Alt-RAMEC with MSE + FM for class III

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I'm considering switching to 2 turns per day for both forward and backward. The molar sensitivity makes it uncomfortable to apply the same amount of tension with the facemask. The changes are so small that it's impossible to judge on a day to day basis if there has been any incremental protrusion, but sometimes I think my bite feels a little different, and I'm not really noticing anything this morning after using the facemask all night. I wonder if contracting the MSE might hinge the bones back together in the AP dimension in addition to the lateral dimension. The real test will be if I notice improvement when I start expanding again.
 
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I'm considering switching to 2 turns per day for both forward and backward. The molar sensitivity makes it uncomfortable to apply the same amount of tension with the facemask. The changes are so small that it's impossible to judge on a day to day basis if there has been any incremental protrusion, but sometimes I think my bite feels a little different, and I'm not really noticing anything this morning after using the facemask all night. I wonder if contracting the MSE might hinge the bones back together in the AP dimension in addition to the lateral dimension. The real test will be if I notice improvement when I start expanding again.
You’re the man with these updates. Keep it up!
 
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I decided to make just 3 reverse turns yesterday on my last day of the first contraction week. My molars weren't as sensitive and it was more comfortable to use the facemask traction last night. I started expanding again this morning. If I'm able to comfortably expand at 3 turns per day, it will take me 9 days to get back to fully open. Maybe then I can do cycles of 3 turns per day for 7 days forward and backward. This would amount to a little less than 3mm back and forth. This time I contracted almost 4mm and my intermolar width measures about that much less than the maximum when I had finished expanding. There's still a little gap between my central incisors, but the tips are almost touching. I'll feel better if my diastema and intermolar width seem to open back up smoothly as I expand again without tilting the teeth or TADs.
 
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When I switch directions, turning forward to turning backward or turning backward to turning forward, the first several turns have less resistance. So I've been doing 4 forward turns per day. I'd like to get back to fully open within a week if possible, but if I start feeling significant resistance or tenderness in my molars, I'll slow down. I have a theory that the traction doesn't make much forward progress during the reverse turns, but just prevents the maxilla from shifting backward as you close down the expander. Then when you start turning forward again, the traction swings out the halves of the maxilla farther than before. Maybe I'm just imagining this, but I'll try to observe how my bite changes in the sagittal dimension during this expansion week since it didn't seem to change much during the contraction week.
 
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I've had to go down to 2 forward turns per day because of tenderness not just in my molars but generalized around the back of my hard palate. There's also a good amount of resistance when I turn. I guess this suggests my perimaxillary sutures are still resisting and maybe this alternating schedule will get them to release and allow for more forward displacement with the facemask. I can't say that I've noticed a lot of forward change in my bite during the past couple weeks. I was hoping once I started going forward again I would notice progress. I'm also a little concerned that my diastema doesn't seem to be opening back up as much, but hopefully my teeth are just shifting together while the bone is still separating. It will take me longer to get back to fully open since I'm making fewer turns per day. When I switch to reverse again, I'll probably just make 2 or 3 turns per day for a week.
 
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After completing one cycle of contracting and expanding, my diastema did open up so that the tips of the incisors were slightly separated, but not as much as they were when I finished my initial expansion. They appear to be tilting together with a wider gap near the gums. I guess this just reflects dental movement and not skeletal relapse. For my second contraction/expansion cycle, I'm making fewer turns per day and won't wind it back as far.
 
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Thanks for the updates.
 
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Any updates boyo? I’m getting mse installed in April. Need to do the dental cleaning, checkup, sizing. Will be using a facemask, as prescribed by ortho.

like you, my a point is slightly behind my b point but occlusion ‘appears’ class I to novices, with no prior ortho. I have class III tendency, so only need to squeeze out a few mm of sagittal. Did you get any a-point advancement?

my ortho is using bite turbos to correct a deep bite and swing my mandible CW. I’m fine with it because when I simulate the occlusion effect my mandible rests more forward, my chin appears taller from frontal, and more projected from side. My theory is that I have compensation for the class III tendency such that my mandible is being pushed back to a certain extent and that correcting the bite will allow it to rest more forward. That said, you mentioned retraction. What are some of the things I should look out for if the ortho attempts to retract the mandible? I want to be able to protest if he attempts it. He insisted I have wisdom teeth removed if that’s relevant.
 
