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Alyssa Luck

Alyssa Luck

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Video: Is AGGA dangerous? My thoughts on tooth instability and bone loss

Alyssa Luck · Jul 1, 2020 · 18 Comments

Ramblings on the risks of AGGA, from my personal perspective. Also, yes, not only did I not manage to make this video five minutes, as intended, but the second take was actually LONGER than the first. Video: 1 Alyssa: 0

Below are the blog posts I mentioned in the video that touch more on this topic. And to add – since I published this video a week or so ago, Ronny Ead reached out to me privately with further warnings about the dangers of AGGA. He had a negative experience towards the end, and knows several more people who have had even worse experiences (i.e. losing their front teeth with no chance of implants).

So let this just be a reminder to anyone reading this that AGGA/CAB isn’t something that should be undertaken lightly or without just cause, and I would encourage anyone considering this treatment to check out the videos/posts Ronny has published on the topic for a different perspective. It’s always good to keep in mind that the entities who financially benefit from a treatment may not always be totally unbiased and objective when evaluating the risks.

Palate Expansion Update: Concerning CBCT Scan Results

Why I Decided to Try AGGA (plus some lingering concerns)

Everything You Need to Know about AGGA (but not really because I need to update this page…)

Related

Functional Orthodontics & Orthotropics

Reader Interactions

Comments

  1. Doug says

    July 1, 2020 at 5:23 pm

    Hi Alyssa!

    I am also not a concise writer or talker, so I will probably go about as far over on this post as you didn’t want to with your video. But to be fair, these procedures are really out there on the edge of medical/dental capabilities, so I think more discussion is good. Don’t ever feel bad about your 5 minute videos that stretch into 12.

    So first off – disclaimer, I have no medical or dental background. I’m just someone like you, trying to get a problem fixed.

    As far as the pain you are feeling, that is (as I understand it) the normal inflammatory response process of orthodontics. That’s what causes the bone resorption on one side, and (in theory) remodeling on the other side – via inflammation. There are other devices that claim they accomplish movement without traditional orthodontic inflammation, but the science is all still far too new on this.

    In terms of Ronald’s case – well, he’s an interesting one. And to be 100% fair and transparent, I will have to say that I had a lot of concerns with AGGA too … even before I saw Ronald’s case. And Ronald and I are both in the same Facebook group for some of these treatments, so he and I have exchanged messages in the past (and I’ve posted comments on some of his YouTube videos) so I’m not really saying anything that hasn’t been discussed elsewhere. And he might even see this comment, and choose to respond – and that’s all fine … because like I said, discussion is so critical for those of us going through procedures that do not have long established histories. Effectively being a “pioneer” in this space … is anything but fun.

    So let me give you my thoughts on Ronald’s case, and it is a very unfortunate outcome.

    First things first, prior to doing AGGA – Ronald tried an acrylic appliance based strategy for expansion. I’m not sure on the reasons why he stopped that or which appliance he was using, but I think it might be safe to assume that he achieved at least a couple millimeters of expansion off of that.

    Did he tell his AGGA provider that he had already expanded a bit? Who knows. Perhaps he didn’t.

    If you’ve spent any time reviewing Ronald’s history, you’ll see that he’s just a little bit obsessed with getting a lot of expansion. I don’t know why this is, but it’s clear in his videos that he wanted to go big. Now, if AGGA could do maybe 10mm … but he already gained 2 or 3mm from his previous protocol … did that put his provider in the unfortunate position where they would actually be pushing Ronald past his genetic potential? Again, who knows – it’s hard to be sure.

    I had not heard before that he stopped treatment “halfway” through. I know he didn’t complete it, but I thought he was most of the way through the AGGA part. But he did post a good detailed analysis of his before-and-after CBCTs and you can see that yes … his upper front six were not sitting in bone in the front, and now he’s looking at tunnel grafts, SFOT, etc. to try to re-stabilize his teeth. I hope those procedures go well for him – I am keeping an eye on his updates there just so that I can know what protocols might be available if something goes wrong once I start down this path in a couple of months.

