21 yo male RPHG+MSE ceph

[Deleted member 3020]

Green is after black is before

you can see mentalis strain was fixed a little, nose moved drastically forward
Although VDO changed. May be due to MSE or angle of force in facemask. I don’t know. This was all from ~2-3 mm forward midface displacement
By Dr Richard Ting

 

[balding17yomanletcel]

0

 

[Melo95]

 

[Deleted member 5385]

If your ceph doesn't looks like that

Its over

Also thanks dr Ting for making his midface longer
Even infraorbitals went lower and rounder WTF
I know maxilla grow only downward and forward

 

[Chad69]

0.05 psl increase

 

[Deleted member 3635]

If your ceph doesn't looks like that
View attachment 671101
Its over

Also thanks dr Ting for making his midface longer
Even infraorbitals went lower and rounder WTF
I know maxilla grow only downward and forward

so what you are saying is we can only prevent downward growth with say frontal mewing and increase forward growth with facepulling

 

[Deleted member 5385]

so what you are saying is we can only prevent downward growth with say frontal mewing and increase forward growth with facepulling

Yes
It look like upward growth is not natural maxilla growth

 

[spark]

clockwise rotation downward growth

 

[spark]

Green is after black is before
View attachment 670946
you can see mentalis strain was fixed a little, nose moved drastically forward
Although VDO changed. May be due to MSE or angle of force in facemask. I don’t know. This was all from ~2-3 mm forward midface displacement
By Dr Richard Ting

View attachment 670950

Can you ask Ting about the downward growth? I don't like seeing this at all tbh.

 

[Deleted member 3020]

Can you ask Ting about the downward growth? I don't like seeing this at all tbh.

MSE alone creates some downward growth. But the sufficient amount of downward growth you see in the picture is the facemask. You would want to have the horizontal bar of the headgear to be superior to the upper lips to avoid this downward movement.

 

[spark]

MSE alone creates some downward growth. But the sufficient amount of downward growth you see in the picture is the facemask. You would want to have the horizontal bar of the headgear to be superior to the upper lips to avoid this downward movement.

There are some people who claim upward growth is impossible no matter what.

 

[curryslayerordeath]

MSE alone creates some downward growth.

isnt this only in other rpe devices (not mse) bc of teeth tilting making the mandible rotate downwards? or does the actual nasal spine move down even in mse?

 

[Deleted member 6892]

Did they pull downwards?

 

[Deleted member 3020]

There are some people who claim upward growth is impossible no matter what.

I actually don’t think upward growth is possible anymore. It doesn’t really seem logical. But an upward angle is good either way to avoid a downward movement and higher chances of having a neutral translation

isnt this only in other rpe devices (not mse) bc of teeth tilting making the mandible rotate downwards? or does the actual nasal spine move down even in mse?

In Won Moon’s ‘Seminars in Orthodontics’ it states “Figure 2 illustrates that MSE influences the entire midfacial structure. Besides the midfacial expansion, a forward and downward movement of the maxilla was clearly illustrated” (Moon 7).

Figure

Did they pull downwards?

It pisses me off that they never fucking tell us what their force vector was. But it’s prob downward

 

[curryslayerordeath]

In Won Moon’s ‘Seminars in Orthodontics’ it states “Figure 2 illustrates that MSE influences the entire midfacial structure. Besides the midfacial expansion, a forward and downward movement of the maxilla was clearly illustrated” (Moon 7).
View attachment 680071
Figure
View attachment 680072

damn unfortunately that discussion doesnt go into any more details on the specifics of the movement, leaving it still rly vague as to if the whole maxilla undergoes clockwise rotation or smth else.

this study on displacement patterns in RME is quite disconcerting tho (https://pubmed.ncbi.nlm.nih.gov/17628242/)

almost a mm of downward movement at the ANS from only 5 mm of expansion

even more suifuel given i have 4-5 mm of VME and an already ~20 degree occlusal plane but also pretty bad transverse deficiency

@Sergio-OMS @RealSurgerymax do you know if the downward movement from RME is significant? and is there anything that can be done to avoid cw movement?

