Using Piezotome with every patient is the way to go to increase success. It should be noted that all MSE providers are orthodontists. I could not help thinking that a new measurement was developed to evaluate a new technique? Watch this video I prepared that explains this. This would not be unethical because the control group can be treated six months later. BTIG Sees 260% Upside In Mustang Bio With PT of $11; Early - Benzinga Mandibular growth is restricted on the side of the crossbite, leading to a relative shortening of the ramus height and subsequent development of mandibular and facial asymmetry. I feel that we need more unbiased data so that patients can come to the best decision for their health. After three weeks, start turning three times a week until Dr. Roca says the expansion is finished. I have yet to see any negative consequences yet but it is bound to happen. Photos above were taken three weeks after MARPE was placed
Patient was a 36-year-old male
MARPE placed: 7/22/22
Photo date: 8/13/22, * We want both lips to be touching the line extending from the nose, * We want both jaws in front of the line extending from the forehead, * We want a counterclockwise rotation of the lower jaw so the face grows more forward and wider, * We want the line to go through the ankle, middle of the shoulder and in front of the ear. Any patient that has a deviated septum and constant sinus infections. Where the heck are the clinical trials that justify the use of this technique by Evans and Ting? Micro-implants appear much larger than they are in the mouth. Do functional appliances influence skeletal pattern? I have heard of people having vision problems due to shifts in the other bones of the skull connected to the maxilla, and others having asymmetrical expansion that is difficult to correct if not caught early. Since Homeoblock is not offered in Australia yet, my idea was to figure out a way for me to legally make you an appliance. Im 24, soon to be 25. There are many MSE providers that have lots of Data about it. About a year and a half ago, maybe more, I decided to get to the bottom of my TMD, which at that time was increasing exponentially in severity. The MSE is also used to treat children and adults whose molars are flared and cannot be treated from the Rapid Palatal Expander (RPE) which could cause an unstable bite through additional flaring. Services | Ting Orthodontics Have you got any updates on progress with the vivios? Lastly it is important to know if the MARPE does not work additional treatment may be required due to unforeseen circumstances or inability of midpalatal suture to split (e.g. Unfortunately, this is the case with this paper because all the patients were successfully treated. Getting the expansion will help enable the tongue to be parked on the roof of the mouth. I am showing it to patients to help them decide. If it is just dental expansion, we are just moving teeth, and over time, as many adults know, all the expansion is lost and they need braces all over again. If all goes to plan and we have a successful split, the patient will be finished with the expansion in no longer than three months. Everyone has studied with different mentors and finds what works best in our hands and with their patient pool. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Unless one can get to California to see Kasey Li. Can we attach the supporting arms to dental implants? Thank you for all the detailed info your posting. This lower expander help bring out any molars or teeth that maybe tipped inwards. Im not really looking for more hatred in my life, but thanks for the suggestion. Remember that the top of the mouth is the floor of the nose and that you can receive more air and breathe better with palate expansion. Age is not the deciding factor. The zygomatic buttress needs to remain intact in order to get full mid face expansion and open the nasal airways. The only problem occurs if you have anterior implants we will not be able to close the space with Invisalign and we need to get very creative how to handle this hurdle. If you search for user Jessaroo on YouTube, you can see she shared 2 sleep studies before DNA and after about 8 months of treatment time. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Thanks for your kind words about my articles. I believe he uses MSE with other patients, but I havent confirmed this. If the Piezotome CUBE was not used, turn two to four times until you experience resistance. Turning schedule following Dr. Rocas protocol she learned from Dr. Ilya Lipkin. Every patient gets a custom MARPE (miniscrew-assisted rapid palatal expander). Is it one to one? They could randomise to MSE and a delayed treatment group. Maxillary advancement alone would only help those with severe underbites. The equivalent of bloodletting would be extractions and retracting the patients jaw right into their throat, not expanding the maxilla and giving someone increased oral and nasal volume. The strength of MSE is rapid and significant sideways expansion of the maxilla. Every expansion with any device is asymmetric. The patient will still have the expander until the new bone forms at the site of the midpalatal suture, which takes about four to six months. MSE is a great thing, but it's nowhere