Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.
@@JawHackshell yeah it was great, can you make videos about FMA when more info comes out about it. I am looking forward to see what it can do. Thank for all you do Ron.
I had an MSE installed three years ago. Removal was a year ago. It was used to create space for my crowded teeth. I was told I would need a second one installed to create expansion towards the back of my pallet. Instead I went with a regular expander attached to the molars. I did not want to go through the MSE process again. I regret it. This new FME looks like a game changer as it covers more of the maxilla with the 6 screws helping with overall expansion.
holy shit. The depth of Dr. Manuele's understanding and knowledge is just insane. It reaches into the deep oceans. First time I was actually blown away on JawHacks Podcast and I'm not even trying to exaggerate!!
Thanks Ron…you keep providing such great content and content providers, that it demonstrates the advancements that are taking place in this arena. Now, because of you ;-) I find myself trying to figure out when/who the best time to pull the trigger on Skeletal Expansion! All the information you are providing is making my decision-making more difficult! Lol. I can guarantee that your knowledge in this area is greater than most of the providers that are licensed to do work in this area!
Great content, Ron. Do you think an appliance like that could move the upper portion of the maxilla anteriorly (including the zygoma and infraorbital rim), or does it only affect the lower portion? Are there any alternatives for addressing the upper portion? I'm looking for a solution to correct a 3mm negative orbital vector and overall recession in that area, but I’d prefer to avoid implants.
One of your best interviews ever due to the high guest quality. Dr. Jeremy Manuele should teach cos his mind is pretty well organised and he has the ability to clearly expose his thoughts in a very meaningful way.
Does FME solve the problem of undesirable conical expansion? Also does EASE also have the same effect of maxilla coming forward and down? How do you think EASE compares with FME after doing these back to back interviews, Ron?
Can you make a video on fixing a maxillary cant surgically as a result of a incorrect marpe installation? Because I got a cant because my orthodontist put my expander in at an angle where it was lower on the right. So now I’m in the process of suing him and getting jaw surgery because my smile is slanted and gummy now
This may have well been one of the best informative interviews on this topic I have seen! I’m going to forward this video to a couple of doctors on the edge of this knowledge…Hopefully recruit/convert a few more MSE disciples ;-)
The thing about the nasomaxillary fracture with asymmetric expansion.. Doesn't that suture always disarticulate with nasomaxillary / midface expansion? I feel like that's totally normal. Of course the thing that's not normal is the asymmetric expansion, like if one side is dropping down and not the other. Maybe calling it a fracture is the wrong move? To me that's just normal sutural disarticulation. Tons of sutures are disarticulating lol. When I think of facial fracture, I think of something that's not supposed to fracture. I would be concerned about calling it a fracture, because patients might freak out.
Great question. The auxiliary sutures are supposed to reorganize/remodel but not disarticulate/fracture. Asymmetry caused by fracture is much different than an asymmetry caused by uneven forces/appliance design. The latter is simple and straightforward to correct in most cases, the former is not.
@@vegasorthodoc Great to hear from you Dr. Manuele. Well, you know I recall Dr. Li mentioning that his EASE disarticulates the nasomaxillary sutures. I often saw this with midface expansions as I was doing the superimpositions, so that's my experience at least. I have seen many FME cases more recently, have full disarticulation along the frontonasal suture even.. and the frontal bone moves up and away relative to the cranial base / basion (some EASE cases too). I think if you check before/afters, you might be surprised to find more disarticulation than you think there is. I think the zygomaticofrontal and zygomaticotemporal sutures are the least likely to fully disarticulate, but the temporal even can, and Won Moon has shown data on that a few years ago too. I think he said that's partly why he thought to use the facemask in females and teenagers. I was also recalling a review I read on Dr. Ting's Google Reviews page.. (lol), which a patient was unhappy about a facial fracture, and Dr. Ting's office replied back and kind of downplayed it or said its fine or something. So, I was kind of starting to wonder if it was that kind of fracture? I WAS picturing a fracture along the actual maxilla, like the zygomaticomaxillary suture, so my reaction was like whoa.. but if it's the nasomaxillary suture, like okay, big deal. To me with that, the problem is the asymmetrical movement of the hemimaxilla. Expansion pattern problem.
@@vegasorthodocso is the drop down effect just a normal part of expansion? Not a fracture of the nasiomaxillary suture (between the eyebrows). If you are younger or have more parallel expansion is it possible you won’t have as much of the drop down effect. I’m looking to avoid that 17yr male.
