I recently found a doctor that uses the MSE device, so before I meet with him I've decided to dig in and do some serious homework. My first plan of action was to start coming up with a document of @varbrah's approach and all the questions he's been so kind to answer over the past. I'm trying to cover all of my bases for any questions my doctor may have. As I was doing this I realized these notes may be of use to members here and a help to prevent users from asking the same questions that already have answers (admittedly, something I'm guilty of having done).
I'm hoping to keep this first post up to date with any relevant questions I find in this, and the other MSE threads on this forum. If there is something important that you feel should be added, I'll add it if the more educated users feel it's important to add.
Helpful Links:
https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf
https://www.semortho.com/article/S1073-8746(18)30009-4/pdf
Treatment Protocol
Expansion:
-Expansion of 0.8mm per day.. 6 turns per day.. 4 turns per day until suture opens (you know the suture is open when a diastema forms, some people even feel a pop or a crack when it comes apart) and then 2 turns per day after until desired expansion
-I went from 41mm to roughly 50mm IMW and 2-3mm of forward displacement of the maxilla - pure bone growth with no dental tipping
Protraction (forward growth):
-Combined with a face mask, 1kg (edited original comment based on comments later in the thread) of force per side and a force vector of -30 degrees to the occlusal plane should result in almost pure orthopedic forward movement and slight anterior tipping (ccw rotation) of the maxilla based on FEM models.
-I'm using two of the elastics (1/2", 16oz. = ~500g) per side. Keep in mind that each of those elastics exerts ~500g of force when stretched to 3 * 1/2". If you stretch them further, then they simply exert more force... 500-1500g (no higher) of force per side has been found to be suitable.
-Anchorage are the metal orthodontic bands on my 1st molars which direct the force to the MSE, so total bone anchored.
Mandible Adaptation:
As far as just expansion with MSE, the mandible should adapt fine as long as you do not expand the maxilla well beyond it. I’m using the MSE now and was able to expand from 41mm to 47mm (last measured a few days ago, probably 48mm now) IMW without disrupting my bite at all, but that’s because my lower jaw was already a bit wider
Bilateral Sagittal Split Osteotomy (BSSO) may be an option for those using the MSE/FM protocol where the mandible does not track with the maxilla.
Ancillary/Supplemental Treatment:
HGH Peptides & MK-677
Post Op Treatment:
You will relapse post-MSE, but if done right not by much. Relapse is mitigated by overexpansion of 2-3mm and then by keeping the MSE in post expansion for 3-6 months to stabilize the suture.
FAQs:
Useful Definitions & Figures for discussion:
Good compilation :)
One thing I changed my mind on after doing more research was the relapse - I think that if you take the full 6 months to stabilize the suture then little to no relapse should occur.
Just found at least one practitioner in my area who does MSE. This guy, who was partnered with Dr. Moon https://orthodontistfullerton.com/ and this guy http://www.tingortho.com/treatment-information/maxillary-skeletal-expander/
I don't know if either of them would be willing to install hooks to use a protraction device though.
Finding out about this is really making me regret getting a conventional expander in the first place. I've undoubtedly benefitted from having it in, but the results didn't yield quite the effects I had hoped for. I should have definitely have gone with the mse instead. I might just give face mask a try with my current expander, and if that's fails I'll try tongue posture for a few months, then in about a year or so if things haven't improved I might just go with the mse.
I’m using the MSE now and was able to expand from 41mm to 47mm (last measured a few days ago, probably 48mm now) IMW without disrupting my bite at all, but that’s because my lower jaw was already a bit wider
Great summary. One very crucial piece of information that is not clear is the inter molar width. Which standard of measurement is being used for those numbers? There are many standards to take this measurement and they can yield quite a difference.
my story: http://www.aljabri.com/blog/my-story/
I’m using the MSE now and was able to expand from 41mm to 47mm (last measured a few days ago, probably 48mm now) IMW without disrupting my bite at all, but that’s because my lower jaw was already a bit wider
Great summary. One very crucial piece of information that is not clear is the inter molar width. Which standard of measurement is being used for those numbers? There are many standards to take this measurement and they can yield quite a difference.
Shouldn’t matter as long as the standard being used remains consistent throughout treatment.
Shouldn’t matter as long as the standard being used remains consistent throughout treatment.