near as effective as say something like maxillary advancement in terms of cosmetic enhancement. Im close to the age where the reduction in life expectancy due to obstructive sleep apnea becomes really significant and some options, such as those involving major surgery, may not be available to me very much longer. What is MSE? It generally stays within the sheets which splits at the bottom as the PNS split. I noted Ronald Eads bad experience, but suspect part of the problem was being overly-aggressive with the degree of expansion he attempted in such a short time. just curious your sources to be able to say that all the appliances/methods (two with facemask) are able to achieve forward expansion. This is why jaw surgery may be necessary, but its more effective when done in combination with MSE. SARPE is an invasive procedure that, like distraction osteogenesis maxillary expansion (DOME), corrects narrow plates. , specifically the jaws and the teeth. This allows more than one night to give us more accurate results in case you have a bad nightand it makes it easy to test throughout treatment to see positive rerduction in fragmented sleep and apneas. Dr. Evans has a huge pool of patients. Additional orthodontic treatment during or after treatment? And no, IMDO is short for Intermolar mandibular distraction osteogenesis. EDIT: When i refer to MA, i mean maxillary mandibular advancement. Richard Ting, DDShttps://www.instagra. I was alarmed about the safety of the appliance given reports I read online and focussed my research on the other options that appear to be lower risk. Also sir, would you maybe offer an opinion as to precisely when in their childhoods each of these 18.2 year-olds comprising the experimental cohort were first diagnosable (and possibly first treatable?) It improved his sleep, body pains and breathing while sleeping, but he was not able to get the kind of expansion we wanted from the Homeoblock since his suture were so tight. Graham. Its amazing how many secondary conditions OSA can manifest. I have popping/clicking when I open my mouth wide and yawn. The options will be discussed with patients. A minimally invasive one but a SARPE. Copyright 2009-2020. In theory the forward pressure of the facemask should cause some bone remodelling/growth to move the maxilla forward. I will discuss pros and cons of other options and we decide together. Where does the orbital process of palatine bone, that little presentation on the medial wall of the orbit, archially move? Is Menopause the Beginning of the End?: Transcript - TED For the past 14 weeks my mouth has been empty of any braces, bite plates or other appliances, and I have worn no retainers. We want to achieve symmetrical expansion on all cases. The DNA appliance has expansion screws for both sideways and forwards expansion of the maxilla. I disagree. The other advantage is that most patient between that have the indication of maxillary expansion can have it without surgery. Graham. Use tab to navigate through the menu items. The retention phase lasts for a minimum of 24 months. The MSE will then be turned once a day for three weeks. In January 2019 I was made aware of an orthodontic appliance called MSE (Maxillary Skeletal Expander) which is a non-surgical method of splitting the mid-palatal suture and creating dramatic amounts of lateral expansion. The following week, turn forward once a day and then rest for a week. This is something all AGGA patients should be aware of. (So without any surgery), Hi Stephane. Importantly, the patients had to have CBCT images taken at the start of treatment and within 3 weeks after active expansion. Um, so I feel like I'm fan girling. Maybe all of the above. Nu-wanda999. I have the exact same situation as you. Ive since seen a post from Dr Derek Mahony saying that hes been using Homeoblock for almost 20 years, but I dont recall him mentioning it to me. DOME uses a limited Lefort 1 osteotomy as described in this paper, and Dr Vaughans MSE surgical assist technique described in this video looks identical to me; he even says its the same in this video comparing them. When RPE is provided before the palatal suture is fused, there is expansion at the suture. I don t know. Any patient that needs to exercise with the mouth open because they cannot get enough air through the mouth. Reddit, Inc. 2023. That yields only marginal results, is painful, takes several sessions, and is unlikely to cure severe sleep apnea. I rated risk of relapse low because of all the options, MMA with MSE/DOME and MSDO comes closest to leaving the jaws where nature intended, assuming the surgeon does an excellent job. 102 102 comments Best Add a Comment Space-TimeTsunami 5 mo. I havent heard of people using retainers after MSE. We are looking for the location of the best bone available for insertion. Dr. Jen Gunter: That's Anthropologist Dr. Kristen Hawkes. Im prepared to wait to get the best outcome possible, provided I can get health benefits from the treatment early in the process. I dont believe DOME is essentially identical to Surgically Assisted MSE. We need to remember that when a study includes retrospective data, we must assume that it is subject to selection bias. Why should my 10-year-old get a MARPE vs. a RPE? How about the MSE? Corticotomy