@@goodgrass864, yes, it is primarily due to the fact that the resistance at the auxiliary sutures is higher in non-growers than in growers. You will have less downward forward movement in growing patients with expansion alone.
I'm not as invested in the mechanics of skeletal expansion so take what I say with a grain of salt, but FME seems like a promising improvement on MSE and MARPE.
18:00 I have a Marpe on and it created an open bite on one side and now I have a cant. I’m perefect example of this topic. Going to do rubber bands most likely but man I don’t want a gummy smile
If someone needed forward expansion, would it be best to wait until FME can move the maxilla in all 3 dimensions? Or could you start with FME as is and then do it a 2nd time with a focus on the forward movement?
Hey man great job with this interview I’m personally after some general advice as I’ve basically lived with a underbite which has progressed from my childhood into adulthood as I had no braces or dental treatment growing up as my parents focus was to get me psychological help as I had a eating disorder I’m now 35 years old so I wanted to get my under bite sorted originally I was going to be given the surgery for jaw but now the professionals have changed the plan and instead build the top teeth up I’m worried this is still negotiating the jaw
For FME, it really depends. If the palate is more narrow it it might have to be placed more anteriorly or posteriorly, or set higher off the palate (all of which could lead to decreased stability/predicability). For now, my go to is custom MARPE for severely narrow palates
Thanks, makes sense. I've gotten 4mm wider, by Dr De Souza of Olde Oakville Dental, who built a very strong MARPE to bust my suture with help from lots of corticotomy. I'm enjoying better sleep, breathing, restored sense of smell. Currently seeking someone with an acoustic rhinometer, to locate the remaining flow resistance points. I'm still amazed that a dentist has improved my sense of smell.
@@profortunebaron, although DAME is less surgical, It still requires surgery. The lower jaw is fused and essentially 1 bone (unlike the maxilla which maintains some level of patency in the midline suture). Expanding using DAME requires a cut in the midline of the mandible and then after that the intraoral appliance is used to essentially perform distraction osteogenesis to broaden the lower jaw. There are significantly higher risks with this procedure compared to MARPE and compared to traditional orthognathic surgery options and results are less predictable, that is why most orthodontists/periodontists/surgeons don’t do it. SFOT is an option for some to gain some buccal width of the alveolar bone without risking asymmetry or condylar problems but it doesn’t widen the entire mandible, only the bone around the teeth.
@vegasorthodoc The DAME procedure is still minimally invasive and doesn't require complex surgeries like maxillomandibular advancement. That's what I meant.
Does MARPE move the maxilla upward as well or it's only expanding laterally? I've heard that some appliances can move the maxilla 3-dimentionally but others don't, this is why I'm asking. Thank you!
The maxilla will move away from the areas of resistance. Once the midline suture splits, the remaining resistance is superior and inferior (frontomaxillary, nasomaxillary, zygomaxillary, pterygomaxillary) relative to where the force is being placed so you will see downward and forward movement of the maxillary complex. That being said, the maxillary teeth can be intruded with TADs to minimize excess gingival display or shorten the lower 3rd of the face if either of those things are needed.
I think most clinicians want as much anchorage as possible, especially when the highest force is needed (when trying to do the initial split of the palatal suture)….why don’t they develop an FME with “extension arms” that allow tads to be placed even more laterally…that way, you’re still anchoring to more BONE and avoiding anchoring to TEETH. Or….have a WIDER FME…that have a second (lateral) row of TADs LATERAL to the first row. Or if this “wide FME” is too wide to start, have it placed after some palatal expansion occurs, and you gain a little space. Just some ideas to keep the appliance “fully bone anchored”
That is correct. The maxilla will move away from the areas of resistance. Once the midline suture splits, the remaining resistance is superior and inferior (frontomaxillary, nasomaxillary, zygomaxillary, pterygomaxillary) relative to where the force is being placed so you will see downward and forward movement of the maxillary complex.
@@vegasorthodocdoctor I’ve already split with my MSE but my expander has maxed out. I now may need to get a second expander to create adequate tongue space. Could I ask them to install it without the arms and be okay?
This was also one of my big takeaways from Dr. Manuele, the inherent tendency of the maxillary complex to drop down and forward with MARPE. It is especially pertinent for patients presenting with vertical maxillary excess to begin with, as MARPE might exacerbate that. For example, a patient with a gummy smile, MARPE might not bode well aesthetically.
