Posted by: Sugr2.
Ucla has some valid points and probably has good intentions of trying to protect members of the public. Especially in forums information can become Chinese whispers and before you know it people are doing things which are simply - dangerous.
I personally have not used MSE but I have some experience with other MARPE appliances. I think like a lot of these things the concepts are similar but where they differ is in treatment case selection and philosophical debates on mechanisms of growth etc which ultimately may have very little clinical value, other then biological explanations etc. The main thing is you get a result leading to better health outcomes.
Treatments of these nature done for aesthetic results will often result in disappointment.
I cannot emphasize this enough. Thank you.
It is great to meet another practitioner. Especially someone who has done MARPE and has experiences with it. The MARPE has been known to be effective but it is known to cause more of a V-shaped expansion compared to the MSE because of the position of the TADS, usually placed more anterior. Case by case. However, this does have higher success rates because the bone is thicker in this region. MSE has been a good modification but there are still issues with this appliance. Specifically the type 2. There have been many orthodontists not getting a diastema (indicating suture spit) because the screws have been bending, the torque is much more.
Recently, we incorporated a method that makes several perforations called corticopuncture for the MSE that allows the suture to split more easily despite being placed posteriorly, but as far as I know, few orthos are experienced in this procedure.
Many orthodontists will try to “forcibly” split the suture such as the guy named “MSE merchant” had done. This is how I know his orthodontist is not experienced with the MSE. The highest failure rates that we see for MSE involve when it is turned to fast and this results in the expander being deformed. The expansion protocol is outdated. However, it may still work, as it has worked for him.
Due to the complexity of sutures in adults, most often as you initiate expansion, you will have areas where bone is jammed against bone. What works is using bone physiology by not crushing the blood supply, allowing osteoclastic activity to take away the bony interferences first, then, once the sutural structure allows for a more normal separation of the bones at the suture, you can slightly accelerate the expansion rate.
You are, in some areas along the suture in adults, jamming bone into bone when you start the expansion. If you don’t crush the local blood supply, you get osteoclastic activity within the first couple of hours. This clears away the bony interferences physiologically and within 2 days those the two sides of the maxilla/ palatine bone complex have moved laterally to a position that bone used to be in the way of. If you add too much pressure, you kill those interfering bone cells through ischemia, don’t get the osteoclastic activity you want, and it takes around 7 days to clear away the dead and dying bones cells through inflammatory cell infiltration. That being said, the MSE is still a trial in works. Every year, we get better at developing new protocols.
But two final matters to clear things up for the young kids/adolescents/and even adults trying to fix their craniofacial discrepancies:
1.) You will not achieve the type of protraction with a facemask stated by many users on this forum
2.) The MSE will not cause any "major" changes in the face. You will not look that noticeably different after the expansion. Like I said and have been repeatedly saying, if you have issues with airway, or a crossbite/class 3, it will be suitable. But again there are other complications with this case-by-case with each patient (e.g. torus palatinus), that make the appliance hard to place and failure much more likely. That is why I said this is a case-by-case basis. It is not some sort of "holy grail" touted by this forum. Life isn't that easy to be able to fix a lifetime worth's of discrepancies by just a one month expansion protocol.
Again, I am not bashing on anyone who is trying to "look" better. Understandable. However, the ways listed here are not accurate and WILL NOT work. The only way any of these solutions have been significantly documented on real people or to be proven to be true is in surgery. That is it.
Thank you all for your time.
P.S: "MSE Merchant" or Varbrah has personally reached out to me and has confirmed that what I said is true. You can all PM him if you want about this.
