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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 20 hours 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 17 hours ago 2 times by Apollo
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Posted : 09/12/2018 6:57 pm
Varbrah
(@varbrah)
Trusted 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)
Estimable 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?

name changed from abdul to Abdulrahman

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Posted : 10/12/2018 1:41 am
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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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