Of course it does, it might not for you, but for us to make sense of the numbers we have to know where the measurement was taken.
because this, which we follow here on the forum will produce a much smaller number:
than this which I suspect your doctor is measuring for you:
my story: http://www.aljabri.com/blog/my-story/
I am already aware of everything outlined above but yeah, no. This thread is in the context of treatment with MSE, and in the context of treatment with MSE it doesn’t matter since all of the gains will be skeletal. Why exactly would you have to make sense of the changes someone else was experiencing during their treatment when the net change in width would be the same no matter where you measured from? Is that supposed to be the mewers’ equivalent of a dink measuring contest? Gotta make sure I’m measuring bone pressed in that case 😂
And no my doctor did not measure like that. Why do you ‘suspect’ that?
I am already aware of everything outlined above but yeah, no. This thread is in the context of treatment with MSE, and in the context of treatment with MSE it doesn’t matter since all of the gains will be skeletal. Why exactly would you have to make sense of the changes someone else was experiencing during their treatment when the net change in width would be the same no matter where you measured from? Is that supposed to be the mewers’ equivalent of a dink measuring contest? Gotta make sure I’m measuring bone pressed in that case 😂
And no my doctor did not measure like that. Why do you ‘suspect’ that?
People can get confused by the different standards of measurements. Using Mew standard, 48mm is impressive but very big compared to what we discuss here. Plus you already started at a much higher width (41mm) than most people here can achieve after treatment. Unless your lower jaw is massive it's normal to assume your measurements are done differently. After all, most doctors do not use the Mew standard in measuring.
How was your measurement done?
my story: http://www.aljabri.com/blog/my-story/
I am already aware of everything outlined above but yeah, no. This thread is in the context of treatment with MSE, and in the context of treatment with MSE it doesn’t matter since all of the gains will be skeletal. Why exactly would you have to make sense of the changes someone else was experiencing during their treatment when the net change in width would be the same no matter where you measured from? Is that supposed to be the mewers’ equivalent of a dink measuring contest? Gotta make sure I’m measuring bone pressed in that case 😂
And no my doctor did not measure like that. Why do you ‘suspect’ that?
People can get confused by the different standards of measurements. Using Mew standard, 48mm is impressive but very big compared to what we discuss here. Plus you already started at a much higher width (41mm) than most people here can achieve after treatment. Unless your lower jaw is massive it's normal to assume your measurements are done differently. After all, most doctors do not use the Mew standard in measuring.
How was your measurement done?
Yeah my lower jaw is pretty big and I have a pretty large tongue too so I had trouble mewing correctly even at that IMW. And my measurement was done like you described. Initial 41mm I even confirmed on an old dental casting using that method. Right now I am around 50mm
Yeah my lower jaw is pretty big and I have a pretty large tongue too so I had trouble mewing correctly even at that IMW. And my measurement was done like you described. Initial 41mm I even confirmed on an old dental casting using that method. Right now I am around 50mm
Thanks, for clarifying. Compared to most people with malocclusion that's massive. For example, ClaimingPower barely made it to 39mm upper inter molar width and that's after almost 2 years of orthotropic treatment with bioblocs expanders and mewing.
my story: http://www.aljabri.com/blog/my-story/
Yeah my lower jaw is pretty big and I have a pretty large tongue too so I had trouble mewing correctly even at that IMW. And my measurement was done like you described. Initial 41mm I even confirmed on an old dental casting using that method. Right now I am around 50mm
Thanks, for clarifying. Compared to most people with malocclusion that's massive. For example, ClaimingPower barely made it to 39mm upper inter molar width and that's after almost 2 years of orthotropic treatment with bioblocs expanders and mewing.
Yeah aware haha. Kind of makes me think I’d be Cro Magnon mode if everything had developed properly
Yeah my lower jaw is pretty big and I have a pretty large tongue too so I had trouble mewing correctly even at that IMW. And my measurement was done like you described. Initial 41mm I even confirmed on an old dental casting using that method. Right now I am around 50mm
Thanks, for clarifying. Compared to most people with malocclusion that's massive. For example, ClaimingPower barely made it to 39mm upper inter molar width and that's after almost 2 years of orthotropic treatment with bioblocs expanders and mewing.
Yeah aware haha. Kind of makes me think I’d be Cro Magnon mode if everything had developed properly
Do you know how you find out if maxilla or mandiable is wider?
Yeah my lower jaw is pretty big and I have a pretty large tongue too so I had trouble mewing correctly even at that IMW. And my measurement was done like you described. Initial 41mm I even confirmed on an old dental casting using that method. Right now I am around 50mm
Thanks, for clarifying. Compared to most people with malocclusion that's massive. For example, ClaimingPower barely made it to 39mm upper inter molar width and that's after almost 2 years of orthotropic treatment with bioblocs expanders and mewing.