is primarily used for cases where, Unlike corticotomy where cuts are made through the palate, cortipuncture uses micro perforations that are preformed along the palate for bone that is. We want the location with the most amount of bone possible to get bicortical engagement for our custom MARPE. By doing so, MARPE avoids unwanted tooth movement and achieves more bone expansion while minimizing negative dental side effects. The Homeoblock and DNA appliances are almost identical, so I generally gave them the same ratings. The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea. ago These are my facial before and afters of my MSE treatment. Hi Graham, I actually never heard of DNA and homeoblock before your article. So Im not sure it would have a lot of additional research value they all seemed to be searching for answers, but not finding any. . Increase Mouth Volume and Tongue Space - By widening the maxilla I will increase my mouth and airway volume and create more space for my tongue, which will facilitate proper tongue posture. Turn once every day until maxed out or the appliance fails. I am considering DNA/Vivos. The blue box represents the nose. The lower expander also corrects jaw disharmony and widen a narrow jaw. They should be a good resource for research. If we consider the tongue should be the driving force for maxillary growth both transverse and sagittal, not only does the aetiology become clear but so does the recognition of the pervasiveness of this issue exacerbated iatrogenically by extraction orthodontic therapy. We did the Homeoblock for a year. I know I said the DNA appliance isnt an RME and Im not aware of any published data on relapse rates in adult DNA patients, so this may be overly pessimistic. Patients should start using the reverse-pull facemask one week after turning has begun. I have provided some cases too. All rights reserved. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Instead of standing making her blood pressure fall, it actually increases while standing. The inventor of this technique was a co-author of this paper. Ideally, the upper palate can get to 59.55 (if we add the 5 mm to width from bone to bone on maxilla). Progress in Orthodontics: https://doi.org/10.1186/s40510-020-00320-w. More reviews giving us the answer! The screws are on either side of the septum. However, every Sunday Dr Roca likes the patient to text her photos of the marpe expansion, bite, and diastema directly to my cell phone. Part 2 of my interview with Dr. Ting, the world's most experienced MSE provider. I expand until the narrowest area above the maxillary first molars becomes wider than the estimated lower buccal surface. It may not even be the best one for me. However, the other options besides Homeoblock usually require further orthodontic treatment which makes their total treatment time comparable. So its unfortunate that the folks in the Discord wont consider actual patients curing their sleep apnea and dropping their UARS (if RDI is truly the best measure we have). Since Dr Roca uses the Piezotome in her adult cases she has never had one fail and does not expect one with the intense custom planning she does for every case. But ran into some unique issues with it and now only wearing during day for short periods until I find a solution. Its also by far the most painful option. Heavier force and longer duration are more efficient. If still does not open we will take a new CBCT to check. MSE with Dr.Ting : r/orthotropics - Reddit The images below show the result of 13 weeks and 6 days of no braces, no Controlled arch, no bite plates, no retainers. Sometimes I get the impression that a surgeons idea of how painful their treatments are is rather different to the patients. Treatment Update After MSE Removal - YouTube Top 1% Invisalign Diamond Plus Provider in the country. During my training, Dr. Belfor showed me a CBCT of one of his patients that is currently in Homeoblock treatment that recently finished a failed DNA treatment. Airway & Functional | Ting Orthodontics | Rancho Santa Margarita/ MSE MSE/EASE/DOME+MMA do it rapidly by brute force and surgery, while DNA/Homeoblock appliance do it slowly over a long period of time by bone remodelling. Thank God for your blog Dr O,brien! Patients that get MARPE from Dr. Roca at Arlington Smile Center are given her personal cell phone number and asked to text photos every Sunday so she can confirm that the expansion is happening symmetrically and the patient is following directions. Most of the time, the lower jaw is not narrow but the dental arch is because of the lingually collapsed lower posterior teeth. For the past 14 weeks my mouth has been empty of any braces, bite plates or other appliances, and I have worn no retainers. I did about 18 months research into palate expansion and surgical options for treating my severe obstructive sleep apnea (OSA). I prefer to expand first and then de-rotate after cutting off the arms. I am proposing a DNA/ Homeoblock face off. Orthodontics are required to close the diastema in the front teeth. MSE/EASE/DOME+MMA do it rapidly by brute force and surgery, while DNA/Homeoblock appliance do it slowly over a long period of time by bone remodelling. Other DNA users on the Adult non-surgical palate expansion