Alt-RAMEC with MSE + FM for class III

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ALT RAMEC is used to protract the maxilla faster with FM. It’s essential because of longer duration pulling and more loosen sutures.

I've almost finished my MSE expansion using the Ting 1 turn/day protocol. I started with a slight class III malocclusion. I've been pretty committed to using the facemask protraction and my upper incisors seem to have moved forward a couple millimeters relative to the lower incisors, but I'd still like at least 3 more millimeters of sagittal expansion based on where it feels most comfortable to position my mandible. Dr. Ting says men my age are lucky to get 2 millimeters with the reverse pull headgear and @varbrah estimates he got 3-4mm. I'm considering alternating expansion and contraction to help loosen the perimaxillary sutures and prolong the period for the facemask to work. Typical Alt-RAMEC protocols call for 4-9 weeks cycling between opening the expander all the way one week and then closing the expander all the way the next week. My diastema is only a couple millimeters wide and I don't want to loose the limited transverse expansion my 10mm MSE has achieved by going backward, but I really want to maximize my sagittal expansion. So I'm trying to decide:

1) How far back to turn before turning forward again
2) How rapidly to open and close the appliance
3) How many cycles to expand and contract before moving on to stabilization with the appliance fully open

Currently, I think I'm only going to turn the expander back to about 35 turns when my diastema appeared. I don't want to crush any new bone that is starting to fill in the midpalatal gap. Typical Alt-RAMEC protocols might open and close as fast as about 1mm per day, or around 8 turns on the MSE. The Moon protocol recommends opening at 4-6 turns per day for mature adults before the diastema. Until now, I've been turning slowly at 1 turn per day to minimize tilting, dragging, and warping of the appliance. Maybe turning backwards rapidly would help upright the tilted TADs. So I think I might try closing the appliance at 6 turns per day and then reopen at 2 turns per day. I guess that I'll give this a try and decide how many cycles to complete based on if it seems to be helping or hurting my expansion.

I'd really appreciate any advice from people like @Aeons who have tried alternating expansion and contraction with the MSE or anyone like @Sergio-OMS @retard and @Agendum knowledgeable on the topic! @Aeons said he had to slow down because his overjet is getting worse. I need more overjet to correct my occlusion. Should I worry about losing my progress to tilting or dragging the TADs by closing and reopening the MSE? I don't want to get greedy and loose the improvements to my nasal breathing from transverse expansion by chasing more forward expansion.
 
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What direction are you pulling?
 
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I've almost finished my MSE expansion using the Ting 1 turn/day protocol. I started with a slight class III malocclusion. I've been pretty committed to using the facemask protraction and my upper incisors seem to have moved forward a couple millimeters relative to the lower incisors, but I'd still like at least 3 more millimeters of sagittal expansion based on where it feels most comfortable to position my mandible. Dr. Ting says men my age are lucky to get 2 millimeters with the reverse pull headgear and @varbrah estimates he got 3-4mm. I'm considering alternating expansion and contraction to help loosen the perimaxillary sutures and prolong the period for the facemask to work. Typical Alt-RAMEC protocols call for 4-9 weeks cycling between opening the expander all the way one week and then closing the expander all the way the next week. My diastema is only a couple millimeters wide and I don't want to loose the limited transverse expansion my 10mm MSE has achieved by going backward, but I really want to maximize my sagittal expansion. So I'm trying to decide:

1) How far back to turn before turning forward again
2) How rapidly to open and close the appliance
3) How many cycles to expand and contract before moving on to stabilization with the appliance fully open

Currently, I think I'm only going to turn the expander back to about 35 turns when my diastema appeared. I don't want to crush any new bone that is starting to fill in the midpalatal gap. Typical Alt-RAMEC protocols might open and close as fast as about 1mm per day, or around 8 turns on the MSE. The Moon protocol recommends opening at 4-6 turns per day for mature adults before the diastema. Until now, I've been turning slowly at 1 turn per day to minimize tilting, dragging, and warping of the appliance. Maybe turning backwards rapidly would help upright the tilted TADs. So I think I might try closing the appliance at 6 turns per day and then reopen at 2 turns per day. I guess that I'll give this a try and decide how many cycles to complete based on if it seems to be helping or hurting my expansion.