Yeah aware haha. Kind of makes me think I’d be Cro Magnon mode if everything had developed properly
Do you know how you find out if maxilla or mandiable is wider?
My mandibular arch was clearly wider and the mandibular molars tipped lingually while the maxillary molars tipped buccaly in order to prevent crossbite.
Where is your doctor located if you don't mind me asking?
In Massachusetts. I might have to pump the breaks on the celebration though. While the doctor I'm looking at does MARPE type surgeries, and according to his receptionist they use an expander device by Moon, she didn't refer to it as MSE specifically, but by another acronym like RME or RPE (neither which usually involved screws/implants, I think, but I think she was just using those acronyms as general terms for palate/maxilla expanders). When I did ask directly she said their RME/RPEs are a form of MARPEs, involving screws and such, and the only MARPE type devices that their distributor has are, in fact, MSEs (the last fact didn't come from her, I had to do some digging to find that out). Sooooo, that was just a jumbled way of me saying that I'm 99% sure I have the right doctor and the right expander (sorry, I'm exausted right now, lol).
Regardless, I decided to start a discussion with the ortho's receptionist expressing my mostly tempered excitement about this treatment's benefits on mental health and body posture (both of which their practice seems fully aware of, based on their website). She suggested I send in some pictures of my mouth for my ortho to look at, and she was happy to pass along Won Moon's research paper on his MSE+FM approach. I'll likely hear back soon, if the ortho is willing to use this approach, depending on his thorough assessment of my situation. If this practice is as helpful as their receptionist, I have high hopes.
I'll keep you all posted.
Good compilation :)
One thing I changed my mind on after doing more research was the relapse - I think that if you take the full 6 months to stabilize the suture then little to no relapse should occur.
So other than braces for diastema, you don't anticipate requiring any other appliances? Very nice.
Btw, do you have that MSE brochure you referenced in the 'holy grail' thread? I know good ol' @apollo managed to download it too, where the link was dead for me (and googling yielded no results for me either). If either of you have a live link to it, I'd appreciate seeing it!
Another question or two I suppose... and even though I'm sure the answer is obvious to a few, if I'm paying $10k for a procedure, I want to make sure I don't assume I know and get a safe answer from the master lol:
When you're not using the face mask do you recommend chewing gum and heavy mewing? Maybe it hasn't been touched on because it's obvious, but I don't think I've seen you talk about it. I honestly see myself putting in a lot of effort incorporating the chin tuck with the face mask as much as possible.... or something close to what jamo/@neveragain practiced. Do you see any value in it?
Good compilation :)
One thing I changed my mind on after doing more research was the relapse - I think that if you take the full 6 months to stabilize the suture then little to no relapse should occur.
So other than braces for diastema, you don't anticipate requiring any other appliances? Very nice.
Btw, do you have that MSE brochure you referenced in the 'holy grail' thread? I know good ol' @apollo managed to download it too, where the link was dead for me (and googling yielded no results for me either). If either of you have a live link to it, I'd appreciate seeing it!
Another question or two I suppose... and even though I'm sure the answer is obvious to a few, if I'm paying $10k for a procedure, I want to make sure I don't assume I know and get a safe answer from the master lol:
When you're not using the face mask do you recommend chewing gum and heavy mewing? Maybe it hasn't been touched on because it's obvious, but I don't think I've seen you talk about it. I honestly see myself putting in a lot of effort incorporating the chin tuck with the face mask as much as possible.... or something close to what jamo/@neveragain practiced. Do you see any value in it?
https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf
Chewing gum not recommended since it can get stuck in/under, pull on, etc MSE/braces. Mewing is perfectly fine, and yeah there is some value in it, but the MSE and FM are your workhorses.
https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf
Chewing gum not recommended since it can get stuck in/under, pull on, etc MSE/braces. Mewing is perfectly fine, and yeah there is some value in it, but the MSE and FM are your workhorses.
How are you able to posture your tongue with that thing on your palate?
my story: http://www.aljabri.com/blog/my-story/
https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf
Chewing gum not recommended since it can get stuck in/under, pull on, etc MSE/braces. Mewing is perfectly fine, and yeah there is some value in it, but the MSE and FM are your workhorses.
How are you able to posture your tongue with that thing on your palate?
