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Why MSE (maxillary expansion) won't expand mandible with maxilla?  

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Le_Fort_or_Bust
Trusted Member

Read a lot how mandible "follows maxilla" in expansion, but it is jus not true.

My orthodontist (high standing) confirmed it won't expand with maxilla and his latest video Ronald Ead also confirmed the same (he is undergoing MSE+FM treatment now). But in his case it is not bad, because his maxilla is more narrow than mandible.

But why is this not the case?

30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.

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Posted : 01/08/2019 1:19 pm
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EddieMoney
Reputable Member

Why would the mandible change shape when no force is being applied to it? If Ronnie's maxilla lengthened there is no reason for his mandible to do so.

The Mandible adjusts to the pitch of the maxilla. That's it. It doesn't magically lengthen just because. It also doesn't widen for the same reason. No force applied = no reason for change. 

My goal with palate expansion is counterclockwise rotation of the maxilla. The mandible can change its position accordingly but not its size. Mandible usage (masseters, medial pterygoid) is what affects the size. 

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Posted : 01/08/2019 2:00 pm
Roflcopters
Trusted Member

Nothing new. Your mandible will follow upper transver expansion if you do it slowly, aka heavy mewing and chewing.

But when you destabilize your bite with an appliance that grows your palate 10mm, the mandible won't magically grow.

Well functioning bites grant good results when properly exercised. 

The 'the mandible will follow' is possible on certain cases and just not possible in others. 

That's why a class 3 that's left untreated will worsen. That's why a recessed mandible will worsen if you continue mouth breathing. No function=no gains. 

Sagitally speaking it usually just shifts in position, to a more forward one, as seen in AGGA patients. Decompressed airways and TMJ, mandible goes kinda like down, forward and up. There may be bone changes on the mandible but it can't naturally keep up with an unnatural mechanical change of the upper because that means your bite is off. That's why they use the bite pads on AGGA treatments to stimulate the mandible to come forward/deposit bone. Bite pads are there to maintain functioning bite while mechanically expanding the upper. 

You'd need to use a mandibular appliance, bone grafting, surgery to change the shape of your mandible transversely if you were to expand further than the mandible allows. 

There is appliances for the lower jaw but as we all know, bone modeling, aka bone shape growth takes years and might even not work for the mandible. Also there's no sutures on the mandible so most people have to go for more invasive procedures if widening of the mandible is required. Damon Braces can also gain some space on the lower to expand further on the top of the zygo allows.

But the whole trick is maintaining function. 

If they don't want surgery, alot of people is stuck with only a few mm of MSE expansion because their lower jaw usually won't follow the sutural transverse expansion.

MSE is awesome for alot of stuff but if you lack mandibular development you'd need to take care of that probably before or while MSE. 

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Posted : 01/08/2019 3:09 pm
sinned
Estimable Member

I don't think it's fair to use Ronald Ead as proof that the mandible won't expand with the maxilla. The agga appliance just expanded his front teeth while anchoring the molars, his molars stayed in the same place of course his mandible didn't follow.

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Posted : 01/08/2019 4:30 pm
sinned
Estimable Member

Before_Left.jpg

44 Weeks Left.jpg

Just take a look at this, the molars are in the exact same place, how would it ever be possible to get expansion like this? At most only the canines are being stimulated, the molars are left in the dust.

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Posted : 01/08/2019 4:36 pm
GoTTi
Trusted Member
Posted by: @eddiemoney

Why would the mandible change shape when no force is being applied to it? If Ronnie's maxilla lengthened there is no reason for his mandible to do so.

The Mandible adjusts to the pitch of the maxilla. That's it. It doesn't magically lengthen just because. It also doesn't widen for the same reason. No force applied = no reason for change. 

My goal with palate expansion is counterclockwise rotation of the maxilla. The mandible can change its position accordingly but not its size. Mandible usage (masseters, medial pterygoid) is what affects the size. 

