Notifications
Clear all

NOTICE:

DO NOT ATTEMPT TREATMENT WITHOUT LICENCED MEDICAL CONSULTATION AND SUPERVISION

This is a public discussion forum. The owners, staff, and users of this website are not engaged in rendering professional services to the individual reader. Do not use the content of this website as an alternative to personal examination and advice from licenced healthcare providers. Do not begin, delay, or discontinue treatments and/or exercises without licenced medical supervision.

What's better, rapid maxilla expansion or slow expansion in adults?  

  RSS
FutureModel
Trusted Member

What's peoples thoughts on the DNA/Vivos appliance compared to bone anchored maxilla expansion/MARPE?

Which would be the most beneficial?

I wish I could work with an ortho who would help me achieve an SNA angle of 98 degrees tbh tbh tbqh

Quote
Posted : 01/12/2018 8:27 pm
Fred
 Fred
Estimable Member

Slow, rapid maxillary expansion can be harmful Mike Mew said. This is pretty evident when you see people who try to hardmew their molars tip out. Diz hap 2 mi sat

ReplyQuote
Posted : 01/12/2018 9:18 pm
Abdulrahman
Reputable Member

I don't remember where I was reading this but the sutures in the skull have fibers that keep them together and more importantly give them the chance to keep changing throughout life. When external devices are used to forcefully pry open the sutures this fiber is violently torn apart. Even worse, since the bones are rapidly expanded apart, the fibers never get the chance to rejoin and heal properly. 

Long story short: slow.

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

ReplyQuote
Posted : 01/12/2018 10:08 pm
Fred
 Fred
Estimable Member
Posted by: Abdulrahman

since the bones are rapidly expanded apart, the fibers never get the chance to rejoin and heal properly. 

I was never sure in that answer, I thought that would've been incorrect. I have suspected something like this would happen, because there is a remodeling process in maxillary expansion and the process of must be done at it's own pace. Thanks Abdul'

ReplyQuote
Posted : 01/12/2018 10:18 pm
Apollo
Reputable Member

Dr. Mike Mew recommends what he calls "semi-rapid" expansion for adults at a rate of around 1mm per week. That's a little faster than one 1/4mm turn every two days (  https://youtu.be/QCNqbvOALZI ). He says that slow expansion is more likely to cause dental tipping rather than skeletal changes and rapid expansion is too traumatic. In contrast Dr. Derek Mahony recommends "slow" expansion for adults at a rate of around 1mm per month (  https://youtu.be/K4Id4QKFHkg ). That's about 1/4 the speed of Dr. Mew. He defines "semi-rapid" as 1mm every 2 weeks and says it is suitable for teens. I asked for his upcoming Q&A video how he avoids the dental tipping that Dr. Mew says occurs at slower rates. When I did my palate expansion, I advanced at a rate of one 1/4mm turn every 2 to 5 days (or 1mm every 8 to 20 days) whenever the expander felt less tight in my mouth. This is in keeping with the rate recommended by Dr. Chester Handelman (  https://the-great-work.org/community/case-discussions/my-routine/#post-1145 ). While I didn't advance quite as fast as Dr. Mew recommends, I was conscientious about daily chewing exercises and I didn't experience significant side effects like dental tipping, gum recession, etc. I think the vast majority of my expansion came from remodeling rather than suture separation. While the contacts between my front teeth became less tight, I didn't develop an obvious midline diastema, and my torus palatius didn't get discernibly wider, although the areas beside the torus seemed to flatten out closer to its level. I found this recent discussion between @varbrah (who has undergone rapid bone-anchored expansion) and @imperialmajesty to be interesting:

Posted by: Varbrah
Posted by: ImperialMajesty

@varbrah

Rapid palatal expansion is less stable than its semi rapid counterpart, due to bone only being able to fill in at about 1mm per week at maximum.  When RPE is anchored to the teeth, it crushes the periodontal membrane and risks root resorption.  Because you are using a microscrew anchored expansion appliance, you don't have much to worry about.

Oh and what force does your facemask apply on each side?

You need large forces to overcome the resistance of the maxillary buttress, so you want rapid palatal expansion with full sutural disarticulation. Semi-rapid palatal expansion results in bone bending and increased expansion in the inferior maxilla relative to the superior maxilla, vs RPE. sRPE actually ends up being LESS stable specifically because it is not disruptive enough, and is never able to fully overcome the resistance of the surrounding structures. 

The above is probably the reason why Dr Mew failed to achieve skeletal expansion of his adult patient, even when using the MSE. 

