the maxilla upswings forwards from mse? Does the mandible go along with it? How does that work? I have not got a clear answer from people, does anyone else have an explanation? The ortho from ontario said that if you pull too far than they will have to do surgery on the mandible to advance it forward to meet the maxilla, is this true? Why doesn't the mandible just swing along with it?

Heres my ortho btw, shes in montreal and uses mse https://www.orthodrseguin.com/en/equipe/dr-johanne-seguin/

 

I think it has more to do with the sutures not being able to stay open for long enough to protract to 20mm effectively like I discussed a while ago. You would have to disrupt them periodically somehow.

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Posted : 14/12/2018 12:04 am
FutureModel
(@futuremodel)
100+ Forum Posts

@Varbrah okay, what happens to the mandible after the maxilla comes forwards? Does the mandible go along with it or does one need to get surgery to advance the mandible to meet the maxilla?

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Topic starter Posted : 14/12/2018 1:24 am
varbrah
(@varbrah)
200+ Forum Posts
Posted by: FutureModel

@Varbrah okay, what happens to the mandible after the maxilla comes forwards? Does the mandible go along with it or does one need to get surgery to advance the mandible to meet the maxilla?

I’ve already addressed this multiple times publicly and thru pm

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Posted : 14/12/2018 1:41 am
FutureModel
(@futuremodel)
100+ Forum Posts

@Vabrah Just read the pm and you said it auto rotates, coolio. I don't know why orthos don't know this, how does it auto rotate? Do you have to jutt your jaw forward to meet your teeth together and then it remodels into the new position?

I'm so confused as to why this ontario ortho girl told me that surgery has to be done on the mandible in for it to match up with the now forward maxilla, why? Lol how do they not know this? Do they not teach this in their universities? That is really strange, why would you get surgery on the mandible when it will auto rotate to meet the maxilla? That is just stupid

 

If Dr Seguin tells me I'll have to get surgery on the mandible after protraction then I wont know what to tell her, it really amazes me that they don't know this information. What amazes me even more is that when you tell them they put you down and don't believe you, it's so bizarre

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Topic starter Posted : 14/12/2018 2:16 am
James
(@james)
50+ Forum Posts

In the AGGA paradigm, the mandible is expanded with a FRLA appliance, so mandibular expansion definitely doesn't require surgery. I am wearing one right now. I've heard it claimed that the FRLA can give 5-7mm transverse expansion; not sure if it can expand forward, but decompressing the TMJ gives you forward movement of the mandible (via making more room through maxillary expansion). AGGA treatment also involves bite pads which helps free the mandible to swing forward. I got several mm forward motion in my mandible immediately once these were installed in the beginning of my treatment.

20mm forward growth seems like a lot. Ronald Ead the AGGA patient has around 9mm, and his results are dramatic. I have never seen any cases of 20mm expansion in adults, but if you have case studies of this then I would be curious to see them. Otherwise, I am going to continue to suspect that 5-10mm is probably enough for the vast majority of cases.

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Posted : 14/12/2018 3:21 am
FutureModel
(@futuremodel)
100+ Forum Posts

@Varbrah I just sent Won Moon a message and asked him if it was possible to protract 20mm and he said

"I have never done it. I have done 8-10 mm."

 

wonmoonmessage
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Topic starter Posted : 14/12/2018 4:18 am
varbrah liked
varbrah
(@varbrah)
200+ Forum Posts
Posted by: FutureModel

@Varbrah I just sent Won Moon a message and asked him if it was possible to protract 20mm and he said

"I have never done it. I have done 8-10 mm."

 

wonmoonmessage

Probably a young child

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Posted : 14/12/2018 4:42 am
FutureModel
(@futuremodel)
100+ Forum Posts

We don't know, I'll ask him again tomorrow because he did not answer if it is possible or not

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Topic starter Posted : 14/12/2018 4:48 am
varbrah
(@varbrah)
200+ Forum Posts

Lol why are you bothering the guy? He would’ve given you a more direct answer if he could or even felt like it. He already told you that it is technically possible to get 8-10mm of protraction so why not just get the MSE already and try to do it yourself. Him directly telling you how much forward growth you can achieve doesn’t change how much you will be able to achieve.

