In mid 2019 i will be getting sarme surgery (concurrent with hyrax expander) to obtain width for narrow upper palate and then cda appliance for maxilla expansion (foward growth) followed by braces. I havent seen anyone online with this combination. The cda appliance is similiar to fagga appliance as shown here; https://www.robinatowndental.com/jaw-expansion-without-surgery. Note i am a young adult so all my maxilla sutures are fused. Thought i would be interesting case study. I think i have some interesting insights.
1) How i got narrow upper arches and recessed maxilla; pet for prolonged led to nasal congestion. Even when my nose was blocked i didnt mouth breath during day when conscious (only when asleep). This interesting; instead of opening mouth to increase airflow, instead i accepted lower oxygen intake and co2 outtake and my eyes became very sleepy; indeed i was always tired during the day. Mouth and nose muscles basically were not functioning; no muscle lip development. In a state of hyperventilation but closed mouth meant my concentration wasnt too bad; my high school marks were still outstanding despite this annoyance. See attatched pictures.
2) To improve this problem prior to orthondontic intervention i found that applying a velcrostrap around jaw (to keep mouth closed) coupled with tape on lips led to the development of some facial lip muscles which enabled better breathing and swallowing patterns. Since my tongue cant fit in narrow upper palate swallowing properly is difficult. I found swallowing like this helpful to build the use of tongue and lip function; close teeth together, lips together, flare the nose; now blow air into front of mouth while doing cheesy smile then swallow with good posture. I found this way of swallowing led to forces being exerted outwards and upwards on teeth and maxilla. I could feel force being transmitted though nose cheekbone and some forehead and eye socket. If i do not blow air into front of mouth with lips closed i find my swallowing is more of a sucking pattern whereby i swallow and suck at the time and basically pull teeth backwards and maxilla backwards. I have noticed my repeated my special swallowing pattern + velcrostrap and tape and led to much improved mouth function; breathing is better; eyes less sleep; lips and tongue stronger, little bit of maxilla expansion. Note i have had no orthondontic treatment thus far.
3) "mouth breathing" with lips closed. I never been a mouth breather but still have lips closed; imagine gagging with mouth closed; i use air my mouth to breathing through nose with tongue inbetween teeth (to get it out of my throat). Since i cant use my tongue properly I must rely tips 2 to improve breathing. Even with poor tongue posture i have seen good improvements by use of 2)
4) Breathing and body posture; i have noticed that some people breathe by burrowing their head into their neck. https://www.youtube.com/watch?v=0pOcU8dHtgw; malcom turnbull does this; nose his upper back is quite rounded from doing so; note the face is also quite long; https://www.google.com/search?q=malcolm+turnbull+young&source=lnms&tbm=isch&sa=X&ved=0ahUKEwifzM7UorjfAhVFMo8KHQqHAwYQ_AUIDigB&biw=1163&bih=526&dpr=1.65#imgrc=WjoqxpXEJwLDOM:
Others breathe with their stomachs, some by sucking in on teeth as this guy and with bulging eyes; https://www.google.com/search?q=mitch+mcconnell%3B&source=lnms&tbm=isch&sa=X&ved=0ahUKEwigwfzZo7jfAhWIqY8KHRTHBAsQ_AUIDigB&biw=1163&bih=526&dpr=1.65#imgrc=K2O0FqUjGl0hCM:
Others have sleep eyes.
What i am saying is this; breathing requires a certain tension to keep the body relaxed. This tension can is properly exercised with tongue on palate. But of course burrowing the head into neck, squeezing gut out, bulging eyes, sleepy eyes (body in flight mode), sucking hard on teeth with lips are all ways in which the body compensates for poor mouth and palate development. Personally i through my school years used my posture to breathe; i would burrow head into neck (my upper back is quite rounded) with sleep eyes; the sleepy eyes is due to tongue in airway and so lack of airflow with mouth closed. This forces the lower jaw downwards so that air is placed in mouth which then allows nasal breathing albeit poor.. I hope you understand with my poor explaining how breathing is altered when mouth development is poor.
