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Won Moons MSE (Maxillary Skeletal Expander) Appliance is the best appliance for what we are trying to achieve  

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FutureModel
(@futuremodel)
Trusted Member

I have not seen any other appliance that will give as good results as this in this short amount of time. This MSE literally is the best option for people 18+ years old.

The mse expands your entire midface and nudges it forward, if you combine it with a facemask you can pull your maxilla up and forwards, like an upswing as Mike Mew was talking about

This link goes into more detail https://www.semortho.com/article/S1073-8746(18)30009-4/pdf

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Posted : 08/12/2018 10:07 am Apollo liked
Apollo
(@apollo)
Reputable Member

Thanks for sharing this article! The before and after pictures are pretty impressive. Unfortunately, I don't think this appliance is an option for me because of the obstruction of my torus palatinus, the cost, and the lack of providers in my area.

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Posted : 09/12/2018 5:51 pm
Apollo
(@apollo)
Reputable Member

This quote from the article is interesting:

The more mature the patient, the faster expansion is required in order to build adequate inter-sutural tension for initial disarticulation. A diastema will typically appear after a successful split, and the activation rate can be slower onwards since the resistance has been reduced significantly.

Varbrah has reported the same thing with his MSE treatment. I questioned a few days ago in a thread about the rate of palate expansion (  https://the-great-work.org/community/main-forum/whats-better-rapid-maxilla-expansion-or-slow-expansion-in-adults/# ) if a similar tapered approach could be used with a removable expander: 

Posted by: Apollo

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?

This post was modified 2 months ago by Apollo
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Posted : 09/12/2018 6:07 pm
Apollo
(@apollo)
Reputable Member

I'm also curious to read this citation, which suggests that alternating between expansion and constriction could help disarticulate perimaxillary sutures:

Wang YC, Chang PM, Liou EJ. Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod. 2009;79(2):230–234.

http://www.angle.org/doi/pdf/10.2319/031208-141.1

The study, alternating between expanding and constricting the midpalatal sutures of cats as an animal model, found that sagitally-running circummaxillary sutures disarticulated significantly more than coronally-running circummaxillary sutures that required more than 5 weeks to increase opening. This makes sense that opening the midpalatal suture sideways would induce separation of other sutures around the maxilla sideways, but would be less effective at separating circummaxillary sutures in a forward direction.

This post was modified 2 months ago 2 times by Apollo
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Posted : 09/12/2018 6:57 pm
Varbrah
(@varbrah)
Estimable Member
Posted by: Apollo

I'm also curious to read this citation, which suggests that alternating between expansion and constriction could help disarticulate perimaxillary sutures:

Wang YC, Chang PM, Liou EJ. Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod. 2009;79(2):230–234.

http://www.angle.org/doi/pdf/10.2319/031208-141.1

The study, alternating between expanding and constricting the midpalatal sutures of cats as an animal model, found that sagitally-running circummaxillary sutures disarticulated significantly more than coronally-running circummaxillary sutures that required more than 5 weeks to increase opening. This makes sense that opening the midpalatal suture sideways would induce separation of other sutures around the maxilla sideways, but would be less effective at separating circummaxillary sutures in a forward direction.

Applies to less sophisticated forms of MARPE. MSE does this just fine without.

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Posted : 09/12/2018 11:52 pm
Abdulrahman
(@abdulrahman)
Reputable Member
Posted by: Apollo

Thanks for sharing this article! The before and after pictures are pretty impressive. Unfortunately, I don't think this appliance is an option for me because of the obstruction of my torus palatinus, the cost, and the lack of providers in my area.

Why would you be interested in this? Didn't you use an expander successfully?

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

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Posted : 10/12/2018 1:41 am
Apollo
(@apollo)
Reputable Member
Posted by: Abdulrahman

Why would you be interested in this? Didn't you use an expander successfully?

Starting at about 34mm, my intermolar width is still below 40mm, and I haven't achieved any discernible forward progress. My desire for at least a little more transverse expansion and any sagittal expansion is what has me intrigued by options like AGGA and MSE+FM.