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Posted : 14/12/2018 4:56 am
megamandude
(@megamandude)
100+ Forum Posts

I agree with @varbrah here man, be happy with what you can get... Even 5mm could drastically change your face.

Also @varbrah do you know if MSE helps nasal airways? Right now I can only breathe though my left nostril, my right one is obstructed. Would MSE open it up? 

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Posted : 14/12/2018 6:26 am
Mewb liked
FutureModel
(@futuremodel)
100+ Forum Posts

Oh yeah I'm definitely going to keep pulling past 5 or 10mm, earlier you said "I think it has more to do with the sutures not being able to stay open for long enough to protract to 20mm effectively like I discussed a while ago. You would have to disrupt them periodically somehow."

How would you disrupt the sutures again? Just expand more with the mse to disarticulate the sutures again? So, instead of expanding all of the way first chance maybe you only expand half way, then pull as far as you can and if the sutures close again you can expand more and then pull again. I'm guessing that's how it's work

@megamandude I'm sorry bro but I'm not one to settle, if I can get to 20mm I will do it one or another, this $h!it is life changing

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Topic starter Posted : 14/12/2018 7:22 am
Abdulrahman
(@abdulrahman)
500+ Forum Posts
Posted by: FutureModel

@megamandude I'm sorry bro but I'm not one to settle, if I can get to 20mm I will do it one or another, this $h!it is life changing

This attitude is whats driving doctors to hate patients who do research online. They often come with conflicting ideas and wild expectation, which begs the question: how did you determine you need 20mm of forward expansion? 

Obviously Dr. Mew was making a general comparison between ancient man and modern patients. That does not mean you need that much expansion. In fact, for most patients Dr. Mew does not recommend anything beyond the 8-10mm Dr. Moon already mentioned.

According to Dr. Mew, if you want to know how much forward expansion you need measure your vertical growth indicator line. Most people fall in the 40 to 50mm range. Subtract your number from 38mm, which is the ideal, and that will give you theoretically how much forward expansion you need.

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

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Posted : 14/12/2018 11:14 am
Abdulrahman
(@abdulrahman)
500+ Forum Posts
Posted by: James

In the AGGA paradigm, the mandible is expanded with a FRLA appliance, so mandibular expansion definitely doesn't require surgery. I am wearing one right now. I've heard it claimed that the FRLA can give 5-7mm transverse expansion; not sure if it can expand forward, but decompressing the TMJ gives you forward movement of the mandible (via making more room through maxillary expansion). AGGA treatment also involves bite pads which helps free the mandible to swing forward. I got several mm forward motion in my mandible immediately once these were installed in the beginning of my treatment.

FRLA expands the alveolar ridge but dose not change the skeletal bone of the mandible. This kind of expansion is prone to tipping and relapse often and I am not sure what is the long term viability of this treatment.  

By the way how is your treatment progressing? It sounds like you have finished the FAGGA phase. It would be really nice if you share with us an update in the main FAGGA thread.

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

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Posted : 14/12/2018 11:36 am
letsgochamp
(@letsgochamp)
10+ Forum Posts

@FutureModel

I think you are right about maximising protraction, one would have to do the MSE expansions in steps. If one achieves full expansion in the first go,  you only have a short window through where you can protract the maxilla, while the sutures are still loose. Although, that 'short window' still gives you a substantial protraction of 8-10mm, and as others have mentioned, is quite sufficient for anybody. But for aims like yours of 20mm, it would probably has to be achieved over two sittings. 

Because as I understand, for achieving forward protraction the sutures have to be loosened, which is done with a MSE and then capitalize on that moment to pull the maxilla forward. So far so good, as this has been explained many times ad infinitum.

But here comes the question. So basically, once the sutures are expanded, and the plates pulled from each other - are the sutures then depositing bone material at the edges to close the gap? Obviously that has to be the case, or else the sutures will just adhere back to there initial position, and no real chances would have been affected.  