I'd really appreciate any advice from people like @Aeons who have tried alternating expansion and contraction with the MSE or anyone like @Sergio-OMS @retard and @Agendum knowledgeable on the topic! @Aeons said he had to slow down because his overjet is getting worse. I need more overjet to correct my occlusion. Should I worry about losing my progress to tilting or dragging the TADs by closing and reopening the MSE? I don't want to get greedy and loose the improvements to my nasal breathing from transverse expansion by chasing more forward expansion.
Yo, Im getting MSE w Ting. Did you get better under eye support w just MSE? Pics?
 
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Yo, Im getting MSE w Ting. Did you get better under eye support w just MSE? Pics?
Dr. Ting isn't my orthodontist. I'm just following the 1 turn/day protocol he recommends. I have observed a subtle increase in midface volume using the MSE and FM. I think this is most obvious in the paranasal area of my cheeks, but there might be a little more support under my eyes. My dark undereye circles have improved, but I attributed that to better sleep and breathing. I'm still hoping for more forward expansion from the FM and might try Alt-RAMEC to further reduce my underbite. Let me know if Dr. Ting has any advice about alternating expansion and contraction to maximize protraction!
 
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You are wasting your time. You're in your 30s, MSE will have next to no effect at all aesthetically and jaw surgery is far superior for fixing bite problems.
 
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How much did MSE implant cost? Did they split your suture surgically or just implant MSE?
 
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You are wasting your time. You're in your 30s, MSE will have next to no effect at all aesthetically and jaw surgery is far superior for fixing bite problems.

My main goal is improved nasal airway and I've already achieved that, with a little bit of aesthetic improvement for good measure. My class-III isn't so severe as to require surgery. I'd just like 3 more millimeters of maxillary protrusion if at all possible. Maybe alternating expansion and contraction could help me eke out just a little more forward change.
 
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How much did MSE implant cost? Did they split your suture surgically or just implant MSE?

The majority of the expense is in the orthodontic alignment required after the expansion messes up your bite and puts a gap in the middle of your teeth. My initial installation cost over 3K. I had cortipuncture to help facilitate separation of the midpalatal suture.
 
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3k wow cheap
 
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do they need to use braces or invisalign ok? Can’t do Invisalign with big diastema?
 
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do they need to use braces or invisalign ok? Can’t do Invisalign with big diastema?
My orthodontist plans to use invisalign. I don't know if the size of the diastema is a factor. Mine is only just over 2mm.
 
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@MSEFM

any aesthetic changes to nose?
 
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any aesthetic changes to nose?

I think the columella between the nostrils might be a little wider. One of my nostrils started narrower than the other and I think it might be a little more symmetrical now. The bridge of my nose always deviated to one side and I think the opposite side got a little wider and might have evened it out slightly. Generally I think the aesthetics of my nose are the same or slightly better.
 
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I think the columella between the nostrils might be a little wider. One of my nostrils started narrower than the other and I think it might be a little more symmetrical now. The bridge of my nose always deviated to one side and I think the opposite side got a little wider and might have evened it out slightly. Generally I think the aesthetics of my nose are the same or slightly better.

do you have photos for comparison? Just the nose in dm. I’m considering mse but don’t want to ruin my nose.
 
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do you have photos for comparison? Just the nose in dm. I’m considering mse but don’t want to ruin my nose.
Umm, I have old pictures of my face that I could crop out the nose. I haven't taken any new pictures to compare. Let me finish all of my turns and then I'll try to replicate the same lighting and camera angle as the before shots. For me, I really think the changes in the nose are so minute as to not be noticeable offhand. I suppose the changes could be more dramatic in someone younger with less rigid perimaxillary sutures or more transverse skeletal expansion than me. Maybe if I start Alt-RAMEC my frontomaxillary sutures will open more and expand the bridge of my nose.
 