5) Breathing and abdominal muscles (including diaphragm). Incorrect breathing leads to shallow chest breathing, poor development of torso muscles (including diaphragm) and thus poor posture/ worser fitness. I noticed that with mouth Velcro shut and lip tape that i would wake up more refreshed and with slight soreness in the belly; muscles were being used that weren't being used before. However my back was rounding to do so, suggesting that to breathe from belly required me to bend my back becuase i didnt have the muscle development in abs to breathe from belly and stand fully upright simulatenously.
Attatched below are some of my pictures. Notice my mouth development is poor but my neck posture is still straight.
Pictures include; orthondontics photos and xrays;
Since you are going to use a skeletal expander did you consider using MSE? That would save you the burden of surgery and still expand your maxilla. You could also use it with a face mask to expand forward a little.
my story: http://www.aljabri.com/blog/my-story/
Since you are going to use a skeletal expander did you consider using MSE? That would save you the burden of surgery and still expand your maxilla. You could also use it with a face mask to expand forward a little.
I'm very interested to see the results from SARME (or even DOME - out of Stanford which is less invasive than SARME). Very exciting! If my teeth looked like that, I'd be really very cautious about trying to move dentition forward. The dentition looks like class 1 already... https://support.clearcorrect.com/hc/en-us/articles/115007235967-Glossary-of-technical-terms The bottom teeth are already losing gums since they're forward a bit. It looks like those back wisdom teeth may be trying to squeeze in on the bottom where there's no room. Top ones not in sight yet. I haven't heard of anything bad by removing bottom wisdom teeth, though I haven't researched it too much & cannot make personal recommendations. You won't find any orthodontist to throw you out of class 1. Especially with CDA. The gums above your/for your teeth are already pretty light.
You may want to look at "Tooth Size Discrepancy" here:
https://drbarrowes.com/before-after-gallery/
Also, I haven't looked too much into this... but heard this really works great... https://www.desertrosedental.com/treatments/pinhole-surgical-technique/
There's a bit of a dance required when having orthodontic treatment. Part is taking some steps.. and part is relying on your partner. Find someone you trust and seek multiple opinions if necessary.
Personally, I would not agree with @abdulrahman suggestion to do facemask on maxilla. Perhaps facemask overall? Look up facemask thread about the "bow"... but I still think it's a little early and I haven't seen any results from the bow yet. Their before/afters are taken from elsewhere. Problem is.. if you do with maxilla, you have to do with mandible. And adults can't to facemask unless disarticulated. I suppose if you wanted to go hog wild...
SARME with hooks and controlled protrusion of maxilla. But then you'd have to follow it with surgery on mandible.
It doesn't look like your profile outline is bad. Airway looks like it has space behind teeth and I don't know why you'd want to pull everything forward.
If it were me, I'd do DOME or SARME and maybe a little gum stuff on bottom and filler of teeth on top. Call it good. If the reason to pull forward is to balance the nose... I'd just directly address that instead with consult with plastic surgeon. Do you have a tongue tie? https://www.youtube.com/watch?v=gQihz4JOPps My guess is that even if not... then the tongue muscles may need to be exercised.
In regards to the bottom jaw; i think i have a bit of an underbite anyway so the forward growth by the cda expander will be met by bottom jaw coming up and forwards. I know this to be true becuase i tend to talk with my lower jaw jutted out. My orthodontic said that i could get periodontial disease so i appreciate your input and will try follow it up; do not want me teeth falling out. I dont have tongue tie either.
In regards to the bottom jaw; i think i have a bit of an underbite anyway so the forward growth by the cda expander will be met by bottom jaw coming up and forwards. I know this to be true becuase i tend to talk with my lower jaw jutted out. My orthodontic said that i could get periodontial disease so i appreciate your input and will try follow it up; do not want me teeth falling out. I dont have tongue tie either.
Great information to have. Perio I had before. Water pick (with highly adjustable speeds so I could start low) helped a ton. They say it isn't reversabible... but my pockets improved. Also, I think pinhole is useful from talking to a dentist I trust. Interesting.
IF you were my sibling...Here's what I might suggest.
I see what you're saying on the jaw. For any lower mandibular repositioning I suggest checking condyles to see how they're shaped in socket... I honestly don't know much about it but some place that offers mandibular repositioning guidance may have ideas. I am not very knowledgable in this area. The only thing I know is that range of motion does affect non-surgical options. For example... faceliftdentistry.com does no surgery... but they redo bites all the time. Crazy pricey. Anyway... I have a wonder...
