Any way to increase the amount of protraction when using bollards?

[spark]

Are there any methods to increase the amount forward protraction possible? Dr. Ting said something along the lines of how the majority of protraction happen in the first 1-2 months when the sutures are opened. I mean would reinstalling the MSE once the expansion is done and always going 1 or few turns forward then back to keep it open should be possible? What about redoing the corticopuncture?

Also what about using some exogenous stuff? Growth hormone, peptides etc.? Could any of that increase the ability to get more protraction?

I think these are important questions since as far as I know people protract very few mms at best. I definitely am not willing to even entertain the idea of a le fort which doesn't even move anything above the alveolar.
@noprogressno

 

[189]

Why u want to increase prolactin u dumb fuck

 

[spark]

Why u want to increase prolactin u dumb fuck

Nobody has mentioned prolactin but if you're talking about growth hormone it has shown to accelerate bone regeneration. I mean what was the purpose of your monkey comment anyways?

 

[189]

Why u want to increase prolactin u dumb fuck

shit wrong thread

 

[noprogressno]

Are there any methods to increase the amount forward protraction possible? Dr. Ting said something along the lines of how the majority of protraction happen in the first 1-2 months when the sutures are opened. I mean would reinstalling the MSE once the expansion is done and always going 1 or few turns forward then back to keep it open should be possible? What about redoing the corticopuncture?

Also what about using some exogenous stuff? Growth hormone, peptides etc.? Could any of that increase the ability to get more protraction?

Well you and I have different views on protraction. If you are talking about bone remodelling that comes along with protraction, again I don't believe that could give significant result for an adult other than alveolar bone remodeling. So I don't have any informaton about that. Maybe if you used bollards for a very long time it could happen to give aesthetic results from outside. But again I am not sure...

However if you are talking about sutural growth I have a few ideas on that. Like Dr. Ting said protraction happens mostly in the first 1-2 months of expanding. Because thats when the pterygomaxillary sutures are most distrupted, since maxillary expansion happens rapidly. After a while of not expanding the resistance from those sutures starts to increase. Thats why some orthodontists use Alt-ramec protocol alongside with protraction because if you kept opening the diastema and closing back again and keep doing that over and over the sutures would keep on being distrupted and resistance would be kept low therefore in turn that would increase the amount of potential protraction one could gain, thats in theory though. No one knows if that protocol actually increases the amount of protraction or not

Now Dr, Ting also said that pulling from MSE molar bands, to be able to see any results, the amount of protraction needs to be at least a kg(I know the topic is about bollards, so the amount of force needed to actually protract the maxilla would be lower obviously, since bollards are absoultely bone anchored for protraction unlike MSE). Thats on one side only.I also believe that increasing the amounts of force similar to the amount of force that accumulates on MSE with each daily turn, would ensure that sutural seperation happens(not distruption, seperation). I know that bollards can't stand that much force, but still, just wanted to drop this info here

I also don't know if the amount of force bollards are able to withstand is enough to make sutural seperation happen...

 

[spark]

Well you and I have different views on protraction. If you are talking about bone remodelling that comes along with protraction, again I don't believe that could give significant result for an adult other than alveolar bone remodeling. So I don't have any informaton about that. Maybe if you used bollards for a very long time it could happen to give aesthetic results from outside. But again I am not sure...

However if you are talking about sutural growth I have a few ideas on that. Like Dr. Ting said protraction happens mostly in the first 1-2 months of expanding. Because thats when the pterygomaxillary sutures are most distrupted, since maxillary expansion happens rapidly. After a while of not expanding the resistance from those sutures starts to increase. Thats why some orthodontists use Alt-ramec protocol alongside with protraction because if you kept opening the diastema and closing back again and keep doing that over and over the sutures would keep on being distrupted and resistance would be kept low therefore in turn that would increase the amount of potential protraction one could gain, thats in theory though. No one knows if that protocol actually increases the amount of protraction or not

Now Dr, Ting also said that pulling from MSE molar bands, to be able to see any results, the amount of protraction needs to be at least a kg(I know the topic is about bollards, so the amount of force needed to actually protract the maxilla would be lower obviously, since bollards are absoultely bone anchored for protraction unlike MSE). Thats on one side only.I also believe that increasing the amounts of force similar to the amount of force that accumulates on MSE with each daily turn, would ensure that sutural seperation happens(not distruption, seperation). I know that bollards can't stand that much force, but still, just wanted to drop this info here

I also don't know if the amount of force bollards are able to withstand is enough to make sutural seperation happen...

Wouldn't it be possible to keep the pterygomaxillary sutures disrupted manually? With drilling or something?

By the way did Ting really say you needed 1KG per side? Mahony said he uses 600g per side of facemask protraction and that he gets visible changes in the CT scan even in adult males.