That was my take on this, as well… that perhaps it would not be good for someone with an elongated gummy smile. In my case, I had an expander 30 some years ago… And it did not expand my two front teeth nor my mouth. I think it only moved my teeth outward a little bit… Not nearly far enough for my tongue to fit the roof of my mouth. Needless to say, my tongue rest back and down and I have had sleep apnea all my life…. Just didn’t know it for the first 40 years that that’s why I was so tired. I did have double jaw surgery years ago to bring them forward, but apparently it did nothing to improve my sleep apnea. I’m thinking I might need to get it done again, but was also thinking that perhaps it was best to expand my pallet through surgery… so that my tongue could rest at the roof of my pallet. I have an elongated lower jaw, and though I had surgery years ago to improve my gummy smile and overbite, I still have a long mid face, as well. I guess all of it contributes to my sleep apnea. I will be 60 in December and wonder if it’s too late to fix any of this a second time.
1:15:45 Can you “intrude” teeth at a quicker pace…to try to eliminate “dark triangles”? (I know “slow intrusion”, wouldn’t change the relative gingival attachment point on the tooth) I know if intrusion is too quick, you may get root resorption or pulp trauma. But maybe there’s a sweet spot of speed/pressure. I just hate removing enamel…stripping interproximal surfaces. It seems once the enamel surfaces are sanded, they are never as smooth as natural tooth surfaces (therefore higher risk of decay or food entrapment, staining etc)
Great question. The typically the attachment level will remain constant during intrusion. That being said, during intrusion, the excess gum tissue will often bunch up and the result is the pocket depth increases. But this does result in the interproximal papilla being more robust (even though the attachment level hasn’t changed). If it bunches up too much, you actually have to remove some of it via gingivectomy. Regarding IPR (stripping), there has been lots of long term research showing there is no increased risk for cavities. That being said, it can still be done poorly (or too much) leading to sensitivity or ledging.
@@vegasorthodoc, thanks for your reply. I live in phoenix and entered your office into my GPS, and checked the EV charging locations along the way. From MY standpoint, it would be worth the back and forth traveling. I’m just not sure of the specifics of treatment, and if it would even be a viable option.
For FME, my opinion is that the jury is still out. Haven’t seen enough convincing evidence yet to say it is better or worse in this and other areas of Orthopedic expansion. That being said, a well designed custom MARPE does provide as parallel expansion as anything else out there (EASE, SARPE, etc). It will never be perfectly parallel as the skeletal resistance is never right in the middle of ANS/PNS. Here is the cross section of the adult male custom MARPE case we reviewed showing how parallel the expansion is. www.dropbox.com/scl/fi/5xrjhb1h1vn6115ipafuq/parallel-expansion.jpg?rlkey=nuiuha5fvvz59i8ovcn3gx5ln&st=15dpiidz&dl=0
IMO, the jury is still out and FME is constantly being updated and re-designed to overcome current limitations, so for now I would say “not yet”. Would love to know Ron’s opinion on this as well.
If I could chime in, I think a big question is, better for who? The patient, or the orthodontist? For the patient, so I guess you're looking at two devices that are essentially experimental. I haven't seen any asymmetric expansion with FME so far, so that's I think a good sign. But I'm sure there's going to be a fog of war so to speak given it hasn't been used for that long. For the orthodontist, I mean, I feel like if I were an orthodontist I probably would use neither, or I could at least see a lot of reasons to choose that. If I use a custom MARPE, I'll get sued or have class actions against me potentially from people having asymmetric expansion, facial deformity, over-expansion, can't chew because they have a brodie bite, etc (training TMJ dentists and non orthodontists on Lipkins method seems like a problem in hindsight based on people i've talked to who had had problems), maybe somebody loses their teeth, maybe you do a corticotomy and cut their root, just so many things.. do you warn the patients that there are risks, or do you tell them it's 100%? In comparison to if I use a FME, like who even knows what could happen. Who wants to be the pawn to test that out? Dr. Newaz I guess lol, god bless him. So it kind of seems like you're screwed either way. Maybe when there is extensive scientific literature, everything is totally FDA approved, and you can just look it up and see the data for yourself and know it's safe and effective, okay, maybe then the risk profile is more reasonable? My feeling is that FME is going to have an easier time getting to that point, but we'll see.
