How can I make my orthodontist (Zahnarzt) to give me RPE (if still possible at 17) or MARPE?

[Jesus_ist_König]

Since my teeth are fine I dont know how I can get marpe or rpe. My doctor indeed has interest in the aesthetic part of things since he the last time asked me if I wanted smth, which was for pure aesthetic. I want to increase my bizygomatic distance (fwhr = 1,64), by expanding the maxilla. This would improve my fwhr but the thing is that my bizygomatic width/bigonial width ratio is extremely high, meaning that my bigonial distance is way to narrow. The thing I dont understand is that my teeth are perfectly aligned at this bad bizygomatic/bigonial ratio, so increasing my bigonial distance to get a lower (better) ratio would result in my mandible being way to wide in comparison to my maxilla and my lower teeth would be outside and not under my upper jaw. So in other words they wouldnt be aligned. Some1 exerienced pls answer
@hye732 my man

 

[fabri_1742]

Idk

 

[Jesus_ist_König]

Idk

Kinda tempted to mark u as solution but i feel like some1 has the answerr

 

[fabri_1742]

Kinda tempted to mark u as solution but i feel like some1 has the answerr

Give into your temptations

 

[Jesus_ist_König]

Bump

 

[Jesus_ist_König]

B

 

[Jesus_ist_König]

B

 

[Jesus_ist_König]

B

 

[hye732]

Since my teeth are fine I dont know how I can get marpe or rpe. My doctor indeed has interest in the aesthetic part of things since he the last time asked me if I wanted smth, which was for pure aesthetic. I want to increase my bizygomatic distance (fwhr = 1,64), by expanding the maxilla. This would improve my fwhr but the thing is that my bizygomatic width/bigonial width ratio is extremely high, meaning that my bigonial distance is way to narrow. The thing I dont understand is that my teeth are perfectly aligned at this bad bizygomatic/bigonial ratio, so increasing my bigonial distance to get a lower (better) ratio would result in my mandible being way to wide in comparison to my maxilla and my lower teeth would be outside and not under my upper jaw. So in other words they wouldnt be aligned. Some1 exerienced pls answer
@hye732 my man

RPE won't do anything for you, I had it when I was 9 so unless youre very young, your mid palate is mostly fused and very resistant. MARPE is for adults who have an actual orthodontic issue. If you only want aesthetic changes MARPE is not a reliable or effective way to widen the lateral zygomas because it works indirectly by widenening the maxilla, and even then it does not reliably produce aesthetic outcomes in adults.

Based off what you've said you likely have a narrow skull overall, zygomas AND mandible. First you need to increase the fwhr, either through lateral zygomatic implants (hardmax) and/or lateral cheekbone filler, lip lift (softmax). Only after you increase the fwhr, do you start lowering the bizygo / bigonial width. The misconception here is that bigonial width is a orthodontic/skeletal term, in reality (for aesthetics) the bigonial width should be the width of your lower jaw including soft tissue such as fat and the thick masseter muscle over the mandible. People do not see your skeletal bigonial width they see the width of your lower jaw.

The issue here is not your orthodontic bite/teeth, it is aesthetics. So you should not be expanding your lower teeth. You should be creating the visual effect of a wider lower jaw (after increasing the fwhr). Through mandible filler or possibly masseter hypertrophy (softmax) and/or mandibular implants, masseter augmentation (hardmax).

 

[Jesus_ist_König]

RPE won't do anything for you, I had it when I was 9 so unless youre very young, your mid palate is mostly fused and very resistant. MARPE is for adults who have an actual orthodontic issue. If you only want aesthetic changes MARPE is not a reliable or effective way to widen the lateral zygomas because it works indirectly by widenening the maxilla, and even then it does not reliably produce aesthetic outcomes in adults.

Based off what you've said you likely have a narrow skull overall, zygomas AND mandible. First you need to increase the fwhr, either through lateral zygomatic implants (hardmax) and/or lateral cheekbone filler, lip lift (softmax). Only after you increase the fwhr, do you start lowering the bizygo / bigonial width. The misconception here is that bigonial width is a orthodontic/skeletal term, in reality (for aesthetics) the bigonial width should be the width of your lower jaw including soft tissue such as fat and the thick masseter muscle over the mandible. People do not see your skeletal bigonial width they see the width of your lower jaw.

The issue here is not your orthodontic bite/teeth, it is aesthetics. So you should not be expanding your lower teeth. You should be creating the visual effect of a wider lower jaw (after increasing the fwhr). Through mandible filler or possibly masseter hypertrophy (softmax) and/or mandibular implants, masseter augmentation (hardmax).