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Any updates boyo? I’m getting mse installed in April. Need to do the dental cleaning, checkup, sizing. Will be using a facemask, as prescribed by ortho.

like you, my a point is slightly behind my b point but occlusion ‘appears’ class I to novices, with no prior ortho. I have class III tendency, so only need to squeeze out a few mm of sagittal. Did you get any a-point advancement?

my ortho is using bite turbos to correct a deep bite and swing my mandible CW. I’m fine with it because when I simulate the occlusion effect my mandible rests more forward, my chin appears taller from frontal, and more projected from side. My theory is that I have compensation for the class III tendency such that my mandible is being pushed back to a certain extent and that correcting the bite will allow it to rest more forward. That said, you mentioned retraction. What are some of the things I should look out for if the ortho attempts to retract the mandible? I want to be able to protest if he attempts it. He insisted I have wisdom teeth removed if that’s relevant.
Still not much to report. The past couple days I've thought that maybe I detected some forward changes in my bite. I was noticing improvement earlier during my expansion, but not for a while. I still only think I've gotten a few millimeters of maxilla advancement and haven't had new x-rays or CBCT to measure. My mandible used to want to comfortably rest with my lower incisors ahead of my upper incisors and now it wants to rest about end-on-end. I guess I'm worried that my invisalign might line up the upper and lower teeth in a position that crams my mandible back into my throat when I bite together to force class I occlusion. The chin cup on facemask protraction and typical class iii elastics can also retrude the mandible. I have been using the typical facemask during the day for convenience. All of my wisdom teeth were removed long ago. I don't know if there's any hope that the space created by MSE expansion could upright impacted wisdom teeth, but I feel like there's enough room where I could fit them now without crowding if I still had mine.
 
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I'm getting MSE in April likely as well (have a posterior crossbite). Have you noticed any cheekbone changes? And how is your breathing currently?
 
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Still not much to report. The past couple days I've thought that maybe I detected some forward changes in my bite. I was noticing improvement earlier during my expansion, but not for a while. I still only think I've gotten a few millimeters of maxilla advancement and haven't had new x-rays or CBCT to measure. My mandible used to want to comfortably rest with my lower incisors ahead of my upper incisors and now it wants to rest about end-on-end. I guess I'm worried that my invisalign might line up the upper and lower teeth in a position that crams my mandible back into my throat when I bite together to force class I occlusion. The chin cup on facemask protraction and typical class iii elastics can also retrude the mandible. I have been using the typical facemask during the day for convenience. All of my wisdom teeth were removed long ago. I don't know if there's any hope that the space created by MSE expansion could upright impacted wisdom teeth, but I feel like there's enough room where I could fit them now without crowding if I still had mine.

I have all my wisdom teeth. One on the mandible is .18% covered in gum. Ting said that all will have to be removed because they are tipped and wisdom teeth cannot be moved. Where can I obtain the forwardontics facemask? I will be using the facemask all day except when eating. I’m low inhib so I’ll wear it out in public.

I will be happy with even a few mm of forward growth.

How were your zygos changes?
 
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Still not much to report. The past couple days I've thought that maybe I detected some forward changes in my bite. I was noticing improvement earlier during my expansion, but not for a while. I still only think I've gotten a few millimeters of maxilla advancement and haven't had new x-rays or CBCT to measure. My mandible used to want to comfortably rest with my lower incisors ahead of my upper incisors and now it wants to rest about end-on-end. I guess I'm worried that my invisalign might line up the upper and lower teeth in a position that crams my mandible back into my throat when I bite together to force class I occlusion. The chin cup on facemask protraction and typical class iii elastics can also retrude the mandible. I have been using the typical facemask during the day for convenience. All of my wisdom teeth were removed long ago. I don't know if there's any hope that the space created by MSE expansion could upright impacted wisdom teeth, but I feel like there's enough room where I could fit them now without crowding if I still had mine.
Ask your ortho about "The Crane". I know Ting gives patients The Crane.

