And shes not finished with treatment. If a patient has a reduced apnea-hypopnea index (AHI) score and better breathing, we do not need SFOT. How about the MSE? The MSE will remain on for another six months after the turning ends. I agree that EASE sounds better for the reasons you cite, provided the expander doesnt fail. The expanders are also almost identical; heres MSE above the DOME expander: Hi what do you think of the EASE procedure offered by Kasey Li MD DDS? Some DNA patients require minor orthodontic treatment afterwards to give optimal cosmetic results. For lower crowding, we expand using a spring like device. Invisalign and the Invisalign logo, among others, are trademarks of Align Technology, Inc., and are registered in the U.S. and other countries. We merge the X-ray and the scan of the teeth into one image to get the exact ideal location for the micro-implant placement. The images below show the result of 13 weeks and 6 days of no braces, no Controlled arch, no bite plates, no retainers. In the world for MSE functional and airway expansion! Use tab to navigate through the menu items. I expand until the narrowest area above the maxillary first molars becomes wider than the estimated lower buccal surface. So far, the doctor's oldest male patient is 53 and the oldest female patient is 54. These areas will appear radiolucent (black). The options will be discussed with patients. I felt that this was the case with this paper. About a year and a half ago, maybe more, I decided to get to the bottom of my TMD, which at that time was increasing exponentially in severity. I have heard of people having severe tension headaches before the suture splits but this should be reduced with a technique like EASE. https://www.robinsoncosmeticsurgery.com/wp-content/uploads/2015/12/before-after-26.jpg https://www.drantipov.com/images/cases/corrective-jaw-surgery/oms000047/1/preview@2x-09f0cf47.jpg https://www.drantipov.com/images/cases/corrective-jaw-surgery/oms000042/4/preview@2x-42d4832f.jpg, https://ars.els-cdn.com/content/image/1-s2.0-S1073874618300094-gr9.jpg, https://looksmax.me/proxy.php?image=https%3A%2F%2Fwww.dentistry.ucla.edu%2Fsites%2Fdefault%2Ffiles%2FMSE%2520cropped%25203.jpg&hash=c9c74b9761919485a965cd8009481bf6. Ill post the link there and see what happens. Do functional appliances influence skeletal pattern? Also, how is your treatment progress coming along? Nevertheless, I used to be a biomedical engineer before undiagnosed sleep apnea destroyed my career and my health, and this combined requirements analysis and risk assessment illustrates the main factors I considered. The default expansion regimen of one turn per week, which equals 0.25mm of expansion, should prevent this. Thanks for the questions. I know I may sound like a surgical case, but I am hoping that I can almost or even entirely correct it all without surgery. Many patients use reverse-pull facemasks to bring the upper jaw forward, which can provide anterior-posterior growth versus just transverse growth, and this is a whole lot easier than maxilla-mandibular advancement surgery (MMA). Learn how your comment data is processed. You can expand the upper basal bone as much as required to accommodate for lower decompensation and tongue space. In a nut shell, her pulse goes from 70 at rest sitting to 182 after just standing for 10 minutes. I dont know what it will cost if/when it becomes available in Australia, but I hope it provides some serious price competition to Vivos. Skeletal expansion is much more permanent due to the bone filling in, whereas in dental expansion, the teeth can move back and the palate become narrow again. I have read widely on the Homeoblock appliance, watched all the videos available online, sent my CBCT scans to Dr Belfor for analysis, and had a private consultation online with him where he told me he couldnt cure severe obstructive sleep apnea but could definitely help me. I recently heard that a teenage girl had died during surgery, but this fact sheet says no patient deaths have occurred. Reddit and its partners use cookies and similar technologies to provide you with a better experience. All due to extraction/retraction orthodontics in my teens. I have popping/clicking when I open my mouth wide and yawn. Dr Ting also provides Invisalign as a favorable alternative for kids, teens and adults. That same month a reader referred me to Dr. Zubad Newaz, the orthodontist at Manhattans Gelb Center and an experienced MSE provider. I am not sure that these are clinically significant and I would like to see what we can get with traditional RME. Now that we are using the software with Partners dental studio we know that we are only penetrating 1 mm beyond bicortical so I can confidently say this is not an issue. Comparison of Different Palate Shapes and Their Nasal Volume. Advice for people wanting MSE. : r/orthotropics - Reddit There is a reason why many people, including me, have gone out of their way to seek MSE providers, instead of orthodontists and their so-called proven methods. Just curious on the pricing outcome with or without insurance and the overall process 6 15 comments Best Add a Comment Selotude 2 yr. ago I had a consultation a couple months ago, everything went great, I enjoyed the office. Its very expensive for an acrylic expander, even with the fancy springs. Would you confirm that when you say corticotomies you are referring