However, how long is it also possible to keep the sutures disengaged, once the MSE has finished expanding? Since there will be no forces acting on the palate from no further extension, won't the sutures close up due to new bone formation, and thus make the forward protraction more difficult? 

@Varbrah has already achieved 5mm protraction, and I reckon you have earlier said, that you are finished with the MSE expansion. And the MSE appliance, beside being an anchor for the FM, is there to stabilize your gains, but not expanding itself. Furthermore, you said you will be protracting till april,  thus most likely ending up in the 8-10mm range.  So obviously, maxilla protraction is possible even after expansion - but why? As outlined earlier, why don't the sutures close up and make the foward movement difficult?

The only way that would be possible, is for the bone formation still be going on even after expansion. The palate and maxilla as a structural unit, are probably still malleable even after the MSE has done its job.  However, once everything is fused, and I suppose in @Varbrah 's case, somewhere in april, protraction henceforward is not easy.

What @FutureModel has proposed, makes therefore beautiful sense. Maybe not sensible, but sense. Only expand the palate so much at a time, and take advantage of the slow bone formation at the sutures, until they almost closed, and then repeat. We are still doing rapid expansion, but just in smaller intervals. Instead of expanding the palate in one go, doing it over steps. That will give the forward protraction of the maxilla more time, and possibly achieving 20mm. Hypothetically speaking, that is. 

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Posted : 14/12/2018 6:11 pm
FutureModel
(@futuremodel)
100+ Forum Posts

@Abdulrahman I don't know if I need 20mm of forward expansion or not my friend, I just used John Mews statement as a reference number, John Mew said modern man is roughly 20mm back from ideal, I would just like to achieve that ideal is all, I don't know if I need 20mm or not, maybe I only need 15mm, or 10mm or 5mm I don't know for sure.

If I expand 6mm and I look as good as mr Barrett  in my profile pic I'll be happy, I just want to be healthy and look good. I don't know how to measure my vertical growth indicator line, acordingto John Mew this pic is what ideal is

maxilla
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Topic starter Posted : 14/12/2018 7:12 pm
FutureModel
(@futuremodel)
100+ Forum Posts

All I want is to reach those measurmentsin that pic or get as close as I can to it so I will be really healthy and look incredible, after all, I am the Future Model 🙂 hahahaha

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Topic starter Posted : 14/12/2018 7:13 pm
Mewb liked
varbrah
(@varbrah)
200+ Forum Posts

Best of luck 

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Posted : 14/12/2018 7:58 pm
Abdulrahman
(@abdulrahman)
500+ Forum Posts
Posted by: FutureModel

@Abdulrahman I don't know if I need 20mm of forward expansion or not my friend, I just used John Mews statement as a reference number, John Mew said modern man is roughly 20mm back from ideal, I would just like to achieve that ideal is all, I don't know if I need 20mm or not, maybe I only need 15mm, or 10mm or 5mm I don't know for sure.

If I expand 6mm and I look as good as mr Barrett  in my profile pic I'll be happy, I just want to be healthy and look good. I don't know how to measure my vertical growth indicator line, acordingto John Mew this pic is what ideal is

maxilla

That's not necessarily a good looking fellow in the tracing, but yeah I am familiar with it.

Do you see on the right side a faint blue line with arrows on both ends of it touching the tip of the hose and the bottom of the upper incisors. Next to it is written 38mm, that's the vertical indicator line.

It's easy to measure but if you can't measure it and have cephalometric x ray send it to me and I will give you a rough estimate of the forward expansion you need. 

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

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Posted : 14/12/2018 8:46 pm
FutureModel
(@futuremodel)
100+ Forum Posts

What do you think @Varbrah ? What do you think about this

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Topic starter Posted : 14/12/2018 8:46 pm
varbrah
(@varbrah)
200+ Forum Posts
Posted by: FutureModel

What do you think @Varbrah ? What do you think about this

Technically possible but not feasible. A few potential problems:

1) Rigidity, or loss of rigidity of the body of the MSE as you expand, which would make reopening the suture extremely problematic in your model. You would probably have to get a new MSE reinstalled after each run.

