Alt-RAMEC with MSE + FM for class III

[ascentium]

Any midface changes are subtle. My perinasal area might have a little more volume in the lateral dimension, but I don't notice any more cheek convexity in a profile view. I do think my upper lip might have a little more support. I've definitely expanded more transversely than anteriorly, so any midface changes are probably mostly from the MSE. My orthodontist thinks the facemask is unlikely to have much effect at my age.

is the ortho aware that you’re following ALT-RAMEC?

 

[MSEFM]

is the ortho aware that you’re following ALT-RAMEC?

My orthodontist was skeptical, but he said that I could experiment with it if I started the 6 month stabilization window after I finish the alternating cycles.

 

[patricknotstar]

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.

Hi can I ask how much ur MSE cost , If u don’t answer I will physically harm myself hahahjahahahahahhahahah

 

[MSEFM]

Hi can I ask how much ur MSE cost , If u don’t answer I will physically harm myself hahahjahahahahahhahahah

The MSE and installation cost about 3 thousand dollars, but the majority of the expense is the realignment afterward to close the diastema and fix your bite.

 

[Agendum]

2K of my cost (of $8K) was for MSE but my ortho thought Id only need one. I will be on my 3rd.

 

[MSEFM]

ive done it for 7-8 weeks now

@Aeons have you finished alternating backward and forward? How many total weeks did you cycle through? I'm debating if I should stop after 7 weeks or continue to 9 weeks or more.

 

[ascentium]

Will you compare your before and after CBCTs for us?

did you notice your inter-canthil distance increase or that area get ‘enhanced’ in some capacity?

 

[MSEFM]

Will you compare your before and after CBCTs for us?

did you notice your inter-canthil distance increase or that area get ‘enhanced’ in some capacity?

I'm not sure if my orthodontist will want to take another CBCT or not. It would be interesting to measure the changes, but probably isn't clinically necessary, so we might avoid the radiation exposure. I'll report any observations from any imaging we do. I don't notice an obvious difference in the space between my eyes. There might be a little less asymmetry in the bridge of my nose there.

 

[MSEFM]

Tomorrow I will complete 8 weeks of contracting and expanding. This is when a typical Alt-RAMEC protocol would stop, but I think I'm going to go for at least 2 more weeks since I feel like I'm still making gradual progress but haven't reached my goal.

 

[MSEFM]

I'm feeling a little tenderness around one of the TADs if I tap on it with something hard. I don't want hylinization of the bone from all of this rapid back and forth pressure. So I think I might stop the alternating cycles today, after 8 weeks rather than going ahead with an extra cycle beyond the typical alt-RAMEC protocol. Hopefully the sutures will remain mobile for a couple more months to allow me to make a little more progress with the extra-oral traction. I'm also eager to start the 6-month countdown before the appliance can be removed.

 

[ascentium]

I'm feeling a little tenderness around one of the TADs if I tap on it with something hard. I don't want hylinization of the bone from all of this rapid back and forth pressure. So I think I might stop the alternating cycles today, after 8 weeks rather than going ahead with an extra cycle beyond the typical alt-RAMEC protocol. Hopefully the sutures will remain mobile for a couple more months to allow me to make a little more progress with the extra-oral traction. I'm also eager to start the 6-month countdown before the appliance can be removed.

It’s been a long journey. Thank you for advancing the MSE frontier. Mine is being installed soon.

any mid-facial gains to note?

 

[MSEFM]

It’s been a long journey. Thank you for advancing the MSE frontier. Mine is being installed soon.

any mid-facial gains to note?

When I look in the mirror, I think I see improvement, but when I took some standardized "after" pictures 8 weeks ago after completing my initial expansion before starting my alternating protocol I couldn't identify obvious changes. I'm curious to take some new pictures now.

 

[MSEFM]

I've been playing around with the webceph morphing feature, and the main thing I've realized is that even drastically advancing my maxilla by about 5mm is subtle enough in the comparison that it would be hard to say definitively there was improvement if these were real before and after pictures. Part of this might be because the morph only seems to advance the lefort 1 area. When you look at the animation it becomes more obvious. I think the increased support that I've noticed behind my upper lip is similar to what the morph shows, so it makes me hopeful that I'm getting actual forward results from my reverse pull headgear, as the change in my bite suggests, even though it's hard to definitively recognize in profile pictures so far.

 

[ascentium]

I've been playing around with the webceph morphing feature, and the main thing I've realized is that even drastically advancing my maxilla by about 5mm is subtle enough in the comparison that it would be hard to say definitively there was improvement if these were real before and after pictures. Part of this might be because the morph only seems to advance the lefort 1 area. When you look at the animation it becomes more obvious. I think the increased support that I've noticed behind my upper lip is similar to what the morph shows, so it makes me hopeful that I'm getting actual forward results from my reverse pull headgear, as the change in my bite suggests, even though it's hard to definitively recognize in profile pictures so far.

when will you get post expansion cephs, so you can superimpose ?

 

[patricknotstar]

I've been playing around with the webceph morphing feature, and the main thing I've realized is that even drastically advancing my maxilla by about 5mm is subtle enough in the comparison that it would be hard to say definitively there was improvement if these were real before and after pictures. Part of this might be because the morph only seems to advance the lefort 1 area. When you look at the animation it becomes more obvious. I think the increased support that I've noticed behind my upper lip is similar to what the morph shows, so it makes me hopeful that I'm getting actual forward results from my reverse pull headgear, as the change in my bite suggests, even though it's hard to definitively recognize in profile pictures so far.

Holy shit thanks for introducing me to this god tier site

 

[MSEFM]

when will you get post expansion cephs, so you can superimpose ?

We might wait until the MSE comes out to take the "after" lateral ceph, but at least a couple more months since I'm still hoping for more progress.

 

[MSEFM]

Holy shit thanks for introducing me to this god tier site

I learned of it from this thread, so props to @SixCRY

https://looksmax.org/threads/surgery-simulation-at-home-2d.319479/

 

[ascentium]

Any update?

 

[MSEFM]

Any update?

Not really. It's been about 5 weeks since I stopped the alternating cycles. If I'm getting any more advancement it is very minor, but I'm continuing to use the reverse pull headgear.

 

[ascentium]

Not really. It's been about 5 weeks since I stopped the alternating cycles. If I'm getting any more advancement it is very minor, but I'm continuing to use the reverse pull headgear.

do you have to use the reverse pull headgear in the retention phase?

 

[MSEFM]

do you have to use the reverse pull headgear in the retention phase?

You can use reverse pull headgear as long as you still have the molar arms and bands with the elastic hooks attached. Sometimes these need to be cut off during the expansion if they are tilting your molars.

 

[Fgsfds]

@MSEFM whats good my boy

 

[MSEFM]

@MSEFM whats good my boy

I still think I'm getting very gradual forward change.

 

[Fgsfds]

I still think I'm getting very gradual forward change.

Excellent. Even long after you discontinued the turning?

 

[MSEFM]

Excellent. Even long after you discontinued the turning?

Yeah, it's been over 10 weeks since I finished my alternating cycles. My bite still feels like it's incrementally changing from the reverse pull headgear.

 

[Fgsfds]

@MSEFM Any more updates mate?

 

[N1c]

I only say this because of Ronald's results. He did too much expansion but the change in his zygos was night and day. IIRC he did 10-12 mm, I plan on 8-10 (posterior crossbite)mm. He went from flat zygos to essentially full zygos through his expansion.

View attachment 968764

Mouth got noticeably wider too.

I think one of the reason why he got so big change in his zygo is that his forward growth where already ok but his lateral growth was bad

 

[MSEFM]

@MSEFM Any more updates mate?

I'm not sure if my forward progress has stopped or if it's just too gradual to notice. My bite when putting my mandible in the most comfortable position has gone from an underbite with the lateral incisors touching to and end-on-end bite with the right central incisors touching to now an end-on-end bite with the left central incisors touching. It feels like maybe my lower incisors now want to hit just behind the tips of the upper incisors, but not all the way back into maximal intercuspation. Even just one more millimeter of forward advancement would be great, but I think I'm reaching the point of diminishing returns. I'm planning to continue using the reverse pull headgear for at least a couple more months, maybe longer if I notice continued progress.

 

[Fgsfds]

@MSEFM how's it going now?

 

[MSEFM]

@MSEFM how's it going now?

Looks like it's been about 7 weeks since my last update. If there has been any forward progress since then, it is very small, a fraction of a millimeter at most. At that time I said that my teeth want to touch with the left central incisors hitting end-on-end or with the lower left central incisor just slightly behind the upper. Now it feels more definitive that they want to hit with a very small overjet, but I'd estimate still a millimeter or more away from being really comfortable in maximal intercuspation or with an overjet in the normal range of 1-3mm. There's more overjet on the right side, so maybe the left side could be proclined into a good position, but I really wanted to overcorrect to allow some room for relapse. My orthodontist has said he would be ready to remove the MSE in September, but I want to keep it to continue with the reverse-pull headgear for now.

 

[Patient A]

Maybe turning backwards rapidly would help upright the tilted TADs.

just loosen TAD screws theory

 

[Deleted member 7725]

Looks like it's been about 7 weeks since my last update. If there has been any forward progress since then, it is very small, a fraction of a millimeter at most. At that time I said that my teeth want to touch with the left central incisors hitting end-on-end or with the lower left central incisor just slightly behind the upper. Now it feels more definitive that they want to hit with a very small overjet, but I'd estimate still a millimeter or more away from being really comfortable in maximal intercuspation or with an overjet in the normal range of 1-3mm. There's more overjet on the right side, so maybe the left side could be proclined into a good position, but I really wanted to overcorrect to allow some room for relapse. My orthodontist has said he would be ready to remove the MSE in September, but I want to keep it to continue with the reverse-pull headgear for now.

How much total maxilla forward advancement did you get? I have an edge-to-edge slight class 3 bite right now and would love to avoid surgery if I could while simultaneously expanding zygos.

 

[MSEFM]

How much total maxilla forward advancement did you get? I have an edge-to-edge slight class 3 bite right now and would love to avoid surgery if I could while simultaneously expanding zygos.

I haven't had a follow-up lateral ceph or CBCT to measure yet. If I had to guess, based on my bite, there might be 3mm of forward advancement. At least in my case, it takes a lot of effort for minimal change.

 

[Fgsfds]

@MSEFM hello lad. What's new