You are partially incorrect, as you can see this gentleman expanded his maxilla and his lower jaw actually grew forwards. Also, one other example is how molar spaces eventually close out on their own without any external force whatsoever. Bones and bone spurs also can heal themselves on their own provided you give you digestive system a break and indulge in some prolonged fasting. I can go on and on. External force is not needed for any of this actually. If you give the body the proper signals, it'll do exactly what it needs to do. Stimuli is key, whether it comes from direct forces or indirect forces. The body works as one unit, all muscles are interconnected and the subconscious controls it all. that's why muscle testing is a thing.

https://www.youtube.com/watch?v=R5S5AZ50pAE&feature=youtu.be

You should also stop doubting the body and how efficient it is at healing. It's smarter than your conscious mind. Not anything against you, I am just speaking in general terms.
Also, I am curious... you mentioned ccw rotation of the maxilla from palate expansion? How, like with an appliance? Can something like a dna/homeoblock induce ccw rotation of the maxilla? I didn't know that if that is the case... 

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Posted : 02/08/2019 3:42 pm
GoTTi
Trusted Member
Posted by: @roflcopters

Nothing new. Your mandible will follow upper transver expansion if you do it slowly, aka heavy mewing and chewing.

But when you destabilize your bite with an appliance that grows your palate 10mm, the mandible won't magically grow.

Well functioning bites grant good results when properly exercised. 

The 'the mandible will follow' is possible on certain cases and just not possible in others. 

That's why a class 3 that's left untreated will worsen. That's why a recessed mandible will worsen if you continue mouth breathing. No function=no gains. 

Sagitally speaking it usually just shifts in position, to a more forward one, as seen in AGGA patients. Decompressed airways and TMJ, mandible goes kinda like down, forward and up. There may be bone changes on the mandible but it can't naturally keep up with an unnatural mechanical change of the upper because that means your bite is off. That's why they use the bite pads on AGGA treatments to stimulate the mandible to come forward/deposit bone. Bite pads are there to maintain functioning bite while mechanically expanding the upper. 

You'd need to use a mandibular appliance, bone grafting, surgery to change the shape of your mandible transversely if you were to expand further than the mandible allows. 

There is appliances for the lower jaw but as we all know, bone modeling, aka bone shape growth takes years and might even not work for the mandible. Also there's no sutures on the mandible so most people have to go for more invasive procedures if widening of the mandible is required. Damon Braces can also gain some space on the lower to expand further on the top of the zygo allows.

But the whole trick is maintaining function. 

If they don't want surgery, alot of people is stuck with only a few mm of MSE expansion because their lower jaw usually won't follow the sutural transverse expansion.

MSE is awesome for alot of stuff but if you lack mandibular development you'd need to take care of that probably before or while MSE. 

Bone grafting and uprighting teeth should suffice for most. I'm not sure why anybody would need any surgery to lengthen the mandible past that? There are also appliances like the Trombone appliance that may induce some change. Mike Mew has commented on it.

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Posted : 02/08/2019 3:51 pm
GoTTi
Trusted Member
Posted by: @sinned

Before_Left.jpg

44 Weeks Left.jpg

Just take a look at this, the molars are in the exact same place, how would it ever be possible to get expansion like this? At most only the canines are being stimulated, the molars are left in the dust.

So you are suggesting that the agga does not shift the lower jaw forward in order to decompress the tmj/lower airway?

ReplyQuote
Posted : 02/08/2019 3:53 pm
GoTTi
Trusted Member
Posted by: @le_fort_or_bust

Read a lot how mandible "follows maxilla" in expansion, but it is jus not true.

My orthodontist (high standing) confirmed it won't expand with maxilla and his latest video Ronald Ead also confirmed the same (he is undergoing MSE+FM treatment now). But in his case it is not bad, because his maxilla is more narrow than mandible.

But why is this not the case?

Like it was stated on this thread, the mandible doesn't really expand with the maxilla. However, I think what you have read is that the lower jaw autorotates upon maxilla advancement. I don't believe this has been proven to be false, but anybody can chime in and correct me if I am wrong??