to a SARPE along the lines of Proffitt (and his references to your co-authored papers), a SARPE that is in essence a LeForte I without the downfracture? All points cephalad to the center of rotation would tend to rotate medially as the maxilla rotates laterally. This is why jaw surgery may be necessary, but its more effective when done in combination with MSE. Dr Belfor has suggested that the Homeoblock should be worn for life as a retainer. If you live outside of the above mentioned areas but would still like Dr. Ting's expert opinion on treatment options for you, you are welcome to schedule an in-office or Zoom consultation for a fee of $250.00. Breathe, breathe in the air. I have heard of people having vision problems due to shifts in the other bones of the skull connected to the maxilla, and others having asymmetrical expansion that is difficult to correct if not caught early. The X-ray above is the view looking at the nose. Where the heck are the clinical trials that justify the use of this technique by Evans and Ting? Curiously, we now have a situation where an appliance that can be fitted and executed in an orthodontists office (MSE) is superior to actual jaw surgery. He is an orthodontist and creating straight smiles is his specialty. Often I need to use another MARPE design like a superscrew for initial expansion and switch over to MSE as a second expander if second expander is needed for more expansion. If it is just dental expansion, we are just moving teeth, and over time, as many adults know, all the expansion is lost and they need braces all over again. All rights reserved. Maxillary Skeletal Expansion (MSE) | Dentist Arlington, VA Mustang Bio Inc MBIO and the City of Hope, an independent cancer research and treatment center, have dosed the first patient in Phase 1 trial evaluating MB-101 in patients with leptomeningeal . The authors state that this is not ethical. I dont believe DOME is essentially identical to Surgically Assisted MSE. My jaws are too narrow and too far back, and MSE only addresses one of these. The midfacial structure rotates forward with the fulcrums near TMJ area. Reddit and its partners use cookies and similar technologies to provide you with a better experience. I am so impressed with how much youve researched and so happy how much you have persevered and not given up on your health. In February 2019 I decided to pursue treatment with Dr. Newaz, and he removed Controlled Arch Braces and composite bite plates in preparation for future MSE treatment. It sounds like the best option for use with MSE to split the suture, and I believe Kasey Li is one of the top surgeons in this field. We honor each patients concerns and budget to get to the best solution to meet their needs. Nevertheless, in my opinion genetics still plays the major role. My goal is to get her off these meds and feeling like a normal healthy 22 year old girl should feel with a full life a head of her. I had a quick look at these. Turning schedule following Dr. Rocas protocol she learned from Dr. Ilya Lipkin. But ran into some unique issues with it and now only wearing during day for short periods until I find a solution. Im sorry to hear youre dealing with that Briana; it must be heavy going. Where does the orbital process of palatine bone, that little presentation on the medial wall of the orbit, archially move? They promote parallel expansion, and having four reduces the strain per implant during the expansion. Whatever you do, DO NOT do MSE if you don't have a plan for the mandible, and are not willing to also get braces in order to close the gap in the teeth that MSE creates. These areas appear radiopaque (white). After the MSE is placed, wait one week before turning twice, either at home or at our office. The child patient I like to see one week post op to be the one to turn it for the first time and introduce the reverse pull facemask. http://www.arlingtonsmilecenter.com. We did the Homeoblock for a year. We cut off the arms to the MSE and Leave the jackscrew with implants for 6 months but start the orthodontic treatment immediately. Having said that, one should keep in mind that patient older than 30-35 may still require corticotomy because the MSE failed to split the maxilla. Thank you for all the detailed info your posting. For example, we test the health and vitality of each tooth involved with the MARPE before we place the MARPE and track these teeth along the way. This can happen as the MARPE expands everyone reacts differently usually we see improvement in breathing within a couple weeks. From all the options I considered, these appealed to me the most fairly on in the process and I ended up doing the most research on them: The shortlist: DNA, Homeoblock, MSE, DOME, MMA, and AGGA. In life, I feel that everything happens for a reason, reading your story hits close to home for me personally because I have a 22 year old daughter that has Hyperadrenergic Postural Orthostatic Tachycardia Syndrome (POTS) with cervical instability in C1 and C2, hypovolemia, moderate positional sleep apnea. This is something all AGGA patients should be aware of. They suggested that this represented 60% skeletal expansion, 16% alveolar bone bending and 23% dental tipping. The type of MARPE and number of temporary anchorage devices (TADS) depends on the amount of bone and the age of the patient. Do you believe it can help correct my issues? They