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Agendum

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I've almost finished my MSE expansion using the Ting 1 turn/day protocol. I started with a slight class III malocclusion. I've been pretty committed to using the facemask protraction and my upper incisors seem to have moved forward a couple millimeters relative to the lower incisors, but I'd still like at least 3 more millimeters of sagittal expansion based on where it feels most comfortable to position my mandible. Dr. Ting says men my age are lucky to get 2 millimeters with the reverse pull headgear and @varbrah estimates he got 3-4mm. I'm considering alternating expansion and contraction to help loosen the perimaxillary sutures and prolong the period for the facemask to work. Typical Alt-RAMEC protocols call for 4-9 weeks cycling between opening the expander all the way one week and then closing the expander all the way the next week. My diastema is only a couple millimeters wide and I don't want to loose the limited transverse expansion my 10mm MSE has achieved by going backward, but I really want to maximize my sagittal expansion. So I'm trying to decide:

1) How far back to turn before turning forward again
2) How rapidly to open and close the appliance
3) How many cycles to expand and contract before moving on to stabilization with the appliance fully open

Currently, I think I'm only going to turn the expander back to about 35 turns when my diastema appeared. I don't want to crush any new bone that is starting to fill in the midpalatal gap. Typical Alt-RAMEC protocols might open and close as fast as about 1mm per day, or around 8 turns on the MSE. The Moon protocol recommends opening at 4-6 turns per day for mature adults before the diastema. Until now, I've been turning slowly at 1 turn per day to minimize tilting, dragging, and warping of the appliance. Maybe turning backwards rapidly would help upright the tilted TADs. So I think I might try closing the appliance at 6 turns per day and then reopen at 2 turns per day. I guess that I'll give this a try and decide how many cycles to complete based on if it seems to be helping or hurting my expansion.

I'd really appreciate any advice from people like @Aeons who have tried alternating expansion and contraction with the MSE or anyone like @Sergio-OMS @retard and @Agendum knowledgeable on the topic! @Aeons said he had to slow down because his overjet is getting worse. I need more overjet to correct my occlusion. Should I worry about losing my progress to tilting or dragging the TADs by closing and reopening the MSE? I don't want to get greedy and loose the improvements to my nasal breathing from transverse expansion by chasing more forward expansion.

Very interesting read, thank you for posting in detail. Ive hit a bit of a roadblock in my own expansion and havnt finished it yet so Im not at the FM phase ( tbd 2021 after expansion). This protocol seems very interesting and Ive heard it circulating around abit about expansion->contraction. My ortho hasnt had me do anything like that though, she is doing kinda barebones stuff.

I was @ 2 turns a day the whole way, (I secretly added 1 extra turn every other mid-day on my 2nd MSE to break the suture since the 1st mse failed to break the suture @24 turns + molar tipping.) The 2nd MSE was placed a few mm anteriorly and suture breakage @21 turns with heavy corticopuncture. IMO I think that extra 'umph' helped break the suture but I dont think I got any maxillary sutures loosened. I think that happens only when you expand past a certain amount, where the zygos begin to flare and rotate outwards disrupting the other facial sutures due to positional changes. Im not sure if cycles of reversal/expansion matter until that overall rotation is changed.

My ortho advised against ever reverse turning during expansion for my case (I had to since the arms were digging into my gums+pushing aveolar bone,) thats why its interesting to hear that your protocol includes cycles of reversal. In the Great Work I think I also saw Sergio talking about it to another MSE user. My ortho didnt care to explain to me her reasoning behind her ideas of expansion protocols but I get the feeling she is operating on and older+simpler methods thats more one-size-fits-all approach. I believe the limiting factor of loosening perimaxillary sutures is related to the frontal bone restricting tension that leads to the zygomatic flaring that relates to the canthal tilt of the orbits. The bone shape is different for everyone so it might give different results.

Ive heards someone say that some of the growth from protraction can be from the stretching of the actual sutures before any split. Not sure how true that is but might be something to consider.

Ever since Ive been told to wait for the new bone to form in the middle of the parallel split Ive noticed that some sort of relapse occurred where it feels like my nasal passages arent as open as there where when I initially split the suture. I dont really have an explanation for why this occurred, I think its related to maxillary cant. It is worth considering since you want to preserve the expansion of your nasal floor but I dont think screw drag is an issue if you have dense bone (seen in scans.)
 
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Very interesting read, thank you for posting in detail. Ive hit a bit of a roadblock in my own expansion and havnt finished it yet so Im not at the FM phase ( tbd 2021 after expansion). This protocol seems very interesting and Ive heard it circulating around abit about expansion->contraction. My ortho hasnt had me do anything like that though, she is doing kinda barebones stuff.

