44 Weeks with AGGA: Last Photos Before Braces

Is non-surgical maxillary growth possible in adults?

These photos were taken on 09/17/2018, 44 weeks into my treatment with the Anterior Growth Guidance Appliance (AGGA). You can see my week 42 photos here.

These past 2 weeks the increase in gap size was minimal. This is because my last adjustment with Dr. Kundel was on August 16th and I have had almost 1.5mm of growth on both the left and right sides since then.

It seems that 1-1.5mm is about the maximum amount of rapid movement you can get out of a single spring re-tensioning, as we saw a similar slowing-of-growth between weeks 36 and 38.

As usual, AGGA gaps were measured using plastic feeler gauges. I now need 3 sets to measure my gaps. You can see my technique for taking these measurements here.


How Much More Forward Expansion?

I’m definitely approaching the end of the AGGA expansion phase. How do I know?

1) Sufficient Tongue Space to Fix Neck Posture

I now have just about as much tongue space as I need to fully remove my tongue from my airway at all times, thus allowing me to habituate an elongated neck posture.

Correcting my neck posture was my primary reason for pursuing AGGA treatment, and I have achieved that goal. This is amazing news and I am so grateful to Dr. Kundel for seeing me through this process.

This is a dream come true.

2) Mandible Maxed Out

I think my mandible has reached its limit in terms of how far forward it can actually come. Right now my mandible can come far enough forward for my upper and lower front teeth to meet without my TMJ being hyperextended.

But if I keep moving my maxilla forward then my TMJ will be pushed beyond its sweet spot as my mandible attempts to remodel forward to meet my maxilla.

If I go farther forward than my TMJ/mandible can handle then I will end up with either a chronically strained TMJ or an ugly overbite.

3) You Can Always Add Growth Later, But Can Never Subtract It

I can always do another AGGA treatment later if I decide I want more space. But if I keep expanding forward I can’t reverse that movement.

So I think a conservative approach to deciding when to stop expanding with AGGA is best, as growth will always be possible but shrinkage won’t.

4) Still Need to Widen

Dr. Kundel says that the controlled arch braces (the next phase of treatment) will add a noticeable amount of width. So any remaining desire I have for more tongue space might actually be a desire for widening, not forward growth.

I can’t know for sure, and since forward remodeling is irreversible, this is all the more reason to be conservative with AGGA expansion at least until the controlled arch braces work their magic.

Smiles and Angle Views


Questions? Speculations? Aesthetic analysis of my face? Post it below in the comments! Don't worry, I've got thick skin.

Ronald Ead47 Comments