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Part 1: FORM FOLLOWS FUNCTION
As a child, I had the habit of biting/sucking on my lower lip, and my tmj was mobile enough to allow the mandible to slide back, which created what looked like a class 2 malocclusion. I do not know/remember if the lip biting caused the deterioration of the tmj; or if an injury or other postural problems first caused the tmj to deteriorate allowing the mandible to slide back, which then led me to develop the lip biting habit. Although, the lip biting definitely gave me an excessive overjet, I would wake up in the mornings with my lip clenched in my teeth and my incisors would be tender. I continued this habit for many years. At 12 years of age, I was first diagnosed by an orthodontist. The diagnosis: class 2 div 1 malocclusion with excessive overjet. All correct. The treatment plan, not so much. The approach taken was to extract the upper first bicuspids, and retract the canines and incisors to meet the lower arch. Instead, what should have been done was the mandible's position should have been corrected, and the tmj stabilized, then minor finishing adjustments with orthodontics. With the mandible sliding forward into its true functional position, there would be no class 2, and it would be a normal class 1 bite. The treatment plan was actually a camouflage plan, which aimed to hide the symptoms rather than correcting the underlying cause.
The results were devastating. Extraction/Retraction orthodontics caused my maxilla to shrink, my upper arch width at 27 years was only 35 mm at the second molars. I am otherwise a big guy, at 6'3 210 lbs. The shrunken upper jaw caused the cusps of the upper and lower arches to collide, and consequently, the mandible shifted to the right causing a lateral crossbite of the right side. I also developed a deep bite as a result of the Retraction, my upper incisors now covered over 2/3 of my lower incisors. However, my bite seemingly looked normal, apart from what were termed as negligible aesthetic concerns. This is where the treatment was deemed a success and terminated. I had a class 1 relationship of the canines, and there was no overjet (rabbit teeth) which was the primary complaint my parents had registered at my first appointment. They had managed to camouflage the rabbit teeth, but functionally, this was a disaster. My maxilla was too constricted, causing breathing difficulties. I could not fit my tongue inside my palate, and developed improper tongue posture. This impacted my overall body posture, I had the whole package: forward head posture aka nerd neck, which developed into upper cross syndrome, which then later also caused an anterior pelvic tilt.
As I grew older, I found out it was also a disaster aesthetically. My face was sunken in, there was no support for the lips and cheeks, and I was stuck with a perpetual baby face and a recessed maxilla and mandible. At some point, I also realized that the true position of the mandible should be more forward, and it made me look like I actually had a jaw. So then, I lived for years with my lower jaw in a jutted out position, with my incisors in direct contact with each other tip to tip, and only reversing to the class 2 molar relationship when I was chewing/eating.
I always knew there was something wrong with my face. And finally, I have only now, in the past 2 years, been able to put it all together.
As is evident from this chain of events, form follows function, every time.
Part 2: Reversing extraction orthodontics
I started my second round of orthodontics at almost 28 years of age. It has been 1 year into my treatment now. Using a 3 way expander for palatal expansion and arch advancement, and combined with traditional braces to move the roots along with the crowns, we have been able to reopen 5 mm of space between the canines and the premolars, and another 3 mm between the incisors and the canines, which is currently being closed by moving the canines forward. This will create 8 mm of space for implants on either side. Intermolar width measured at the lingual cusps of first molars has increased to 42 mm from 30 mm, and I can breathe so much better. I do not snore anymore. There has been no damage to the roots or the bone. My deep bite has improved significantly. As the upper arch advanced forward, my mandible also shifted forward into its functional position, and we will finally achieve a class 1 molar relationship soon. The changes to the jawline are very noticeable and honestly, better than I had expected, and we are not done yet! My upper lip has support now and I can actually smile showing the full upper arch for the first time. I have also been working on general body posture which has improved tremendously.
Attached are photos current as of today. Note the stark difference in the size of the palate. The cast is before starting treatment, the size of the appliance is where my jaw is currently. This is the second appliance, the first one reached its limits. We anticipate another few months before I'm ready for implants.
Therefore, evidently the palate can be expanded significantly and extraction spaces reopened quite easily as late as 28 years of age. New studies also indicate the sutures do not close as previously thought, and bone remodeling does not stop or slow down significantly. For my case, the 3 mm of space between the incisors and the canines was achieved in a span of 6-7 weeks using light springs. That is quite fast. Goes to show a competent orthodontist can accomplish things the old quacks who get their information from textbooks written in 1920 would dismiss as impossible.
Hello mewology,
Thanks for a very interesting post, with an excellent description of the problem / diagnosis initially. Very encouraging what you have achieved.