It's funny how some people think one can achieve downward growth from bad function in an adult (the mandible is said to not change after 18-20 years of age at all, but can move forward or backward at any age according to stimuli, as said by @SUGR2) but no upward growth can be equally achievable from good function. Kind of reminds me of how people still believe things like cancer are incurable. If you eat plant based/fast your cancer is pretty much gone or will never show up in the first place. But of course, there's not much money in something like that. If you pay attention to contect on here you will realize that the same type of thinking is carried on... You can somehow damage the body to a certain point, but cannot influence it to go back to normal even with all of the new studies on neuroplasticity, epigenetics, eft, fasting, the placebo/nocebo effect, plant based food consumption etc. which has imo debunked this type of thinking time and time again

Side note, posture plays a big part in cfd imo. You fix your posture, you fix neck, you are then able to induce significant facial changes. Will you need more work done? Maybe. Especially if you grew up with bad function or whatnot, but I can't say the same for a person who is a case like myself that experienced significant recession in his early 20's from bad posture.  All one needs is a good enough therapy that can fix body posture/forward head posture. That one good therapy, imo, is Bowen Therapy. I have recently came across a site of a Bowen Therapy practitioner who seems to have some fairly large interest in the teeth/cranium. He has fixed an 11 year old's cross bite (?) or malocclusion through this therapy. Nothing else but Bowen was used to achieve the results with the q1 year old girl. He has also proved in his practice that proper atlas positioning leads to changes in the neurocranium (Progress has shown this, SUGR has spoken of this) and even the lower jaw, which can occur as late as in one's 70's (his case subject on the article was 73) 

http://www.bowenseminars.com.au/bowen-technique-influences-cranial-base-cranial-nerves-part-1/

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Posted : 02/08/2019 4:18 pm
sinned
Estimable Member

@gotti

Here is what I think, the lower jaw doesn't expand to meet the maxilla, ie get longer, which is what Ronald Ead basically said was the problem with AGGA, that the mandible didn't expand forward with the maxilla. I think some people might be experiencing relief in the TMJ because their bite possibly changes. It seems variable though.

Image result for agga results

You see here in Ronald Ead that the mandible doesn't expand forward, like he addresses, instead it's "moved" forward to meet the front teeth if that makes sense. What's unclear is whether Ronald is doing this on purpose or not, I remember in one of his videos he said that for an x ray he moved his mandible forward to meet with the front teeth in proper occlusion, I guess this was to see how the TMJ looked when he put himself in proper occlusion. When he did that however his condoyle was dislocated forward.

Image result for condyle and fossa

So his condyle was dislocated in front of the fossa.

What's interesting though is when we look at someone who wore the bow appliance it doesn't seem to be the case

 

Image result for forwardontics results

To me it seems like this kids mandible did grow with the maxilla. I wish the lighting was better in the first before pic, so we could see how his mandible is positioned. My only question is whether the bow appliance actually moves the maxilla forward or expands the maxilla forward, I think the latter occurs. I think upswinging the maxilla involves the soft palate not the hard palate if that makes sense. Expansion occurs in the hard palate while upswinging the maxilla requires engagement from the back of the tongue to pull the soft palate via the palatoglossus, that's what I think anyways.

 

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Posted : 02/08/2019 5:24 pm
GoTTi
Trusted Member
Posted by: @sinned

@gotti

Here is what I think, the lower jaw doesn't expand to meet the maxilla, ie get longer, which is what Ronald Ead basically said was the problem with AGGA, that the mandible didn't expand forward with the maxilla. I think some people might be experiencing relief in the TMJ because their bite possibly changes. It seems variable though.

Image result for agga results

You see here in Ronald Ead that the mandible doesn't expand forward, like he addresses, instead it's "moved" forward to meet the front teeth if that makes sense. What's unclear is whether Ronald is doing this on purpose or not, I remember in one of his videos he said that for an x ray he moved his mandible forward to meet with the front teeth in proper occlusion, I guess this was to see how the TMJ looked when he put himself in proper occlusion. When he did that however his condoyle was dislocated forward.

Image result for condyle and fossa

So his condyle was dislocated in front of the fossa.

