I'll ask the clinical director. Get them all together, guys! Go... (By the way... he is legit and I just happen to be in the same city as him right now as I type this). Dropped dentistry and revamped all for airway. Love is the greatest force on the planet. All leaders in this space (the airway space between orthodontia and medical) are here for a loved one.
Is there evidence of expansion that shows teeth staying in bone? If so... how far?
For someone who does not have dental crowding, but a smaller arch perimeter (such as due to extractions or teeth not blossoming to their optimal size)....
If an overall expansion is achieved (width and length) of the dental arches... then if there are associated gaps in teeth... how do these resolve or do they? I have read that teeth will tend to float forward... but wasn't sure about molars. I believe CDA moves these one by one forward. I know that tooth size discrepancy can be address through tooth widening or potentially even implants.
Curious, you're in the same city, do you have an upcoming appointment, or..well how detailed can these questions be and what are the chances you can get a thorough answer? And we're talking about Dr. Bennet or Dr Liao?
Dr. Bennett. I don't know how thorough of an answer... but it's worth a shot. :-)
Cool. I think Dr. Bennet has a better grasp than Dr. Liao on craniofacial issues. I do have questions I'd like to have answered, but not sure which one's to pick. I'll need to think on a it a bit. Is there a time limit by which you will need all questions submited?
Cool. I think Dr. Bennet has a better grasp than Dr. Liao on craniofacial issues. I do have questions I'd like to have answered, but not sure which one's to pick. I'll need to think on a it a bit. Is there a time limit by which you will need all questions submited?
Nah... just whenever. Think about it. 
Really, his office is pretty awesome. They do some education for everyone who goes to see him. He's the only consult I paid to see. Definitely learned a lot. I have a LOT of respect for him. Saw people who come in from out of state there.
I am researching DNA appliance for a friend. Questions:
- Possible growth in sagittal and tranverse planes?
- Treatment time to achieve this result?
- Does the appliance make it hard to have tongue on the roof of your mouth during sleep?
- Can it be billed in a way that insurance will reimburse some of it?
- Case studies with good photography (lighting and head angle)
I am researching DNA appliance for a friend. Questions:
- Possible growth in sagittal and tranverse planes?
- Treatment time to achieve this result?
- Does the appliance make it hard to have tongue on the roof of your mouth during sleep?
- Can it be billed in a way that insurance will reimburse some of it?
- Case studies with good photography (lighting and head angle)
I can answer most of these. Been researching DNA/Vivos for over a year now.
- published evidence indicates both transverse and sagittal growth. However, in my opinion the evidence isn't explicit and questions as to the nature of the remodeling that has occurred remain unanswered. I am trying to get better information for myself on this topic.
-Treatment times vary, which is part of why the published evidence is unclear. Some patients report improvement in 1 week. Which suggests the appliances main source of 'I feel better' may not involve remodeling and instead reposition of the mandible to positively influence airway. Whether that be protrusion as with MADs (the mRNA is a MAD) or simply chaning the vertical dimension to increase intra-oral volume through some method that insures the airway patiency improves, is unclear in many instances. For changes attributed to remodeling my observation is that improvement is reported about 3 months into treatment time, with noticeable improvements in quality of life at 6-8months and treatment completion, and in some cases symptom resolution, at 18 months.
- The appliance does impede myofunction simply because it takes up space. Presumably the bite blocks on the appliance can...compensate for this, but who really knows. The appliance, as I understand it, to some extent acts as a surrogate tongue while also providing additional force. With the 14-16 hour wear time, myofunctional therpay can occur during the day to retrain the tongue. Also, there are many variations of the Vivos/DNA so there is probably a version which is all wire and doesn't impair tongue on palate.
- When treating airway related dysfunction the ability to bill medical will depend upon the provider. For apnea, a simple diagnosis will make it easy for nearly any Vivos provider to bill medical. For cases of TMD, UARS, or somatic disorders associated with airway dysufnction, it requires siftin through the medical history and demonstrating how facial growth has influended the patients health and how this treatment aims to correct these issues. One then has to argue medical necessity with insurers which take sup more of the doctors time, which makes it hard to get it covered. Yet, for me, personally, this is my only option, as I do not have the financial means to access care. The medical system is broken, really, as I have multipole doctors (ENT , Sleep doc, PCP, Pscyh) all saying I need care, but none taking charge to insure that happens. I've had to become very involved to make simple things happen, and getting access to treatment remains elusive despite this. Yet, I have heard many times of doctors who do the work and get treatment covered, so it's not unheard it, it's not really even particularly hard, the hard part is that the doctor needs to become educated on the medical reasons as to why correcting craniofacial growth impacts medical issues and demonstrating that their ability to correct that facial growth will address those medical issues (if not with clinical trials, then with a very explicit illustration of the foundational science). Insurance can be very difficult to work with, and something many dentists are intimidated by, and opt to avoid however possible (by doing direct pay, or using a third-party service to bill medical, or saying 'you pay us, then we file on your behalf, and maybe you get something from insurance'. I gather some Vivos providers use a third-party provided by Vivos corporate, and some have their own arrangements, and some do it in-house because they're already experienced with TMD/Sleep and did the work to become educated and train staff.