@@shuikai272is it really true that the younger you are the less chance of the maxilla dropping and sometimes the frontal bone can even go up. I am hesitant of expansion because of maxilla drop. (17yr male)
@@goodgrass864 Like Dr. Manuele said, it is a factor of the placement of the device and the resistance. If the resistance is much less, I think it can be less likely to drop down. But, I don't really know for sure. I think even if the risk is a bit less, what goes into the decision about what device to use I think may be effectively the same regardless of age. Like, what if they put in a MARPE totally tilted? Well, and I guess furthermore, what about the case at 1 hour 56 min? It literally did drop down, and he was a child right? So there you go? 1:56:05 The fact that his maxilla moved forward when the expander was tilted at like a 45 degree angle in the yaw though, is really good news for their FMA thing.
Heads-up people!! This video is just for information and isn’t medical or dental advice-I’m not a doctor, dentist or licensed healthcare provider of any kind. Always check with a qualified professional for your health questions. Use this info at your own risk-it’s not meant to diagnose, treat, or recommend specific providers, products or procedures.
Holy Crap…I’m only 14 mins into the video, but to hear that this doc monitors skeletal and dental expansion weekly, seems like a major step forward.
I can already tell this is gonna be one of the best interviews
Did it meet your expectations?
@@JawHackshell yeah it was great, can you make videos about FMA when more info comes out about it. I am looking forward to see what it can do. Thank for all you do Ron.
I had an MSE installed three years ago. Removal was a year ago. It was used to create space for my crowded teeth. I was told I would need a second one installed to create expansion towards the back of my pallet. Instead I went with a regular expander attached to the molars. I did not want to go through the MSE process again. I regret it.
This new FME looks like a game changer as it covers more of the maxilla with the 6 screws helping with overall expansion.
what a fantastic interview! Dr. Manuele is very informative and is such a clear communicator, and seems to be such a competent provider.
Agreed.
holy shit. The depth of Dr. Manuele's understanding and knowledge is just insane. It reaches into the deep oceans. First time I was actually blown away on JawHacks Podcast and I'm not even trying to exaggerate!!
Thanks Ron…you keep providing such great content and content providers, that it demonstrates the advancements that are taking place in this arena.
Now, because of you ;-) I find myself trying to figure out when/who the best time to pull the trigger on Skeletal Expansion!
All the information you are providing is making my decision-making more difficult! Lol.
I can guarantee that your knowledge in this area is greater than most of the providers that are licensed to do work in this area!
Really appreciate that bro thanks for always chiming in with positive comments
Great content, Ron. Do you think an appliance like that could move the upper portion of the maxilla anteriorly (including the zygoma and infraorbital rim), or does it only affect the lower portion? Are there any alternatives for addressing the upper portion? I'm looking for a solution to correct a 3mm negative orbital vector and overall recession in that area, but I’d prefer to avoid implants.
One of your best interviews ever due to the high guest quality.
Dr. Jeremy Manuele should teach cos his mind is pretty well organised and he has the ability to clearly expose his thoughts in a very meaningful way.
Thank you for this great content. I am an orthodontist in CA, and learned alot from your videos recently. What made you so passionate about expansion?
Just trying to help prospective patients solve a difficult problem, which is how to safely and effectively augment the jaws.
Good stuff! You and Dr Manuele are both very well spoken. I would love to visit his office one day
Does FME solve the problem of undesirable conical expansion? Also does EASE also have the same effect of maxilla coming forward and down?
How do you think EASE compares with FME after doing these back to back interviews, Ron?
Can you make a video on fixing a maxillary cant surgically as a result of a incorrect marpe installation? Because I got a cant because my orthodontist put my expander in at an angle where it was lower on the right. So now I’m in the process of suing him and getting jaw surgery because my smile is slanted and gummy now
Very high quality content
Dr. Manuele is a beast, all I did was get him going haha.
This may have well been one of the best informative interviews on this topic I have seen!
I’m going to forward this video to a couple of doctors on the edge of this knowledge…Hopefully recruit/convert a few more MSE disciples ;-)
Thank you brother
The thing about the nasomaxillary fracture with asymmetric expansion.. Doesn't that suture always disarticulate with nasomaxillary / midface expansion? I feel like that's totally normal. Of course the thing that's not normal is the asymmetric expansion, like if one side is dropping down and not the other. Maybe calling it a fracture is the wrong move? To me that's just normal sutural disarticulation. Tons of sutures are disarticulating lol. When I think of facial fracture, I think of something that's not supposed to fracture. I would be concerned about calling it a fracture, because patients might freak out.