    In that video where he posts his CBCT, one of the commenters made a very good point (which I chimed in on) that if AGGA was simply pushing teeth and there was ZERO remodeling happening, then the teeth would have been out of the bone within a month or two, because there’s really only just a couple millimeters of alveolar bone in front of any tooth. If the bone wasn’t remodeling at all and the tooth was just moving forward, he would have had tooth failure in just a couple months. So given how long Ronald was in AGGA, it seems like he did get some remodeling and expansion.

    But did he push it too far, too fast? Once again – who knows. It could be that if he had targeted 5-6mm of expansion (instead of what I assume he was aiming for – more like 10mm) maybe he’d be fine now.

    It is also worth noting that it is believed that Ronald’s AGGA provider is not actually a member of the LVI or FBI or whatever the institute’s name is. I have not checked into this personally, but there is that to consider as well.

    And then, after noticing that he had a bone issue when he saw his CBCT – what did he do next, consult a specialist that could potentially fix the issue? Nope, he went right into MSE (and facemask, I think).

    So Ronald is a bit of an interesting case. But nevertheless, it is one that people should be familiar with. There are other cases which seem to have gone along just fine – have a look at Dental Dork on YouTube, her process so far seems to have been rather uneventful (as I assume many – if not most – AGGA procedures probably are).

    Having said all of that (phew!) one of my biggest gripes in this little niche of dentistry/orthodontistry … is that there doesn’t seem to be a strong inclination towards periodic safety check procedures. I mean, I don’t know what’s a safe amount of X-Rays for the body … but I would think that if it’s not associated with any significantly increased health risks … then doing something like a new CBCT every 3-4 months to check for safety concerns would be a HUGE help to all of the providers and all of these new procedures. But It just doesn’t seem to happen all that often. I think I’ve spoken to one other patient (in a different protocol) who said her provider does a new CBCT every six months.

    So unfortunately, it falls on us – the patients, in this wild-west segment of the market – to be our own best advocates for safety. If you’re working with a provider, ask to see before-and-after CBCTs. Have them show you that patients have alveolar bone in front when the procedure is done. Have them show you that the teeth are not tilting/flaring, that they are mostly keeping the same angle. Have them show you that patients are not getting root resorption. Whether a provider will spend time with a patient and show them all of that, I think varies widely from one provider to the next … and it’s just so frustrating.

    Thanks again for all your videos. Come find us in our Facebook group “Adult non-surgical palate expansion ALF/AGGA/ControlledArch Ortho/Vivos/MSE” – 750 members strong and growing!

    Reply
    • Alyssa Luck says

      July 7, 2020 at 3:02 pm

      Hey Doug,

      Well thank you! I’ll take justification for my long-winded videos/posts any day 🙂 And I totally agree – more discussion is better!

      Really appreciate the additional context on Ronald’s case and the conversations you’ve had with him. As far as stopping halfway through – I believe he fully finished the AGGA portion, but then stopped after only a short time in CAB. He reached out to me privately after seeing this video to express concern that I’m not taking the risks seriously enough, and cautioning me against staying in CAB, which I really appreciated. It’s clear he just wants to keep others from experiencing his same fate! One piece of clarification I got from him that was helpful was the risks of CAB specifically. In my head, AGGA was the “dangerous” part, since that’s where the expansion is happening; now that I’ve made it to CAB with my front teeth intact, I assumed it would be more or less smooth sailing. But Ronald pointed out that using those front teeth as anchors puts additional stress on them, even though it’s in the opposite direction, and there’s also a torquing force (which makes sense when you think about it).

      With that in mind, I feel even more confident in my decision to do implants, rather than pulling all the molars fully forward to fill the gaps. This will at least keep the anchoring forces as minimal as possible. I also plan to discuss risk management/safety checks with my dentist next time I go in, because like you said – this really should be a routine part of treatment, and it’s disconcerting that it isn’t.

      I believe I’m already part of that Facebook group, as a matter of fact, but I haven’t been active on there! Perhaps I need to pay it another visit. Thanks again for this comment and sharing your thoughts, and I look forward to keeping these discussions going as we all learn more!!