Your experience is similar to a part of my own case. After braces in my teens I ended up with cross bite, forced chewing on one side and narrow upper jaw. I have over the last year treatet myself with a total of three expanders. I have expanded from 2,8 cm. to 4.8 cm. Mostly I have achieved remodeling of the upper jaw, but of course I have also got some tooth tipping. If anything is also due to the opening of the suture, I am uncertain. I have also seen a clear effect on the face, where the cheekbones have widened, and the hint of babyface has disappeared.
To me, it also seems that a lot of what you have achieved is due to remodeling of the jaw, and I think that is about the best you can achieve in adulthood. Congratulations on finally having a palate that is no longer not so different from what the genes had planned for you! Would be very nice if you continued to keep us updated on how things are going.
Very cool mewology! I am considering reversing extraction orthodontics. I've had 7 teeth pulled (ouch!) and ever since I had 5 teeth pulled in the past two years my face has not been the same. Glad to see what's possible!
Good result. Check out my similar situation. I'm still looking at surgery.
I think your website is excellent. Is it possible to ask if your bite is more stable now? Remember you have written that it easily collapses somewhat whitout the expander.
I've done about the same thing as you. Am in the 40s. Have significantly expanded upper jaw, and am satisfied. But the price is gaps between the teeth and the chewing surface has deteriorated. I stopped expanding 3 months ago and my impression is that it is becoming more and more stable. Have planned to put on veeners to cover the gaps and create an aesthetic smile.
One key thing to note is that you seem to have only used the expander appliances without braces. The appliance only pushes the crowns of the teeth, the resulting torque causing them to tip outwards, as in your case.The archwire applies torque to the roots of the teeth balancing the appliance's torque on crowns, the resultant force is directed sagittally outwards which causes the alveolar process of the maxilla to grow sagittally, instead of just tipping the incisors.
I have also been hard mewing by pushing the appliance with my tongue the whole time.
It seems to be. I had Essix retainers (generic name of Invisalign) made to prevent relapse. I just wear these at night, and haven't noticed any significant movement. If I miss a night, there's a little pressure so it seems a tendency for the teeth to move back.
I have huge gaps between incisor and canine, and canine and first molar (not premolar - I was missing all 4 up top and 2 lower). Like @mewology has noted above, there wasn't great root movement. I could see this happening and eventually left my dentist citing this as one of the reasons.
So relatively stable bite, slightly deep, skeletal class III which causes my lower jaw to 'pull back' slightly in order to fit the incisors behind the uppers.
I was about to write my story before I read this. I could have written the exact same story with same upper premolar extracted, lower jaw locked backward, daily in incisors end to end to relax while back to molar relationship for eating.
Only difference is they did to me chin surgery to do more camouflage.
Life has become a nightmare
Advice: Keep your mouth closed while you have the appliance in your mouth, with the lower incisors and the tongue slightly touching the appliance. The resultant force will induce translation instead of tipping the upper teeth.
Advice: Keep your mouth closed while you have the appliance in your mouth, with the lower incisors and the tongue slightly touching the appliance. The resultant force will induce translation instead of tipping the upper teeth.
Hello Mewolody--- great overview of the extraction-retraction consequences on the whole body, and bravo to your successful reversal! A question: I too am reversing, and am choosing between 3 doctors, one who uses sagittal appliances (what you had I think), one who uses FAGGA and another who uses just braces. Can I plrease ask what is the advantage of using a saggital expander vs braces? And where is your own doctor located? He/she sounds excellent!
entelechy
...and if anyone who has had the extractions would be up for taking this survey on consequences, would much appreciate!
https://forms.gle/F5LEdN9ujjiMu4Mt6
It's part of a project to raise awareness about extractions--and to lobby the orthodontic industry to do research in reversal and to provide it for free to all victims.
To anyone who responds, I send an overview of the most common reversal techniques, plusses and minusses, according to the doctors I have interviewed, from Bill Hang and the Mews to Won Moon.
thanks!
entelechy
Is the 3-way expander you had a Schwartz?
could anyone please help me out and take this survey on extraction consequences? I am a university researcher investigating the consequences of extractions, and will be publishing the first academic article on patients' experience this summer.
This survey is extremely important as it is the first like it, and can potentially change the field of orthodontics. The published report can be used to show insurance companies, doctor and orthodontists to back up your claims that you have problems due to your orthodontic extractions.
The aim of this project is to make it easier for "victims" to get reversal treatment (and reimbursed) and to regulate the use of extractions in the future.