TLDR: Call the office and ask the staff of the practice on their billing practices with medical.
- There is published research on the DNA/Vivos which shows a lot of promise. It's not as explicit as Won Moon's MSE research. I have other issues with the research that I am trying to get answers to. My opinion is the appliance is doing something, in some people, some of the time, but it's unclear what. Why did the AHI drop from 70 to 1? Is it really because the jaws remodeled, or is it for other reasons...there's so much going on with airway to where honestly the published research is somewhat misleading in some instances, and in others was published before some knowledge became more well-known and thus may have simply been overlooked. Appliance therapy with the DNA does seem to provide positive results in some cases, and in others there some sign that maybe the positive results aren't really so positive. This is something I'm looking into and think eventually I'll need to make a youtube video about to educate others about (patients primarily, but also providers).
Thanks, that definitely helps. During a consult with a DNA appliance provider, I was quoted 5mm in both directions as possible. I decided to go with the AGGA in the end, because I felt that I might need more than 5mm forward growth, and AGGA had more information about sagittal results. I also hoped that despite a long treatment time, the AGGA would "front-load" the results earlier in the treatment to help my sleep. But the DNA appliance could make sense for someone who needs more transverse growth and less forward growth than I do.
Another question: Does the DNA appliance require a braces phase after to close gaps? How long is this phase? We need this info to know the total treatment time.
Another question: Does the DNA appliance require a braces phase after to close gaps? How long is this phase? We need this info to know the total treatment time.
I haven't noticed any major gaps presenting with the cases I've seen for the DNA/Vivos. No diastema. Some spacing between the teeth increases, suggesting either jaw growth or (devils advocate) teeth tipping. Though I do believe they have reclaimed premolar spaces using this technique. DNA/vivos expands slowers and seems to do things differently; promotes growth like the body is 'supposed to' and thus it adapts without needing braces to move stuff into place. The face knows how to organize itself when the right inputs are provided. Though, it seems relatively common to finish some cases with aligners or braces, it's unclear how much of that is cosmetic or geared towards orthopaedics/airway.
I haven't noticed any major gaps presenting with the cases I've seen for the DNA/Vivos. No diastema. Some spacing between the teeth increases, suggesting either jaw growth or (devils advocate) teeth tipping. Though I do believe they have reclaimed premolar spaces using this technique. DNA/vivos expands slowers and seems to do things differently; promotes growth like the body is 'supposed to' and thus it adapts without needing braces to move stuff into place. The face knows how to organize itself when the right inputs are provided. Though, it seems relatively common to finish some cases with aligners or braces, it's unclear how much of that is cosmetic or geared towards orthopaedics/airway.
Hmmm, if there is expansion without opening up spaces, this would definitely be a big advantage over treatments like AGGA, where 2/3rds of the treatment is braces to deal with the gaps and move the back teeth up. However, I would worry that without spaces, it's hard to prove how much expansion happened. Even ALF, which works very slowly can cause spaces, so there must be something special about the DNA appliance if it's getting expansion without spaces.
Hmmm, if there is expansion without opening up spaces, this would definitely be a big advantage over treatments like AGGA, where 2/3rds of the treatment is braces to deal with the gaps and move the back teeth up. However, I would worry that without spaces, it's hard to prove how much expansion happened. Even ALF, which works very slowly can cause spaces, so there must be something special about the DNA appliance if it's getting expansion without spaces.
AGGA does things different from DNA/Vivos. AGGA is mostly all just AP repositioning, while DNA does more palatal expansion and some AP/Midfacial growth and...I think, maybe it can change maxillary cant/pitch/yaw to some extent while agga just draws things forward. Not a lot of information on AGGA and my knowledge has limitations. Could be AGGA does far more than I think it does; uncertain due to lack of published data.
In my view, combining the two treatments could have benefits as each has limitations and strengths. I think the theory of craniofacial epigenetics has a great deal of merit; the idea that waking up genes which are dormant through the right signals would then allow those genes to fully express could easily account for the growth we see both in AGGA and the DNA/Vivos. I think, in the paradigm of epigenetics AGGA and Vivos are incomplete in getting genes to express, and I think that is why combing them is likely to yield a superior result.