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Posted : 10/12/2018 2:45 pm
Pame
 Pame
(@pame)
Eminent Member

What is he going to do about he gap between the incisors? Why does this occur, and could it happen with just regular mewing? Also, John Mew posted a video explaining why they prefer semi rapid expansion over rapid expansion  https://www.youtube.com/watch?v=YtzHjF6qP8Y

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Posted : 10/12/2018 4:35 pm
Apollo
(@apollo)
Reputable Member
Posted by: Pame

What is he going to do about he gap between the incisors? Why does this occur, and could it happen with just regular mewing? Also, John Mew posted a video explaining why they prefer semi rapid expansion over rapid expansion  https://www.youtube.com/watch?v=YtzHjF6qP8Y

The midline diastema opens because of the separation of the midpalatal suture. With regular mewing, some people have reported smaller gaps forming between their central incisors. It's more likely that the contacts between your teeth (not just the central incisors) will become less tight but you won't get an obvious diastema because any expansion will mostly occur through remodeling rather than suture separation and at a rate slow enough for mesial drift of the teeth to maintain interproximal contact. Mike Mew also warns against rapid expansion in this video (  https://youtu.be/QCNqbvOALZI ). 

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Posted : 10/12/2018 4:48 pm
Abdulrahman
(@abdulrahman)
Reputable Member
Posted by: Apollo

Starting at about 34mm, my intermolar width is still below 40mm, and I haven't achieved any discernible forward progress. My desire for at least a little more transverse expansion and any sagittal expansion is what has me intrigued by options like AGGA and MSE+FM.

I see, are you wearing a retainer, or are you able to maintain all the gains you made so far on your own?

I am asking because just last night I met with the only doctor in the country that offers this treatment. While MSE was not the main topic of our discussion he was so against traditional acrylic expanders and implied that if he were to use it on a case like mine or yours he would would wait for recession to take place and for the bite to stabilize before attempting such treatment. 

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

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Posted : 10/12/2018 8:09 pm Apollo liked
Apollo
(@apollo)
Reputable Member
Posted by: Abdulrahman

I see, are you wearing a retainer, or are you able to maintain all the gains you made so far on your own?

I am asking because just last night I met with the only doctor in the country that offers this treatment. While MSE was not the main topic of our discussion he was so against traditional acrylic expanders and implied that if he were to use it on a case like mine or yours he would would wait for recession to take place and for the bite to stabilize before attempting such treatment. 

I have been using a large myobrace A2 and A3 for the past 4 months to help stabilize my expansion. If I've had any relapse it has been minor, and could just be uprighting of any dental tipping that occurred during the expansion. The width of the large adult myobrace at the level of my first molars is approximately 40mm so it isn't really exerting significant expansive or contractive force on my upper arch. I'm planning to continue using the myobrace for at least 2 more months for a total of 6 months.

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Posted : 10/12/2018 9:22 pm
Fred
 Fred
(@fred)
Estimable Member

What happens to the tooth gap? Is it just gonna be there?

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Posted : 10/12/2018 9:40 pm
Apollo
(@apollo)
Reputable Member
Posted by: Fred

What happens to the tooth gap? Is it just gonna be there?

No, they use braces or other orthodontic methods to bring the teeth together. I believe they do this after several months of stabilization to minimize skeletal relapse.

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Posted : 10/12/2018 9:53 pm
Apollo
(@apollo)
Reputable Member
Posted by: Apollo
Posted by: Abdulrahman

I see, are you wearing a retainer, or are you able to maintain all the gains you made so far on your own?

I am asking because just last night I met with the only doctor in the country that offers this treatment. While MSE was not the main topic of our discussion he was so against traditional acrylic expanders and implied that if he were to use it on a case like mine or yours he would would wait for recession to take place and for the bite to stabilize before attempting such treatment. 

I have been using a large myobrace A2 and A3 for the past 4 months to help stabilize my expansion. If I've had any relapse it has been minor, and could just be uprighting of any dental tipping that occurred during the expansion. The width of the large adult myobrace at the level of my first molars is approximately 40mm so it isn't really exerting significant expansive or contractive force on my upper arch. I'm planning to continue using the myobrace for at least 2 more months for a total of 6 months.

@abdulrahman what do you think of my stabilization strategy? Do you think 6 months using the myobrace will be long enough to prevent relapse if my tongue posture is good?