I was @ 2 turns a day the whole way, (I secretly added 1 extra turn every other mid-day on my 2nd MSE to break the suture since the 1st mse failed to break the suture @24 turns + molar tipping.) The 2nd MSE was placed a few mm anteriorly and suture breakage @21 turns with heavy corticopuncture. IMO I think that extra 'umph' helped break the suture but I dont think I got any maxillary sutures loosened. I think that happens only when you expand past a certain amount, where the zygos begin to flare and rotate outwards disrupting the other facial sutures due to positional changes. Im not sure if cycles of reversal/expansion matter until that overall rotation is changed.

My ortho advised against ever reverse turning during expansion for my case (I had to since the arms were digging into my gums+pushing aveolar bone,) thats why its interesting to hear that your protocol includes cycles of reversal. In the Great Work I think I also saw Sergio talking about it to another MSE user. My ortho didnt care to explain to me her reasoning behind her ideas of expansion protocols but I get the feeling she is operating on and older+simpler methods thats more one-size-fits-all approach. I believe the limiting factor of loosening perimaxillary sutures is related to the frontal bone restricting tension that leads to the zygomatic flaring that relates to the canthal tilt of the orbits. The bone shape is different for everyone so it might give different results.

Ive heards someone say that some of the growth from protraction can be from the stretching of the actual sutures before any split. Not sure how true that is but might be something to consider.

Ever since Ive been told to wait for the new bone to form in the middle of the parallel split Ive noticed that some sort of relapse occurred where it feels like my nasal passages arent as open as there where when I initially split the suture. I dont really have an explanation for why this occurred, I think its related to maxillary cant. It is worth considering since you want to preserve the expansion of your nasal floor but I dont think screw drag is an issue if you have dense bone (seen in scans.)

Thanks @Agendum! It's nice to compare notes with someone else going through the same process! I'm sorry to hear that your improved nasal breathing might be relapsing while you're waiting to start another round of expansion! You're stabilizing with the current MSE in place before replacing it, right? Have you had any more imaging since your suture separated? I also immediately noticed better breathing out of my narrower side the same day my diastema appeared, but I've occasionally had a day or two where it seemed stuffy again. Maybe it's just the dry winter air. My whole goal is better breathing and sleeping, so I'd hate to cancel that by attempting alternating expansion and contraction. Since using Alt-RAMEC with MSE is entirely experimental, I don't expect anyone to have a definitive answer, but I would like to hear from someone like @Aeons who has tried it to hear how many turns per day he used, how many times he cycled, if he closed the MSE all the way before opening it again, and if he noticed loss of any transverse expansion as he gained sagittal expansion.
 
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but I would like to hear from someone like @Aeons who has tried it to hear how many turns per day he used, how many times he cycled, if he closed the MSE all the way before opening it again, and if he noticed loss of any transverse expansion as he gained sagittal expansion.
I was doing 1 turn a day, until my orthodontist told me to do 2 turns then 2 reverse turns the next day, I decided to convert more towards the ALT RAMEC technique and did 2 turns everyday for a week, then the next week i relapsed all of that this was to keep the sutures loose for the FM. Can’t say I lost any transverse expansion.
 
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I was doing 1 turn a day, until my orthodontist told me to do 2 turns then 2 reverse turns the next day, I decided to convert more towards the ALT RAMEC technique and did 2 turns everyday for a week, then the next week i relapsed all of that this was to keep the sutures loose for the FM. Can’t say I lost any transverse expansion.

Thanks @Aeons! This is very helpful! Just to be sure I understand, sometime after your diastema had already opened, you started advancing 2 turns every day for 1 week and then reversing 2 turns every day for the next week and repeated this a few times until you felt that your overbite was getting bad. Is that correct? So you were just cycling through about 14 turns forward and then 14 turns back without ever closing the device back farther. This sounds safer to me than the typical Alt-RAMEC protocol that calls for opening and closing the MARPE all the way each week. About how many times did you cycle back and forth?
 