What's interesting though is when we look at someone who wore the bow appliance it doesn't seem to be the case

 

Image result for forwardontics results

To me it seems like this kids mandible did grow with the maxilla. I wish the lighting was better in the first before pic, so we could see how his mandible is positioned. My only question is whether the bow appliance actually moves the maxilla forward or expands the maxilla forward, I think the latter occurs. I think upswinging the maxilla involves the soft palate not the hard palate if that makes sense. Expansion occurs in the hard palate while upswinging the maxilla requires engagement from the back of the tongue to pull the soft palate via the palatoglossus, that's what I think anyways.

 

Interesting observation. Well, since I am a novice and unfamiliar with a good amount of the technical information you guys share on here, I always try to do my best to understand it. I've been learning and understanding more as I go. 

With that said, to me at least, this information would put us right back to square 0. If the condyles don't respond to stimuli like SUGR has proposed (if agga can't do it, what can?) then I truly can say that nothing we do on this forum will work against, or for us aside from palate expansion via appliance/very long term mewing and general body posture correction. it seemed like class 2 was easier to fix after reading SUGR's condyle comments, but what you are saying here completely goes against that. I also would like to say that I have seen more than a handful of adult fagga cases, and I'm sure SUGR has seen even more, enough to the extent that he himself can make some sense of the agga actually inducing forward mandible growth and for me to able to confirm it (for what it's worth) He is a practitioner and has seen 100's of cases and he says that's what happens. But at this point, who really knows anything at this point? One day it's something, the next day it's something else on this forum. It's pretty annoying.

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Posted : 02/08/2019 6:36 pm
sinned
Estimable Member

@gotti

Interesting, I'd like to know how he thinks that exactly happens. I don't see how AGGA could remodel/stimulate the condyle. After watching Ronald Ead's latest videos it becomes harder for me to imagine how the AGGA could do this because it seems like the AGGA just expands the alveolar bone.

https://youtu.be/BWy91bUt5xc?t=198

 

edit: I said that the AGGA could possibly relief the TMJ because the bite changes

https://www.youtube.com/watch?v=ntVMr5mDybc

Ronald Ead says the same thing in this video. 

2nd edit: Maybe this is what SUGR means by stimulating the condyle? If your bite changes the TMJ might remodel as well.

ReplyQuote
Posted : 02/08/2019 6:51 pm
GoTTi
Trusted Member
Posted by: @sinned

@gotti

Interesting, I'd like to know how he thinks that exactly happens. I don't see how AGGA could remodel/stimulate the condyle. After watching Ronald Ead's latest videos it becomes harder for me to imagine how the AGGA could do this because it seems like the AGGA just expands the alveolar bone.

https://youtu.be/BWy91bUt5xc?t=198

 

edit: I said that the AGGA could possibly relief the TMJ because the bite changes

https://www.youtube.com/watch?v=ntVMr5mDybc

Ronald Ead says the same thing in this video. 

2nd edit: Maybe this is what SUGR means by stimulating the condyle? If your bite changes the TMJ might remodel as well.

This is an extract from the thread he posted this on, and he's actually right because I've read a study concluding  that splints which are worn for a period of years results in correction of class 2 in many cases.

"Good job, 

This clearly shows that good orthodontists is simply that.... good!

even more pertinent in this case because our friend here had bad orthodontic treatment previously. 

Just giving my thoughts on the case. 

- Apart from IMW the canine and premolars has also improved. We focus a lot on IMW but these are also just as important in a lot of people. You will find adults with poor swallowing patterns who may have 42mm IMW but very narrow tappered arch’s because their anterior 2/3 of tongue never met the palate. 

- still some asymmetry on arch but it will improve with time and other postural changes. More importantly as you progress through the wires and go to finishing wires you will level and balance out occlusion which will also improve the symmetry. 

- limiting rate of ‘expansion’ in post puberscent. Firstly hate the word expansion.... typically relates to the concept of growth at suture or breaking open a suture.  We are actually trying to achieve Distraction Osteogenesis where by we get bone remodelling changes.  This is very important because let’s compare some concepts. 

Rapid maxillary expansion is a concept to break open suture of the maxilla. This is painful and always results in relapse due to scar formation. Also this fails to remodel the palate downwards so you will still have a high vault. 