Another way to say it is, many of us with craniofacial underdevelopment have a phenotype of genetic expression (Class 1, 2, 3, high-arched palate, etc). The AGGA can influence part of the genes leading to the phenotype, and alter the phenotype in one way, but in others, it does not. So too can the DNA/Vivos. In terms of a metaphor, it's like having a room with toys on the floor everywhere - problem, cluttered floor; type of clutter, toys; solution, clean floor; the AGGA cleans one part of the floor and the DNA cleans another part, and that leaves us with a mostly clean floor, but parts of the floor will still be cluttered. We're really in our infancy in trying to understand how and why the face grows and ways to influence it for 'ideal' growth. I think it's quite likely that while some of the genes involved can be woken up, and stems cells recruited to remodel and provide new growth, there will be aspects which are tied into early development and we won't be able to influence non-surgically. Keep in mind, that with this theory we have an explanation for what is occuring, but it doesn't offer much in terms of predictability. The field of epigenetics shows different people have different responses to the same inputs due to differences in biology - how to consistently get optimal outcomes isn't established. It'll be many years until that day, but currently there are options where before there were little to none.
It definitely sounds correct that each expander addresses some aspect of the problem. Unclear whether the mechanism is epigenetic, or whether the DNA appliance is more epigenetic than other appliances (though it's true that jaw development is not genetically fixed).
AGGA treatment does have some transverse expansion in the braces phase, when the sagittal expander has been taken out and the FRLA intermolar wire put in. My understanding is that the FRLA provides transverse expansion (up to 7mm my dentist claims), while the wire provides an anchor for the braces without retracting the expansion from the AGGA phase. Here is one of Anne Maree Cole's finished cases with the results.
What I am now wondering is if there is some difference between the transverse expansion of the FRLA in the Controlled Arch phase, vs the DNA appliance.
I have been wearing the DNA for over 15 months now. My health (TMJ and sleep) improved a lot. My treatment isn't finished yet but if anybody has questions I'll do my best to answer them.
However I'm also quite interested what darkindigo will find out :)
I have been wearing the DNA for over 15 months now. My health (TMJ and sleep) improved a lot. My treatment isn't finished yet but if anybody has questions I'll do my best to answer them.
However I'm also quite interested what darkindigo will find out :)
Well, I'd be very interested in pictures showing progress so far. Any information on treatment progress (how much expansion, increases in nasal volume or pharyngeal volume, etc). Also curious which Dr. you saw and your impression of them.
I measured my intermolar width and it increased from 34/35mm to 39mm. However my orthodontist prefers another method of measurement. I expanded about 1mm a month.
I have never measured my nasal volume or pharyngeal volume. But nasal breathing got a lot easier.
As I already got threatened by my previous orthodontist and my insurance I'm afraid to post pics. I'm sorry.
Threatened by your ortho and insurance? Seems odd that they'd want to limit you from sharing your medical records however you choose. I'm not sure that's even legal.
Here's another question: Does the DNA appliance require monthly adjustments like AGGA and most other appliances?
Here's another question: Does the DNA appliance require monthly adjustments like AGGA and most other appliances?
Yes. It is adjusted usually once of a month. I've heard of providers extending visits though. doing 1 0.25mm turn every 10 days instead of every 7, which would alter the once of a month to a bit longer between visits.
Don't know if this is a dumb question but I'll ask anyways. Would the doctor be willing to treat patients out of the country? As in the patients sending plaster casts and the doctor creating the appliances for them?
I ordered a palate expander from Germany, but I'm not sure it will cause any effect in forward growth as they say the DNA does. And I'm not able to travel at the moment :/
Any more updates on DNA appliance - is it the same as Homeoblock? My dentist uses Homeoblock and said it's the same device - and he said FRLA is superior as it works quicker.
May I ask approximately how much this treatment is costing you? And how long it will take?
How does the Vivos appliance feel in your mouth at night? My son (19 yo) tried the myobrace for one night and spit it out. I know he needs some kind of appliance (he sleeps with mouth open and has sinus and tmj issues), but compliance is going to be an issue.
Vivos DNA and mRNA appliance results look natural. Just take a look at the speaker in the video below who underwent the Vivos Treatment.
I've noticed this as well. It's the leading reason I was drawn to DNA/Vivos over MSE. MSE for sure makes a bigger difference. Even from the outside, you can easily see the maxilla expansion. The problem is, most men with narrow palettes *also* suffer from weak jaws and recessed chins. In men especially, the wider maxilla only servers to highlight and emphasize this problem. So while the smile looks better, his overall facial appearance isn't strongly improved. He ends up looking better in one sense, but as a whole looks even more "off". One patient in particular went from looking weak and underdeveloped to almost looking deformed.