With difficulty. Obviously it is impossible to mew correctly with it in as you cannot make contact with the entire palate, but I do my best to exert an upwards force at all times, and sometimes I’ll push forward with my posterior tongue against the expander when not wearing FM. Can’t hurt imo
Can't your doctor remove the expander and place a lingual wire or a Hawley style retainer that's easier on your tongue? I remember my doctor telling me about using such retention method in cases he treated with traditional skeletal expander. I wonder if your doctor left the expander in place because he can't risk removing the mini screws at this stage.
my story: http://www.aljabri.com/blog/my-story/
Can't your doctor remove the expander and place a lingual wire or a Hawley style retainer that's easier on your tongue? I remember my doctor telling me about using such retention method in cases he treated with traditional skeletal expander. I wonder if your doctor left the expander in place because he can't risk removing the mini screws at this stage.
Neither are as stable. We are doing this by the books, even recommended by Won Moon himself for the MSE protocol. I guarantee the above methods resulted in significant skeletal relapse for your doctors patients probably somewhat mitigated by alveolar ridge remodeling.
Neither are as stable. We are doing this by the books, even recommended by Won Moon himself for the MSE protocol. I guarantee the above methods resulted in significant skeletal relapse for your doctors patients probably somewhat mitigated by alveolar ridge remodeling.
I don't know, but all of his expansion was done on children in the post 12 years age range.
my story: http://www.aljabri.com/blog/my-story/
@Varbrah, I spotted above that the list mentions getting "2-3mm of forward displacement of the maxilla" under the "expansion" heading: do you mean that the expansion itself induced 2-3mm of forward movement alone, before protraction?
Thanks!
You are doing God's work!
Please keep us updated with your continued progress. Preferably with picture documentation of changes (you can blank out the eyes).
This could be really useful for people like me who think of undergoing MSE+Facemask in future.
Want to see how wide, robust and symmetric you can get.
ONE QUESTION:
If you use FACEMASK to pull maxilla forward, will it also pull MAXILLA upward which would in turn change shape of nose making it upturned? If that is a risk it is something to take into account since upturned noses are not attractive.
30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.
You are doing God's work!
Please keep us updated with your continued progress. Preferably with picture documentation of changes (you can blank out the eyes).
This could be really useful for people like me who think of undergoing MSE+Facemask in future.
Want to see how wide, robust and symmetric you can get.
ONE QUESTION:
If you use FACEMASK to pull maxilla forward, will it also pull MAXILLA upward which would in turn change shape of nose making it upturned? If that is a risk it is something to take into account since upturned noses are not attractive.
Nasal tip rotation, not rotation of the entire nasal complex which would result in the exposed nostril look you are referring to and also probably impossible to acquire unless you already genetically have that nose shape
You are doing God's work!
Please keep us updated with your continued progress. Preferably with picture documentation of changes (you can blank out the eyes).
This could be really useful for people like me who think of undergoing MSE+Facemask in future.
Want to see how wide, robust and symmetric you can get.
ONE QUESTION:
If you use FACEMASK to pull maxilla forward, will it also pull MAXILLA upward which would in turn change shape of nose making it upturned? If that is a risk it is something to take into account since upturned noses are not attractive.
Nasal tip rotation, not rotation of the entire nasal complex which would result in the exposed nostril look you are referring to and also probably impossible to acquire unless you already genetically have that nose shape
But this is not good, is it?
If I have a nose that is perfectly horizontal then slight curving of tip upwards will result in a less aesthetic nose and upturned look which could be corrected by rhinoplasty theoretically, but that is just added risk and problems.
30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.
You are doing God's work!
Please keep us updated with your continued progress. Preferably with picture documentation of changes (you can blank out the eyes).
This could be really useful for people like me who think of undergoing MSE+Facemask in future.
Want to see how wide, robust and symmetric you can get.
ONE QUESTION:
If you use FACEMASK to pull maxilla forward, will it also pull MAXILLA upward which would in turn change shape of nose making it upturned? If that is a risk it is something to take into account since upturned noses are not attractive.
Nasal tip rotation, not rotation of the entire nasal complex which would result in the exposed nostril look you are referring to and also probably impossible to acquire unless you already genetically have that nose shape
But this is not good, is it?
If I have a nose that is perfectly horizontal then slight curving of tip upwards will result in a less aesthetic nose and upturned look which could be corrected by rhinoplasty theoretically, but that is just added risk and problems.
No it looks great.
Hey all, I see in the paper by Dr. Won Moon he successfully avoided getting more gingival exposure (aka gummy smile) from treatment. But in this paper, 3mm gingival exposure occurred due to treatment.