 

[noprogressno]

Wouldn't it be possible to keep the pterygomaxillary sutures disrupted manually? With drilling or something?

You mean with corticopuncture? Theoretically an orthodontist could corticopucture the transversal palatal suture. However unlike midpalatal suture, transversal palatal suture isn't a straight line and its shape differs between people. These are one of the examples:

One issue would be that far back into palate soft tissue start to get involved more so that would be an issue. However the biggest issue corticopuncturing the transversal palatal suture might be the potential to damage the internal maxillary artery. Although I don't know the exact location of the internal maxillary artery, I think that it is very close to that area. In fact thats one of the many reasons why Lefort-3 is dangerous, damaging the internal maxillary artery is a severe complication. It's over if you damage that artery or its branches... (Well the same cut is made with SARPE and the pterygomaxillary junctuon is released but its a risk for SARPE as well anyways)But again, I don't know the exact location of that artery so this is just only my opinion. It might be completely safe as well...

Plus I am afraid that cone beam CT cannot accurately locate the transversal palatal suture, so the sort of splint that orthodontists use to accurately corticopuncture the midpalatal suture before installing MSE cannot be made if someone was to corticopuncture the transversal palatal suture

Also the maxilla is connected to other bones with more than 1 suture so unlike mse to be able to provide real suture seperation, all of the resistance from all those sutures would need to be overcomed. For example, corticopuncturing the zygomaticomaxillary sutures or the nasomaxillary sutures are out of question...

By the way did Ting really say you needed 1KG per side?

My bad, its Dr.Moon who recommends that for adults. Ting recommends as much force as tolerable(which could be a good thing or a bad thing depending on the amount of minimum force he meant by that). So many doctors I confuse what each one said. Even in the N2 implant study they used 1000grams of force on each side. I also remember seeing that recommendation somewhere, I have been looking at some articles of Dr.Moon to find it but I wasn't able to. When I find it I will link it. Thats why it took too long for me to reply I was looking for the source

Mahony said he uses 600g per side of facemask protraction and that he gets visible changes in the CT scan even in adult males.

Thats a good amount of force to be honest, 600 on each side. I thought they were stable up to 350g only.
If he got a visible CT scan of sutural seperation that would be exteremely great. If you can get a hand on that I would like to see that also.In children maxillary sutures other than the midpalatal suture as well could be released with maxillary protraction and it looks something like this:

seperated zygomaticotemporal suture and midpalatal suture

seperated internasal suture

seperated pterygomaxillary suture

seperated frontomaxillary suture

seperated zygomaticomaxillary suture

These results were obtained from children who undergone rapid palatal expansion only(Without protraction) So the most seperation is of course are going to be at transversally expanding sutures.(the most visible ones are going to be the internasal suture and midpalatal suture.) And since they were children the sutures were open the begin with but if Dr.Mahony got a similar result like this one it would mean that it is legit working. However if its just teeth tilting with some alveolar bone remodelling I wouldn' call that a skeletal protraction. So I am just showing how it would look on the ct scan so the result would be similar if he really achieved that

And of course this is how the seperation of the midpalatal suture with MSE looks on CBCT:

But I really have to say this again: What doesn't make sense to me however, is that rapid palatal expanders generate forces 2-5 kg per turn with accumulated loads more than 9kg. Some of that force goes onto teeth and some of it goes to bone as most palatal expanders are not bone anchored. And rpe without bone anchorage fails and just tips the teeth for adults because the amount of force that goes onto bone is not enough to open the midpalatal suture and overcome the resistance there before the teeth starts to shift. With MSE all that accumulated force goes straight onto bone. Even that is sometimes not enough to overcome the resistance from the midpalatal suture, so the screws tip and the device fails. Result? A non opened midpalatal suture. Please keep in mind that the midpalatal suture is the weakest suture on the whole skull. What doesn't make sense to me with what Dr.Mahony is claiming and the claims of some other orthodontists as well is that even the midpalatal suture which is the weakest suture on the skull sometimes fails to open with as much accumulated force as 9kg, then how is the more stronger sutures are going to open with such a weak force like 600g? For example: zygomaticomaxillary sutures are one of the sutures that holds the maxilla in its place, and they are also one of the strongest sutures of the skull. How is he even able to seperate that suture with just 600g, even midpalatal suture,the weakest suture, doesn't open on an adult with such a low force? Lets say he was able to significantly seperate the pterygomaxillary suture with protraction, then how is he going to move the actual maxilla forward without overcoming the resistance from the zygomaticomaxillary suture? With that suture not opened the maxilla will simply stay at its place?