Here it is. It takes one minute. Please be part of this project for change! https://forms.gle/F5LEdN9ujjiMu4Mt6
entelechy
could anyone please help me out and take this survey on extraction consequences? I am a university researcher investigating the consequences of extractions, and will be publishing the first academic article on patients' experience this summer.
This survey is extremely important as it is the first like it, and can potentially change the field of orthodontics. The published report can be used to show insurance companies, doctor and orthodontists to back up your claims that you have problems due to your orthodontic extractions.
The aim of this project is to make it easier for "victims" to get reversal treatment (and reimbursed) and to regulate the use of extractions in the future.
Here it is. It takes one minute. Please be part of this project for change! https://forms.gle/F5LEdN9ujjiMu4Mt6
I just wanted to put an extra plug in here for Eneltechy's poll - I filled it out late last year, only took a few minutes ... and as a result, I now truly understand what my extraction orthodontics potentially did to me as a child, and she sent me a very thorough report afterwards on the strategies available in the market.
I am very much looking forward to your final report, and I hope that somewhere ... this spurs some class-action lawsuits against the orthodontists association for disfiguring so many of us for decades. At a minimum, it would be nice to recapture my costs that I'm going to have to pay out to try to reverse what was done. Seeing positive outcome reports from folks like @mewology here lead me to believe that it is possible without surgery, and can be done safely if approached cautiously and patiently ... working in conjunction with a skilled provider.
@mewology Thanks so much for this extremely well-researched and presented post! After a while of reading this forum, you start to believe that surgical palatal splits are the only thing anyone thinks works. Your outcome - assuming all your teeth are stable and bite is fully functional - shows that that's not always necessarily the case.
Out of curiosity, which types of expanders were you using for the upper and lower? I'm likely going to get onboard with the Vivos system shortly - and they have a variety of different expanders they use depending on the patient case, but they look similar to some of the ones you've shown.
What was the turn rate for the expanders as your provider worked you through this process? Vivos DNA's default schedule is a full turn of the screw (0.25mm) every 4-7 days or so. If there are problems, they slow it down ... but it seems like they are targeting a "1mm per month" goal which I've heard is the "safe" target that orthodontists use regularly for tooth movement.
Also, did your provider advise you to only wear the expanders a certain number of hours of the day, or was it full-time 24x7? Vivos wants a minimum of 8 hours "out-of-mouth" time per day to let the oral structures rest and compensate for the forces that were just applied to it ... so you typically just wear it overnight.
Would you care to share the name of your provider? It looks like he or she has done an excellent job for you!
Lastly - what did your provider say (if anything) about long-term relapse? I was speaking with a MMA surgeon a few weeks back, and he said that to treat OSA they typically need to expand a minimum of 8mm ... but even he said there's always a bit of relapse with MMA (which typically requires some orthodontics before and after) so that they typically try to go for 10-12mm depending on the patient case. I'm operating under the assumption that I'll likely need to wear some sort of retainer overnight for the rest of my life (which - compared to a CPAP right now, is light years better) but I'm curious to know what your provider advised you on long-term stability.
The idea is that the entire front part of the maxilla (teeth and palate/alveolar process included) needs to be moved forward. Therefore, I think that the best solution would be applying an outward force to both the teeth and the palate. Think of it this way - braces act by pulling the teeth outwards (periodontal ligament (PDL) remodelling) which then causes the palate to remodel in response, but there is no direct force applied to the palate; FAGGA actively pushes the palate alone outwards (remodeling mainly at the maxillary suture) but does not apply force to teeth, and thus may not effectively utilize PDL remodelling.
I think, and I do not know this to be true - but neither does anyone else - that the best approach may be two pronged - applying an outward force to BOTH the teeth and the palate. This would allow the most effective application of force because 1) Better force vector control - sagittal appliances without braces are unable to apply torque, result is flared teeth, 2) As concurrent force is applied to both the teeth and palate, there is less torsion and consequently a lower risk of pushing teeth out of bone, 3) Both PDL and maxillary remodeling is utilized, and 4) Force is spread over a large surface area = less pressure = less complications.
I did not have any expander for the mandible as the lower jaw was sufficiently wide. It was, however, set back at the TMJ into a Class 2 molar relationship which made it appear as if it wasn't wide enough. With the expansion of the maxilla and forward movement of the upper teeth, the mandible translated forward also, and is the same size as the expanded upper jaw.
I have posted pictures of my upper expander in this thread, I do not know what it is called specifically. Appliances have fancy names but the basic principles remain the same = Force and its application. My expander was a 3-way expander, with 3 screws - two at premolars for sagittal expansion and 1 at the palatal suture for lateral expansion. In my case, the turning regimen was 2 turns of 0.25 mm per each screw per week. I turned one screw every day, taking Sundays off. This would translate to 2 mm per month at each screw. This is the rate of expansion of the appliance, the actual expansion of the jaw will be less than that as the jaw remodels and the appliance fits less well over time.
