The Fixed Anterior Growth Guidance device is the LVI / FBI branding for a
device which remodels the alveolar ridge in the premaxilla area. Using a
spring system anchored to the molars, these devices push a nance button
into the premaxilla which causes alveolar remodeling and dental
movement. Many dentists combine FAGGA with molar pad treatment and
Craniosacral Therapy. FAGGA treatment is usually followed by straight
wire Controlled Arch braces to close gaps opened between teeth. The
device is also known as the Anterior Remodeler, CD Advancer, and other
names depending on the producing laboratory. There is also a
(Removable)AGGA used in growing patients, which are functionally
identical to typical acrylic sagittal expanders.
Devices using this mechanical design have existed for many decades, under different names depending on the production laboratory. The appliance had limited uses for most patients after growth cessation, as treatment remodeling the alveolar bone creates gaps between the molars and front six teeth. Typical braces would pull teeth back into the gaps and undo growth. Steve Galella DDS began to use the appliance in conjunction with Controlled Arch braces, which allow the molars to be brought forward into the gaps. Galella has been using this method since the 1990s, opening the Facial Beauty Institute (FBI) for both teaching the method and to maintain quality control on labs where FAGGA and AGGA branded devices are made.
Steve Galella / FBI have begun to work closely with the Las Vegas Institute (LVI), who use neuromuscular dentistry practices such as bite pads and TENSing in conjunction with FAGGA/RAGGA.
Device Mechanics and Procedures
A dental cast of the upper palate, which is sent to a lab for device creation. Spacers are placed between the molar teeth to produce gaps of approximately 1mm. The rear anchoring of the device is slotted and cemented between the molars, while the front section is cemented to the front six teeth to prevent flaring. On the front section there is a Nance button which pushes into an area between the premaxillary suture and the incisive foramen.
The anchoring and front section are connected on a spring, which pushes the Nance button into the palate and causes alveolar remodeling, including new bone growth. While the molar teeth are pushed back slightly, the majority of movement happens to the front six teeth as they move into newly modeled alveolar bone. The spring causes approximately 1mm of separation per month between the molars and front teeth, and the expanded spring is pulled back to its loaded position periodically – usually monthly, if 1mm of growth pet month is achieved.
Molar pads are typically used to prevent moved teeth from coming into contact while biting, especially in the case of an under bite where the top teeth start begin to meet the bottom teeth. The pads can also cause remodeling of the lower jaw (mandible). In physiological dentistry treatment, the pads are indexed or left flat in such a way that the jaw muscles are resting when the bite is held.
Theory and Science
There are multiple theories of bone growth, and multiple possible theories about what the FAGGA / CD Advancer accomplishes. As per Enlow’s work on skull development, the maxilla naturally grows at the tuberosity (back of the maxilla). There is currently no supporting evidence that these devices accomplish this type of growth, or causes movement / growth of the maxilla outside of the alveolar ridge of the premaxilla.
The Nance button being pushed into the area between the premaxillary suture and the incisive foramen is largely accepted as the reason for remodeling and growth achieved by the FAGGA. As this growth is concentrated entirely in the premaxillary areas, there are two possibilities:
- The entire premaxilla is growing forward at the premaxillary suture
- The nance button is stimulating the many nasopalatine nerves which exist through the incisive foramen, and stimulate the premaxilla to remodel away from the force.
Notable Practitioners and Researchers involved
- Steve Galella (DDS, Founder of FBI)
- Anne Marie Cole (DDS)
- David Buck (DDS)
- Bill Dickerson (DDS, Founder of LVI)
- Timothy Bromage (PHd, Professor NYU Dentistry)
Professional Publications and Advertisements for device
LVI List of Practicioners
Facial beauty Insitute website
Anne Marie Cole and David Buck Website
Community Threads about device: