- Dec 21, 2020
- Time online
- 3d 21h 2m
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.