 

[spark]

You mean with corticopuncture? Theoretically an orthodontist could corticopucture the transversal palatal suture. However unlike midpalatal suture, transversal palatal suture isn't a straight line and its shape differs between people.

I specifically meant the pterygomaxillary suture since that one is responsible for the majority of forward protraction if I am correct. It doesn't have to be done via corticopuncture or by an orthodontist. Most top orthos (the only ones who are worthy of a visit since 99% of orthos are utter scum) work with surgeons. Just some sort of a weakening of the suture or something. Don't they engage in some cut there during the DOME procedure? I of course don't want the "lefort" cut as I want upper maxillary expansion so DOME as a whole is out of question though.

My bad, its Dr.Moon who recommends that for adults. Ting recommends as much force as tolerable(which could be a good thing or a bad thing depending on the amount of minimum force he meant by that). So many doctors I confuse what each one said. Even in the N2 implant study they used 1000grams of force on each side. I also remember seeing that recommendation somewhere, I have been looking at some articles of Dr.Moon to find it but I wasn't able to. When I find it I will link it. Thats why it took too long for me to reply I was looking for the source

Thats a good amount of force to be honest, 600 on each side. I thought they were stable up to 350g only.
If he got a visible CT scan of sutural seperation that would be exteremely great. If you can get a hand on that I would like to see that also.

I know Sergio said he uses bollards up to 350g without any issues. Not sure how much further it is possible to go with them. I have always heard larger numbers for the facemask so 600g doesn't seem that crazy to me. I also think wouldn't the tooth tipping be more likely to occur with higher forces applied to the molar? If one combined 100-200g of molar-lower braces elastics similarly to what Won Moon did with 400g of bollards that could prevent the molar from significantly pushing onto the other teeth. Or what if the molar was stabilized through an extra tad or something different?

But I really have to say this again: What doesn't make sense to me however, is that rapid palatal expanders generate forces 2-5 kg per turn with accumulated loads more than 9kg. Some of that force goes onto teeth and some of it goes to bone as most palatal expanders are not bone anchored. And rpe without bone anchorage fails and just tips the teeth for adults because the amount of force that goes onto bone is not enough to open the midpalatal suture and overcome the resistance there before the teeth starts to shift. With MSE all that accumulated force goes straight onto bone. Even that is sometimes not enough to overcome the resistance from the midpalatal suture, so the screws tip and the device fails. Result? A non opened midpalatal suture. Please keep in mind that the midpalatal suture is the weakest suture on the whole skull. What doesn't make sense to me with what Dr.Mahony is claiming and the claims of some other orthodontists as well is that even the midpalatal suture which is the weakest suture on the skull sometimes fails to open with as much accumulated force as 9kg, then how is the more stronger sutures are going to open with such a weak force like 600g? For example: zygomaticomaxillary sutures are one of the sutures that holds the maxilla in its place, and they are also one of the strongest sutures of the skull. How is he even able to seperate that suture with just 600g, even midpalatal suture,the weakest suture, doesn't open on an adult with such a low force? Lets say he was able to significantly seperate the pterygomaxillary suture with protraction, then how is he going to move the actual maxilla forward without overcoming the resistance from the zygomaticomaxillary suture? With that suture not opened the maxilla will simply stay at its place?

As far as I know the facemask or whatnot is not 100% responsible for the loosening up of the suture. Apparently the MSE induced midpalatal split is already weakening the other sutures to the point of them being able to be stimulated with less force than otherwise.

You could contact Mahony. He hasn't answered the last time I sent him a message but a few months ago we spoke somewhere in a facebook thread regarding protraction and someone asked him whether he uses CT scans to asses the results and he responded that yes and that XRAY is a thing of the past. He was then asked by the same dude to show a CT before after. He said sure when he gets back to the office but never really got to it and did it. Probably forgot. But the good news are that he is likely willing to share the CT images.

 

[noprogressno]

Don't they engage in some cut there during the DOME procedure? I of course don't want the "lefort" cut as I want upper maxillary expansion so DOME as a whole is out of question though.

Well I don't know too many procedures that could achieve something like this. I have never heard of a surgical suture release other than the midpalatal suture. Even with Lefort-2 or 3 I don't think the cut surgeons make are exactly through any of the maxillary sutures.

I also think wouldn't the tooth tipping be more likely to occur with higher forces applied to the molar? If one combined 100-200g of molar-lower braces elastics similarly to what Won Moon did with 400g of bollards that could prevent the molar from significantly pushing onto the other teeth. Or what if the molar was stabilized through an extra tad or something different?