( https://www.hindawi.com/journals/crid/2014/270257/)
The article states, "The facemask had forehead and chin anchorage pads secured to a vertical bar. The 14 oz 1/2 inch elastics used to deliver a force of 500 gm bilaterally were attached to hooks on the expander in the maxillary canine areas and a crossbar on the facemask with a downward direction of about 30 degrees. The patient agreed to four months of protraction (during the summer while out of school) for 18–20 hours per day. "
How can gingival exposure be avoided with the facemask? If the MSE is implanted on the roof of the mouth, and the facemask pulls at an angle so that the jaws can close, wouldn't this be pulling at a downward angle? Is there any way to pull at an angle that doesn't cause gingival exposure? Thanks.
-MO
Hey all, I see in the paper by Dr. Won Moon he successfully avoided getting more gingival exposure (aka gummy smile) from treatment. But in this paper, 3mm gingival exposure occurred due to treatment.
( https://www.hindawi.com/journals/crid/2014/270257/)
The article states, "The facemask had forehead and chin anchorage pads secured to a vertical bar. The 14 oz 1/2 inch elastics used to deliver a force of 500 gm bilaterally were attached to hooks on the expander in the maxillary canine areas and a crossbar on the facemask with a downward direction of about 30 degrees. The patient agreed to four months of protraction (during the summer while out of school) for 18–20 hours per day. "
How can gingival exposure be avoided with the facemask? If the MSE is implanted on the roof of the mouth, and the facemask pulls at an angle so that the jaws can close, wouldn't this be pulling at a downward angle? Is there any way to pull at an angle that doesn't cause gingival exposure? Thanks.
The appropriate force vectors are all broken out for you if you actually take the time to read and comprehend the won moon studies. -30 degrees to the occlusal plane is ideal for protraction for maxillary retrusion but otherwise good vertical dimensions.
Any updates varbrah? How are you progressing?
30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.
Any updates varbrah? How are you progressing?
All gucci, progress good, still protracting. Face looks more angular for sure and no issues with the mandible swinging forward.
Any updates varbrah? How are you progressing?
All gucci, progress good, still protracting. Face looks more angular for sure and no issues with the mandible swinging forward.
Good to hear breh. I got a few question for you. I recall you saying that you plan to protract 8-10mm until april if possible, is that right? When you say this are you referring to the A point or to the tip of the incisors? Also you are using the mini-implants of the MSE for the facemask, right? . Moon recreated this protocol in the FEM modelling (model B) which is the one with less magnitude overall. I think he wanted to create a sub-group comparison of model A (conventional facemask anchored to the molars) pulling distally vs model B (hyrax-y MSE-y) same sagital placement, distinct coronal placement (two practical extremes basically). Why'd you choose this route, instead of say anterior placed miniimplants. I'm asking all of this assuming you want the most ammount of protraction.
edit:fugg i forgot to tag you @Varbrah
It looks like my case is worse than even I myself expected. The cephalometric analysis revealed that I have an area of 1.7mm2 to breathe from and my doctor is going to move forward with the same treatment plan as @varbrah. He's certain that transverse expansion will help my case, but he's not certain that I'd be able to achieve the protraction I need to help me meet the minimum acceptable airway area of 150mm2 (according to this practice). He's willing to let me use the face mask approach for 3 months to get a feel for what's achievable, but if he's not seeing the results I need, we'll be moving forward with a maxillomandibular advancement.
Regardless, I'm excited that I'll be able offer myself as another lab rat for the forum here ;)
If anyone is in the Massachusetts area, or willing to travel, let me know and I'll PM you the name of my doctor (I can't imagine he'd mind the free advertising, but I don't want to assume). The doctor himself called me on a Saturday to detail his thoughts and his staff has been great. There's not a bad thing I can say about this practice.
It looks like my case is worse than even I myself expected. The cephalometric analysis revealed that I have an area of 1.7mm2 to breathe from and my doctor is going to move forward with the same treatment plan as @varbrah. He's certain that transverse expansion will help my case, but he's not certain that I'd be able to achieve the protraction I need to help me meet the minimum acceptable airway area of 150mm2 (according to this practice). He's willing to let me use the face mask approach for 3 months to get a feel for what's achievable, but if he's not seeing the results I need, we'll be moving forward with a maxillomandibular advancement.
Regardless, I'm excited that I'll be able offer myself as another lab rat for the forum here ;)
If anyone is in the Massachusetts area, or willing to travel, let me know and I'll PM you the name of my doctor (I can't imagine he'd mind the free advertising, but I don't want to assume). The doctor himself called me on a Saturday to detail his thoughts and his staff has been great. There's not a bad thing I can say about this practice.