Optimal rate of distraction for any osteogenetic tissue is 1mm/day. Maybe you are referring to cortical bone and not cancellous bone. In any case, you DO NOT want bone to fill in/heal completely when expanding, that is counterproductive — you want the suture to remain disarticulated/pliable.

Agree Re: root resorption risk with tooth-anchored expansion.

I remember a user called asdfasdf123 on BTM reported some pretty remarkable changes in appearance, breathing, and well-being after expanding at an alarmingly fast rate initially before slowing down (he later deleted his posts for privacy concerns). For those using removable acrylic expanders, I wonder if a tapered schedule might be most effective, faster to initially induce some suture separation, but then slower to avoid traumatizing the fibrous connective tissue in the sutures that @abdulrahman is talking about and limit compression of the periodontal membrane. What about something like 4 days for the first millimeter (turning 1/4mm every day), then 8 days for the second millimeter (turning 1/4mm every 2 days), then 12 days for the third millimeter (turning 1/4mm every 3 days), before slowing down to about 28 days per millimeter for the rest of the expansion (turning 1/4mm every 7 days)? I think this kind of approach might achieve more suture separation and dramatic improvements in breathing and appearance than the kind of subtle remodeling changes I saw from advancing 1/4mm about every 2 days to begin with and then slowing to about every 5 days. What do you think?

ReplyQuote
Posted : 01/12/2018 11:04 pm
Fred
 Fred
Estimable Member

Can I control the speed of my expansion? If so what must I do in order to achieve semi-rapid expansion?

ReplyQuote
Posted : 01/12/2018 11:08 pm
Apollo
Reputable Member
Posted by: Fred

Can I control the speed of my expansion? If so what must I do in order to achieve semi-rapid expansion?

With tongue posture alone, any changes are likely to be at a "slow" rate. However, there should be less risk of dental tipping if your tongue is in the right position and mostly pressing outward against the alveolar ridge and any minimal contact with the teeth is balanced by a competent lip seal, the pressure of the buccal curtains, and occlusion. Whereas, the acrylic framework of removable expanders put significant force against the teeth and the alveolar ridge, but increasingly the teeth as the palate levels out and the expander slips down without adjustments to file the acrylic and maintain the fit. Obviously tongue pressure can cause your teeth to tilt, but that would suggest you have a problem with where you place your tongue or how you use it. So focus on mastering your tongue posture and swallow technique and the rate of expansion should take care of itself. This just becomes a concern when you introduce an appliance.

ReplyQuote
Posted : 01/12/2018 11:29 pm
Fred liked
FutureModel
Trusted Member

Well, I don't think any adult with a narrow palate will want to wait 3 years for minor improvements from mewing alone

 

Derek Mahony talks about bone anchored expansion here https://youtu.be/hqJ4YSkQNus?t=96

ReplyQuote
Posted : 02/12/2018 10:20 am
FutureModel
Trusted Member

It's called distraction osteogenesis maxillary expansion, it's rapid expansion too

ReplyQuote
Posted : 02/12/2018 10:22 am
Greensmoothies
Estimable Member

I remember how upset I felt about how Mew said in what I think was the last q&a video about how it supposedly doesn't matter if growth occurs at the sutures vs remodelling. I suspect that it's not a matter of fast vs slow expansion so much as getting the suture pliable. In my entire mewing journey I saw the biggest changes with 3 weeks of @allixa thumb pulling method, after 5 years of mewing... main difference being as far as I can tell was mewing opens sutures minimally if at all, thumb pulling seemingly make them quite pliable. But the method is limited by the limits of the skull, seems to require use of a retainer device and there is a report of someone messing up their bite. I'd like to experiment further but need to gather more materials first and study more.

Posted by: Fred

Slow, rapid maxillary expansion can be harmful Mike Mew said. This is pretty evident when you see people who try to hardmew their molars tip out. Diz hap 2 mi sat

What? People have tipped their molars out with hard mewing? And you say this happened to you as well? I did this for years and I just thought it was a waste of energy in the end. Thankfully my molars never tipped out. A woman in her 40s who posted here hard mewed but her technique was particularly damaging judging by her description of her method, now claims she needs braces to fix the damage. 

 

 

Remember this pain... and let it activate you.

ReplyQuote
Posted : 02/12/2018 8:43 pm
Apollo liked
Fred
 Fred
Estimable Member

Oh, it's because of my narrow palate where my tongue doesn't comfortably glide in and it's touching the teeth(keep in mind I have to maintain contact with the tip of the tongue and the incisive papilla). What do I do? 

ReplyQuote
Posted : 02/12/2018 8:57 pm