From what I've seen, an MSE for someone with a weak jaw and recessed chin is only advisable if paired up with either a BSSO or a wrap around jaw implant.
I'm currently in the process of determining whether to undergo AGGA or DNA appliance treatment. One orthodontist I spoke to advised I needed at least 1cm growth both laterally and forward but wasn't comfortable treating adults without surgery, yet another one advised he thought 5-7mms would be good (he recommended homeoblock for my case which from what I understand is basically the same as the DNA appliance). As such I have gone for a third opinion, this time to a DNA appliance provider who also does AGGA. He has given me a one night sleep test kit to do at home and advised that depending on the results of that will determine what his recommended device is. Funnily enough, the orthodontist that recommended the homeoblock said that my issue wasn't really forward growth but more so transverse growth. I guess this would make sense then that he recommended the homeoblock instead of AGGA as from my understanding AGGA does not really address lateral growth (it does to a limited degree in the controlled arch brace phase). I'm curious to see what the DNA provider recommends to me based on the results of my sleep study. I suppose he will recommend AGGA if my results are worse than expected, but I'm leaning more towards the DNA appliance system at this stage from what I have read. AGGA seems to leave more room for further issues down the line.
Hey there. How is it going with DNA? I read this whole thread and I want to know more. I have TMD (extraction orthodontics as a teen). I am considering ALF or VIVOS.
Thank you for your previous informative posts!
Thanks for sharing your story! I agree with so much of what you posted about this last year. Your point about "The belief that everyone should have killer jaws and model-like bone structures are likely flawed" is probably one of the single most important sentences anywhere on this forum. I kind of get sad that some people here are so concerned about their appearances despite having perfectly functional jaws and airways.
I, myself, do not have perfectly functional jaws and airways. So for me, the consideration of Vivos (which I hope to get started on next month) is - to a certain degree - life and death (I am severe obstructive sleep apnea, but currently being "managed" via CPAP).
One question for you, if you don't mind my asking? How did your provider know you were "done"? This is the one part of the Vivos equation I've simply not been able to uncover. I know pretty much every other part of the protocol and how they deliver it ... but I have no idea how any particular provider comes to the conclusion that a patient's treatment has completed. Obviously, if you try to push too far you would risk damaging the oral structures ... but I've no idea how individual providers figure out when a patient has crossed the finish line.
Have you considered post-treatment traditional orthodontics to get your smile aligned back nicely again? Seems like some patients seem to do this, whereas others just decide to skip it.
Do you feel that your face became more symmetrical? Do you see a difference between your before and after photos?
Thanks! That tends to mirror other inputs I’ve received, that it kind of just becomes a “we’re done when we’re done” kind of thing.
So were you a sleep apnea or UARS patient, is that why you sought out Vivos treatment?
Thanks for the additional info! I wish you well as you continue your journey! The entire breathing equation is a complicated one, for sure ... and I think we are just starting to unlock its secrets. Certainly, getting enough air initially - making sure airways aren't impaired/cramped - is the first step, and that's something that Vivos seems like it can help with.
My wife just sent me an interesting link the other day about a technique from the "Postural Restoration Institute" that is very breathing focused - apparently there's a guy on YouTube and he's actually trained a couple hundred people, including physical trainers and ... dentists.
https://elemental.medium.com/everything-you-know-about-good-posture-is-wrong-cca9b941b651
The Vivos System is not meant to make a person look like a model. Models are born not made. Vivos will change your face in very subtle ways. I already look very different than when I started. My upper face appears fuller, my jaws have moved slightly forward, my breathing is phenomenal. I'm not entirely sure of this but Vivos aims at giving the patient what they should have had if they had grown under perfect conditions for craniofacial development. Under this idea, once the treatment is finished you can go on with your life as opposed to looking for other treatments to fix the part of the equation that your current treatment failed to address.
There's no use in undergoing Agga, or MSE if they eventually solve a problem yet create another one. The Vivos system is utterly gentle and it moves linearly, one step at a time, as opposed to other alternatives that move one step forward but two steps back. Vivos is mainly addressing breathing, airway, and overall well-being by default maps to the development of underdeveloped jaws.
The belief that everyone should have killer jaws and model-like bone structures are likely flawed. This can be proven by looking at before and afters of AGGA treatment. As you said, the faces look deformed. One guy looked like a completely different species. Their faces were not designed to contain the jaws that AGGA has given them.