Keep in mind the projected protraction for a PEREFECTLY compliant adult male (23 hours a day wear) is 3 mm which is very small. Alt-RAMEC might allow you to fight for--who really knows--probably around 5 mm.

Here is inspiration from a recent ortho who is doing backturning:

 
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Ask your ortho about "The Crane". I know Ting gives patients The Crane.

Keep in mind the projected protraction for a PEREFECTLY compliant adult male (23 hours a day wear) is 3 mm which is very small. Alt-RAMEC might allow you to fight for--who really knows--probably around 5 mm.

Here is inspiration from a recent ortho who is doing backturning:


What is the crane?
 
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Have you noticed any cheekbone changes? And how is your breathing currently?
Where can I obtain the forwardontics facemask?

How were your zygos changes?
Any change in my zygos/cheekbones isn't obvious, but I started out with pretty prominent cheekbones in the lateral dimension. I'd really like to see my cheekbones look more convex on profile from the protraction. The forwardontics bow is available for purchase through their website. Although, for the price, I would have expected better quality and have had to make modifications to the padding and straps.

Ask your ortho about "The Crane". I know Ting gives patients The Crane.
I thought in one of his interviews Dr. Ting said he uses a combination of the typical facemask that braces on the forehead and chin and another design that braces on the forehead and cheeks. I haven't considered the second type because I don't want to push back on my zygomas.
 
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ting is my ortho. What is the crane?
The crane uses a neck brace for extra-oral anchorage. So there's no reciprocal force on the face. JawHacks showed it in one of his videos. I haven't tried it.
 
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Any change in my zygos/cheekbones isn't obvious, but I started out with pretty prominent cheekbones in the lateral dimension. I'd really like to see my cheekbones look more convex on profile from the protraction. The forwarontics bow is available for purchase through their website. Although, for the price, I would have expected better quality and have had to make modifications to the padding and straps.


I thought in one of his interviews Dr. Ting said he uses a combination of the typical facemask that braces on the forehead and chin and another design that braces on the forehead and cheeks. I haven't considered the second type because I don't want to push back on my zygomas.

Ah, well mine are kind of flat from an anterior POV so do you think it would make a difference? I have read anterior projection is the biggest benefit in the upper maxilla from MSE.
 
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Ah, well mine are kind of flat from an anterior POV so do you think it would make a difference? I have read anterior projection is the biggest benefit in the upper maxilla from MSE.
Honestly, I'd temper your expectations for cheekbone changes based on my results, but maybe a younger case or someone who advanced faster than I did might have gotten more dramatic changes in that area. Maybe another CBCT would measure significant increase in my interzygomatic width and it just isn't obvious under my soft tissue. I guess there's still a chance my ogee curve could still show more definition if I get any more forward advancement. My infraorbital and paranasal hollowing are bigger falios than my zygomatic prominence. My main goals were breathing and sleep improvements and I'm still pretty hopeful that these effects will be worth it.
 
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Honestly, I'd temper your expectations for cheekbone changes based on my results, but maybe a younger case or someone who advanced faster than I did might have gotten more dramatic changes in that area. Maybe another CBCT would measure significant increase in my interzygomatic width and it just isn't obvious under my soft tissue. I guess there's still a chance my ogee curve could still show more definition if I get any more forward advancement. My infraorbital and paranasal hollowing are bigger falios than my zygomatic prominence. My main goals were breathing and sleep improvements and I'm still pretty hopeful that these effects will be worth it.

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.



Mouth got noticeably wider too.
 