I don't know if this would apply for adults... but I had more than a few consults for my child. In the RPE camp.. some combine with braces...
Depending on how the braces are done... they can either shorten or keep longer the arch. Example... some can even leave gaps of tissue between teeth for later (secondary teethe eruption). Maxillary teeth have bigger secondary teeth. What can happen then is something interesting. If there is more space during the development of secondary teeth then they come in bigger than primary teeth... If severely crowded.. they may not have enough room to expand to the size they were meant to be. This is like where they put feet in tiny shoes or stretch necks in Africa. The bone width does appear smaller for some of your upper teeth. Leaving gaps is an option or filling in with stuff on the side. Getting coloring right can be tricky. If tou decide to broaden some teeth... you'll want to start getting to the ideal coloration now. If you're not concerned about about gaps then no stress...
Also.. I am looking again at your photos.. in my opinion... with palatal expansion there will be less v shape... more arc... this means typically that central incisors actually retrude... except that I have also seen in RPE for kids that the maxilla advances along the maxillary plane. It makes me wonder if that's due to the typical bite being used as keeping upper teeth in front of lower? That would make a lot of sense. Haven't looked too much into SARPE but my thought would be that perhaps the maxilla advances on its own... primarily driven by the bite of the lower jaw. Looking at a before/after ceph for SARPE or other jaw disarticulating RPE may (without braces intervention... just speaking naturally)... advance the maxilla to varying degrees depending on the patient and their natural bite. If this is true... I would assume thst someone who has an underbite mah get more maxillary advancement than someone with an underbite. To take advantage... if it were me... I would not worry about biting in a chin-forward position to try and "save a step" during SARPE. Instead... I would just be natural. The reason being that yanking it forward can cause a loss of posterior real estate... and sunken eyes. See my observations about facemask protrusion somewhere about 2/3 or 3/4 down my post on growing an awesome face.
Often, what happens for more arriculate control of teeth during RPE is a combination of RPE and braces. I see this in kids. I've never heard of this in relation to SARPE though I haven't looked much into it. Yep - right here: http://joeysarpe.blogspot.com/search?updated-max=2013-08-04T21:04:00-07:00&max-results=7&m=1 If it were me... I'd srart DOME or SARPE but ask for exterior bracket holders in the design and keep forward teeth forward... creating gaps as necessary. The gaps I would try to transition to about 3 or 4th teeth back... wherever CDA creates them. I'd fill the teeth to broaden. Then as done in CDA move the bavk molars up individually. That's me and so I can't give advice as I'm not a doctor. I'd trust your doctor.
Does SARPE lower the high palatal arch??? I know braces does (though limited in amount of movement). DNA does, too... but I have not seen evidence if it not pulling teeth outside of bone. I like DNA over braces due to gums moving with more. Anyway.., keep us posted!
So basically this is what you had in mind. SARPE/MSE/DOME (haven't looked too much into the differences between these but see a ton of excitement and buzz around dome... I'll start a DOME thread) followed by CDA. I'd just consider using the natural gaps that'll be created to start the CDA process. :-) Awesome! Can hardly wait to see how it goes. Hope it goes well!
I think you may be right in regards to forward growth; mabye i dont need it. I have attatched picture of my cousins mouth which is what i think mine should look like. My surgeon said sarme should create oral space to make nasal breathing easier.
I didn't say not to create forward growth. I don't know. I just said that if you're going to do CDA... save a step as your teeth will be all separated by gums with the expansion side-to-side. Dr. Derek Mahony talks about the optimal maxillary positioning here: https://www.youtube.com/watch?v=CAsBdrZmFmk But that's more for kids, IMO... who may continue to grow their arches. I would read my article on growing an awesome face: /community/community/main-forum/growing-an-awesome-face/
Orthodontists ought to have been trained on the difference between skeletal and dental classifications, I'd assume. This is taught by Dr. Derek Mahony in some videos. Facemask pulls the whole enchilada.... so unless the enchilada needs to be moved... I'd generally avoid... due to the type of conversation here: /community/community/main-forum/question-about-deep-set-eyes-and-forward-growth/
There are WAY too many factors to comment on someone's own case. I just wanted to share generic ideas. Do what you feel is best. :-) Please also keep us posted!
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