could randomise to MSE and a delayed treatment group. These values represent 96% skeletal, 0.3% alveolar bone bending and 0.09% dental tipping. Essentially, they superimposed the sequential CBCTs on the cranial base. http://www.arlingtonsmilecenter.com. Consider the risk to my airway that my childhood orthodontist didnt foresee when he told my parents it would be a good idea to extract my four bicuspids and pull my front teeth back, compromising my vital airway in the process. It generally stays within the sheets which splits at the bottom as the PNS split. In my opinion extractions are a lot more invasive! I am using MSE device since mid 2017. We kept the same device but ask for a corticotomy la SARPE. Im comfortable using a DNA provider who I know has only recently done the Vivos training and has not yet had a single patient complete treatment; but I wouldnt want an inexperienced surgeon doing MMA on me. As a result, we do not know anything about the cases that were not successful. for marked transverse deficiency? Here are the main requirements and considerations I had for the treatment, listed from most important to least important: Total treatment time includes any post-treatment orthodontics required to align teeth and open my extraction spaces so I can replace my missing bicuspids with dental implants. The concept is that when the patient is locked head down, it is often due to the bite not allowing the neck and body to be neutral due to the temporal bones and sphenoid being locked into position, creating the asymmetrical expansion. MSE + Facemask before and after- Negative results : r/orthotropics - Reddit MSE will only widen your maxilla, and inturn accentuate your zygomatic bones. Often patients are unable to park their tongue on the roof of their mouths because the tongue is too big. The palatal suture splits in the center of the palate and between the two front teeth. Some tads are shorter some are longer just to make sure we get bicortical engagement which we know we will since they use this software to get us precision removes all guesswork. The day the MSE is placed, if the Piezotome CUBE was used, turn four or five times until you experience resistance. After three weeks, start turning three times a week until Dr. Roca says the expansion is finished. surgically assisted ROE. I would be happy to talk with your dental provider and see the best way to approach this without having you incurring any cost. I am proposing a DNA/ Homeoblock face off. I believe the cost is insanely high; like $25k or something ludicrous. I really cant say either way; it would depend on your specific skeletal structure but you do have youth on your side. Reddit, Inc. 2023. In my opinion doing something non exclusive like Master in Biomedical engineering dilutes the value of your exist. However, every Sunday Dr Roca likes the patient to text her photos of the marpe expansion, bite, and diastema directly to my cell phone. Dr Moon did an extensive optic study and found that No functional change was observed. In February 2019 I decided to pursue treatment with Dr. Newaz, and he removed Controlled Arch Braces and composite bite plates in preparation for future MSE treatment. SFOT helps to enhance the function and appearance of the smile. Then they will start orthodontic treatment on the upper arch and continue orthodontic treatment on the lower arch. We want the location with the most amount of bone possible to get bicortical engagement for our custom MARPE. Many patients want the quickest fix possible, and others would rather have a conservative approach. Genetics would involve millennia whereas these changes have occurred within 250 years (pre industrial revolution). Being diagnosed with severe obstructive sleep apnea Read more, Yesterday I received a response from the Therapeutic Goods Administrations Device Support Team in response to my Medical Device Incident Report regarding the failure of my Vivos mRNA Appliance and the fact that it tipped Read more. Note: This post may contain statements that I no longer consider true.See: The Vivos mRNA Appliance Didn't Improve My Obstructive Sleep Apnea. What is. I always like to think out of the box! Conventional linear measurements can falsely exaggerate the alveolar and dental components of MSE treatment. All the options I considered either purport to do this or have been used for this purpose. Another theory is to wait for 2 months once you stop turning the upper to start closing space. Stephen Vaughan and Richard Ting on MSE Surgical Assist is also useful, but beware that some of their comments regarding other options are not consistent with the science on bone biomechanics. I thought that this methodology was very complicated, and to be honest, I could not understand it. Perhaps, I am getting old, but this was beyond me. Cheers, Graham. The patient will still have the expander until the new bone forms at the site of the midpalatal suture, which takes about four to six months. I think you are on the right track and I really hope Homeoblock does the trick for her! I have a proposal that I would like to talk to you about if you are interested. Why I Chose DNA over Homeoblock, MSE, DOME, MMA and AGGA, My Experience Of Dan Neuffers ANS Rewire Program, The Difference Between Vivos DNA and Homeoblock Appliances, Review of The Gupta Program For Chronic Health Conditions, Low risk of relapse or need