 

[SoyGune]

0

 

[Sergio-OMS]

damn unfortunately that discussion doesnt go into any more details on the specifics of the movement, leaving it still rly vague as to if the whole maxilla undergoes clockwise rotation or smth else.

this study on displacement patterns in RME is quite disconcerting tho (https://pubmed.ncbi.nlm.nih.gov/17628242/)
View attachment 680154
almost a mm of downward movement at the ANS from only 5 mm of expansion

even more suifuel given i have 4-5 mm of VME and an already ~20 degree occlusal plane but also pretty bad transverse deficiency

@Sergio-OMS @RealSurgerymax do you know if the downward movement from RME is significant? and is there anything that can be done to avoid cw movement?

It is a finite element method study, I think it is better not to comment clinical outcomes from that. Find a more recent clinical study and I will comment it.

 

[curryslayerordeath]

It is a finite element method study, I think it is better not to comment clinical outcomes from that. Find a more recent clinical study and I will comment it.

@Sergio-OMS @RealSurgerymax
hey, i cant find a solely mse study with clinical cephalometric data, but both of those papers from earlier this year by dr Moon which attempted to elaborate on the mechanism of action for the device described it as:

"Maxillary rotation around this fulcrum area during expansion could explain the downward movements of anterior nasal spine and posterior nasal spine induced by expanders" & "As the zygomaticomaxillary complex rotates outward around the frontozygomatic suture area, a half maxilla initially moves downward and outward" (https://pubmed.ncbi.nlm.nih.gov/30173836/)

"the zygomaticomaxillary complex, along with its inferior structures, move in a downward and outward direction in the coronal plane with a fulcrum localized slightly above the frontozygomatic suture" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355053/)

some other clinical studies on other RME devices describe an increase in facial height and posterior rotation of the maxillary complex (increase in MPA). from your experience, do you think this is a concern for vertically growing, class 2 patients? if u are willing, could u expand on the geometry of this movement (im sadly unable to visualize it properly)?

its scary for me, as someone with excess facial height (~4 mm VME, ~20 deg OP, ~3 mm overjet), that correcting my nasal airways would have a horrific impact cosmetically

 

[Deleted member 3020]

damn unfortunately that discussion doesnt go into any more details on the specifics of the movement, leaving it still rly vague as to if the whole maxilla undergoes clockwise rotation or smth else.

this study on displacement patterns in RME is quite disconcerting tho (https://pubmed.ncbi.nlm.nih.gov/17628242/)
View attachment 680154
almost a mm of downward movement at the ANS from only 5 mm of expansion

even more suifuel given i have 4-5 mm of VME and an already ~20 degree occlusal plane but also pretty bad transverse deficiency

@Sergio-OMS @RealSurgerymax do you know if the downward movement from RME is significant? and is there anything that can be done to avoid cw movement?

It is also interesting that protraction without expansion can lead to upward rotation of the maxilla. But with expansion, it leads to 0 rotation.

 

[RichardwillImprove]

It is also interesting that protraction without expansion can lead to upward rotation of the maxilla. But with expansion, it leads to 0 rotation.

Im meeting with Dr.Richard Ting on Tuesday is the only thing I can do to prevent midface lengthening pulling 30 degrees upward. Also is there somthing similar to the n2 that I can utilize for protraction that would prevent downward growth. Btw if u want me to ask him a question u would like the answer to im more than happ to.

 

[Deleted member 3020]

Im meeting with Dr.Richard Ting on Tuesday is the only thing I can do to prevent midface lengthening pulling 30 degrees upward. Also is there somthing similar to the n2 that I can utilize for protraction that would prevent downward growth. Btw if u want me to ask him a question u would like the answer to im more than happ to.

