16 Weeks with Controlled Arch: Considering MSE

I wrote this post on January 11, 2019 but did not publish it because I was uncertain about MSE at the time. In May 2019 I officially decided to pursue MSE and am posting this now to reveal my thinking over the last few months.

16 Week Controlled Arch Update

Before the current Controlled Arch phase of treatment shown in the images below, I wore the Anterior Growth Guidance Appliance (AGGA) for 44 weeks.

The photos below were taken on January 11, 2019, 16 weeks into the Controlled Arch phase of my treatment. Week 12 photos can be seen here.

Updates and Observations at Week 16:

Minimal Relapse of AGGA Progress After 5 Weeks Without Controlled Arch

On December 7, 2018 Dr. Kundel removed my FRLA (Controlled Arch) as part of his effort to correct my cant.

In the 5 weeks since removal of Controlled Arch, AGGA gaps have shrunk by fractions of a millimeter.

One of the purposes of the Controlled Arch (FRLA) is to preserve and stabilize AGGA growth, especially while braces use front teeth to drag back teeth forward.

The fact that my gaps have gotten smaller without FRLA means that some amount of relapse of progress is occurring, but not much.

The Big 3

I believe that my myofunctional habits are helping me to preserve AGGA growth. I am dedicated to mastering The Big 3:

  1. Lips together

  2. Nasal breathing

  3. Tongue on the roof of the mouth

Even when I wake up in the middle of the night my tongue is pressed softly on the roof of my mouth

This habituated correct tongue posture is the result of years of practice now made good with increased mouth volume created by AGGA.

Mastering the Big 3 will be the key to stabilizing AGGA results going forward. They are the ultimate retainer.

Every person at any stage of treatment should dedicate themselves to habituating The Big 3, even though it is very difficult to do so without sufficient mouth and airway volume.

Cant Not Yet Corrected

My cant is not yet corrected. If it has improved, the improvement is negligible. But certainly the cant hasn’t gotten worse either.

It is unclear whether AGGA caused the cant or whether I always had it.

Certainly it will be corrected eventually as straightening cants is part of the bread and butter of orthodontists.

It’s just about finding the proper tactic to get it to budge. Not sure when to expect it to be resolved. But it’s not a question of IF, it’s a question of WHEN.

 

In my opinion I did not have a cant before treatment. But I certainly still do at this point, after 10 months of AGGA and almost 4 months of braces.

 

Controlled Arch, MSE, and Adult Lateral Maxillary Expansion (Widening)

You can see in the image below that my maxilla is narrower than my mandible.

 
 

It is not clear whether or not the Controlled Arch is going to be capable of expanding my maxilla laterally enough to be able to eliminate the crossbite that results from my underdeveloped maxilla.

It has also been suggested that the discrepancy in width between maxilla and mandible was caused by my prior Schwartz appliance treatment which flared my lower teeth.

The suggestion is that once the lower teeth return to their upright position, that the mandible will no longer be too wide for the maxilla.

Due to the turmoil surrounding this issue I have begun considering alternatives to Controlled Arch for the purpose of lateral maxillary expansion.

I’m told that I need 4-5mm of lateral maxillary expansion to eliminate the crossbite and bring the maxilla to a state of full development.

It seems that the best non-surgical option for adult lateral expansion is MSE (Maxillary Skeletal Expander) invented by Dr. Won Moon, the chair of orthodontics at UCLA Dental School.

 
Dr. Won Mon, chair of orthodontics at UCLA and champion of MSE (Maxillary Skeletal Expander).

Dr. Won Mon, chair of orthodontics at UCLA and champion of MSE (Maxillary Skeletal Expander).

 

MSE is one class of MARPE (micro-implant assisted rapid palatal expander). Not all MARPE’s are the same. Maybe MSE can be thought of as the “latest and greatest” MARPE.

The way MSE works is that two implants are screwed into the roof of the mouth on either side of the midpalatal suture. An expansion screw is then used to pry these two implants apart.

The result of this is that the midpalatal suture is split. Bone then fills in the split. Many millimeters of widening are possible with MSE.

 
 

The key to MSE is that no force is applied to the teeth. All force is applied to the midpalatal suture.

In my case this is important as there is only so much more wear and tear my gums can take after Schwartz appliance treatment, AGGA, and several months of Controlled Arch.

It may be time for me to shift the entire burden of lateral expansion to the midpalatal suture itself. YTBD.

 
 
Ronald EadComment