2) Time constraints. It takes 6 months to stabilize the suture following expansion. Repeating this more than once means 12 months minimum of having an expander (probably more), and walking around with a giant gap tooth for over a year — I did it for two months and trust me it is not fun, you will hate smiling/laughing/etc in public. After that you are looking at 12-24 months of braces. Total treatment time probably about three years (again, probably more).

3) Protracting 20mm (in any case unlikely) I highly doubt the mandible will be able to autorotate as there will be relatively small counter-clockwise component to its displacement, and you will absolutely need jaw surgery.

4) Getting a doctor to agree to all of the above.

5) It’s possible that multiple, smaller disruptions of the sutures (as you suggest) are actually inferior to a one time extremely large disruption for protraction purposes. I think this is probably the case.

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Posted : 14/12/2018 9:17 pm
Abdulrahman
(@abdulrahman)
500+ Forum Posts

Here is the cephalomatric analysis. Keep in mind that it might not be accurate. Since it's based on a mobile camera snapshot it could be distorted, but I tired my best to draw the analysis as accurate as I can.

The most important angle is the SNA, which is 75°. If that number is correct you are significantly recessed in the maxilla. The standard most orthodontist use called Steiner, calls for 82°, you are 7° behind that.

Now if you want to go with the McNamara standard you should be at 88°. That's the same standard Steve Galella uses for his FAGGA treatment. Dr. John Mew put ancient man at a whopping 98°. I don't think you want that. Most models are at 88° if I am not mistaken.

What does it take to reach those angles? If we were to use the figures available from FAGGA treatment, for every 1° improvement you need 1.25mm forward/upward expansion. So to get to:

82° you need 8.75mm.

88° you need 16.25mm.

98° you need 28.75mm.

That last one is a crazy figure. The maximum figure I heard of was 20mm done by Dr. Anne Mare-Cole in FAGGA treatment. 

Please don't take those figures as absolute. I could be off on the SNA, but you can be sure by contacting your x-ray provider and asking them to send you a copy of your x-ray with a version highlighting the SNA.

 

IMG 0532

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

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Posted : 14/12/2018 11:48 pm
MikeMewacca, letsgochamp, FutureModel and 1 people liked
letsgochamp
(@letsgochamp)
10+ Forum Posts

@Varbrah thanks for your feedback. I think you are absolutely right on all your points. Not feasible. I was trying to advance my own understanding by putting it into words and the theory of what we all are trying to do. 

 

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Posted : 15/12/2018 12:02 am
FutureModel
(@futuremodel)
100+ Forum Posts

@Abdulrahman, thanks for that. Jesus lol that's pretty bad, I'm going to have to try real hard to get to 88 degrees, looks like I'm going to have to pull quite a bit, so those numbers are how far forward I have to pull?

Well, I'm going to try as hard as I can to see if my ortho will let me pull like 20mm forward LOL fml, I wish orthos were like mike mew and let you pull to the optimal position

I'm going to have to keep pulling even if she tells me to stop, 75 degrees is bad

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Topic starter Posted : 15/12/2018 12:16 am
Abdulrahman
(@abdulrahman)
500+ Forum Posts
Posted by: FutureModel

@Abdulrahman, thanks for that. Jesus lol that's pretty bad, I'm going to have to try real hard to get to 88 degrees, looks like I'm going to have to pull quite a bit, so those numbers are how far forward I have to pull?

Well, I'm going to try as hard as I can to see if my ortho will let me pull like 20mm forward LOL fml, I wish orthos were like mike mew and let you pull to the optimal position

I'm going to have to keep pulling even if she tells me to stop, 75 degrees is bad

Leave it to the doctor to determine how much to expand. They know the limits of their treatments. If you want to get the best out of them ask them to provide you with an analysis of how much you need to expand forward. If they tell you you are at 75° and you need to get to 82° then you are at a disagreement in principle. If they tell you you need 88° but can only get you to 82° then that's something you have to accept. The one group that does not mind to expand you forward multiple times are FAGGA practitioners, but it does not give full rotation of the maxilla like MSE seem to from what I can tell. 