From personal experience, I can tell you that the appliances are much more effective if worn 24/7. I have tried both 24/7 and 16 hours per day regimens, and 24/7 was much more effective and this is not even close. After leaving the appliance out of your mouth for 8 hours, the oral structures do indeed reset. You will notice this when you try to insert the appliance back in your mouth after leaving it out for 8 hours, that your maxilla has contracted and the appliance barely fits. This is especially a concern if your tongue does not fit/rest in the palate in which case there is nothing opposing the maxilla from contracting. You will occasionally have to skip turning the screw, and sometimes might even have to revert a turn. It seems to me that the potential for damage is more when trying to forcibly insert an oversize appliance into your now contracted maxilla (because you will not want to revert back the screw turns all the time, it sucks), than just wearing the appliance all the time. Reinserting the appliance after 8 hours off is also more painful than just leaving it on all the time. Orthodontist probably won't tell you this but keeping your mouth closed will also enhance the effectiveness of the appliance as the upward force of the tongue and teeth will keep the appliance snugly fit.
Long term stability is dependent upon you correcting your tongue posture. When force is applied, bones remodel. In terms of your maxilla, soft tissue applies a constrictive force and the appliance applies an opposing expansive outward force. The resultant of these forces determines the direction of bone remodelling - expansion or constriction (relapse after treatment). After you end expansion treatment and remove the appliance, this will remove the outward force of the appliance. The new shape after expansion will be retained if the net forces are in equilibrium in the new position, i.e. your tongue should replace the function of the appliance to apply a new constant outward force to balance the constrictive force of soft tissue, which will then keep the results stable. If the tongue is not in correct posture and the appliance is removed, there will be a net constrictive force which will cause relapse. Note that this is the same principle used for treatment, but in reverse. You will have to wear a retainer until your tongue posture is corrected to prevent relapse.
That is the real end goal, and the most important lesson to take - treat the underlying cause of the problem, not camoflague the symptoms. If you do not address the actual cause, i.e. imbalance of forces due to poor posture, the same symptoms will return and you will relapse.
@mewology Again, a great summary.
For me, long-term relapse is a concern - but not the highest on my list (safely moving the teeth and not tipping is #1 on the list). As I am currently sentenced to a lifetime of CPAP if I don't do something, I would gladly trade a lifetime of CPAP for a lifetime of just popping in a fixed retainer overnight.
I'd be curious to get your thoughts - if you don't mind opining for a bit - on what you said about a an "appliance + braces" strategy giving you the forces at the root and the crown of the tooth simultaneously in order to avoid tipping. The Vivos DNA appliance is an acrylic Y-expander so that's what's providing the force to the alveolus, but there are also tiny springs embedded into the appliance and these are designed to make contact with each tooth and provide a "light force" to stimulate/direct the movement as the alveolus expands. You can see them here - https://oralsystemiclink.net/image/18/600
The inventor has claimed "no tipping of the teeth" in video recordings of presentations to other dentists ... so now that I've read your post I'm wondering if he was actually onto something by applying an outward force mechanism to both the root (through pressure on the alveolus) and crown simultaneously.
I also wanted to repeat the question that @eneltechy had asked ... if you are comfortable with sharing, would you be able to share the name of your provider who guided you through all of this? It seems like they did an excellent job and delivered a great outcome, and I like the fact that they came up with that dual strategy to improve safety.
It seems to me that the potential for damage is more when trying to forcibly insert an oversize appliance into your now contracted maxilla (because you will not want to revert back the screw turns all the time, it sucks
I've experienced this as well. I end up turning it back till it fits.
There doesn't appear to be much rhyme or reason to it either, so I don't know what's going on. Sometimes I can put it on in the evenings without issue, and sometimes I need to retract it.
I share you concern about forcing it though.
The one study I've read about this on Pubmed did conclude that intermittent force, taking it off, resulted in more growth. It may also be a good idea to let your mouth rest as well. Of course, that's not how it works when you're a child.
I know this is an old thread but I want to use a palate expander along with my current braces treatment. My question is can I have one while wearing braces or will the arch wire have to be removed temporarily until after the expansion? Also, how should I approach my orthodontist about this as I am 8 months into braces treatment and currently am using Class 1 elastics.
Advice: Keep your mouth closed while you have the appliance in your mouth, with the lower incisors and the tongue slightly touching the appliance. The resultant force will induce translation instead of tipping the upper teeth.
