So having only joined this forum about a week ago, I apologize if this has already been hashed out somewhere and I haven't found it yet - but there seems to be quite a lot of opinions on this topic (some which seem to be quite strongly held), so I wanted to get to the bottom of it ... as I am speaking to doctors about both procedures (DNA and DOME) this week, and hope to commit to a course of action in the next 60-90 days.

I have to admit, so far some of the opinions I've seen don't seem to have anything more than hand-wavey assertions behind them ... so I'm proposing an evidence-based approach to this discussion, where citations and case studies carry the most weight.  Then, hopefully this may serve as a useful reference for someone else in the future who is considering one or both of these appliances.

Ok?  Let's begin:

Claim:  "Acrylic-based devices that put any pressure on the insides of your teeth will tip them outward/out of occlusion!  Therefore MSE is safer!"

Argument:  3D acrylic appliances apply pressure to the outward ridges of the palate, but also on the backs of the teeth as well ... and this creates a far greater risk of "pushing the teeth through the bone", and/or tilting them outwards enough that occlusion is impacted.

Evidence:  A MSE device is clearly only applying pressure to the outer ridges of the palate, therefore it couldn't ever create an occlusion problem.  So anything that achieves expansion any other way, obviously must be prone to this type of risk - putting pressure on the teeth will push them through the bone / tilt them outward.

(I can't say I've found any other evidence other than that yet - just statements ... so I'm really hoping we can point to some actual cases with a modern 3D acrylic to back up that claim).

Counter-evidence:  If we take that logic - that anything applying any pressure on teeth will risk pushing them through / tilting them - and reverse the logic ... then wouldn't traditional metal braces have this risk as well?  Wouldn't there be risk of "pulling" the teeth inward through the bone, or tipping them inward ... if done improperly (i.e.: too fast)?  Yet, we have millions of people that get braces every year, and I don't think this ever really happens?

Throughout the sum total of orthodontics ... we must have amassed the knowledge of how quickly you can safely move a tooth around by applying a pressure force to it, no?  If so, then why should the direction (outward via a DNA or Biobloc, instead of inward with braces) matter? 

According to this article, Vivos' DNA appliance has been used by over 7,000 patients (at the time of writing, in 2017).  That number must be even higher now.  There would have to be more evidence of this tipping teeth / pushing through problem with Biobloc and DNA type appliances ... if it was such a high risk?