Using mini plates while using MSE as expansion simultaneously may lead to CCW rotation. Rather than using FM hooks. This may cost a lot more though as it is surgery

 

[RichardwillImprove]

Using mini plates while using MSE as expansion simultaneously may lead to CCW rotation. Rather than using FM hooks. This may cost a lot more though.

Thank u ill do that I dont give a fuck about money.

 

[Deleted member 3020]

Thank u ill do that I dont give a fuck about money.

Okay, it’s just a theory lol. Theoretically, if you pull posterior maxilla, then it should move it upward. But these are from FEM study models, so this you might have to talk to Richard Ting to confirm.

 

[RichardwillImprove]

Okay, it’s just a theory lol. Theoretically, if you pull posterior maxilla, then it should move it upward. But these are from FEM study models, so this you might have to talk to Richard Ting to confirm.

Guess will find out whether the theory will work or not.

 

[hopelessphoenix]

Results and studies like these that show downward growth with protraction as well as rapid MSE leading to asymmetric expansion is why I chose slow MSE expansion on its own followed by djs . I might even go for round 2 of a slow expansion MSE because of the results I have had in the past few months. One tip I would give to anyone doing MSE would be to remember to keep the teeth together lightly and chew for 2 hours a day so the lower arch has a chance of expanding to the maximum it can as well

 

[curryslayerordeath]

It is also interesting that protraction without expansion can lead to upward rotation of the maxilla. But with expansion, it leads to 0 rotation.

protraction w/o expansion is usually w those weird bands anchored to the palate and chin tho right? iirc it was ccw by pulling posterior maxilla downwards, which seems too tedious when conventional bimax procedures are done the same way.

Im meeting with Dr.Richard Ting on Tuesday is the only thing I can do to prevent midface lengthening pulling 30 degrees upward. Also is there somthing similar to the n2 that I can utilize for protraction that would prevent downward growth. Btw if u want me to ask him a question u would like the answer to im more than happ to.

pls pls pls ask abt preventing facial height increase/cw rotation!! ting has done a lot more cases than the orthos ive visited tbh, so his clinical experience must be very high.

 

[RichardwillImprove]

protraction w/o expansion is usually w those weird bands anchored to the palate and chin tho right? iirc it was ccw by pulling posterior maxilla downwards, which seems too tedious when conventional bimax procedures are done the same way.


pls pls pls ask abt preventing facial height increase/cw rotation!! ting has done a lot more cases than the orthos ive visited tbh, so his clinical experience must be very high.

Got it man Ill ask him on tuesday and message u.

 

[Deleted member 5385]

There are some people who claim upward growth is impossible no matter what.

Its way easier to lenghten bone than to shorten.
Actually nobody knows cause nobody does any studies/research about vertically compression/ shortening/ ccw call IT as you like.
There is no study like Ifluence of something on vertically shortening bone.
And conclusion to such study : this treatment reverse excess anterior part of Maxillary complex which affect vertically lenght of nasal and zygomatic complex which increase men sex appeal by 65 percent and cause to put their penises in vaginas 5 times more often jfl
(If I was a dentistry student I would go to Ting and did such studies only for myself as a research work)

 

[Deleted member 5385]

Im meeting with Dr.Richard Ting on Tuesday is the only thing I can do to prevent midface lengthening pulling 30 degrees upward. Also is there somthing similar to the n2 that I can utilize for protraction that would prevent downward growth. Btw if u want me to ask him a question u would like the answer to im more than happ to.

Similar to n2 you said.
Interesting

 

[PubertyMaxxer]

I actually don’t think upward growth is possible anymore. It doesn’t really seem logical. But an upward angle is good either way to avoid a downward movement and higher chances of having a neutral translation


In Won Moon’s ‘Seminars in Orthodontics’ it states “Figure 2 illustrates that MSE influences the entire midfacial structure. Besides the midfacial expansion, a forward and downward movement of the maxilla was clearly illustrated” (Moon 7).
View attachment 680071
Figure
View attachment 680072




It pisses me off that they never fucking tell us what their force vector was. But it’s prob downward

Ofcourse upward movement is possible

 

[Sinjiyam]

Got it man Ill ask him on tuesday and message u.

