Has your dentist done a CBCT scan yet? By comparing the scan with population norms, your dentist can try to figure out how much the mandible is held back by the maxilla vs held back by the retroclined incisors (the inward-slanting teeth you've noticed).

Some patients only need a few mm of forward growth during the expansion phase, which would not cause large changes to your daughter's midface, but it would cause larger movement of the mandible. After the expansion phase, then the Controlled Arch phase will fix the slanted incisors, allowing the mandible to come forwards even more.

When I was at 4mm gaps with the FAGGA, I took photos, and there was only a small change to the nasolabial angle, with a much larger change at the level of the mandible.

So if it's true that you daughter's maxilla is only a little bit deficient, then don't worry about large changes to her midface if it only needs a few mm growth of the maxilla. On the other hand, if the dentist looks at the CBCT scan and says that the maxilla is very deficient, then you might want to consider expansion to make sure your daughter gets the forward growth (and airway size) that Nature intended. This will make her midface look different from now, but my opinion is that this would likely be for the better, if indeed there is a large midface deficiency. In all the AGGA cases I've seen, I haven't seen a child with an after picture that looked aesthetically worse than the before. 

The midface and lower-third are very vulnerable to developmental deficiency, so we should never count on the maxilla's position being correct. Even if it looks normal, the person may be disguising a deficient maxilla with forward-head posture. 

Your daughter's face is already going to change as she grows up, so it would make sense to make sure her face grows forward to its genetic potential. You can ask the dentist how much forward growth they think is necessary.

Hello Katherine,

If you take your sweet, beautiful daughter to 10 different orthodontists you will 10 different treatment plans with 10 different results on the face.  As a mother of a gorgeous daughter myself, I have been driven to find the most aesthetic treatments available.  I have some philosophies on this.  If you’d like to compare notes, I would love to discuss!

James, thank you so much for your reply! This is very helpful food for thought. My daughter had a scan of some sort several months ago when we started with a palate expansion treatment. Her airways looked pretty good. But I’m not sure if the dr has done the other evaluations you mentioned.

The doctor is talking about 8mm of forward growth on the maxilla for my daughter with the FAGGA, which sounds like a whole lot to me. It’s good to hear, though, that you experienced considerable growth to your mandible with just 4mm of forward growth of the maxilla. If this happens for my daughter, then maybe we can remove the FAGGA at that point.

Could you possibly direct me, James, to before and after photos of children who have used the FAGGA? That might help me make a final decision. 

Again, thank you so much for taking the time to share your thoughts! I really appreciate it!

katherine 

Posted by: katherine4

James, thank you so much for your reply! This is very helpful food for thought. My daughter had a scan of some sort several months ago when we started with a palate expansion treatment. Her airways looked pretty good. But I’m not sure if the dr has done the other evaluations you mentioned.

The doctor is talking about 8mm of forward growth on the maxilla for my daughter with the FAGGA, which sounds like a whole lot to me. It’s good to hear, though, that you experienced considerable growth to your mandible with just 4mm of forward growth of the maxilla. If this happens for my daughter, then maybe we can remove the FAGGA at that point.

Could you possibly direct me, James, to before and after photos of children who have used the FAGGA? That might help me make a final decision. 

Again, thank you so much for taking the time to share your thoughts! I really appreciate it!

katherine 

8mm suggested by your dentist is a lot, so he must have strong reasons for recommending that. You could ask him to explain where that number comes from. My dentist recommended 5-7mm, and showed me reference lines on my scan of where she thought my maxilla should be based on cephalometric norms.

How the airway looks in a scan depends a lot on head posture. I had two scans with different head positions, and the airway looked different in each.

For pediatric cases, Anne-Maree Cole (AGGA dentist with LVI) has a good presentation including several cases kids or teens towards the end. This is a must-watch for anyone wanting to understand AGGA treatment.

Here is the change in my profile at 4 months with 3.9mm gaps. Notice that the chin, neck, area, and head posture have changed the most, with only small changes in my midface and nasolabial angle.

Thanks for showing me the silhouette images, James. I looked breifly at Anne-Maree Cole's presentation and saw the photos. They do look impressive.

Thank you again!