Vivos will never go outside of bounds. It will give you exactly what you're supposed to have, no more, no less. It is a treatment to enhance all areas of your life, not only your facial structure. Additionally, most of these other alternative treatments pale in comparison to Vivos in the testing as they don't seem to care too much about what's going on inside. Vivos will create a completely unique treatment plan based on a series of tests including a sleep apnea test + dental ct scan which they will use to model your airway. After the treatment, they will test again and show you the results.
My replies definitely sound like an advertisement but I'm sort of explaining my reasoning as to why I decided to get for the mysterious arcane "epigenetics" route rather than the brute force alternatives.
Hey, just wanted to ask did the DNA appliance manage to split your midpalatal suture? If not, where is the expansion coming from?
Does the DNA appliance promise forward growth and upswing? Or just forward and lateral expansion?
Does the DNA appliance promise forward growth and upswing? Or just forward and lateral expansion?
If you just focus on "split the mid-palatal suture", you're looking at things the wrong way. You're trying to take a DOME or MSE or EASE success metric which is two-dimensional, and assume it is the one you should be using.
Whether you agree with that sentiment or not, that is how Vivos views this. So if you keep chasing "mm's of spit at the suture" you'll likely end up disappointed.
Vivos believes that changes are happening in 3 dimensions, everywhere. Pay attention to figure 4 and table 2 in this peer-reviewed research report - they measured total bone volume (not just width) pre- and post-treatment, and were able to document about 2 additional cubic centimeters of bone material. That's the size of a set of six-sided dice.
The only thing that DNA promises (and even that, is not a guarantee) is that you have a good chance of having your sleep apnea cured if you are in the "mild" or "moderate" tiers. That is because they believe that not only the changes in the maxilla and the palate are at work, but also sinus cavities getting bigger (documented), nasal passages getting bigger (documented), and pharyngeal structures getting bigger.
So you're never really going to find "how many mm's can you make?" research for them ... because they don't seem to think it's the right playing field for them to be arguing on.
You can agree with it or disagree ... but I wanted to save you some trouble of trying to keep tracking down something that you won't find, because Vivos doesn't think it's important. They even have one case they presented where a patient got about 1mm additional transpalatal width ... but actually cut their AHI from 14 down to 7. That's pretty significant. That's why they specifically state "this is not palatal expansion."
Any changes that might be happening in the suture, are believed to be due to stretching forces. The simultaneous downward suction created by appliance making contact with the roof of your mouth only when you swallow, combined with the light outward forces laterally. Imagine standing inside of a little monopoly house, and tying a rope to the roof and gently tugging at it, while also gently pushing out at the walls. All through intermittent signaling (not constant force like AGGA). The roof will lower, even if you don't make any additional roofing material. You'll get more transpalatal width and you will lower your nasal floor (very big for us OSA people) even if there is zero bone creation at the suture.
MSE jams a crowbar into the roof and splits the monopoly house in two. So, that's another way to do it. But IMO it might not deal as well with the "vaulted maxilla" situation that many OSA/UARS patients are coping with.
Here's something else for you to review - they used these same kind of "intermittent stretching" forces on the palatal sutures in rats and guess what? The sutures grew: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/
I believe there is a scientist at Columbia who has replicated the same type of research, but in humans.
There are no other promises outside of having a good chance of lowering your AHI, potentially to the point of being cured.
But if you want to see an example of "upswing" - here's a very early DNA patient (a dentist in FL, who then became a provider as well):
@toomer this is a way better explanation than the one I got at my patient education session. They should hire you to do it.
The only thing that bothers me about the Before/After they included (the one you've included above) is that the angles of those two pictures are so painfully different. In the before it's clearly taken from a much lower angle. I don't doubt she's made a lot of progress though.
@toomer this is a way better explanation than the one I got at my patient education session. They should hire you to do it.
The only thing that bothers me about the Before/After they included (the one you've included above) is that the angles of those two pictures are so painfully different. In the before it's clearly taken from a much lower angle. I don't doubt she's made a lot of progress though.
Thanks! Only spent about the last 9 months studying everything I could about them, before pulling the trigger.
I agree, the before-and-after photos weren't a perfect match of angles ... and I don't think they were even meant to be before-and-afters ... I think they are just both of her professional headshots for her dentistry practice. But it still seems pretty obvious the DNA appliance resolved her "gummy smile".
My wife has a gummy smile. Head angle doesn't make that big of a difference ... you still see it.
Dr. Griffin's case was at least 7 years ago I think, you can actually watch her present her complete case at the Vivos conference - including CBCT views and all: https://vimeo.com/296958510
@toomer this is a way better explanation than the one I got at my patient education session. They should hire you to do it.