for further treatment. Im very confident in these ratings. Since Homeoblock is not offered in Australia yet, my idea was to figure out a way for me to legally make you an appliance. Ill do another update soon, but you can always see my latest updates here. Dr. Ting specializes in identifying and improving airway problems, facial deviation, jaw disharmony, slanted smile lines, excessive or loss of vertical facial dimension and treatment of clenching/grinding related TMJ issues that conventional Orthodontists do not diagnose or avoid treating. It appears to expand too fast for bone growth processes to keep up with, particularly when used by inexperienced practitioners. The equivalent of bloodletting would be extractions and retracting the patients jaw right into their throat, not expanding the maxilla and giving someone increased oral and nasal volume. Graham. This small, easily tolerable, appliance, Invisalign First aligners can fix a broad range of teeth straightening issues, including, The orthodontic temporary anchorage device (TAD) is a miniature device that is temporarily fixed to the bone to accomplish difficult tooth movement such as, . This has increased our predictability immensely. I rated safety low because of the many accounts Ive heard of people losing or almost losing teeth. Airway & Functional | Ting Orthodontics | Rancho Santa Margarita/ MSE Cant praise you enough for doing all this research and taking the time to share it and allow others to share as well. What is very surprising to me is that when I crawled around the internet looking for academic findings on this topic; I found TOTALLY unqualified folks ,especially on u tube,giving opinionson all these expansion techniques including mewing. Dr. Evans has a huge pool of patients. Leave the MSE in place for six months after the last turn. Top 1% Invisalign Diamond Plus Provider in the country. Dr. Roca sends the patients 3D CBCT X-rays to the lab along with an iTero scan of the patients teeth, and she meets with the lab over Zoom to discuss each MARPE case. She looks at these photos closely every week to follow each case and make sure we do not need to pause or change course. I have heard of people having vision problems due to shifts in the other bones of the skull connected to the maxilla, and others having asymmetrical expansion that is difficult to correct if not caught early.. We might use MSE, but it will be a custom MSE, often with more than 4 TADs. BTW- I started using Vivos DNA appliance this fall. This makes mitigating risk particularly important and is another reason I prioritised less aggressive treatments which are slower, less invasive, and less likely to have unforeseen risks. Thanks for the comment. If I dont get the results I seek, can I get back to you in 2022? We want to achieve symmetrical expansion on all cases. Dr. Roca has not had an MARPE or MSE fail but it does happen. On the other hand, 3 out of 15 patients with severe sleep apnea were cured in one study, so theres hope. Some of those things have to do with expanding my lung capacity, and cutting out habits and activities which restrict lung capacity and narrow the airway. All rights reserved. Where is the center of rotation? Everything I know about MSE is based on research papers I have read, YouTube videos, testimonials from users, discussions with other people evaluating treatment options, and postings on online forums; some of which can be highly unreliable. Cause I was like, Oh my gosh, I'm going to get to talk to her. This is what happens to AGGA expansion when all devices are abruptly removed. The presence of a unilateral crossbite is associated with a variable chewing patterns and large lateral deviation during closure. I did about 18 months research into palate expansion and surgical options for treating my severe obstructive sleep apnea (OSA). Has anyone on this subreddit received an MSE device from Dr. Ting in California? Thanks for the clarification John. Im 24, soon to be 25. The screw not advancing. Reddit, Inc. 2023. Sometimes I leave MARPE it in place and use it as an anchorage for various tooth movements. If the expansion is maxed out before reaching the ideal forward growth, start turning backwards once a day for one week. I live by myself so I had to be super-careful not to let that happen. The following week, turn forward once a day and then rest for a week. Progress in Orthodontics: https://doi.org/10.1186/s40510-020-00320-w. The right image shows a condyle that is dislocated forward. I need an implant on upper left and want to explore homoeblock. Start wearing the facemask right away. So far, the doctors oldest male patient is 53 and the oldest female patient is 54. However, I may use it in future if I end up needing MMA surgery; see the note below under MMA. MSE was removed yesterday and some new hardware was added. https://www.toportho.org/think-pieces/sarpe-a-frequently-misunderstood-surgical-procedure, Note: Even with this SARPE the movements of the hemimaxilla are not parallel but have a center of rotation somewhere in the upper nose. https://doi.org/10.1186/s40510-020-00320-w. Expansion with Damon appliances results in buccal bone loss? Tech or BE degree as well. I do not know because this was included in the paper. Are front teeth moving backward? The Vivos DNA Appliance is now FDA Approved for the treatment of mild-moderate obstructive sleep apnea. The former