Great question. The auxiliary sutures are supposed to reorganize/remodel but not disarticulate/fracture. Asymmetry caused by fracture is much different than an asymmetry caused by uneven forces/appliance design. The latter is simple and straightforward to correct in most cases, the former is not.
@@vegasorthodoc Great to hear from you Dr. Manuele. Well, you know I recall Dr. Li mentioning that his EASE disarticulates the nasomaxillary sutures. I often saw this with midface expansions as I was doing the superimpositions, so that's my experience at least. I have seen many FME cases more recently, have full disarticulation along the frontonasal suture even.. and the frontal bone moves up and away relative to the cranial base / basion (some EASE cases too). I think if you check before/afters, you might be surprised to find more disarticulation than you think there is. I think the zygomaticofrontal and zygomaticotemporal sutures are the least likely to fully disarticulate, but the temporal even can, and Won Moon has shown data on that a few years ago too. I think he said that's partly why he thought to use the facemask in females and teenagers.
I was also recalling a review I read on Dr. Ting's Google Reviews page.. (lol), which a patient was unhappy about a facial fracture, and Dr. Ting's office replied back and kind of downplayed it or said its fine or something. So, I was kind of starting to wonder if it was that kind of fracture? I WAS picturing a fracture along the actual maxilla, like the zygomaticomaxillary suture, so my reaction was like whoa.. but if it's the nasomaxillary suture, like okay, big deal. To me with that, the problem is the asymmetrical movement of the hemimaxilla. Expansion pattern problem.
@@vegasorthodocso is the drop down effect just a normal part of expansion? Not a fracture of the nasiomaxillary suture (between the eyebrows). If you are younger or have more parallel expansion is it possible you won’t have as much of the drop down effect. I’m looking to avoid that 17yr male.
@@goodgrass864, yes, it is primarily due to the fact that the resistance at the auxiliary sutures is higher in non-growers than in growers. You will have less downward forward movement in growing patients with expansion alone.
@ how do you determine someone is a non-grower, can you see on an xray? Or is just an estimate. I am 17 and haven’t grown significantly in 3.5yrs.
I'm not as invested in the mechanics of skeletal expansion so take what I say with a grain of salt, but FME seems like a promising improvement on MSE and MARPE.
Thanks for chiming in Robby I agree.
18:00 I have a Marpe on and it created an open bite on one side and now I have a cant.
I’m perefect example of this topic.
Going to do rubber bands most likely but man I don’t want a gummy smile
Where can I get FME in Portugal? or at least Spain or italy... somewhere in Europe, is it possible?
Great Interviews
insane interview!
Incredible chat! Wish this doc was on the east coast lol. Plane tickets to the Las Vegas aren’t too bad tho…
If someone needed forward expansion, would it be best to wait until FME can move the maxilla in all 3 dimensions? Or could you start with FME as is and then do it a 2nd time with a focus on the forward movement?
Hey man great job with this interview
I’m personally after some general advice as I’ve basically lived with a underbite which has progressed from my childhood into adulthood as I had no braces or dental treatment growing up as my parents focus was to get me psychological help as I had a eating disorder I’m now 35 years old so I wanted to get my under bite sorted originally I was going to be given the surgery for jaw but now the professionals have changed the plan and instead build the top teeth up I’m worried this is still negotiating the jaw
How many mm top of palate width is needed to place one of these? The examples shown weren't really that narrow, compared to the one I'm familiar with.
For FME, it really depends. If the palate is more narrow it it might have to be placed more anteriorly or posteriorly, or set higher off the palate (all of which could lead to decreased stability/predicability). For now, my go to is custom MARPE for severely narrow palates
Thanks, makes sense. I've gotten 4mm wider, by Dr De Souza of Olde Oakville Dental, who built a very strong MARPE to bust my suture with help from lots of corticotomy. I'm enjoying better sleep, breathing, restored sense of smell. Currently seeking someone with an acoustic rhinometer, to locate the remaining flow resistance points. I'm still amazed that a dentist has improved my sense of smell.
Can Dr. Manuele expand the Mandible as well?
No he is not a surgeon.
@bunb8541 The mandible can be expanded with the DAME device without surgery.
@@profortunebaron i am not sure what are you talking about.