First of all still sad u didnt follow me
Second: Okay I understand that marpe and stuff is unnecesary. You said „because it works indirectly by widenening the maxilla“ but widening the maxilla should result in more bizygomatic distance?
Third: lip lift is a hardmaxx since its surgery or fillers and my lips look fine. It would look weird on me a li lift so no. And my chin to philtrum ratio is perfect.
4th: I get what ur saying but ppl said getting big masseter muscles or fillers look weird and i agree with that. I think it would be more better to as u said 1. Increase fwhr through filler or zygo implats, but for the sake of looks, lets pretend I will get a higher fwhr through le fort osteotomy (or smth) to increase the width of my maxillar and indirectly increase fwhr. The problem now is that regarding my good fwhr, my upper jaw is now way wider and doesnt match my lower jaw and the teeth donw match when biting down. Then obviously through surgery I can increase my bigonial width/ wider mandible. Now I have a higher fwhr, aligned biting but still my bizygomatic/bigonial ratio would be the same as before . So to get a better ratio I would increase my bigonial width/ wider mandible through surgery adn not implants or stuff and that would fix my ratios but then again my lower jaw would be to wide and not match with my upper jaw and leave me with a retard bite, SO WHAT COULD BE THE SOLUTION FOR THAT? Without looking at fillers or implants
5th: I dont know if getting a wider maxilla would help me bizygomatic distance since the zygos are fused to the temporal bone, which may keep them in place. Sorry for writing so much hahaha

 

[hye732]

First of all still sad u didnt follow me
Second: Okay I understand that marpe and stuff is unnecesary. You said „because it works indirectly by widenening the maxilla“ but widening the maxilla should result in more bizygomatic distance?
Third: lip lift is a hardmaxx since its surgery or fillers and my lips look fine. It would look weird on me a li lift so no. And my chin to philtrum ratio is perfect.
4th: I get what ur saying but ppl said getting big masseter muscles or fillers look weird and i agree with that. I think it would be more better to as u said 1. Increase fwhr through filler or zygo implats, but for the sake of looks, lets pretend I will get a higher fwhr through le fort osteotomy (or smth) to increase the width of my maxillar and indirectly increase fwhr. The problem now is that regarding my good fwhr, my upper jaw is now way wider and doesnt match my lower jaw and the teeth donw match when biting down. Then obviously through surgery I can increase my bigonial width/ wider mandible. Now I have a higher fwhr, aligned biting but still my bizygomatic/bigonial ratio would be the same as before . So to get a better ratio I would increase my bigonial width/ wider mandible through surgery adn not implants or stuff and that would fix my ratios but then again my lower jaw would be to wide and not match with my upper jaw and leave me with a retard bite, SO WHAT COULD BE THE SOLUTION FOR THAT? Without looking at fillers or implants
5th: I dont know if getting a wider maxilla would help me bizygomatic distance since the zygos are fused to the temporal bone, which may keep them in place. Sorry for writing so much hahaha

Yea youre right actually, at 17 the zygomatic bone + temporal bone suture is rigid, I was just thinking of my own RPE, which helped widen my zygomas because my bones were responsive at 9. But that's even more reason why widenening the maxilla in adults does not reliably translate to a wider zygomatic projection. You're essentially relying on a wider maxilla to indirectly transmit to nearby facial bones (zygomas) through the zygomaticomaxillary region and at 17, when the surrounding sutures are mostly fused. This does not produce a reliable, effective, or isolated aesthetic result. Especially when implants or filler directly address the issue of a narrow zygos.

If your chin to philtrum ratio is perfect, then that isolates the problem. It is a narrow zygomatic projection. So yes, a lip lift would be bad in your case.

You have to forget about trying to widen your bite because this is not an orthodontic issue, it is purely aesthetics. There is no need to change maxilla/palete/bite. Youre thinking of surgical procedures that are almost always done on people with an underlying orthodontic/medical issue (Le Fort osteotomy, MARPE etc). This is a very bad idea because youre looking into extremely invasive, risky (and expensive) surgeries that do not adress your aesthetic problem directly.

Zygos/Mandible implants or masseter augmentation do not change your bite, they are placed outside the mouth on the bone surface and/or surrounding soft tissues. These are really the only options for aesthetics. Also I agree in some areas and especially with superficial placement fillers can look very bad. But they can look very good depending on where it is placed and if you're the right candidate, I suggest looking into more results before you completely brush them off.

So essentially start with a Zygos implant to fix the fwhr, then remeasure your bizygo / bigonial ratio so you can figure out what size/placement Mandible implant you need to lower the ratio.

 

[Jesus_ist_König]

And again @hye732 thank you so mich for helping me out and taking ur time for each detailed respone. I will indeed look at fillers/implants