MSE developmental skeletal factors rant

[Agendum]

Having difficulties with MSE myself, Ive wondered which factors complicate the process. Im beginning to think that preexisting skeletal conditions affect the outcome of the MSE forces it delivers. AFAIK many of the MSE studies are done in the East rather than on Western white faces so this is also a factor.

At late age of 28 my bone structure changed to some degree since when I left high school. My bite has always sucked and I didnt take care of it skeletally with expansion and I think it made my structure worse over time. I got my wisdom teeth extracted at around age 20 (I noticed my facial degradation a few years ago.) Slowly I noticed my teeth still becoming more crowded somehow.... thanks ((extraction orthodontist$!))

My forehead used to be more square-shaped and eye sockets more vertically compact when I was a younger adult. The midface is what held all this up but if you have fundamental problems like poor occlusion, you cannot coast off of your youth as these problems will catch up to you in 10 years or sooner.

The rest of the face needs its sutures loosened if you want to rotate the sides of the maxilla to have the cant of the eye socket rotated to its correct position. The base limiting factor might be the frontal bone if it grew too narrowly upon reaching adulthood as it will press downwards on the zygos drooping them downward. The midface has to meet the rest of the face halfway or else you get a more downswung and droopy appearance. Its not top-down or bottom-up, it is supported by both at the same time. MSE might not be able to combat the resistence of very stubborn downswung fused facial bones in some individuals (like at the zygomaticofrontal area.)

My scan shows the midpalatal split, I will be getting a 3rd MSE in a few months when new scar-like bone fills in the gap.

 

[Deleted member 9699]

TLR?

 

[Deleted member 7125]

Mogs me

 

[Agendum]

tl;dr wait too long to fix midface issues = death + you cant rest easy until you're 25

 

[Sergio-OMS]

My scan shows the midpalatal split, I will be getting a 3rd MSE in a few months when new scar-like bone fills in the gap.
My scan shows the midpalatal split, I will be getting a 3rd MSE in a few months when new scar-like bone fills in the gap.

That is a mistake. When doing serial MSEs (puting one expander after another) it is way better to continue without a pausing

 

[Agendum]

That is a mistake. When doing serial MSEs (puting one expander after another) it is way better to continue without a pausing

I dont think my (Los Angeles based) ortho intended to have more than one MSE initially. She is a sleep apnea ortho and wanted to ensure that my nasal floor was preserved (breathing problems.)

She commented on the fact that I had some degree of palatal tori. I think Ive seen a case (in the Great Work) where the dense bone that was present in palatal tori where its excesses were "absorbed" into that gap. Maybe that was her reasoning but Im not too sure.

Or maybe she wants to prolong the treatment as insurance to protect herself against patient flight to ensure monthly payment for the full duration of treatment. Maybe she knows that I value to MSE aspect of orthodontics more than the invisilign aspect. IDK but I try to have the best interpretation of a person's motives but its crossed my mind.

 

[curryslayerordeath]

brutal future lesson to me ngl, am in the same situation u were in at 18

why are you on your 3rd mse? did you have split issues w the first two?

 

[highT]

It sounds like you are saying that the very skeletal abnormalities that would create the need for an MSE in the first place are also the same features preventing these people from having success with the MSE?

Also confused here you said your palate was successfully split, so what exactly is the problems you’re experiencing with your MSE treatment? edit: I assume you had one or more failed MSE before the successful one?

 

[Agendum]

brutal future lesson to me ngl, am in the same situation u were in at 18

why are you on your 3rd mse? did you have split issues w the first two?

I got slight flaring on one side of my molars and the arms of the MSE were digging into my gum pushing the aveolar bone of the molar out of continuity with the rest of my aveolar ridge. Its all kinda weird.

On the left side of the image (my right side) you can see where the bands were anchored on my right molar, it was shifted more on one side, that being dental+aveolar movment when it should have been just skeletal movement.

When I did the scan I was sitting upright but the scan shows my maxillary cant (tilt.) That can affect the MSE.

 

[highT]

I got slight flaring on one side of my molars and the arms of the MSE were digging into my gum pushing the aveolar bone of the molar out of continuity with the rest of my aveolar ridge. Its all kinda weird.

On the left side of the image (my right side) you can see where the bands were anchored on my right molar, it was shifted more on one side, that being dental+aveolar movment when it should have been just skeletal movement.

When I did the scan I was sitting upright but the scan shows my maxillary cant (tilt.) That can affect the MSE.

sounds shitty. has it been worth the trouble?

 

[Agendum]

It sounds like you are saying that the very skeletal abnormalities that would create the need for an MSE in the first place are also the same features preventing these people from having success with the MSE?

Also confused here you said your palate was successfully split, so what exactly is the problems you’re experiencing with your MSE treatment? edit: I assume you had one or more failed MSE before the successful one?

Correct, that is my suspicion. There are some skeletal developmental abnormalities would still permit you to meet the "in-theory" outcomes of MSE but I think certain combinations might make it less probable due to the stubborn bone. One feature we know for sure that complicates MSE is palatal tori for example.

 

[Agendum]

sounds shitty. has it been worth the trouble?

Its still an ongoing process but I have gotten the benefit of slightly better nasal airways but little asthetic difference. I need the palate expansion regardless of looksmaxxing results for health reasons. The asthetic aspect of only a few mm exansion is too early to tell but my expectations have been lowered so far.

 

[highT]

Correct, that is my suspicion. There are some skeletal developmental abnormalities would still permit you to meet the "in-theory" outcomes of MSE but I think certain combinations might make it less probable due to the stubborn bone. One feature we know for sure that complicates MSE is palatal tori for example.