Facebook group have commented that if it starts to hurt, that indicates I need to slow down even further. MSE before and after F19 -AMA : r/orthotropics - Reddit I would be delighted to help in 2022 if you need it :). Sorry, this post was deleted by the person who originally posted it. The child patient I like to see one week post op to be the one to turn it for the first time and introduce the reverse pull facemask. Cant Correction - As Dr. Newaz puts the finishing touches on my treatment (with clear aligners) I have no doubt that he will leave me with a very fine finished product. Yes, my aim is the same: to increase the size of my airway so my tongue doesn't block it when I'm asleep by expanding the skeletal structure around it. this is why if you already have an overbite and want to get MSE + facemask installed, you're going to need some sort of plan for the mandible in order to have the lower and upper jaw line up and match. Pt 1 - Dr. Ting: MSE is "Greatest Ortho Invention in 100 Years" - YouTube Part 1 of my interview with Dr. Ting, the world's most experienced MSE provider. surgically assisted ROE. In the top two photos, Piezotome CUBE is being used to make a cut in the palatal suture posterior and anterior. Hi Matt, I am not aware of any long-term studies into the safety and effectiveness of any of these treatment options to help in comparing them. She could have had her jaw expanded more, but we had the expansion we needed to fit her tongue. Together we can gather more anecdotal evidence from an unbiased honest patient experience and establish a true pros and cons to help other patients in the same boat. I am posting about a trial that looks at this later this month. I extracted the most relevant variables into these tables. Dr Sergio, how can I contact you with questions about MSE? We will take a scan of their teeth and a CBCT 3D X-ray to look at the size of the airway, the size of tonsils and adenoids, and the position of the jaws. I also have apparently a rockstar of a dental sleep medicine ortho near me that has a proprietary MSE appliance designed for the upper AND lower, which further complicates my decision matrix. One of these is the Midface Skeletal Expander. I think you are on the right track and I really hope Homeoblock does the trick for her! SFOT helps to enhance the function and appearance of the smile. Position the jackscrew perpendicular to the septum rather than adapting it to the canted palatal vault. Pt 1 - Dr. Ting: MSE is "Greatest Ortho Invention in 100 Years" Your situation may be different, and this may mean the treatment I chose isnt the best one for you. I have successfully treated many older patients. I considered this the most viable method for attaining the ~5mm of width that seemed to be necessary to make my maxilla equal to my mandible. It is possible that MSE could also be successful with just corticopuncture depending on the thickness of my palatal bone and zygomaticofrontal sutures, but I havent had this assessed. This would be a great study. COPYRIGHT 2017-2022 RONALD EAD ALL RIGHTS RESERVED, Dr. Won Moon, the chair of orthodontics at UCLA School of Dentistry. Expansion force will be the same. I rated medium for pain because I suspect its triggering inflammatory orthodontic rather than orthopaedic processes. It must be difficult seeing her suffering so much, and my heart goes out to you both. I also doubt Edward Angle used clinical trials to devise his treatment plans , otherwise he would have realised how dangerous the use of some of his appliances such as headgear is. One of these is the Midface Skeletal Expander. The optic nerve comes through a part of sphenoid bone, and an expansion has no impact whatsoever. Dr. Ting has about 400 cases. Once the split takes place, our team will cut off the arms. The authors pointed out that when we measure the effects of MSE, we should use an angular measurement system to take into account that expansion is archial. But patients should not be doing MARPE case for cosmetic reasons. My decision-making process was not nearly as linear as described here; there were many twists and turns along the way. But now that we have the software we can angle the lumen where the tad enters in different angles and depths to correct the canted palate in the custom designed MSE/ Marpe. ; Face mask protraction promotes a forward and downward movement of maxilla; Class III elastic tends to rotate the maxilla in a counterclockwise direction (not good for a high angle case). About 500g each side for growing patientsbut 500-1,000g for mature patients. The right image shows a condyle that is dislocated forward. If I dont get the results I seek, can I get back to you in 2022? The good news is that my orthostatic intolerance went away completely after I got diagnosed with, and treated for, obstructive sleep apnea. No authors declared a conflict of interest. We are on two different continents so we need to be strategic with a plan but I feel that it could be a win/win for both of us. Surgical and Mini-implant Assisted Rapid Palatal Expander (SMARPE) using the, Distraction Osteogenesis Maxillary Expansion (DOME) with Facemask. While conventional Orthodontists limit their treatment to leveling, aligning and mild bite correction, Dr. Ting treats so much more.