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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.
Maybe I'm just a bad judge of these things. Unless the changes are dramatic like surgery, it's hard for me to say definitively that I see a difference beyond just lighting and camera effects. Ron compares his cheekbones in 3/4 view in a video and says one side changed more than the other. I expanded 10mm. Since my cheekbones were relatively prominent to begin with, it might be harder to identify if they got slightly more prominent.
 
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Maybe I'm just a bad judge of these things. Unless the changes are dramatic like surgery, it's hard for me to say definitively that I see a difference beyond just lighting and camera effects. Ron compares his cheekbones in 3/4 view in a video and says one side changed more than the other. I expanded 10mm. Since my cheekbones were relatively prominent to begin with, it might be harder to identify if they got slightly more prominent.

He has a legit Ogee curve especially on the side that had slightly more expansion. But yes, if you already had prominent cheekbones prior, you probably won't notice a difference. For myself and @ascentium it would likely be more obvious since we both have relatively wide cheekbones but lack in the anterior (frontal) projection of the zygoma.

Beyond the aesthetics, have you noticed better function? Breathing, swallowing, easier to keep your mouth closed at night etc.
 
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Beyond the aesthetics, have you noticed better function? Breathing, swallowing, easier to keep your mouth closed at night etc.
My nasal breathing is definitely improved, especially through the side my septum deviates toward. My snoring has stopped. My sleep seems a little better, but I think the headgear keeps it from being really restful still and sometimes I still catch my mouth open, maybe because the elastics break my lip seal. Good tongue posture will probably become more spontaneous once the MSE comes out, but there's definitely more tongue space, and I guess this is why my forward head posture has improved.
 
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My nasal breathing is definitely improved, especially through the side my septum deviates toward. My snoring has stopped. My sleep seems a little better, but I think the headgear keeps it from being really restful still and sometimes I still catch my mouth open, maybe because the elastics break my lip seal. Good tongue posture will probably become more spontaneous once the MSE comes out, but there's definitely more tongue space, and I guess this is why my forward head posture has improved.

how long is the mse protocol? Have you discussed alt-ramec with ortho?
 
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how long is the mse protocol? Have you discussed alt-ramec with ortho?
The retention phase for MSE is supposed to be 6 months after completing expansion until the appliance comes out to allow time for the bone to fill in and stabilize. The length of the expansion phase depends on how fast you advance (turns/day) and the size of your MSE (60, 75, or 90 total turns). My orthodontist wasn't happy about the idea of alternating expansion and contraction. He said I could experiment with it if I started the 6 month stabilization window after I finish turning back and forth. So it will significantly prolong my treatment time.
 
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The retention phase for MSE is supposed to be 6 months after completing expansion until the appliance comes out to allow time for the bone to fill in and stabilize. The length of the expansion phase depends on how fast you advance (turns/day) and the size of your MSE (60, 75, or 90 total turns). My orthodontist wasn't happy about the idea of alternating expansion and contraction. He said I could experiment with it if I started the 6 month stabilization window after I finish turning back and forth. So it will significantly prolong my treatment time.

When is your next check in? I’d assume you’d want to do it sooner rather than later to test if the protocol is working with CBCTs.
 
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When is your next check in? I’d assume you’d want to do it sooner rather than later to test if the protocol is working with CBCTs.
I think we're waiting on another CBCT until everything is done to reduce radiation exposure. I would like to see another lateral cephalogram to measure any change in my SNA angle.
 
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During this expansion cycle, I've noticed wider diastemas between my lateral and central incisors. In the past I had a hairline gap on the left side, but as I've been expanding the MSE this week, there are <1mm gaps opening on both sides visible from a distance, but still narrower than the central diastema. I guess this just reflects that my central incisors are continuing to shift to the center.
 
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During this expansion cycle, I've noticed wider diastemas between my lateral and central incisors. In the past I had a hairline gap on the left side, but as I've been expanding the MSE this week, there are <1mm gaps opening on both sides visible from a distance, but still narrower than the central diastema. I guess this just reflects that my central incisors are continuing to shift to the center.

i am assuming they are shifting in place without ortho?
 