The only thing that bothers me about the Before/After they included (the one you've included above) is that the angles of those two pictures are so painfully different. In the before it's clearly taken from a much lower angle. I don't doubt she's made a lot of progress though.
Actually, when you're downswung, you tend to look better if you take pictures from a lower angle as it shows off your jaw/chin height. If you take pictures straight-on your chin tends to look really weak or short. I'm not saying anything scientific of course, just an observation.
@toomer Yeah I appreciate everything you've typed. I'm in the same boat, on the verge of pulling the trigger and feverishly researching. My worst fear right now is dropping $8k for it to do nothing, but so far anecdotally it seems to have helped a lot of people.
@mysterecessed Good to know, and if that's truly the case then it definitely helps the Vivos case
@toomer Yeah I appreciate everything you've typed. I'm in the same boat, on the verge of pulling the trigger and feverishly researching. My worst fear right now is dropping $8k for it to do nothing, but so far anecdotally it seems to have helped a lot of people.
I looked at things on a scale. I had to ponder whether any solution would:
1) likely help, if not potentially cure
2) perhaps not do much of anything
3) potentially cause harm
For me, Vivos landed firmly in the #1 and #2 category. I ruled out AGGA pretty quickly once I saw Ronald's case.
@toomer Yeah I appreciate everything you've typed. I'm in the same boat, on the verge of pulling the trigger and feverishly researching. My worst fear right now is dropping $8k for it to do nothing, but so far anecdotally it seems to have helped a lot of people.
@mysterecessed Good to know, and if that's truly the case then it definitely helps the Vivos case
Yea I'm at the same place you are too, just afraid that I'll spend all that time and money for no result. Read a lot of good things about the DNA from people using it here though.
Does the DNA appliance promise forward growth and upswing? Or just forward and lateral expansion?
If you just focus on "split the mid-palatal suture", you're looking at things the wrong way. You're trying to take a DOME or MSE or EASE success metric which is two-dimensional, and assume it is the one you should be using.
Whether you agree with that sentiment or not, that is how Vivos views this. So if you keep chasing "mm's of spit at the suture" you'll likely end up disappointed.
Vivos believes that changes are happening in 3 dimensions, everywhere. Pay attention to figure 4 and table 2 in this peer-reviewed research report - they measured total bone volume (not just width) pre- and post-treatment, and were able to document about 2 additional cubic centimeters of bone material. That's the size of a set of six-sided dice.
The only thing that DNA promises (and even that, is not a guarantee) is that you have a good chance of having your sleep apnea cured if you are in the "mild" or "moderate" tiers. That is because they believe that not only the changes in the maxilla and the palate are at work, but also sinus cavities getting bigger (documented), nasal passages getting bigger (documented), and pharyngeal structures getting bigger.
So you're never really going to find "how many mm's can you make?" research for them ... because they don't seem to think it's the right playing field for them to be arguing on.
You can agree with it or disagree ... but I wanted to save you some trouble of trying to keep tracking down something that you won't find, because Vivos doesn't think it's important. They even have one case they presented where a patient got about 1mm additional transpalatal width ... but actually cut their AHI from 14 down to 7. That's pretty significant. That's why they specifically state "this is not palatal expansion."
Any changes that might be happening in the suture, are believed to be due to stretching forces. The simultaneous downward suction created by appliance making contact with the roof of your mouth only when you swallow, combined with the light outward forces laterally. Imagine standing inside of a little monopoly house, and tying a rope to the roof and gently tugging at it, while also gently pushing out at the walls. All through intermittent signaling (not constant force like AGGA). The roof will lower, even if you don't make any additional roofing material. You'll get more transpalatal width and you will lower your nasal floor (very big for us OSA people) even if there is zero bone creation at the suture.
MSE jams a crowbar into the roof and splits the monopoly house in two. So, that's another way to do it. But IMO it might not deal as well with the "vaulted maxilla" situation that many OSA/UARS patients are coping with.
Here's something else for you to review - they used these same kind of "intermittent stretching" forces on the palatal sutures in rats and guess what? The sutures grew: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417680/
I believe there is a scientist at Columbia who has replicated the same type of research, but in humans.
There are no other promises outside of having a good chance of lowering your AHI, potentially to the point of being cured.
But if you want to see an example of "upswing" - here's a very early DNA patient (a dentist in FL, who then became a provider as well):
Hey, thanks for taking the time to explain this. Yea I was pretty hung up on the mid palatal suture split as I thought it was the only way to achieve forward growth or upswing in adults. I'm really surprised that you can get forward growth with the DNA appliance without any suture splits. Do you have any theories about this? Have you been experiencing forward growth and upswing yourself too?
