It's been a while since I last posted because I've been waiting on my original biological dentist to finally get back to me regarding my case (I think because I may be her first case requesting this kind of expansion). Recently, I found out about another dentist who specializes in myofunctional orthodontics in my area.  And I had a consultation with him. He had me do a cast, ceph x-ray with film, photos, and another panoramic x-ray. He looked at my facial structure, mouth, and tongue. This is was his diagnosis and treatment plan:

Age: 35 years old

Diagnosis: Craniofacial Dystrophy with sleep disordered breathing (to be confirmed after PSG)

Clinical Findings:

1. Narrow maxilla and mandible/deep palatal vault.
2. Deficient midface and retruded mandible.
3. Upright upper and lower incisor position with mild crowding
4. Edge to edge bite
5. Linguoverted/ lingually tilted upper and lower posterior teeth.
6. Airway: Nasal chokepoint due to a deep palatal vault (so expansion will open the nasal airway)
7. Chokepoint 2: Mallampatti IV due to a long soft palate/deficient maxilla (no swelling of tonsils/adenoids)
8. Chokepoint 3: Retruded mandible
9. Chokepoint 4: Mild tongue tie/ankyloglossia

Treatment Plan:

1. Further dianosis with Polysomnogram (split study)
2. For nasal congestion: Nasal spray using normal saline 3x a day.Maxillary and Mandibular 3-dimensional expansion using removable Biobloc appliances for Orthotropics (day time wear only) Duration: 5-6 months
3. 1. Oro-Myofunctional Exercises
   • Buteyko breathing technique/exercise 3x a day
   • Mindful nasal breathing during the day
   • Mouth taping with intra-oral Myofunctional Appliance at night/during sleep.
   4. Tongue tie release (minor surgery)
   5. For Finishing: Fixed appliance (braces) using conventional mechanics. Duration: 12-14 months. This is done only after Expansion Mechanics. During the duration of 12 months, the patient is wearing a Myofunctional Appliance at night with mouth taping.

Treatment:

• Phase I: Orthopedic Correction using maxillary/mandibular 3D expander – approx $900
• Phase II: Orthodontic Correction using fixed appliance (braces) –  approx. $2800

For those who have knowledge or experience about this, does this look like a reasonable treatment plan? do you think it's really necessary to have the Polysomnogram if I already know I need expansion and apparently the dentist seems think so as well? Does the Polysomnogram provide information on how to better adjust an expansion appliance to better fit an individual's needs? It just seems to be another inconvenience having to go through with it and spend more money which I'm trying to avoid. Also the  braces are quite pricey. I didn't expect the braces to be more than triple the price of the biobloc.  So I was just wondering if the corrective braces are usually necessary after palatal expansion as well.  Please let me know. Thanks