Slow expansion (rate 1mm/month) will cause the remodeling effect without affecting the suture. The biggest benefits are minimal to no relaps, and the palate Will remodel to flatten. This is significant to tongue suction ability... and nasal breathing and latency. This is why you will hear a lot of experienced practitioners say they hate the removable acrylic expanders.... because it sits on the palate and even with slow expansion it does not allow the palate to drop down. 

Your teeth WILL tip if you excess your adult distraction osteogenesis rate of approx 1mm/month.  That is why different people will have so called diff results due to rate of turning. slower turning is never wrong but takes more time. 

- Mandibular traction forward. In adults of all ages the body of mandible can not Change side or widen. What you can do is develop the alveolar process by uprighting the molars. This will usually result in significant width changes. However up until your death bed the Condyle of the mandible is a growth centre. That is why in adults it is still possible to use a functional appliance to bring the mandible forward (gradually) to follow the maxilla development. Where people get mixed results is due to the fact this must be accompanied by correct breathing and tongue posture. Many practitioners do not care about this and hence say functionals in adults do not work. You much be a nasal breather to ensure lip seal and correct tongue posture as a minimum. In a lot of adults just this alone will allow mandible to tract forward without any functional appliances. The key though is must be gradual... 

if you have a 10mm over jet and didn’t work on mandible at beginning of treatment and at the end thought damn, the Mandible needs to come forward let’s do it... then you will be doomed for failure... the mandible being pushed forward 10mm at once will cause pain and tmd and will not stay there. In children completely different... they are more mobile so doing this will  cause Mandibular remodeling and adaptation very quickly without causing tmd. 

If you read up about Mandibular Advacement Splints eg Somnomed for the treatment of sleep apnoea, you will see very good research by dentists, sleep physicians etc that show ALWAYS with long term use the bite of the patient changes and they become more class 3. Why? Because every night they are promoting Mandibular condyle changes which become permanent making the lower jaw forward posture a permanent change."

https://the-great-work.org/community/main-forum/i-just-made-it-to-39mm-inter-molar-width-and-its-awsome/

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Posted : 02/08/2019 7:20 pm
James
Eminent Member

I am in treatment with AGGA so I can address the question of what happened to the mandible. With 8mm gaps, 8 months, and 1 month rest, my chin came forward 5mm. My TMJ decompressed. I ran my scans by SUGR who says that my condyle position looks fine. Ronald Ead's looks similar to mine, but the difference is that he was getting discomfort, which showed that he had gone too far. My TMJs feel great, and I can hold my mandible forward in the new position without effort. Neither my TMJ nor Ronny's was dislocated, because the condyle is behind the eminence.

SUGR told me that ideal TMJ position has more space at the back than at the front. Here is Michael Gelb's 4/7 condyle position which is ideal:

My mandible did not change skeletally in any dimension. I got +3 IMW on both the bottom and top, even though only the bottom had a FRLA appliance. All of the IMW change is dentoalveolar. AGGA gave me no skeletal changes to the mandible or maxilla during the 9 months I was in it, only dentoalveolar changes.

Patients with compressed TMJs are the best candidates, because then the mandible can easily move forward alone with the maxillary incisors. For patients without TMJ compression, going over 5mm gaps with AGGA might risk the mandible not being able to keep up.

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Posted : 03/08/2019 12:40 pm
sinned
Estimable Member

@james

As I suspected, so basically the purpose of AGGA is to give space for the mandible/condyle to move forward in the TMJ by expanding the maxillary alveolar bone forward. For people with TMJ issues this could give them relief. Could also possibly open up the airway a little if the mandible is that far back? This might also improve someone's head posture. Also Ronald Ead says mewing is easier due to the increased real estate.

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Posted : 03/08/2019 5:41 pm
James
Eminent Member
Posted by: @sinned

@james

As I suspected, so basically the purpose of AGGA is to give space for the mandible/condyle to move forward in the TMJ by expanding the maxillary alveolar bone forward. For people with TMJ issues this could give them relief. Could also possibly open up the airway a little if the mandible is that far back? This might also improve someone's head posture. Also Ronald Ead says mewing is easier due to the increased real estate.