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

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Posted : 15/12/2018 5:40 am
FutureModel
(@futuremodel)
100+ Forum Posts

@Abdulrahman well based on what I've read, there is no hard limit to expanding with the mse and according to @varbrah he said a while back that "improvements can be made indefinitely" so it is possible to get 88 or 98 but it will just take longer to get there. My only possible problem is getting my ortho to go through with this or finding an ortho who will, but even then I will just keep pulling myself as long as I can as soon as I get it put in my mouth.

I don't like Steiners 82 degree bull$h!t because peoples faces still look as flat as a wall afterwards, the road might not be easy but it is a road I'm willing to travel to get a great, nice lookin, healthy face

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Topic starter Posted : 15/12/2018 7:33 am
Jaysan
(@jaysan)
10+ Forum Posts

@varbrah @futuremodel

Would you guys recommend pulling with a standard RME? No MSE in my area unfortunately 😉

Should theoretically get the same results if the maxillae suture is disarticulated?

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Posted : 15/12/2018 1:35 pm
James
(@james)
50+ Forum Posts

As a point of comparison, my SNA is 78.5°, and my dentist's plan (based on LVI methodology) is to expand 5-7mm.

Ronald Ead used another philosophy to decide when his expansion was finished: using his mandible as a guide based on how far it wanted to come forwards.

@abdulrahman Right now I am just coming to my 3rd adjustment. Will report later in treatment.

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Posted : 17/12/2018 6:49 am
paradise
(@paradise)
50+ Forum Posts
Posted by: James

As a point of comparison, my SNA is 78.5°, and my dentist's plan (based on LVI methodology) is to expand 5-7mm.

Ronald Ead used another philosophy to decide when his expansion was finished: using his mandible as a guide based on how far it wanted to come forwards.

@abdulrahman Right now I am just coming to my 3rd adjustment. Will report later in treatment.

Did your LVI provider give you the SNA measurements or did you request to see the CBCT yourself?

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Posted : 18/12/2018 8:29 am
FutureModel
(@futuremodel)
100+ Forum Posts

@James you might as well expand to 88 degrees, it's only 3-5mm more

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Topic starter Posted : 19/12/2018 3:13 am
James
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50+ Forum Posts
Posted by: paradise

Did your LVI provider give you the SNA measurements or did you request to see the CBCT yourself?

I have images from the CBCT scan which include the cephalometric numbers.

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Posted : 19/12/2018 3:45 am
megamandude
(@megamandude)
100+ Forum Posts

Hey @FutureModel can you check ur PMS

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Posted : 20/12/2018 12:17 am
Anomaly
(@anomaly)
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Posted by: Abdulrahman

Save your money, Dr. Mew is going to start the interview by saying "YOU ARE AWARE EVERYTHING I AM GOING TO SAY TO YOU IS ALREADY IN THE CHANNEL". As if he is preparing you in advance to take in the disappointment. And beside all he is going to offer you at best is the Hybrid appliance therapy with absolutely no supporting facts that he used it successfully to fix sleep apnea for adults.

The doctor I referred to in your other MSE thread wanted me to do bimaxillary surgery, but I refused. It's a surgery in a very sensitive area so it carries risks. The recovery process is ****. It introduces significant bone scaring, so the bone is deformed. It still can remodel but in a disrupted way. 

Unlike Lefort 2, it only covers a small section of the maxilla, so the esthetic improvements are minimal. Plus most doctors performing this surgery will not give much attention to esthetics they will just look to achieving expansion. 

Since your main concern is esthetics, why bother with this when you can just have FAGGA plus MSE then followed by lower jaw surgery to expand it forward and sideways?    