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Thanks @Aeons! This is very helpful! Just to be sure I understand, sometime after your diastema had already opened, you started advancing 2 turns every day for 1 week and then reversing 2 turns every day for the next week and repeated this a few times until you felt that your overbite was getting bad. Is that correct? So you were just cycling through about 14 turns forward and then 14 turns back without ever closing the device back farther. This sounds safer to me than the typical Alt-RAMEC protocol that calls for opening and closing the MARPE all the way each week. About how many times did you cycle back and forth?
ive done it for 7-8 weeks now
 
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Dr. Ting alludes to alternating expansion and contraction in this Jawhacks interview:


Starting at about 4:04 he says, "One technique that I use is for patients who are slacking off on headgear, then I will intentionally overexpand them, have them continue to wear it for another month or two, and then I can back turn them and make it go back in a little bit… or I can decrease it first and then increase it to play around with the suture, hopefully that will help." This sounds similar to what @Aeons described, in that he doesn't contract the MSE all the way before he starts expanding again. It also sounds like Dr. Ting maybe only does one cycle of contracting and expanding again. He doesn't mention how many turns per day he uses, but maybe he continues with his typical 1 turn per day. There's no consensus among the other MSE providers that I've seen discuss Alt-RAMEC about its utility in adult non-growing patients or the protocol to follow. I still haven't decided what I'm going to do, but I'll probably be more conservative than my original plan.
 
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What direction are you pulling?

I decided to pull at an angle slightly downward from the occlusal plain to encourage growth at the circummaxillary sutures. This is the angle used in MSE studies, mostly in growing children and adolescents, and @varbrah used the same vector. Because I'm brachycephalic, even a little downward displacement wouldn't be bad for me. Especially on my left side, which seems to be generally less developed with a narrower dental arch, canted higher, and a less prominent zygoma. I've felt a couple popping sensations around the left pterygopalatine suture and I have a little tenderness if I press in that area.
 

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I decided to pull at an angle slightly downward from the occlusal plain to encourage growth at the circummaxillary sutures. This is the angle used in MSE studies, mostly in growing children and adolescents, and @varbrah used the same vector. Because I'm brachycephalic, even a little downward displacement wouldn't be bad for me. Especially on my left side, which seems to be generally less developed with a narrower dental arch, canted higher, and a less prominent zygoma. I've felt a couple popping sensations around the left pterygopalatine suture and I have a little tenderness if I press in that area.
what facemask are u using currently lol.
 
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what facemask are u using currently lol.
Haha, I try to clock upwards of 20 hours per day, whenever I'm not eating, drinking, showering, or brushing my teeth (one advantage of social distancing). Right now I'm using a typical reverse pull headgear with the pad on the forehead and the chin, but I also use the forwardontics bow, mostly during sleep.
 
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Haha, I try to clock upwards of 20 hours per day, whenever I'm not eating, drinking, showering, or brushing my teeth (one advantage of social distancing). Right now I'm using a typical reverse pull headgear with the pad on the forehead and the chin, but I also use the forwardontics bow, mostly during sleep.
Should have used the mew vector which doesn't do CW but CCW instead.
 
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Haha, I try to clock upwards of 20 hours per day, whenever I'm not eating, drinking, showering, or brushing my teeth (one advantage of social distancing). Right now I'm using a typical reverse pull headgear with the pad on the forehead and the chin, but I also use the forwardontics bow, mostly during sleep.
how many mm have u gotten so far.
 
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how many mm have u gotten so far.
So far, MSE+FM seems to have moved my upper incisors 2-3 millimeters forward relative to the lower incisors. This is around the total that Dr. Ting suggests is realistic for adults. My baseline lateral cephalogram, before treatment, showed my SNA was about 1 degree less than my SNB. In other words, my maxilla started slightly behind my mandible. The proclination of my upper incisors camoflagues my borderline class iii maloclusion to some extent. I would need to increase my SNA by at least 1 degree to get my A point back within normal range and by about 3 degrees to reach the average. Unfortunately, I don’t have a current ceph to compare, but my A point might already be about the same AP position or even ahead of my B point now. I’d really like to get at least a couple more millimeters of sagittal expansion to comfortably position my mandible with a normal overbite and upright my upper incisors to improve my incisal display. Maybe alternating expansion and contraction could help me get there.
 