PM me as well

 

[Sinjiyam]

Ofcourse upward movement is possible


View attachment 681865

growth not movement

 

[PubertyMaxxer]

growth not movement

Whats the difference

 

[Deleted member 5385]

Ofcourse upward movement is possible


View attachment 681865

Midface stay as long as before
Ccw Lefort 1 with BSSO is easy.

 

[Sinjiyam]

Whats the difference

movement is surgical

also you can’t get the true benefits of growth with surgery from what I’m aware of

 

[Deleted member 5385]

I actually don’t think upward growth is possible anymore. It doesn’t really seem logical. But an upward angle is good either way to avoid a downward movement and higher chances of having a neutral translation


In Won Moon’s ‘Seminars in Orthodontics’ it states “Figure 2 illustrates that MSE influences the entire midfacial structure. Besides the midfacial expansion, a forward and downward movement of the maxilla was clearly illustrated” (Moon 7).
View attachment 680071
Figure
View attachment 680072




It pisses me off that they never fucking tell us what their force vector was. But it’s prob downward

Upward growth is not natural movement of maxilla
But idk if whole maxilla move only forward it give an ilussion od upward growth i don't know actually

I don't think if it would be able to remodel maxilla like that. Because bone metabolism is active until death It probably would be possible if we knew how to do IT but it would take many years etc.
Another problem is the difference between bone remodelling of alveolar ringe and entire anterior part.

 

[optimusprime]

Got it man Ill ask him on tuesday and message u.

Just Post the answer itt or make a thread.

 

[spark]

Its way easier to lenghten bone than to shorten.
Actually nobody knows cause nobody does any studies/research about vertically compression/ shortening/ ccw call IT as you like.
There is no study like Ifluence of something on vertically shortening bone.
And conclusion to such study : this treatment reverse excess anterior part of Maxillary complex which affect vertically lenght of nasal and zygomatic complex which increase men sex appeal by 65 percent and cause to put their penises in vaginas 5 times more often jfl
(If I was a dentistry student I would go to Ting and did such studies only for myself as a research work)

But do you really have to shorten it?

you just move it forward and slightly up, but only the new bone being slightly up and not forcing the existing bone to shorten

how is this not possible?

 

[Deleted member 5385]

But do you really have to shorten it?
View attachment 684183
you just move it forward and slightly up, but only the new bone being slightly up and not forcing the existing bone to shorten

how is this not possible?

That's the SIM. A or C if I remember correct. Actually I don't think that would be impossible with only bone anchored Puller sińce @Aeons mentioned somewhere on this thread that only facepulling bone result in some upward growth.
But that nose height decrease would be not that great as it look - like 4-6mm, still great tho

 

[SPFromNY914]

I actually don’t think upward growth is possible anymore. It doesn’t really seem logical. But an upward angle is good either way to avoid a downward movement and higher chances of having a neutral translation


In Won Moon’s ‘Seminars in Orthodontics’ it states “Figure 2 illustrates that MSE influences the entire midfacial structure. Besides the midfacial expansion, a forward and downward movement of the maxilla was clearly illustrated” (Moon 7).
View attachment 680071
Figure
View attachment 680072




It pisses me off that they never fucking tell us what their force vector was. But it’s prob downward

So ting was lying on the interview with Eid when he said MSE doesn't promote downward growth and only regular expanders do‍♂fuck

 

[SPFromNY914]

damn unfortunately that discussion doesnt go into any more details on the specifics of the movement, leaving it still rly vague as to if the whole maxilla undergoes clockwise rotation or smth else.

this study on displacement patterns in RME is quite disconcerting tho (https://pubmed.ncbi.nlm.nih.gov/17628242/)
View attachment 680154
almost a mm of downward movement at the ANS from only 5 mm of expansion

even more suifuel given i have 4-5 mm of VME and an already ~20 degree occlusal plane but also pretty bad transverse deficiency

@Sergio-OMS @RealSurgerymax do you know if the downward movement from RME is significant? and is there anything that can be done to avoid cw movement?