Fuk yeah bro
The cephalometric analysis revealed that I have an area of 1.7mm2 to breathe from
Can someone link to an image showing this measurement? Is it the area of a cross section at B or C here?Wouldn't correctly posturing the tongue and elongating the neck during the scan reduce this area? Do they instruct you not to engage the tongue on the soft palate or tuck the chin? Is it safe to assume if we struggle to exchange air with the posterior tongue pushing up that our measurement would also be very small?
The cephalometric analysis revealed that I have an area of 1.7mm2 to breathe from
Can someone link to an image showing this measurement? Is it the area of a cross section at B or C here?Wouldn't correctly posturing the tongue and elongating the neck during the scan reduce this area? Do they instruct you not to engage the tongue on the soft palate or tuck the chin? Is it safe to assume if we struggle to exchange air with the posterior tongue pushing up that our measurement would also be very small?
In my case, they measured the cross sectional area in "slices" roughly between points C and B (maybe a little below B). The slice that was thinnest is what was reported back to me, because that's essentially the bottleneck I have to work with. I think the machine they sat me into forced me to elongate my neck (maybe some chin tuck too), or at least close to it. There was no instruction to not engage the tongue to the palate, as it comes naturally in the elongated neck posture, and because I'm assuming most people don't have the kinesthetic awareness to pull it off. Basically I tried to emulate the posture a healthy person without forward head posture would have and ended up with the results I mentioned.
As for you last question, I can only say that has been the case for me, but I would easily bet the same would be the case for anyone else.
So I had an interesting start to my work day. Now that I know I'll be looking like a freak for a few months, and will likely resort to wearing the mask during work, as well as at home, I've been telling my coworkers what to expect. My supervisor was actually interested and was asking a lot of questions due to her husband's sleep apnea. She might actually be pushing him to do it to if it works out for me. 🤣
My goal is to wear the mask as much as possible, particularity during the first few months, with my only breaks being during meals, showering & lifting or customer interaction. On top of that, I'll be doing my best to maintain perfect body posture with as much as a chin tuck & neck elongation as reasonably possible.
@JimmyB which doctor are you visiting that is doing this treatment to you ?What is the location? Please keep all documented so you can later compare objectively if there were improvements. Thanks!
30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.
It looks like my case is worse than even I myself expected. The cephalometric analysis revealed that I have an area of 1.7mm2 to breathe from and my doctor is going to move forward with the same treatment plan as @varbrah. He's certain that transverse expansion will help my case, but he's not certain that I'd be able to achieve the protraction I need to help me meet the minimum acceptable airway area of 150mm2 (according to this practice). He's willing to let me use the face mask approach for 3 months to get a feel for what's achievable, but if he's not seeing the results I need, we'll be moving forward with a maxillomandibular advancement.
Regardless, I'm excited that I'll be able offer myself as another lab rat for the forum here ;)
If anyone is in the Massachusetts area, or willing to travel, let me know and I'll PM you the name of my doctor (I can't imagine he'd mind the free advertising, but I don't want to assume). The doctor himself called me on a Saturday to detail his thoughts and his staff has been great. There's not a bad thing I can say about this practice.
Note: because of moderating, I will now use "poopy" in place of all of my curse words henceforth
Holy poopy dude, that airway measurement is pretty poopy concerning. I just had a CBCT scan done and I actually had 137mm2 of minimum airway space which my practitioner said was above the minimum for decent breathing which is 100mm2. But 2mm2? I definitely would not fault you for moving forward with surgery if at all necessary. That being said, I think protraction will be worth exploring for sure.
What's extremely interesting about it is if you look at me, my weak chin, hooked nose, long anglo face and thin nostrils would make me a candidate for the poster child for CFD, but my IMW is 33mm and airway measurements are actually somewhat "normal". Just goes to show that receded maxillas can result in wildly different aesthetic results depending on the person
@varbrah don't want to make you do something you're not comfortable with but would you consider doing before and after pictures when you're done with your treatment?
My issue is, I'm probably going to end up pursing palate expansion no matter what, but I'm not sure if MSE + FM is necessary for me, where I might be able to get away with just using something more lowkey like an ALF or some other acrylic appliance. However, if I'm going to be expanding anyway, would you say it is worth doing protraction anyway because you'd be wasting a perfectly good chance to move bone forward while the suture is dis articulated? I'm not sure of the risks and downsides associated with MSE + FM.
On that note, do you have any opinions on Bill Hang? Do you think he uses protraction protocols? I'm moving to LA soon and I figure if I'm going to be in the presence of the god himself I might as well check him out, however it seems like he really only does typical orthotropic treatments plans, i.e. ALF and acrylic expanders. Then my choices really would be
a) Bill Hang but with traditional expanders or
b) some other doctor but with MSE + FM
and I'm not sure what the best would be
Just a fyi to everyone, my expansion doesn't start until mid april.