Of course tooth tipping will occur. As far as I know there isn't a lot of studies about adult maxillary protraction that included Dr. Won Moon in it, the only ones I saw was on children and teenagers, so I don't think pulling from molar bands would give any adult skeletal change to be honest. One study is coming soon but who knows if it's about the N2 implant or just another protraction with MSE study. I messaged him through his social media but as usual he doesn't respond.... But I don't think MSE is a good option for protracting to be honest. It would be an exteremely good option if there was a way to pull from the actual anchorage itself without dislocating the device as MSE screws are the most stable mini implant today because of the place they are placed on
Also Won Moon used bollards to stabilize to tooth from shifting while protracting from MSE? I never saw that. Ridiculous effort... Or did I just understand that completely wrong...?

You could contact Mahony. He hasn't answered the last time I sent him a message but a few months ago we spoke somewhere in a facebook thread regarding protraction and someone asked him whether he uses CT scans to asses the results and he responded that yes and that XRAY is a thing of the past. He was then asked by the same dude to show a CT before after. He said sure when he gets back to the office but never really got to it and did it. Probably forgot. But the good news are that he is likely willing to share the CT images.

Its great that he is willing to show the CT scans, it means that he is confident in what he is doing(hopefully there will actually be truth in that confidence...) I will message him. Hopefully he will respond. Like the pictures I showed, palatal expansion alone distrupts all of the sutures even without protraction. So it would be absolutely great if he got a view of some seperated sutures(other than the midpalatal suture ofc, thats expected with mse anyways) I have a bad luck about messaging orthodontists, they just never respond...

 

[spark]

Of course tooth tipping will occur. As far as I know there isn't a lot of studies about adult maxillary protraction that included Dr. Won Moon in it, the only ones I saw was on children and teenagers, so I don't think pulling from molar bands would give any adult skeletal change to be honest. One study is coming soon but who knows if it's about the N2 implant or just another protraction with MSE study. I messaged him through his social media but as usual he doesn't respond.... But I don't think MSE is a good option for protracting to be honest. It would be an exteremely good option if there was a way to pull from the actual anchorage itself without dislocating the device as MSE screws are the most stable mini implant today because of the place they are placed on
Also Won Moon used bollards to stabilize to tooth from shifting while protracting from MSE? I never saw that. Ridiculous effort... Or did I just understand that completely wrong...?

Nah what I meant was that maybe it could be possible to somehow stabilize the molar which is being pulled from via tad or something in so it wouldn't be dragged too much as a result. I am just hypothesizing, not saying anyone has ever done that .

Its great that he is willing to show the CT scans, it means that he is confident in what he is doing(hopefully there will actually be truth in that confidence...) I will message him. Hopefully he will respond. Like the pictures I showed, palatal expansion alone distrupts all of the sutures even without protraction. So it would be absolutely great if he got a view of some seperated sutures(other than the midpalatal suture ofc, thats expected with mse anyways) I have a bad luck about messaging orthodontists, they just never respond...

Yeah I also rarely get any answers, especially when I message the guys on instagram. I messaged Varela a few times got nothing but he is still doing protractions this is what he posted just yesterday:

 

[spark]

something like this could be useful

 

[Deleted member 8758]

Are there any methods to increase the amount forward protraction possible? Dr. Ting said something along the lines of how the majority of protraction happen in the first 1-2 months when the sutures are opened. I mean would reinstalling the MSE once the expansion is done and always going 1 or few turns forward then back to keep it open should be possible? What about redoing the corticopuncture?

Also what about using some exogenous stuff? Growth hormone, peptides etc.? Could any of that increase the ability to get more protraction?

I think these are important questions since as far as I know people protract very few mms at best. I definitely am not willing to even entertain the idea of a le fort which doesn't even move anything above the alveolar.
@noprogressno

You're not going to change the shape of the bones, all that is happening is the sutures are opened and filled in with bone deposition. The sutures aren't stretched which takes times, they are simply forced open so you don't get those bone shape changes that you need.

 

[Deleted member 8758]

something like this could be useful

MSE can break that with enough expansion but it fucking hurts.

 

[noprogressno]

something like this could be useful

Yeah this was the cut I was talking about with SARME and Lefort-3. Notice how close it is to the internal maxillary artery. That wont be a problem as surgeons are experienced to not cut that arthery of course, but as far as I know this cut is not done through the suture line, It just seperates the bone itself, just so you know. But yes it will make protraction easier probably

 

[noprogressno]

Nah what I meant was that maybe it could be possible to somehow stabilize the molar which is being pulled from via tad or something in so it wouldn't be dragged too much as a result. I am just hypothesizing, not saying anyone has ever done that .


Yeah I also rarely get any answers, especially when I message the guys on instagram. I messaged Varela a few times got nothing but he is still doing protractions this is what he posted just yesterday:
View attachment 1477781

Those are bollards right?

 

[spark]

Those are bollards right?

nah Varela uses tads