Just to clarify, does DNA help align your top teeth as well and give results similar to braces in terms of having straight teeth? What's your experience so far?
Also, are you doing anything for your mandible or lower teeth as well? I have crowding on my lower teeth as well, which I think might suggest there could be room for growth? Anyway, I'd definitely need to do something if I do DNA on the top palate.
Hey, thanks for taking the time to explain this. Yea I was pretty hung up on the mid palatal suture split as I thought it was the only way to achieve forward growth or upswing in adults. I'm really surprised that you can get forward growth with the DNA appliance without any suture splits. Do you have any theories about this? Have you been experiencing forward growth and upswing yourself too?
Just to clarify, does DNA help align your top teeth as well and give results similar to braces in terms of having straight teeth? What's your experience so far?
Also, are you doing anything for your mandible or lower teeth as well? I have crowding on my lower teeth as well, which I think might suggest there could be room for growth? Anyway, I'd definitely need to do something if I do DNA on the top palate.
So one thing I haven't quite gotten all the research down on yet, is that there is potentially forward growth but there is also potentially forward movement. Both would be helpful, IMO, in treating sleep apnea.
I am not currently in the appliance. My provider wanted to work on my mandible first to stabilize it and get my TMJs into the best possible spot first before starting on maxillary expansion. I am expecting to get started in the next month or two.
Funny you mention braces - yes, that was actually the background/history on the entire invention. Dr. Belfor in NYC (inventor of Homeoblock) says he was working with broadway professionals who would be going to do a new headshot photo for their portfolio, and they maybe wanted to straighten a tooth here or there, but they didn't want braces (and I think this was before Invisalign really was a thing). So he built removable appliances to slowly do orthodontic (moving teeth) corrections from behind. And then - if you hear him tell his story - these broadway professionals were not only happier with their straightened teeth, but they felt like their singing ability to carry and sustain a note had improved too. That they were projecting better.
If you look around for some of the Homeoblock videos floating around out on YouTube and Vimeo, you can see some time-lapse views of the dental arch expanding and the teeth moving a bit to straighten. Part of that is just the body doing it on its own (ancient skulls dug up almost always have perfect teeth, the body knows where to put them) but the "axial springs" in the front can also be used to nudge the teeth a little bit as needed. The net result - if you listen to Dr. Singh or Dr. Belfor on this topic - is that most patients don't really need braces after treatment. Some might opt for it to just perfect things a bit more, but many don't feel a need.
As for most patients going through DNA (I may be an exception, either based on my case when I started, or my provider just does things a bit differently) there is also a lower appliance that is often used as well, which also has a midline expansion screw. Some patients need to wear that during the day, probably to help nudge a little bit more growth into the mandible above and beyond what normal chewing will do to make sure the upper and lower jaw are working together.
To be honest, it was this "dual" approach - appliances for both the upper and lower, which can then be coordinated with each other if needed (perhaps via hooks, or rubber bands, or whatever) to make sure both jaws evolve on a similar pathway - which made me really appreciate the DNA approach over other tools. And this is in addition to the occlusal molar pads which are adjusted as-needed during visits to make sure good occlusion is maintained throughout treatment.
Finally, for me - DNA is the only one where the creator has actually published research on really curing sleep apnea. Dr. Moon (MSE) has not published any research like that which I have found. So being a severe sleep apnea patient, and once I felt that DNA was not like other appliances and I didn't think there was risk to my teeth ... it became the #1 choice on my list.
Yes, It happened because I opened the appliance too much. The spacing fixed itself after I stopped wearing the appliance once my dentist told me that my treatment was done.
Did you expand the appliance beyond where your DNA dentist advised you to? Or just faster than he/she advised you to? Because spacing between teeth is not necessarily an unexpected effect from this treatment.
If you imagine driving a tiny car from your upper left rear molar all the way around the incisors and back to your upper right rear molar - in theory that “travel distance” around the arch is going to get longer as you expand. But your teeth are obviously going to stay the same size. Thus, spacing is somewhat inevitable for most patients. Sometimes the body will re-shuffle the teeth back into good position (if there was crowding), sometimes it won’t and patients just leave it, and sometimes braces are a follow-up phase afterwards.
How big was the spacing? Was in the front or back of teeth?
@hannah7404 DNA providers can generally approach this a couple different ways. If they want to "recapture" previous bicuspid extraction spaces to then put in implants, there are ways that they can try to target that. But if someone doesn't want to do 4 implants to replace teeth that were taken away in childhood braces ... the space just kind of occurs everywhere, and then post-DNA orthodontics can be used (brackets or Invisalign) to straighten up the teeth again. This may involve pulling the molars forwards, though, which takes a bit more time/work as far as I understand it.