SUGR1 has said that the lower jaw can continuously grow  forward at any point in your life because the condyles are a centerpoint for forward growth, he also referenced how many orthos report their class 2 patients being more class 3 after undergoing splint therapy for a long enough time. So you can train your lower jaw to keep moving forward with something as simple as a split. With this being said, why would he need surgery when he can either move his lower jaw forward thru FAGGA or something else. Also, why would he need to widen his lower jaw surgery if you can upright the lower set of teeth to match the upper bite and/or utilize a trombone appliance to accomplish sognifixanr jaw expansion? Widening your lower jaw extremely dangerous. 

 
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Posted : 21/05/2019 1:36 am
Neigh and EddieMoney liked
Anomaly
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Posted by: Abdulrahman
Posted by: James

In the AGGA paradigm, the mandible is expanded with a FRLA appliance, so mandibular expansion definitely doesn't require surgery. I am wearing one right now. I've heard it claimed that the FRLA can give 5-7mm transverse expansion; not sure if it can expand forward, but decompressing the TMJ gives you forward movement of the mandible (via making more room through maxillary expansion). AGGA treatment also involves bite pads which helps free the mandible to swing forward. I got several mm forward motion in my mandible immediately once these were installed in the beginning of my treatment.

FRLA expands the alveolar ridge but dose not change the skeletal bone of the mandible. This kind of expansion is prone to tipping and relapse often and I am not sure what is the long term viability of this treatment.  

By the way how is your treatment progressing? It sounds like you have finished the FAGGA phase. It would be really nice if you share with us an update in the main FAGGA thread.

What is the difference between FRLA and the Trombone device in your opinion?

 
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Posted : 21/05/2019 4:29 am
Mr_Man
(@mr_man)
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Regarding bimax or even lefort-1-only, I'm kind of between a rock and hard place in my situation.

I live in Western MD, and I began going to a couple of nearby orthodontists to assess my situation.  They both said that I need either bimax or at least a lefort 1 advancement, and widening of the palate (even though I already once went through the maxillary advancement and 3-piece lefort 1 when I was 19).  They referred me to maxillofacial specialists in suburban MD.

I wanted to explore further, and found that WVU is known for their expertise in orthodontics and maxillofacial treatments (including MSE).  I went there but they said the same thing: I need at least lefort 1 with 8mm advancement (see their analysis below), and likely a 2-piece segment to resolve the transverse issue:

pr1 resize 29

They even suggested I also move the mandible about 4-5 mm forward (making this a true "bimax"), to help with airway issues:

pr2 resize 22

I'd be fine doing either one.  They both would bring my ANS point to the same forward position as the tip of my nasal bone, which I like.  It would require removing old plates and screws first, and also orthodontics first to upright the 32° retroclined lower incisors.  However, they said I'd have to see a periodontist first to make sure the lower bone is thick enough for the orthodontics.  I just went to the periodontist, and they said the bone is indeed too thin.  

That brings me back to square one,  essentially.  They won't do the operation if they can't do the orthodonics first, and they won't do the orthodonics now that the periodontal issue is known.

What I really want to try now is MSE first (as I need the transverse issue corrected anyway) along with protraction.  If I could move my upper jaw 3, 2, or even 1 mm forward, I'd still be happier than leaving everything as is.  I couldn't convince WVU to do this at the beginning, and though I'm going to try again, I'm doubtful that they'll let me move forward with this MSE option.

I'd like to try other MSE providers that are willing to help me move forward; the only ones I know of outside of WVU that are less than 3 hours away are in southeast PA (unless anyone knows of any in suburban MD or northern VA or somewhere else not too far away).

Looking at my 3D moulds, you can probably see that I would benefit from both MSE and protraction.  At minimum, it should solve my transverse maxillary deficiency, which would make me much happier with my maxillofacial situation as it stands:

pr4 resize 75
pr3 resize 24

I'd also like to do orthodontics AFTER MSE (or whatever procedure I do), if possible.  If, after MSE/protraction, I still want to pursue a lefort 1 maxillary adavncement, I would still consider that, but at least I'd be in better standing.

Anyone have any information that could point me to a provider that might be able to do what I'd like, or have any other suggestions?

-Mr. Man

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Posted : 13/03/2021 6:41 am

THE GREAT WORK