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So far, MSE+FM seems to have moved my upper incisors 2-3 millimeters forward relative to the lower incisors. This is around the total that Dr. Ting suggests is realistic for adults. My baseline lateral cephalogram, before treatment, showed my SNA was about 1 degree less than my SNB. In other words, my maxilla started slightly behind my mandible. The proclination of my upper incisors camoflagues my borderline class iii maloclusion to some extent. I would need to increase my SNA by at least 1 degree to get my A point back within normal range and by about 3 degrees to reach the average. Unfortunately, I don’t have a current ceph to compare, but my A point might already be about the same AP position or even ahead of my B point now. I’d really like to get at least a couple more millimeters of sagittal expansion to comfortably position my mandible with a normal overbite and upright my upper incisors to improve my incisal display. Maybe alternating expansion and contraction could help me get there.
thank u for the answers did u get upper maxilla movement or was it mostly teeth movement. also how much bands are u using on each side.
 
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thank u for the answers did u get upper maxilla movement or was it mostly teeth movement. also how much bands are u using on each side.
I've had some dental tipping, but not too bad. Most sources I've seen recommend 1kg traction per side in adults. I've tried to exceed that, really using as much traction as tolerable. In practice this varies depending on which headgear I'm using, which combination of elastic sizes and resistance levels, and how worn out they get before replacing them with new. Some people find that too much traction makes their molars uncomfortable, but for me the limiting variable is mostly the pressure on my forehead.
 
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Should have used the mew vector which doesn't do CW but CCW instead.
The Mew Vector headgear isn't something you can just purchase. Dr. Mew makes his headgear for each patient in the office. He uses a facebow connected to buccal tubes on the first molar wires of his removeable appliances and this wouldn't fit with the J-hooks on my MSE. I experimented with some DIY headgear designs but they weren't as practical as the basic rphg and the forwardontics bow that I use. Some have also speculated that the posterior placement of the MSE TADs means that pulling down in the back would counterclockwise rotate the maxilla. I'm not convinced that CCW rotation is required in my case. I'm more interested in displacing the maxilla along a forward and slightly downward vector to induce separation and growth at the circummaxillary sutures. I guess chewing in the front or back during expansion might be another way to modulate the rotation as @retard proposed.
 
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@MSEFM

any aesthetic changes to nose?

The more I look at my crooked nose, I think the nasal bone itself is still just as deviated to the left as it always was, but the sidewalls made up of the frontal processes of the maxilla have shifted laterally just slightly on both sides, making the bridge overall a little wider and camouflaging some of the dorsum discrepancy. Any advice for how to correct this short of surgery?
 
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With only a couple turns of my initial expansion left, I'm rethinking my plan for alternating contraction and expansion to be a little more conservative based on the comments by Aeons and Dr. Ting. I still want to be aggressive enough to disrupt the perimaxillary sutures. So I'm currently thinking that I will reverse at 4 turns per day for 1 week, totaling 28 turns. This is about half the 1mm per day rate of typical Alt-RAMEC protocols. Then I think I'll advance again even slower at 2 turns per day for 2 weeks, and repeat these cycles at least 4 times. I'll continue the reverse pull headgear throughout. I've had pretty significant resistance to advancing my MSE even after the diastema. I suspect the backward and forward turns should have less resistance during the alternating phase, but I will slow down if I feel too much resistance, and I might speed up if there's very little resistance. Does this sound reasonable? I don't want to cancel out the progress I've made from the initial expansion.
 
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Fgsfds

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This is the future of maxillary protraction for sure. It's known, by experienced MSE practitioners such as Ting, that there's a two-month window after the suture split where where adults can get maxillary protraction. This suggests that the major rate-limiter that prevents adults from achieving childlike protraction is suture articulation. And therefore, Alt-RAMEC will keep the sutures disarticulated and allow great expansion.

I've emailed the top researchers in the field and all have told me that nobody has tried Alt-RAMEC with an MSE yet in any age group. However, it's not unknown principles by any means. I'm optimistic that this will achieve unprecedented results, especially once practitioners nut up, stop being retards, and adopt Alt-RAMEC into the MSE protocol (like they have with tooth-borne RPE).

Godspeed OP, go for it and report back.
 