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Ask your ortho about "The Crane". I know Ting gives patients The Crane.

Keep in mind the projected protraction for a PEREFECTLY compliant adult male (23 hours a day wear) is 3 mm which is very small. Alt-RAMEC might allow you to fight for--who really knows--probably around 5 mm.

Here is inspiration from a recent ortho who is doing backturning:


are you willing to disclose where this case was presented?
 
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i am assuming they are shifting in place without ortho?
Yes, I think my central incisors are just tilting and shifting together due to transseptal fibers and mesialization. I haven't started invisalign treatment yet. I have worried that maybe my central diastema not opening up as much as it did after completing my initial expansion could reflect skeletal relapse, but I don't think that this is the case and these little gaps between the central and lateral incisors are more evidence that it's just dental movement.
 
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Here is inspiration from a recent ortho who is doing backturning:


why did the mandible shift back in the first study?

View attachment 979085

The adult class III correction case @Fgsfds posted is one of the most dramatic I've seen, but I suspect much of it is actually retrusion of the mandible rather than protrusion of the maxilla. If you cover everything from the lower lip down, the cheek line doesn't appear much more convex in the after than the before. The distances from the alar crease to the subnasale and from the subnasale to the pronasale look relatively unchanged. Is the tip of the nose tilted up a bit in the "after"? I notice if I wear the facemask for a few hours, I'm able to position my mandible with a greater underjet and can't position it with as much overjet.
 
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Here's an overlay of the class iii MSE+FM case @Fgsfds posted. The before is colored red and the after is colored blue. There aren't a lot of good landmarks to align the before and after, so it's possible that the way I lined up the images makes it look like the maxilla moved forward when actually the mandible moved backward. It's probably a combination of both.
 

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I've written before that the aesthetic changes to my face are very subtle. If I look in the mirror, I can convince myself that certain features might look different, but they aren't obvious. However, my cheekbones seem to dramatically stand out when I go to brush my teeth in a way that I never used to notice. It's not surprising that my cheekbones would look more prominent while holding the toothbrush in my mouth, but it's just that they never seemed so conspicuous while brushing my teeth in the past. So maybe I got more interzygomatic expansion from MSE than I thought, but it's hidden under my soft tissue. I'd estimate that my body fat percentage is in the high teens. I suspect my cheek hollows would look good if I got a little leaner. I lost about 25 pounds a while ago, but my weight has plateaued. There's also a chance that my buccinators are being recruited during swallowing, since it's hard to swallow with correct form with the MSE obstructing the palate.
 
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It has been significantly easier to reverse turn on my fourth cycle so I've kept to 3 or 4 turns per day. I hope this means that the sutures are putting up less resistance and not that the TADs are just wobbling back and forth.
 
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It has been significantly easier to reverse turn on my fourth cycle so I've kept to 3 or 4 turns per day. I hope this means that the sutures are putting up less resistance and not that the TADs are just wobbling back and forth.

any a-p changes noted on this last cycle?

are the cortical screws tipping or dragging?
 
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any a-p changes noted on this last cycle?

are the cortical screws tipping or dragging?
The TADs look about the same as they did when I first completed expansion before starting the alternating cycles. I think there has been some very gradual forward change from the 4 cycles together, maybe <1mm, but its too subtle to notice a difference each week. The change in my bite hasn't been as noticeable as the forward change I estimated at 2-3mm from my initial expansion. My mandible has gone from feeling relaxed with the lower incisors ahead of the upper incisors to about end-on-end when I first completed expansion and now the lower incisors seem to meet slightly behind the edges of the upper incisors when I make "s" sounds or hold a tongue depressor between my teeth. If my teeth are decompensating, then the skeletal A-P change could be even more significant. I'm really curious to see a lateral x-ray.
 