I am not understanding you Toomer.
@hannah7404 If you think about “travel distance” as measured from your left rear molar, around the front incisors, and to the right rear molar ... expansion will make that distance longer, but your teeth are the same size.
Imagine a tiny car driving from the top of your left molar, around the front, and back to the right molar. That’s the distance I’m talking about getting longer with an expansion.
Maybe cars are a better analogy. Imagine you have a 1 mile long stretch of road, and it is filled with cars that are perfectly bumper to bumper. Now imagine you grab the road at each end and can stretch the road out to be 1.2 miles long. There’s more road now, but the cars are still the same size. So the cars will end up with space in between them somewhere, whereas previously they were all bumper-to-bumper.
If you get expansion, spacing is inevitable. The question will be where does it show up. DNA providers have techniques where they can try to “direct” this space to accumulate right behind your canines if you want - some people who had bicuspid extractions for braces pursue that course, in order to basically re-add those teeth back via implants once the space is open. But implants can be expensive, and some people don’t like them, so in some/many cases people just opt to let the spacing between the teeth to occur “wherever” naturally ... and then at the end make a decision about asthetics. If it’s not too bad, they just leave it - one DNA provider told me they only do orthodontics in about 50% of cases. But other patients often want to have a picture-perfect smile again, so they do braces or Invisalign after DNA to close up the spaces.
@toomer Yeah I appreciate everything you've typed. I'm in the same boat, on the verge of pulling the trigger and feverishly researching. My worst fear right now is dropping $8k for it to do nothing, but so far anecdotally it seems to have helped a lot of people.
So did you pull the trigger?
@toomer how big is the spacing usually like gaps? I’m getting married next year plan to start appliance end of month. They are putting me in a top appliance first for six months the appliance that comes with the tail. It looks more like the MRNA instead of the other one. Thanks for answering my questions! I’m just debating. I already had straight teeth just got braces off. I want to stop my clicking popping and front teeth are protruding some causing my chin to look weak and mess with my speech.
@hannah7404 No real way to predict it. Let's just say that it shouldn't be so large that a good wedding photographer with good photoshop skills could easily make minor corrections to your wedding photos.
If you were of a mindset to get implants to replace extracted bicuspids, those typically measure what is called "7mm A/P" which means that even though the tooth may be wider than 7mm, given that it's angled a bit ... it only takes up about 7mm of space as measured from your nose to the back of your head (anterior/posterior).
So if you got enough expansion to get to bicuspid implants installed (and even that isn't certain for every patient) that would be about 14mm of space they would have collected into those two spots to make room for the implants.
So if you choose not to do implants, imagine maybe 10-14mm of space being spread out somewhat between all the teeth. Most people have 14 or 12 teeth, so it's not huge. But, it might be noticeable in-person. Again, nothing that a good wedding photographer couldn't fix up in post-processing for you.
Good luck! Be sure to keep us posted here on your progress!
@hannah7404 The creator and treating dentists all make claims that it does:
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Is it real, or just angles / hair / lighting? You'll have to decide for yourself. The inventor(s) published a study where they claimed to have measured both oral changes (30% increase in maxillary arch) and facial changes ... including "intercanthal angle" changes, which is the angle your eyes are at.
https://pubmed.ncbi.nlm.nih.gov/15641449/
If those are all true/accurate, then yes - it would seem to create changes to you whole face.
@chickenita do you have any spacing or huge gaps in your teeth? I am estimated 12 month treatment to help with my face development and TMJ clicking popping headaches. I have a wedding coming up in 7 months.
@chickenita do you have any spacing or huge gaps in your teeth? I am estimated 12 month treatment to help with my face development and TMJ clicking popping headaches. I have a wedding coming up in 7 months.
Hello Hannah,
I am now in my fourth year of TMJ treatment. So my time with the DNA Appliance is some years ago. I didn’t not get any spaces in the upper arch during the treatment with the DNA Appliance. I had some crowding so my teeth moved in the right direction and filled the gained space. I have a little space in the lower arch but I don’t remember if it came from the DNA Appliance. I don’t have problems with this little gap.
Then I got the RAGGA appliance for the upper arch and kept the DNA for the lower as a retainer. With the RAGGA I got a little diastema mediale, not more than a millimeter. Many people have greater gaps without Orthodontic treatment. So I would have married the right guy :D
@ancoratu Why dont you just imitate the same posture ? To show us how much “growth” you had with vivos appliance lol
Skull and Jaw Correction
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