@@profortunebaron, although DAME is less surgical, It still requires surgery. The lower jaw is fused and essentially 1 bone (unlike the maxilla which maintains some level of patency in the midline suture). Expanding using DAME requires a cut in the midline of the mandible and then after that the intraoral appliance is used to essentially perform distraction osteogenesis to broaden the lower jaw. There are significantly higher risks with this procedure compared to MARPE and compared to traditional orthognathic surgery options and results are less predictable, that is why most orthodontists/periodontists/surgeons don’t do it. SFOT is an option for some to gain some buccal width of the alveolar bone without risking asymmetry or condylar problems but it doesn’t widen the entire mandible, only the bone around the teeth.
@vegasorthodoc The DAME procedure is still minimally invasive and doesn't require complex surgeries like maxillomandibular advancement. That's what I meant.
Does MARPE move the maxilla upward as well or it's only expanding laterally? I've heard that some appliances can move the maxilla 3-dimentionally but others don't, this is why I'm asking. Thank you!
Forward and downward
The maxilla will move away from the areas of resistance. Once the midline suture splits, the remaining resistance is superior and inferior (frontomaxillary, nasomaxillary, zygomaxillary, pterygomaxillary) relative to where the force is being placed so you will see downward and forward movement of the maxillary complex. That being said, the maxillary teeth can be intruded with TADs to minimize excess gingival display or shorten the lower 3rd of the face if either of those things are needed.
Thanks for chiming in Doc.
@@vegasorthodoc Thank you very much, Dr. Manuele!
@@JawHacks Can you please advice me are there any appliances that move the maxilla upward while expanding it? To shorten the middle third. Thank you!
I think most clinicians want as much anchorage as possible, especially when the highest force is needed (when trying to do the initial split of the palatal suture)….why don’t they develop an FME with “extension arms” that allow tads to be placed even more laterally…that way, you’re still anchoring to more BONE and avoiding anchoring to TEETH.
Or….have a WIDER FME…that have a second (lateral) row of TADs LATERAL to the first row.
Or if this “wide FME” is too wide to start, have it placed after some palatal expansion occurs, and you gain a little space.
Just some ideas to keep the appliance “fully bone anchored”
Did I get it right at 19:15? Doc says "As you're expanding, the jaws are coming down and forward".
That is correct. The maxilla will move away from the areas of resistance. Once the midline suture splits, the remaining resistance is superior and inferior (frontomaxillary, nasomaxillary, zygomaxillary, pterygomaxillary) relative to where the force is being placed so you will see downward and forward movement of the maxillary complex.
@@vegasorthodocdoctor I’ve already split with my MSE but my expander has maxed out. I now may need to get a second expander to create adequate tongue space. Could I ask them to install it without the arms and be okay?
This was also one of my big takeaways from Dr. Manuele, the inherent tendency of the maxillary complex to drop down and forward with MARPE. It is especially pertinent for patients presenting with vertical maxillary excess to begin with, as MARPE might exacerbate that. For example, a patient with a gummy smile, MARPE might not bode well aesthetically.
That was my take on this, as well… that perhaps it would not be good for someone with an elongated gummy smile. In my case, I had an expander 30 some years ago… And it did not expand my two front teeth nor my mouth. I think it only moved my teeth outward a little bit… Not nearly far enough for my tongue to fit the roof of my mouth. Needless to say, my tongue rest back and down and I have had sleep apnea all my life…. Just didn’t know it for the first 40 years that that’s why I was so tired. I did have double jaw surgery years ago to bring them forward, but apparently it did nothing to improve my sleep apnea. I’m thinking I might need to get it done again, but was also thinking that perhaps it was best to expand my pallet through surgery… so that my tongue could rest at the roof of my pallet. I have an elongated lower jaw, and though I had surgery years ago to improve my gummy smile and overbite, I still have a long mid face, as well. I guess all of it contributes to my sleep apnea. I will be 60 in December and wonder if it’s too late to fix any of this a second time.
1:15:45 Can you “intrude” teeth at a quicker pace…to try to eliminate “dark triangles”?
(I know “slow intrusion”, wouldn’t change the relative gingival attachment point on the tooth) I know if intrusion is too quick, you may get root resorption or pulp trauma. But maybe there’s a sweet spot of speed/pressure.