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IIRC he did 10-12 mm, I plan on 8-10 (posterior crossbite)mm
He didnt really get that much. Calculated form the MSE screw turns it would come out to that amount, but due to device banding and screw drag it was MUCH less. Dr. Ting mentioned that in one of the interviews. The way to measure MSE expansion is by front teeth gap.
 
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He didnt really get that much. Calculated form the MSE screw turns it would come out to that amount, but due to device banding and screw drag it was MUCH less. Dr. Ting mentioned that in one of the interviews. The way to measure MSE expansion is by front teeth gap.
I don't think there is a 1:1 relationship between the width of your diastema and the width of your suture separation. Dr. Moon suggests that patients who follow a slow turn protocol might not even see a diastema at all, or just a small one, but their suture is still separated on imaging. Dr. Ting recommends the slow protocol in his interviews to reduce dragging and tilting of the TADs, so more of the total expansion should go to suture separation, but the teeth have a tendency to pull together and move to the center. Dr. Moon also says the slow protocol achieves less perimaxillary changes, so the surrounding sutures might not move as much at the slower rate even though the midpalatal suture is separating.
 
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I don't think there is a 1:1 relationship between the width of your diastema and the width of your suture separation. Dr. Moon suggests that patients who follow a slow turn protocol might not even see a diastema at all, or just a small one, but their suture is still separated on imaging. Dr. Ting recommends the slow protocol in his interviews to reduce dragging and tilting of the TADs, so more of the total expansion should go to suture separation, but the teeth have a tendency to pull together and move to the center. Dr. Moon also says the slow protocol achieves less perimaxillary changes, so the surrounding sutures might not move as much at the slower rate even though the midpalatal suture is separating.
Interesting - so youre saying that a slow protocol is not the best choice if one wants to widen the entire maxilla (to see change in cheekbone)?
I dont understand how could that happen - i mean, youre splitting the entire skull anyway right?
Does that mean that using slow protocol the split happenes, but with slow expansion the bones surrounding the split sututre so t ospeak bends because surrounding sutures that are tough? and with fast expansion they do not have time to adapt so they all get forced at the same time?
 
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Interesting - so youre saying that a slow protocol is not the best choice if one wants to widen the entire maxilla (to see change in cheekbone)?
I dont understand how could that happen - i mean, youre splitting the entire skull anyway right?
Does that mean that using slow protocol the split happenes, but with slow expansion the bones surrounding the split sututre so t ospeak bends because surrounding sutures that are tough? and with fast expansion they do not have time to adapt so they all get forced at the same time?
That's how I understand what Dr. Moon said in a recent virtual lecture. So you might choose a slow protocol if you're at higher risk for the midpalatal suture separation to fail (i.e. male and older like me), but you're probably trading off some of the potential for midface expansion. The very reason failure might be less likely at the slower rate is because it gives the resistance of the surrounding structures time to dissipate through bending and/or remodeling. Dr. Moon talks about a biological and a mechanical process. Fast relies more on mechanical breakage (but there's a risk the appliance will fail before the bone). Slow relies more on biological remodeling. Both will occur in different ratios depending how fast you advance.
 
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That's how I understand what Dr. Moon said in a recent virtual lecture. So you might choose a slow protocol if you're at higher risk for the midpalatal suture separation to fail (i.e. male and older like me), but you're probably trading off some of the potential for midface expansion. The very reason failure might be less likely at the slower rate is because it gives the resistance of the surrounding structures time to dissipate through bending and/or remodeling. Dr. Moon talks about a biological and a mechanical process. Fast relies more on mechanical breakage (but there's a risk the appliance will fail before the bone). Slow relies more on biological remodeling. Both will occur in different ratios depending how fast you advance.
Link to lecture bro?
 