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With only a couple turns of my initial expansion left, I'm rethinking my plan for alternating contraction and expansion to be a little more conservative based on the comments by Aeons and Dr. Ting. I still want to be aggressive enough to disrupt the perimaxillary sutures. So I'm currently thinking that I will reverse at 4 turns per day for 1 week, totaling 28 turns. This is about half the 1mm per day rate of typical Alt-RAMEC protocols. Then I think I'll advance again even slower at 2 turns per day for 2 weeks, and repeat these cycles at least 4 times. I'll continue the reverse pull headgear throughout. I've had pretty significant resistance to advancing my MSE even after the diastema. I suspect the backward and forward turns should have less resistance during the alternating phase, but I will slow down if I feel too much resistance, and I might speed up if there's very little resistance. Does this sound reasonable? I don't want to cancel out the progress I've made from the initial expansion.
I wouldn't worry about losing expansion progress as transverse expansion is an incredibly easy problem, and you've already solved it. Sagittal protraction is, however, a difficult problem, and with the MSE currently in your mouth, you are in a unique opportunity to get some. Once your sutures re-articulate it's game over for protraction.
 
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This is the future of maxillary protraction for sure. It's known, by experienced MSE practitioners such as Ting, that there's a two-month window after the suture split where where adults can get maxillary protraction. This suggests that the major rate-limiter that prevents adults from achieving childlike protraction is suture articulation. And therefore, Alt-RAMEC will keep the sutures disarticulated and allow great expansion.

I've emailed the top researchers in the field and all have told me that nobody has tried Alt-RAMEC with an MSE yet in any age group. However, it's not unknown principles by any means. I'm optimistic that this will achieve unprecedented results, especially once practitioners nut up, stop being retards, and adopt Alt-RAMEC into the MSE protocol (like they have with tooth-borne RPE).

Godspeed OP, go for it and report back.

I know of one MSE practitioner who says he has used it in teens. The one paper I've read about alternating expansion and contraction with a MARPE in an adult was using it as a strategy to get the midpalatal suture to separate but didn't add protraction. I guess it's a bit of a leap of faith, but thanks for the encouragement! I have a 10mm MSE and I'm wishing I had those extra 2mm of the 12mm to really get my nasal breathing perfect. But If I can get my mandible and tongue out of my throat by bringing the maxilla farther forward, it might give me some additional airway/sleep improvements. Without alternating expansion and contraction, the adult class-III correction MSE-FM cases I've seen are never as dramatic as some of the child/adolescent cases, even when the occlusion looks right in the end. I think they sometimes involve retracting the mandible to align with the maxilla and I don't want that. It would be nice to even over-correct a little to allow for uprighting of the upper incisors and account for any AP relapse. I started skeletally class III with some dental compensation. I think my upper incisors might be decompensating a little already. I'll start contracting in a couple days and update here with how much resistance I feel.
 
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I know of one MSE practitioner who says he has used it in teens. The one paper I've read about alternating expansion and contraction with a MARPE in an adult was using it as a strategy to get the midpalatal suture to separate but didn't add protraction. I guess it's a bit of a leap of faith, but thanks for the encouragement! I have a 10mm MSE and I'm wishing I had those extra 2mm of the 12mm to really get my nasal breathing perfect. But If I can get my mandible and tongue out of my throat by bringing the maxilla farther forward, it might give me some additional airway/sleep improvements. Without alternating expansion and contraction, the adult class-III correction MSE-FM cases I've seen are never as dramatic as some of the child/adolescent cases, even when the occlusion looks right in the end. I think they sometimes involve retracting the mandible to align with the maxilla and I don't want that. It would be nice to even over-correct a little to allow for uprighting of the upper incisors and account for any AP relapse. I started skeletally class III with some dental compensation. I think my upper incisors might be decompensating a little already. I'll start contracting in a couple days and update here with how much resistance I feel.
Oh wow. Who is it, if I may ask (you can PM if you want to keep it private). I talked to the top authors who publish in facial orthopedics e.g. De Clerck.

This paper is the closest I'm aware of to what we want (BAMP + Alt-RAMEC) https://www.researchgate.net/public..._with_the_Hybrid_Hyrax_and_Alt-RAMEC_protocol
but I contacted Wilmes and he said he hadn't heard of anyone trying this in adults.

FWIW I'm class III same as you. I consulted with a few top MSE providers and a couple wanted to do the mandible retraction BS. This will have REALLY bad aesthetic results and will probably require lower extractions to make room. If it comes down to it, get bimax after with a redpilled surgeon, do not retract your mandible or do extractions.