I just hate removing enamel…stripping interproximal surfaces. It seems once the enamel surfaces are sanded, they are never as smooth as natural tooth surfaces (therefore higher risk of decay or food entrapment, staining etc)
Great question. The typically the attachment level will remain constant during intrusion. That being said, during intrusion, the excess gum tissue will often bunch up and the result is the pocket depth increases. But this does result in the interproximal papilla being more robust (even though the attachment level hasn’t changed). If it bunches up too much, you actually have to remove some of it via gingivectomy. Regarding IPR (stripping), there has been lots of long term research showing there is no increased risk for cavities. That being said, it can still be done poorly (or too much) leading to sensitivity or ledging.
@@vegasorthodoc, thanks for your reply. I live in phoenix and entered your office into my GPS, and checked the EV charging locations along the way.
From MY standpoint, it would be worth the back and forth traveling. I’m just not sure of the specifics of treatment, and if it would even be a viable option.
Nice one ron,can you do a podcast with dr Mani alikhani about the NIM.i heard it has potential to change entire maxilla without surgery
That sounds cool
Any good providers in Mexico?
Run , question you need to ask are
Does this cause a parallel expansion from ANS to PNS ,
For FME, my opinion is that the jury is still out. Haven’t seen enough convincing evidence yet to say it is better or worse in this and other areas of Orthopedic expansion. That being said, a well designed custom MARPE does provide as parallel expansion as anything else out there (EASE, SARPE, etc). It will never be perfectly parallel as the skeletal resistance is never right in the middle of ANS/PNS. Here is the cross section of the adult male custom MARPE case we reviewed showing how parallel the expansion is. www.dropbox.com/scl/fi/5xrjhb1h1vn6115ipafuq/parallel-expansion.jpg?rlkey=nuiuha5fvvz59i8ovcn3gx5ln&st=15dpiidz&dl=0
Dr. Manuele in da houzzz
i want to see scolopendra photos plss!
1:12:35 amazing results!
Also bring Christoph Moschik from Germany . We European audience need to hear his concept
Would love to have Moschik on. Can you connect us?
@ we would appreciate it Ron if you could . After all you are the main man.
Is it better than CUSTOM MARPE?
IMO, the jury is still out and FME is constantly being updated and re-designed to overcome current limitations, so for now I would say “not yet”. Would love to know Ron’s opinion on this as well.
I feel like an armless 10-TAD FME is tough to beat on paper. Maybe compared to a carefully designed Custom MARPE from a top provider, it's a toss up.
If I could chime in, I think a big question is, better for who? The patient, or the orthodontist? For the patient, so I guess you're looking at two devices that are essentially experimental. I haven't seen any asymmetric expansion with FME so far, so that's I think a good sign. But I'm sure there's going to be a fog of war so to speak given it hasn't been used for that long. For the orthodontist, I mean, I feel like if I were an orthodontist I probably would use neither, or I could at least see a lot of reasons to choose that. If I use a custom MARPE, I'll get sued or have class actions against me potentially from people having asymmetric expansion, facial deformity, over-expansion, can't chew because they have a brodie bite, etc (training TMJ dentists and non orthodontists on Lipkins method seems like a problem in hindsight based on people i've talked to who had had problems), maybe somebody loses their teeth, maybe you do a corticotomy and cut their root, just so many things.. do you warn the patients that there are risks, or do you tell them it's 100%? In comparison to if I use a FME, like who even knows what could happen. Who wants to be the pawn to test that out? Dr. Newaz I guess lol, god bless him. So it kind of seems like you're screwed either way. Maybe when there is extensive scientific literature, everything is totally FDA approved, and you can just look it up and see the data for yourself and know it's safe and effective, okay, maybe then the risk profile is more reasonable? My feeling is that FME is going to have an easier time getting to that point, but we'll see.
@@shuikai272is it really true that the younger you are the less chance of the maxilla dropping and sometimes the frontal bone can even go up. I am hesitant of expansion because of maxilla drop. (17yr male)
@@goodgrass864 Like Dr. Manuele said, it is a factor of the placement of the device and the resistance. If the resistance is much less, I think it can be less likely to drop down. But, I don't really know for sure. I think even if the risk is a bit less, what goes into the decision about what device to use I think may be effectively the same regardless of age. Like, what if they put in a MARPE totally tilted?
Well, and I guess furthermore, what about the case at 1 hour 56 min? It literally did drop down, and he was a child right? So there you go? 1:56:05
The fact that his maxilla moved forward when the expander was tilted at like a 45 degree angle in the yaw though, is really good news for their FMA thing.
No question on bollards yet again we're talking about nonsensical facemasks. Also no question about reverse cone when parallel is clearly inferior. 👎