Yes I have heard about the palatal tori. Do you think the maxillary cant is another feature that contributes to unfavorable outcomes? Definitely seems like it would be harder to predict

 

[Agendum]

Yes I have heard about the palatal tori. Do you think the maxillary cant is another feature that contributes to unfavorable outcomes? Definitely seems like it would be harder to predict

I had some degree of maxillary cant prior to my MSE. You'd be getting your skull scanned in your consultation for MSE so you'd know if you know if you have it. The problem is arms of the MSE, sometimes its manufactured with weak arms and others are really hard, sometimes it can dig into the side of your palate if your aveolar ridge is not moving in the same direction as the skeletal expansion. Some orthos removed the arms soon after the suture split. The ones that dont....I think its because they're lazy or too busy.

The suspected feature thats limiting zygomatic rotation (fixing the canthal tilt of the eye socket) that I was talking about is a frontal bone thats narrow and less square-shaped. Kinda like in the picture I attached, my forehead is small so it looks like its pressing my zygos down and as a consequence the canthal tilt of the lateral eye aspect. This makes your eye area less vertically narrow (I used to have vertically narrow eye area when I was 18.)

 

[Carolus]

Interesting thread. Can I ask in what country/city you're getting the MSE treatment?

 

[Agendum]

Interesting thread. Can I ask in what country/city you're getting the MSE treatment?

Los Angeles, Ca from a sleep anea oriented ortho.

 

[Deleted member 3020]

I dont think my (Los Angeles based) ortho intended to have more than one MSE initially. She is a sleep apnea ortho and wanted to ensure that my nasal floor was preserved (breathing problems.)

She commented on the fact that I had some degree of palatal tori. I think Ive seen a case (in the Great Work) where the dense bone that was present in palatal tori where its excesses were "absorbed" into that gap. Maybe that was her reasoning but Im not too sure.

Or maybe she wants to prolong the treatment as insurance to protect herself against patient flight to ensure monthly payment for the full duration of treatment. Maybe she knows that I value to MSE aspect of orthodontics more than the invisilign aspect. IDK but I try to have the best interpretation of a person's motives but its crossed my mind.

I have palate tori and my ortho installed of below the tori, I still have a successful split, but the excess bone still hasn’t set into the gap.

 

[Agendum]

I have palate tori and my ortho installed of below the tori, I still have a successful split, but the excess bone still hasn’t set into the gap.

I was only speculating on it filling the gap over my interpretation of one image Ive seen. Its not confirmed.

 

[spark]

That is a mistake. When doing serial MSEs (puting one expander after another) it is way better to continue without a pausing

Why do people even do serial MSEs when the MSE limit is extremely high like 12mm. I have never heard of anyone engaging in more expansion than that yet I have seen many people mention serial MSEs.

Also why is it better to not wait? Dr. Ting said something about a half a mm protraction upon the splitting of the suture (if I understood it correctly), wouldn't it make sense to redo the split for more forward protraction?

 

[spark]

tl;dr wait too long to fix midface issues = death + you cant rest easy until you're 25

Do you protract at all, also what are your real problems?

 

[Agendum]

Do you protract at all, also what are your real problems?

I haven't finished my MSE process yet, but I do plan on protraction. I have low expectations for it at my age but hopefully on my next MSE I'll get some facial suture disarticulation as well as at the pterygomaxillary suture too.

 

[spark]

I haven't finished my MSE process yet, but I do plan on protraction. I have low expectations for it at my age but hopefully on my next MSE I'll get some facial suture disarticulation as well as at the pterygomaxillary suture too.

Why does one have multiple MSEs? I don't get it when one MSE can go pretty far like 12mm.

 

[TITUS]

Too long,

 

[Agendum]

Why does one have multiple MSEs? I don't get it when one MSE can go pretty far like 12mm.

The MSE doesnt always expand ideally, and some mm (of device expansion) are lost when trying to break the suture. Its messier the older you get, Im nearing towards age 30. My post intends to speculate on the idea that preexisting developmental problems disrupt the trajectory of your treatment (and that you are not done growing when you finish high school, still alot of risk for downswung growth.)

 

[spark]

The MSE doesnt always expand ideally, and some mm (of device expansion) are lost when trying to break the suture. Its messier the older you get, Im nearing towards age 30. My post intends to speculate on the idea that preexisting developmental problems disrupt the trajectory of your treatment (and that you are not done growing when you finish high school, still alot of risk for downswung growth.)

Yeah but do multiple MSEs make it easier? That is what I don't understand.

 

[Agendum]

I think multiple MSE make it easier when its done to avoid flaring the teeth as in placing them in different positions on the palate, like posterior or anterior according to the resistence of the type of face you currently have or conditions (like palatal tori or stubborn facial sutures.) My reason for multiple MSEs were first because I couldnt get the suture to split and second was that I got asymetric tooth flaring + dentoaveolar movement. Different orthos have different reasoning so I cant really give a good answer.

MSE treatment makes assumptions based on theory but orthos dont actually know the outcome of it. They can only make informed speculation as to what your jaw will look like but it doesnt always fulfill that due to just how many factors there are.

From what Ive understood from my own treatment, orthos are playing it by ear. It feels like trial and error with how its going but adult maxillary expansion is still a very young procedure. New stuff is being discussed like horizontal cuts (rip zygos) or forgoing coritcopuncture and simply surgically splitting the midpalatal suture bypassing the guesswork of forcing open the suture.