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Posted : 11/12/2018 3:34 pm
Abdulrahman
(@abdulrahman)
Reputable Member
Posted by: Apollo

@abdulrahman what do you think of my stabilization strategy? Do you think 6 months using the myobrace will be long enough to prevent relapse if my tongue posture is good?

That depends on how your teeth occlude but in general yes, 6 month is a sufficient period of time. Now weather your tongue will maintain your expansion afterwards all depends on how well it's adapting to it's new role. Are you able to swallow correctly? Have you seen a reduction in size of your facial muscles around your mouth?  

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

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Posted : 11/12/2018 10:54 pm
Apollo
(@apollo)
Reputable Member
Posted by: Abdulrahman

That depends on how your teeth occlude but in general yes, 6 month is a sufficient period of time. Now weather your tongue will maintain your expansion afterwards all depends on how well it's adapting to it's new role. Are you able to swallow correctly? Have you seen a reduction in size of your facial muscles around your mouth?  

My expansion made it much easier to practice good tongue posture, and I believe that I am now reliably maintaining it even during sleep. I believe that my swallowing technique is good, but I haven't noticed obvious buccinator atrophy. I think my structure is just too retruded for defined cheek hollows, and my body fat percentage isn't ideal. If I finish using the myobrace in February, I'll have to decide if I am going to move on to another appliance that might help me get some forward changes, or monitor my progress/regress with oral posture alone.

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Posted : 11/12/2018 11:09 pm
neverrelaxed
(@neverrelaxed)
New Member

Could this bring the LORs forward @futuremodel 

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Posted : 27/12/2018 2:51 pm
darkindigo
(@darkindigo)
Estimable Member

Myobrace lengthens the face.  See my other posts on it... there's a link to their own publication.  

This looks good but to be aware that eyes may drop.  You may be able to help this by manually pushing just behind last maxillary molars somewhat.  🙂  When people here decide that intermolar width should be some figure above 38/39 mm then something must give, unless that suits their mouth.  It's all individualistic.  See my post here on this originally explained concept:   https://the-great-work.org/community/main-forum/growing-an-awesome-face/#post-13146  

This post was modified 2 months ago by darkindigo
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Posted : 27/12/2018 10:32 pm
darkindigo
(@darkindigo)
Estimable Member
Posted by: FutureModel

I have not seen any other appliance that will give as good results as this in this short amount of time. This MSE literally is the best option for people 18+ years old.

The mse expands your entire midface and nudges it forward, if you combine it with a facemask you can pull your maxilla up and forwards, like an upswing as Mike Mew was talking about

This link goes into more detail https://www.semortho.com/article/S1073-8746(18)30009-4/pdf

I have heard of some aggressive orthos attempt traditional (non-surgical) fixed palatal expansion for up to 20/22.  One I know turns a couple... unwind if no separation then try again.. back and forth a few times.  It is Dr. Barrowes in Utah.  Not sure how friendly for potential root absorption with that pressure.  On second thought, probably does okay with it because it's hand crafted and poured in front part of maxilla cavity with arms and multiple strong wraps around back teeth if needed.  This is not your kid's hyrax.  Very natural looks the way he does it.  Palatal expander extraordinairre!  He's board certified, has a good sense of humor and takes on challenging cases.  Message me if you're thinking about going to him.

This post was modified 2 months ago 3 times by darkindigo
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Posted : 27/12/2018 10:57 pm
darkindigo
(@darkindigo)
Estimable Member
Posted by: FutureModel

I have not seen any other appliance that will give as good results as this in this short amount of time. This MSE literally is the best option for people 18+ years old.

The mse expands your entire midface and nudges it forward, if you combine it with a facemask you can pull your maxilla up and forwards, like an upswing as Mike Mew was talking about

This link goes into more detail https://www.semortho.com/article/S1073-8746(18)30009-4/pdf

So when are you going to do it?

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Posted : 27/12/2018 11:03 pm
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As you undergo correction in the near future, please consider keeping records for your own sake and for others. Pictures of dental impressions, scans, medical reports reports can be very helpful even with all personally identifying information blocked out.

Your input could help many, many people

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