accepts students with B. As they are not growing, there would be no harmful effects. Eventually the fibrous tissue calcifies and turns into bone, but this can take between months and decades depending on who you ask. Ideally, the upper palate can get to 59.55 (if we add the 5 mm to width from bone to bone on maxilla). This was a very basic review of the literature that did not take the quality of the included papers into account. Your situation may be different, and this may mean the treatment I chose isnt the best one for you. Cookie Notice This second table is the angular measurements. Often, we do what we can with Invisalign and MSE. I prefer to do MSE in patients with inactive TMJ, although others have used MSE as a TMJ treatment modality. Here at Ting Orthodontics, we use In-Ovation R & C braces to shorten your treatment time. If the incisor position after the expansion is desired to be the final position, then you can cut off the arms and protract to the entire archbut this will be a rare instance. Im close to the age where the reduction in life expectancy due to obstructive sleep apnea becomes really significant and some options, such as those involving major surgery, may not be available to me very much longer. Pt 4 - Dr. Ting Details MSE Aesthetic Changes, and Correcting Facial If you search for user Jessaroo on YouTube, you can see she shared 2 sleep studies before DNA and after about 8 months of treatment time. My intention is to execute them in order, stopping when my sleep apnea is cured and Im confident wont reoccur: Impact of Distraction Osteogenesis Maxillary Expansion (DOME) on the Internal Nasal Valve in Patients with Obstructive Sleep Apnea (OSA) (DOME). Please PM me if you are interested and we can figure out the options we have to put my idea into motion. In 2003, with the help of Dr Proffit, I did a prospective research to find out if the stability of SARPE was better than the expansion with multisegmented Le Fort 1 (JOMS 2008, AJODO 2011). If I need to remind you that Im not a doctor and this isnt medical advice, you shouldnt be reading this. They did a retrospective study and analysed the records of 39 successfully treated patients. What is MSE?https://youtu.be/Kggr4wAiutYDr. However, this is not enough, we all have heard the great testimonials from both appliances but it would be incredible to get your personal view having worn both in your mouth. For more information, please see our I have not updated the blog since January 2019. Dont be afraid to care. I also have apparently a rockstar of a dental sleep medicine ortho near me that has a proprietary MSE appliance designed for the upper AND lower, which further complicates my decision matrix. The other advantage is that most patient between that have the indication of maxillary expansion can have it without surgery. the Midfacial Skeletal Expansion device jointly with Biomaterials Korea. Dr. Roca has spent many hours learning from Postural Restoration Institute (PRI). There is a version with upper and lower appliances that does mandibular advancement. Dr Ting also provides Invisalign as a favorable alternative for kids, teens and adults. DNA/Homeoblock/Adult Expansion Appliance Usage Tracker Spreadsheet Template, FDA Approval of the The Vivos DNA Appliance is Not What It Seems, If Youve Just Been Diagnosed With Sleep Apnea, Empowered Sleep Apnea Is A Good Place To Start, The TGAs Response To My Adverse Event Report About My Vivos mRNA Appliance Failure, The Vivos mRNA Appliance Tipped My Teeth and Didnt Improve My Obstructive Sleep Apnea, Twenty Months Vivos mRNA Appliance Update, Nineteen Months Vivos mRNA Appliance Update, Eighteen Months Vivos mRNA Appliance Update. It is essentially just SARPE with a bone anchored expander. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. ago (25M) Okay, so, here we go. MSE with Dr.Ting : r/orthotropics - Reddit Corticotomy is primarily used for cases where, Unlike corticotomy where cuts are made through the palate, cortipuncture uses micro perforations that are preformed along the palate for bone that is. I have yet to see any negative consequences yet but it is bound to happen. . I rated risk of relapse medium because relapse is fairly common after rapid palate expansion treatment in children, especially if they dont wear their retainers. This allows a full decompensation of both upper and lower posterior teeth. When I saw Dr Derek Mahony, he referred me to an ENT to for MMA, which I turned out not to be suitable for. You may however need to replace the crown on the implant after Invisalign is complete so the new crown fits properly into the bite. A case for SARPE could still be made where a patient requires more accurate repositioning of their maxilla, say for a complex malocclusion. What is MSE? One theory is that there is bone on the medial side of the rootsno different than retracting the canines into the extraction site immediately after extracting bicuspidstaking advantage of the regional acceleratory phenomenon (RAP). Thick bone w bicortical engagement is a good thing and if patient prefers and female I will try without Piezo if they prefer. Yes, before placing the tads we use a pilot drill that is the same size as the lumen so that we are assured correct angle placement of the tad since the tad is more narrow than the lumen it allows easy access direct to the pre-drill hole when we enter with the tad.