Here's how I categorize appliances in my mind. I'm sure that I have forgotten some. Every device has pros and cons. There seems to be pretty good evidence that removable sagittal expanders have the potential for significant side effects in adults. Sagittal expansion (with varying results) could be accomplised with FAGGA or by adding extra-oral traction to the bone-anchored expanders and the removable acrylic expanders. I think devices like ALF and activators like myobrace (when sized appropriately) can provide some modest transverse expansion and improve symmetry.

Removable acrylic expanders (e.g. Schwarz expander, Sagittal expander, Homeoblock, DNA, etc.)

Bone-anchored expanders (e.g. MARPE. MSE,  etc.) 

Fixed sagittal expander (FAGGA)

Symmetry and gentle expansion (e.g. ALF, myobrace, soulet besombes, K3F, etc.)

Conventional orthodontics (clear aligners, braces, etc.)

@Apollo

What is your take on if one first does the Fagga and then afterwards MSE with FM to achieve the best result possible?
With that you get expansions in all the planes. Sagital with the fagga, horizontal with MSE and protrusion with FM.

Are you also on the anti-Fagga team? Some say it only pushes the theet and not creating new bone

@Apollo

The Fagga appliace is also accredited  to widen the airways or at least create more space. You think that the same effect is possible with MSE and FM as well? Or is that Fagga exclusive?

Posted by: letsgochamp

@Apollo

The Fagga appliace is also accredited  to widen the airways or at least create more space. You think that the same effect is possible with MSE and FM as well? Or is that Fagga exclusive?

I think you would probably choose one or the other. The MSE would provide significant transverse expansion plus some forward expansion that could be increased by adding extra-oral traction (i.e. facemask, etc.). Most (if not all) of the forward expansion from this device would probably come from separation of circummaxillary sutures. In contrast, the FAGGA would provide significant forward expansion plus some transverse expansion. Most (if not all) of the forward expansion from this device would probably come from bone remodeling. I am not "anti-FAGGA," (in fact I'm considering it for myself) but I can understand the argument for why the results might be aesthetically, and or functionally better from translating the maxilla forward as a unit along sutures rather than relying on remodeling. Both strategies should increase airway to the extent that they increase tongue space. I suppose if you attempted MSE+FM and your maxilla was still retruded you could then try the FAGGA, but that sounds like a lot of effort and expense.

Thank you all so much! You guys are awesome 🤘

@apollo What changes exactly improve the airways? Is it just expanding the IMW? What benefits are usually seen from improving airway size?

I find myself having pretty poor sleep quality and I always find myself yawning and feeling tired midday even though I've had 9+ hours of sleep and follow an excellent diet.

Posted by: Pame

@apollo What changes exactly improve the airways? Is it just expanding the IMW? What benefits are usually seen from improving airway size?

I find myself having pretty poor sleep quality and I always find myself yawning and feeling tired midday even though I've had 9+ hours of sleep and follow an excellent diet.

Increasing the intermolar width will improve tongue space to some extent, but it's really forward expansion that allows the mandible to position farther forward and the tongue to sit farther forward on the palate, thereby holding the tongue out of the throat during sleep and preventing snoring/obstruction. Because the roof of the mouth is also the floor of the nose, transverse and sagittal expansion can also open up the nasal passages, improving the airway at that level. See this recent post from @abdulrahman showing more airway space in both the pharynx and the meatuses of the nose from FAGGA:

/community/community/main-forum/possibly-new-holy-grail-for-moving-the-maxilla-up-and-forwards/paged/4/#post-12340