JimmyB is the face mask attached here the same type to be used with MSE
@zosogg Bill Hang (when I saw him 2 years ago) seemed to be the guy you went to if you wanted facial surgery for aesthetic reasons but wanted your insurance co to cover it; his main goal seemed to be providing medical basis (apnea, airway, etc) for beautifying double jaw surgery. I went to him specifically looking for nonsurgical ways to grow my midface and he only wanted to recommend surgery.
@zosogg Bill Hang (when I saw him 2 years ago) seemed to be the guy you went to if you wanted facial surgery for aesthetic reasons but wanted your insurance co to cover it; his main goal seemed to be providing medical basis (apnea, airway, etc) for beautifying double jaw surgery. I went to him specifically looking for nonsurgical ways to grow my midface and he only wanted to recommend surgery.
Really?? I thought that Bill Hang was the orthotropics guy in America.
my story: http://www.aljabri.com/blog/my-story/
@zosogg Bill Hang (when I saw him 2 years ago) seemed to be the guy you went to if you wanted facial surgery for aesthetic reasons but wanted your insurance co to cover it; his main goal seemed to be providing medical basis (apnea, airway, etc) for beautifying double jaw surgery. I went to him specifically looking for nonsurgical ways to grow my midface and he only wanted to recommend surgery.
Really?? I thought that Bill Hang was the orthotropics guy in America.
Only for kids, it turns out. Just like every other orthotropics provider in America. I've been calling each of them one by one, and each one either says that they only give Biobloc to kids, OR they SAY that they give it to adults too, but then in person say that they won't give me a Biobloc (and instead recommend a whole slew of other treatments, none of which involve semi-rapid expansion).
I'm gonna go to a consultation for Bill Hang and I'll tel yall my experience
Only for kids, it turns out. Just like every other orthotropics provider in America. I've been calling each of them one by one, and each one either says that they only give Biobloc to kids, OR they SAY that they give it to adults too, but then in person say that they won't give me a Biobloc (and instead recommend a whole slew of other treatments, none of which involve semi-rapid expansion).
Ok, I can imagine why they won't use bioblock for semi rapid expansion. The concept seems sketchy and even Dr. Mike Mew fails in this particular method with some adult patients but what about slow expansion? Did they offer ALF for example?
I'm gonna go to a consultation for Bill Hang and I'll tel yall my experience
Thanks
my story: http://www.aljabri.com/blog/my-story/
Only for kids, it turns out. Just like every other orthotropics provider in America. I've been calling each of them one by one, and each one either says that they only give Biobloc to kids, OR they SAY that they give it to adults too, but then in person say that they won't give me a Biobloc (and instead recommend a whole slew of other treatments, none of which involve semi-rapid expansion).
Ok, I can imagine why they won't use bioblock for semi rapid expansion. The concept seems sketchy and even Dr. Mike Mew fails in this particular method with some adult patients but what about slow expansion? Did they offer ALF for example?
No, Bill Hang doesn't do ALF. (I did have ALF for 14 months, though, and with no results. My palate width was unchanged; it just tipped my teeth, which then un-tipped after I took it out.)
So yes, plenty of providers here in California offer ALF to adults (and sagittals, and AGGA), but no one offers true Orthotropics®️ appliances to adults as far as I've found (though I'm still searching). Including Bill Hang. I'm not 100% sure but I think he only gives appliances to kids, and refers all his adult patients to surgery (to Reza Mohaved or Larry Wolford).
Hello @jimmyb
I am also in the consultation/evaluation phase for a MSE over here in Michigan. Thanks in advance for sharing your experiences ;)
Hi all! I've had the device installed and will update again when my diastema forms :)
@jimmyb Awesome.
How was the installation?
How is the daily pain/what are the daily sensations like?
Worst part?
Please & thanks :3
The installation was not bad, but feeling the screws making their way through the bone was a bit unnerving D:
There was no real pain, I would describe it as a mild irritation more than anything.
The worst part is a mild headache and eating... eating is by far the most irritating thing. I've lost ~5lbs since the 17th (mostly water weight I assume, but still) just because all the fun I get from eating is ruined by this metal contraption lol. It has gotten easier to chew and eat though.
As of now I've expanded the MSE to 1.8mm. I'd like to say I've had some slight diastema, but it's hard to say because I already had a small gap going into it. I've been using my fingernail as a gauge for progress. Right now I have to use a slight force to wedge my fingernail between my front two teeth, and I think day by day, it's getting easier to wedge between by teeth.