Yes, this is a correct understanding. Note that dentists who use AGGA primarily position themselves as treating TMD. The tips of my upper incisors moved forward 5mm which felt like a gigantic improvement in tongue space. Moving my chin forward 5mm did improve my pharyngeal airway at the level of the tongue. (But unfortunately this didn't improve my sleep, probably because I have other obstructions in the nose. I'm sure it would help someone with a tongue obstruction, though.)

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Posted : 03/08/2019 6:31 pm
almighty
New Member

@james

What did you do throughout treatment to keep your mandible forward with your maxilla? Also how did you measure youre IMW in the appliance?

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Posted : 05/08/2019 8:55 pm
James
Eminent Member
Posted by: @almighty

@james

What did you do throughout treatment to keep your mandible forward with your maxilla? Also how did you measure youre IMW in the appliance?

I held my mandible forward, and sometime I would slide it on a plastic wafer. The molar pads disocclude the teeth allowing the mandible to come forward. This was easy for me because my TMJ was compressed.

I measured my before/after IMW on my CBCTs scans, and all the other measurements I mentioned. I have the CBCT files and I signed up for a free Invivo account which gives me access to an online viewer and a downloadable viewer with more features. If your provider using Invivo products, you can request the .inv file with your scan and then use the viewer I just linked (I recommend that downloaded version, not the web viewer, because it has more features).

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Posted : 05/08/2019 11:24 pm
Thefire
Active Member

@gotti

You wrote:

"This is why you will hear a lot of experienced practitioners say they hate the removable acrylic expanders.... because it sits on the palate and even with slow expansion it does not allow the palate to drop down. "

How do you explain that the acrylic expanders drop down after when expanding for a while? The palate drops down and the expander also drops down, thats why people shave down the expander to make it fit. Or have I missed something?

Also, Mike Mew always expands in a semi fast speed. Do you think he is doing it wrong? I think he stated that slow expansion only will tipp the teeth. 

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Posted : 07/12/2019 6:49 am
Eleigh
New Member

@gotti thank you for your reply. It was optimistic.

please can someone please give me their opinion, as every single orthodontist has given me a different opinion. I am in my 30’s, female, and had 8 teeth pulled as a child. I’m currently in SOMA for one year with ZERO improvement. Originally wanted the ALF because it’s gentle. Someone mentioned MSE but it seems too rushed and I have read that the slower the expansion, the better your chance of mandible coming forward. Please someone help me with their opinion!! Thank you 

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Posted : 25/10/2020 7:05 pm
Limebike
Eminent Member

@eleigh The only reason your mandible would come forward naturally is because it is currently being held back, e.g., due to premature contact with teeth that act as door stops / wheel blocks. If this is not the case for you, your mandible would never come forward on its own, regardless of what you do with the upper teeth.

What one could do is to permanently jut out the mandible in hopes that condylar remodeling takes place over the long haul.

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Posted : 25/10/2020 7:46 pm
Eleigh
New Member

@limebike thank you for your reply. How can I permanently jut out the mandible?

thank you,

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Posted : 26/10/2020 5:59 pm
Eleigh
New Member

@gotti please can you help me? I am wearing acrylic SOMA for one year. Only 1mm expansion and its painful. My mandible is very pulled back. I had 8 teeth pulled as child and braces twice. Every ortho gives me different opinion. I Originally wanted the ALF. Now thinking MSE but concerned this rapid expansion won’t do anything for mandible. Please can you help me?

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Posted : 26/10/2020 6:06 pm
Sergio-OMS
Trusted Member
Posted by: @eleigh

@gotti please can you help me? I am wearing acrylic SOMA for one year. Only 1mm expansion and its painful. My mandible is very pulled back. I had 8 teeth pulled as child and braces twice. Every ortho gives me different opinion. I Originally wanted the ALF. Now thinking MSE but concerned this rapid expansion won’t do anything for mandible. Please can you help me?

Posted by: @eleigh

@limebike thank you for your reply. How can I permanently jut out the mandible?

thank you,

 

Haven't you considered surgery?

 

ReplyQuote
Posted : 27/10/2020 4:18 am
Eleigh
New Member

@sergio-oms I’m not eligible, for a certain health reason 

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Posted : 27/10/2020 1:57 pm