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Link to lecture bro?
It has been posted on here a few times. I think this is where I first saw it:
I’m at intermolar width of 38 (not including teeth) going to go up to 46 mm. If you don’t think you’ll get a facial change from that you’re ignorant asf. I’ll get increase of mm to zygomatic bone . Majority of this forum is like me . I have watched to whole presentation . It even has results from older patients
View attachment 897118
here’s a 19 year old male
View attachment 897169
View attachment 897172
4 mm increase to the zygoma
Dr.Von Moon’s presentation he is talking to other orthodontist 3 hr long video
Mse will not make people into models but it will bring you from a 4.5 psl to 5.5 psl. That good enough for me . You can’t deny the the facial changes. I’m mainly wanting it to improve my airway since I get sleep apnea.
 
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That's how I understand what Dr. Moon said in a recent virtual lecture. So you might choose a slow protocol if you're at higher risk for the midpalatal suture separation to fail (i.e. male and older like me), but you're probably trading off some of the potential for midface expansion. The very reason failure might be less likely at the slower rate is because it gives the resistance of the surrounding structures time to dissipate through bending and/or remodeling. Dr. Moon talks about a biological and a mechanical process. Fast relies more on mechanical breakage (but there's a risk the appliance will fail before the bone). Slow relies more on biological remodeling. Both will occur in different ratios depending how fast you advance.

i wouldn’t put too much stock on moontake on “biological remodeling,” as it’s merely conjecture. Even with the Ting protocol mechanical disarticulation is observed, along with a diastema.

remodeling is on the extreme end of the spectrum with something like RPE in early adolescence,

additionally ting has mentioned that Moon’s conjecture was true with MSEI, but not with MSEII.
 
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i wouldn’t put too much stock on moontake on “biological remodeling,” as it’s merely conjecture. Even with the Ting protocol mechanical disarticulation is observed, along with a diastema.

remodeling is on the extreme end of the spectrum with something like RPE in early adolescence,

additionally ting has mentioned that Moon’s conjecture was true with MSEI, but not with MSEII.
In the context of the lecture, Dr. Moon's "biological remodeling" just means giving time for osteoclasts to be recruited and break down the interdigitations of the suture rather than going so fast that mechanical force breaks them. It still results in disarticulation of the suture. He suggests in all cases, there will be some traumatic breaking and some controlled, cellular-signaled breakdown along the suture, but the ratio depends on how fast you advance. Of course, this is all theoretical. I got a <3mm diastema advancing at 1 turn per day. The thumbnail of that video shows how the suture can be separated farther than the gap between the central incisors.
 
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I've now completed 6 weeks with 3 cycles of alternating backward and forward. The original alt-RAMEC protocol calls for 4 cycles. So I plan to do at least 1 more cycle over the next 2 weeks. I haven't noticed dramatic improvement during the alternating cycles, but I think there has been a very slight change in my bite. I have to decide if I want to do one extra cycle afterward for good measure before I move on to the 6 month stabilization phase in the hopes that those stubborn coronally-running circummaxillary sutures will mobilize.
 
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While biting off a piece of hard food with the right side of my mouth, I felt a twinge beside my left eye, near the frontozygomatic suture. I was able to repeat the same feeling by taking a couple more bites, and chewing gave a duller sensation in the same area. Maybe this reflects more mobilization of perimaxillary sutures. I'm on day two of this cycle, reversing 4 turns per day so far.
 
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Was your expansion symetrical? And did your nose and eye area like ipd change?
 
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Was your expansion symetrical? And did your nose and eye area like ipd change?
My bite looks like I got 1-2mm more expansion on the side that started out wider. I don't notice a difference in my ipd, and my nose might be very slightly wider but it's hard to say. I think the bridge of my nose might look a little more symmetrical than it used to.
 
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My bite looks like I got 1-2mm more expansion on the side that started out wider. I don't notice a difference in my ipd, and my nose might be very slightly wider but it's hard to say. I think the bridge of my nose might look a little more symmetrical than it used to.
Have you noticed any more improvments of the cheekbones and is your midface "fuller"? If so do you think it is more because of the mse or the facemask?
 
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Have you noticed any more improvments of the cheekbones and is your midface "fuller"? If so do you think it is more because of the mse or the facemask?
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.
 
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