I also just noticed while typing this, that I'm able to breathe through both nostrils pretty clearly. I don't know how many times in my life, if at all, that I've been able to do that.
I'll report back as I notice changes, both functionally and aesthetically!
And this goes for everyone:
Please don't ask for pictures, or updates asking if I've noticed any facial changes, particularly this soon. I appreciate that this is new and exciting but I don't want to report a change unless I'm certain it's real and undeniable. At my next doctor's visit I will try to get my hands on xrays that might illustrate my progress.
Update:
Unfortunately the device didn't cause expansion. I'll be seeing my doctor this Wednesday about getting it removed, letting my bone heal, and trying again after having a cortipuncture procedure done. See below:
https://www.youtube.com/watch?v=uOYEbghAoOI
@JimmyB thanks for the update.
So you cranked it as recommended everyday and did it just get more and more sore without the gap forming? Or was it pretty tolerable?
I have a lot more info from my doctors, who I will likely start working with in the next month in my thread: /community/community/case-discussions/my-story-20-years-of-tmjd-and-mse-at-35/
The Periodontist was talking about how there is a scale now, from A to E regarding how permanently sealed your suture is. And how it's more accurate than age or gender. Maybe yours was just farther along and more solid/sealed?
That video wasn't so bad, and mos def not as bad as a real SARPE Lefort surgery! You'll be expanded in no time :)
It was pretty tolerable, not bad at all actually. And I read through your thread, it was really informative actually! Thanks for going through your experience so far :)
Unfortunately for me, I may have to start with a new MSE device, being that the screws for the one I currently have in are bent, limiting the expansion I would be able to get. I'll likely have it taken out, let it heal for 6 months, and then start over. It sucks, but I'll live. I'm just glad my doctor is willing to do the cortipuncture because having a full blown SARPE seems like it would completely defeat the point of having an MSE (if you've seen the cuts they make in the bone, it's easy to see what I'm talking about).
Let this be a lesson to men over 20 or women over 40 (as noted at the end of video I previously posted) push for a cortipuncture if you can. It's simple and will potentially save you a lot of time.
@jimmyb thanks so much for the insightful information! Would you mind PM'ing me your ortho?
What is current consensus on this? Any users went through successful MSE+FM plan? Any before-afters?
30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.
Sorry to hear the MSE didn't work at first, I hope it works for you on the next try. I see you are taking HGH Peptides and MK-677. I've heard of people using these with MSE+FM. What are the risks of these in otherwise healthy adults? Of course bone growth etc is good but are there side effects you get when you stop? Can it mess up HGH secretion afterwards? Also isn't there poor quality control on these? Otherwise I would think every guy would want to take these (Since it gives more muscle and bone, it seems like a magic pill almost).
Best, MO
-MO
Treatment Protocol
Protraction (forward growth):
-Combined with a face mask, 1kg (edited original comment based on comments later in the thread) of force per side and a force vector of -30 degrees to the occlusal plane should result in almost pure orthopedic forward movement and slight anterior tipping (ccw rotation) of the maxilla based on FEM models.
-I'm using two of the elastics (1/2", 16oz. = ~500g) per side. Keep in mind that each of those elastics exerts ~500g of force when stretched to 3 * 1/2". If you stretch them further, then they simply exert more force... 500-1500g (no higher) of force per side has been found to be suitable.
-Anchorage are the metal orthodontic bands on my 1st molars which direct the force to the MSE, so total bone anchored.
Thanks for this thread @JimmyB. I'm a 51 yo male looking at doing this to open my airway in the hope of curing my severe sleep apnea.
How long do you anticipate doing the face pulling, and for how many hours/day?
I notice in this case study of a 19 year old female using facemask with a bonded expander "The patient agreed to four months of protraction (during the summer while out of school) for 18–20 hours per day.": https://www.hindawi.com/journals/crid/2014/270257/
And in this case study of a 32 year old female using facemask with SARME: "The Sky Hook headgear was used for maxillary protraction according to Haas protocol5"... Maxillary protraction was performed during 4 month.": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349060/
Reference 5 being: "5. Haas AJ. Interview. Rev Dent Press Ortodon Ortop Facial. 2001;6(1):1–10.", which I can't for the life of me decrypt let alone find, so I'm not sure how long she wore it each day.
And how does anyone sleep with all that shit (and in my case a CPAP mask) on?
So apparently varbrah got great results, but has anyone actually heard from him?
30 yo, need to expand palate, move maxilla upward and forward, reduce gonial angle.
Skull and Jaw Correction
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