14 Weeks of Settling - MSE Transition

Long-Awaited Treatment Update: Transitioning from Controlled Arch Braces to MSE

I have not updated the blog since January 2019. I apologize for this (I have been completely consumed by my pre-dental studies).

But at that time it was clear that I was growing concerned about 1) maxillary cant and 2) narrowness of maxilla which was not changing with Controlled Arch.

In January 2019 I was made aware of an orthodontic appliance called MSE (Maxillary Skeletal Expander) which is a non-surgical method of splitting the mid-palatal suture and creating dramatic amounts of lateral expansion.

I considered this the most viable method for attaining the ~5mm of width that seemed to be necessary to make my maxilla equal to my mandible.

That same month a reader referred me to Dr. Zubad Newaz, the orthodontist at Manhattan’s Gelb Center and an experienced MSE provider.

It should be noted that all MSE providers are orthodontists. This appliance was invented by Dr. Won Moon, the chair of orthodontics at UCLA School of Dentistry.

When I met with Dr. Newaz in Manhattan in January he considered me a potential MSE candidate but told me that if I were to pursue that treatment, that I would have to remove all existing hardware from my mouth and wait several months prior to MSE, in order for my mouth to rest and reach a new homeostasis before beginning new treatment.

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. For the past 14 weeks my mouth has been empty of any braces, bite plates or other appliances, and I have worn no retainers.

I met with Dr. Newaz again last week for the first time since February. He thinks that the majority of requisite settling has occurred. The new homeostasis reveals that I am definitely a candidate for MSE, as the problems that existed several months ago have not been resolved by natural settling.

Why I Am Pursuing MSE

  • Lateral Expansion of Maxilla - my maxilla remains narrower than my mandible and my alveolar bone is too thin to expand with a tooth-borne appliance like Controlled Arch

  • Increase Mouth Volume and Tongue Space - By widening the maxilla I will increase my mouth and airway volume and create more space for my tongue, which will facilitate proper tongue posture. All of this will contribute to easier nasal breathing, which is the most critical result of all.

  • Increase Volume of Nasal Passages - The roof of the mouth is the floor of the nose. By expanding at the mid-palatal suture, the nasal passages become larger which also facilitates nasal breathing. I’m hoping this will allow me to eliminate use of nasal strips in winter and, in general, facilitate nasal breathing.

  • Cant Correction - As Dr. Newaz puts the finishing touches on my treatment (with clear aligners) I have no doubt that he will leave me with a very fine finished product. He is an orthodontist and creating straight smiles is his specialty.

  • Aesthetics - A better appearance is almost always a side-effect of functional orthodontic treatment. When has a broader arch ever looked worse?

Photos - 14 Weeks of Settling

The images below show the result of 13 weeks and 6 days of no braces, no Controlled arch, no bite plates, no retainers. This is what happens to AGGA expansion when all devices are abruptly removed.

As you can see, the AGGA gaps definitely start closing. Why? Who knows.

Are back teeth moving forward? Are front teeth moving backward? Is new bone disappearing? Are the front teeth un-tilting?

Maybe all of the above. I don ‘t know. AGGA remains a mystery to me.

 
 

Why Allow AGGA Gaps to Close?

I am okay with this partial closing of AGGA gaps because x-rays taken in January revealed that I may have gone too far with AGGA expansion. Scans showed that in my forward-most position when my AGGA gaps were largest, the condyle was actually dislocated forward in the TMJ.

This is something all AGGA patients should be aware of. There is such a thing as too much expansion.

This phenomenon is the result of AGGA expanding the maxilla without expanding the mandible. Eventually you get to the point where the maxilla gets so much longer that the only way the mandible can keep up is to dislocate forward in the TMJ.

People often ask, “how do you know when you have expanded far enough with AGGA?” I would say, take an x-ray and look at the position of the condyle in the joint. If it is starting to dislocate forward, it is time to stop.

 
The left image shows normal condyle position in the TMJ. The right image shows a condyle that is dislocated forward. If you expand too far with AGGA you may end up dislocated forward in order to avoid a large overbite.

The left image shows normal condyle position in the TMJ. The right image shows a condyle that is dislocated forward. If you expand too far with AGGA you may end up dislocated forward in order to avoid a large overbite.

 

All things considered, a small amount of forward dislocation may be worth it for you if the benefits of a larger maxilla are greater than the disadvantages of forward dislocation (overbite or discomfort).

These treatments are imperfect and we must all make choices and compromises around questions such as this.

Ronald Ead17 Comments