I don't really see how this could go wrong, as RPE + Alt-RAMEC in children is a well-trodden path. Since the midpalatal suture (and many other sutures) aren't fused yet in children, doing RPE + Alt-RAMEC on them is about just as "intense" on their face as MSE + Alt-RAMEC would be on an adult's, and the kids are fine.
 
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Oh wow. Who is it, if I may ask (you can PM if you want to keep it private). I talked to the top authors who publish in facial orthopedics e.g. De Clerck.

This paper is the closest I'm aware of to what we want (BAMP + Alt-RAMEC) https://www.researchgate.net/public..._with_the_Hybrid_Hyrax_and_Alt-RAMEC_protocol
but I contacted Wilmes and he said he hadn't heard of anyone trying this in adults.

FWIW I'm class III same as you. I consulted with a few top MSE providers and a couple wanted to do the mandible retraction BS. This will have REALLY bad aesthetic results and will probably require lower extractions to make room. If it comes down to it, get bimax after with a redpilled surgeon, do not retract your mandible or do extractions.

I don't really see how this could go wrong, as RPE + Alt-RAMEC in children is a well-trodden path. Since the midpalatal suture (and many other sutures) aren't fused yet in children, doing RPE + Alt-RAMEC on them is about just as "intense" on their face as MSE + Alt-RAMEC would be on an adult's, and the kids are fine.

Here's the adult MARPE Alt-RAMEC (without protraction) case report (it's in Italian):

I'd have to keep searching for the name of the orthodontist who claimed to have good results using MARPE and FM with Alt-RAMEC in adolescents. I remember he was also outside the United States, but I can't remember where.
 
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After advancing all of the turns on my MSE at 1 turn per day, I've been contracting at 4 turns per day. There is less resistance on the reverse turns than there were on the forward turns, but there is still some resistance. It feels a little funny along my mid palatal suture for a couple minutes after I turn back. I'm trying to be consistent about getting as many hours of facemask protraction in during the day in addition to my sleeping hours. After one week, totaling 28 reverse turns, I'll start turning forward again. I haven't decided if I will expand forward at 2 turns per day for 2 weeks or 4 turns per day for 1 week. This will depend on how much resistance I feel. If the turns are as hard as they were during the initial expansion, I'll probably go with the slower 2 turns per day, but they might be easier because I'll be retreading ground I've already covered. So far, I still think I'm getting some minor advancement based on how my incisors meet up. Hopefully alternating expansion and contraction will give my facemask more time to work. Ideally, I'd still like to protrude at least 3 more millimeters.
 
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Should have used the mew vector which doesn't do CW but CCW instead.
How do you get mew vector headgear if you aren’t a patient of Mew’s?
 
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How do you get mew vector headgear if you aren’t a patient of Mew’s?
No idea if he would sell it to someone who is not his patient but of course the only way would be by contacting Mike Mew.
 
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schneebly

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Haha, I try to clock upwards of 20 hours per day, whenever I'm not eating, drinking, showering, or brushing my teeth (one advantage of social distancing). Right now I'm using a typical reverse pull headgear with the pad on the forehead and the chin, but I also use the forwardontics bow, mostly during sleep.
Why do you have both the typical and forwardontics bow? Do they do anything different? Do they feel any different?
 
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Why do you have both the typical and forwardontics bow? Do they do anything different? Do they feel any different?
I use the typical reverse pull headgear during the day because it is less cumbersome and easier to take on and off. I use the forwardontics bow at night because it is more comfortable to sleep with and doesn't put pressure on the mandible.
 
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@MSEFM how long did it take before your suture split and you noticed a diastema? How many days / turns?
 
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@MSEFM how long did it take before your suture split and you noticed a diastema? How many days / turns?
My diastema appeared on day and turn 35 (following a 1 turn/day protocol).
 
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As I've continued 4 reverse turns per day, I guess it's not surprising that my diastema has gotten narrower. I've also started to feel more resistance to turning, but I've continued with 4 turns each day, and this has resulted in some sensitivity in my molars. I wonder if @Aeons had the molar arms removed before he started alternating expansion and contraction.
 
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I wonder if @Aeons had the molar arms removed before he started alternating expansion and contraction.
Sorry, this was a stupid question since you need the molar arms and bands attached to the J-hooks to continue protraction and transfer the tension to the TADs.
 

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