So while you were going through your procedure with your provider ... how did you know you weren't tipping your teeth at all? This is one of the most challenging things I've come across as I have evaluated procedures - and you seem to have a solid understanding of the mechanics involved. That picture you showed earlier in the thread was great.
How does a provider make sure they're not getting any tipping as they put you through their procedure? Do they just eyeball it? Do they do periodic x-rays and check the angle against the previous x-ray to make sure there is no measurable change?
I just met with a traditional orthodontist, who of course wants to go with a traditional procedure (DOME or MSE) as a lead up to working with an oral/maxillofacial surgeon on a MMA procedure. Of course, when I told her I was looking into an appliance strategy first ... of course, that just brought up all the usual stories about how it can't be done (even though you just did it), can't be fixed any way other than surgery, appliances will just tip your teeth to get the measured expansion, etc. etc.
It's quite frustrating as a layperson to be able to try to work through this.
Did your provider have any particular protocol that he/she used to monitor your progress in the appliance + braces strategy and make sure it was progressing safely?
@toomer My response to this: I had major teeth tilting due to MSE (lst molars, where the bands were set), to the point that they are near out of the bone.
Suggestions on how to avoid: take photos every two weeks and send to your orthodontist and ASK if they are tilting and if the device is NOT BROKEN.
Due to coronavirus, I was not able to go in person to see my MSE provider. The device broke during the treatment and he did not pick up on it by the photo I sent: probably not broken at that time. I continued turning the screw. It was only a full month later, when I had new photos taken in a dental lab near me, that he note that it was broken and that my turning of the screw had--for that month---not increased the suture split but had pushed the bands where the lst molars are.
How to avoid it? Well, Dr. Ting in California and others suggest cutting the bands immediately after setting the MSE in (The bands are used to position the MSE) so as to avoid tilting.
I did not want to do that because that would mean you cannot do facemask. The facemask is attached to the bands.
So the only way to avoid MSE tilting is to take regular photos and the second your ortho sees something wrong, CUT THE BANDS.
The rest of the teeth did not tilt, except for perhaps the second molars next to the MSE bands.
As for tilting that is NOT Mse related: same principle. Take photos regularly and email to your practitioner. I also had two BOTTOM teeth flare EXTREMELY because I had put an extremely thick and strong wire on them to move them quickly forward (they were tilted inwards, and I desperately wanted them upright as soon as possible). That was all good until I totally forgot about this wire---
and lo and behold when my ortho saw my photos he wrote me: get some dentist to cut that wire at once!
I am normally a very careful person on treatment, so it kind of bummed me out that I (and the ortho) dropped the ball on this---as regular photos could have prevented what now becomes a matter of necessary bone grafting!!!!
entelechy
One key thing to note is that you seem to have only used the expander appliances without braces. The appliance only pushes the crowns of the teeth, the resulting torque causing them to tip outwards, as in your case.
Just adding this in since I just came across it - apparently it can be done sometimes with an expander only, with no tipping:
https://www.sciencedirect.com/science/article/pii/S1808869415300513
"the results of this study show that the use of maxillary expanders in adults allows for statistically significant expansion, observed by the average increase in the linear measures of facial width (1.41 mm), nasal width (1.92 mm), nasal height (2.5 mm), maxillary width (2.42 mm), jaw width (1.92 mm) and molar-maxillary width (2.0 mm) (Table 3, Table 4, Table 5, Table 6, Table 7, Table 8), in an average time frame of 5 months (table 2)."
"our results do not support the hypothesis that maxillary expansion occurred due to dental tilting"
Interesting reading.
@silberman yes the upper is quite stable, but the lower is a little 'relapsy'. I can get by wearing the lower invisalign for a few hours each day now just to maintain the position of the teeth. I'm going forward with UJS now, meeting an ortho this week to arrange braces. I'll update my blog as I go. https://reversedental.wordpress.com/
@silberman yes the upper is quite stable, but the lower is a little 'relapsy'. I can get by wearing the lower invisalign for a few hours each day now just to maintain the position of the teeth. I'm going forward with UJS now, meeting an ortho this week to arrange braces. I'll update my blog as I go. https://reversedental.wordpress.com/
Could I please ask what you think of Invisalign (as opposed to braces)? I have read negative reports on it...and also neutral ones.
entelechy
@entelechy Hello! Would you mind speaking privately about your experience with MSE and facemask? I'm considering treatment for TMJ but I'm slightly worried and would really appreciate it!
@blackbear
entelechy
Am currently in Romania with Dr Ela Banica - an orthodontist passionate about her work who has never needed to extract in any of her patients
entelechy