Really depressing since I'm getting MSE soon and I thought the facepulling would eventually neutralize and then improve rhe downward growth caused by MSE

 

[SPFromNY914]

@Sergio-OMS @RealSurgerymax
hey, i cant find a solely mse study with clinical cephalometric data, but both of those papers from earlier this year by dr Moon which attempted to elaborate on the mechanism of action for the device described it as:

"Maxillary rotation around this fulcrum area during expansion could explain the downward movements of anterior nasal spine and posterior nasal spine induced by expanders" & "As the zygomaticomaxillary complex rotates outward around the frontozygomatic suture area, a half maxilla initially moves downward and outward" (https://pubmed.ncbi.nlm.nih.gov/30173836/)

"the zygomaticomaxillary complex, along with its inferior structures, move in a downward and outward direction in the coronal plane with a fulcrum localized slightly above the frontozygomatic suture" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355053/)

some other clinical studies on other RME devices describe an increase in facial height and posterior rotation of the maxillary complex (increase in MPA). from your experience, do you think this is a concern for vertically growing, class 2 patients? if u are willing, could u expand on the geometry of this movement (im sadly unable to visualize it properly)?

its scary for me, as someone with excess facial height (~4 mm VME, ~20 deg OP, ~3 mm overjet), that correcting my nasal airways would have a horrific impact cosmetically

Same bro I can't afford my midface to get any longer especially since I alrdy have a short ramus

 

[SPFromNY914]

Results and studies like these that show downward growth with protraction as well as rapid MSE leading to asymmetric expansion is why I chose slow MSE expansion on its own followed by djs . I might even go for round 2 of a slow expansion MSE because of the results I have had in the past few months. One tip I would give to anyone doing MSE would be to remember to keep the teeth together lightly and chew for 2 hours a day so the lower arch has a chance of expanding to the maximum it can as well

What should you chew if you already have slight tmj bruh?

 

[SPFromNY914]

Got it man Ill ask him on tuesday and message u.

Message me too pls brother, I'm in a similar situation as him with the midface I'm planning on starting mse next month

 

[SPFromNY914]

Ofcourse upward movement is possible


View attachment 681865

#1 Head position isn't the same
#2, What exactly was that procedure?

 

[hopelessphoenix]

What should you chew if you already have slight tmj bruh?

If your MSE ortho is smart he will be able to treat your tmj

 

[SPFromNY914]

If your MSE ortho is smart he will be able to treat your tmj

Did MSE personally give you anymore downward growth when you turned slow?

 

[hopelessphoenix]

Did MSE personally give you anymore downward growth when you turned slow?

It probably did just not noticeably because I can tell it definitely moved my maxilla forward at least a mm. Not worried about that though since my bimax will upturn my maxilla anyway

 

[curryslayerordeath]

Really depressing since I'm getting MSE soon and I thought the facepulling would eventually neutralize and then improve rhe downward growth caused by MSE

Same bro I can't afford my midface to get any longer especially since I alrdy have a short ramus

ive read a few of ur posts before, i think we have a lot of similar issues tbh. iirc u are a patient of dr newaz? if ur appliance is being made rn, u should try shooting him an email/message abt if theres any significant cw rotation and how it could be avoided (maybe give the context that u plan to have bimax to fix ur occlusal plane/long face, which could become exacerbated). my ortho didnt mention it as an issue and i have a similar profile as u, but their standards are lower than us psl aspies.

 

[JFM05]

Ill ask him on tuesday and message