      Reply
  2. Doug says

    July 7, 2020 at 5:24 pm

    Interesting. I would have thought the same – that the AGGA part is what was considered most dangerous, since you’re pushing forward.

    I did see another data point that Ronald had gotten just over 9mm of expansion on one side. That definitely seems to be approaching the outer ranges of what any of these protocols aim for. It just makes me wonder if he still had a little bit of expansion left over from his acrylic … and the two combined were just too much for his body’s genetic blueprint.

    To the point that you raise, “using those front teeth as anchors puts additional stress on them, even though it’s in the opposite direction” … it makes me ponder whether or not that would potentially help address any “pushed teeth out of alveolar bone” situations in the front, if you were then pulling them backwards a bit? If Ronald had stuck through CAB, would he have ended up better off? Even movement of just 1mm backward … would that get them mostly re-seated in the bone?

    I think the implants are a wise choice. And certainly, having those in-place will help with lifetime retention of your gains!

    Looking forward to your next update!

    Reply
    • Alyssa Luck says

      July 8, 2020 at 10:39 am

      It’s so hard to say! From what I can tell, most of the discussion on what’s really happening with AGGA expansion is largely speculation, although I must admit I’m not tuned in enough to the LVI community to know what information/research I might be missing.

      For reference, I got 10mm expansion on both sides with AGGA, and also had a bit of leftover expansion from an acrylic appliance. But, I was also quite a bit more recessed to begin with than Ronald was. Either way, I’ll be an interesting data point once my treatment is concluded!

      Reply
  3. Terri says

    September 27, 2020 at 9:03 pm

    Hi..I just found you! I’m researching Agga/Cab as I’m to start LVI on Tuesday with a fixed orthotic. I’m part of the LVI FB group and they have addressed this issue. So much so that I’m going forward with it and trusting my very Advanced LVI doc. I’m aware of the risks of moving teeth. You have a great doc btw! He’s extremely popular.

    My question is I see you are in CAB and wondering if you still intend on filling the gaps with implants or having the molars moved forward? If you plan on the implants then will you get the braces off?

    Thank you!

    I appreciate all your information on here and the conversation between you and Doug has been enlightening to say the least. Really appreciate it!

    Reply
    • Alyssa Luck says

      September 28, 2020 at 3:00 pm

      Hi Terri! That’s great to hear. I’d be interested to know how they address this issue. Are there any specific posts or resources you’d be able to link to? I believe I was part of that group a year or so ago (and might still be), but I don’t recall the issue being addressed thoroughly in a way that completely satisfied me, at least not at the time. But I certainly agree with you that I have a great doc! I’ve been impressed with him so far.

      Yes, I do still intend on filling the gaps with implants, but the braces are still necessary. Prior to implants, we’re pulling one premolar on either side forward, because that will prompt the bone in the gap to remodel, making it stronger and more consistent for the implants. Then depending on if there’s still space left, we might need to pull the molars forward a tiny bit. The braces are also necessary for getting my occlusion fully aligned. But I’m certainly hopeful that doing the implants will help me get out of these braces a tiny bit sooner than I would otherwise! I’m ready to not have metal in my mouth anymore.

      Reply
      • Terri Rasmussen says

        November 8, 2020 at 4:57 am

        Sorry, just now seeing this. There has been more talk in the LVI group on Agga and CAB. Many questions are being asked and they are providing the answers. Look under the files section for Agga information. As for CAB retraction, they are working on doing something called TAD to anchor the top teeth. But everyone is different on what they will need. They are doing classes on it right now. Not everyone will need it tho of course. It sounds like you are doing well in Agga and CAb so I doubt you’ll have any issues. Thanks for letting me know about the implants. Just watched your new video and commented. I’m nervous cause my LVI did mention I probably would need Agga. I worry about gum recession as well. I dread all the metal in my mouth! Best of luck to you! So glad you created this page!

        Reply
        • Alyssa Luck says

          November 8, 2020 at 3:59 pm

          Ah great, thanks for the info Terri! Much appreciated. If/when you do AGGA, definitely keep us posted!

  4. Beth says

    October 24, 2020 at 7:31 pm

    Thanks Alyssa. I love your videos and blogs. We are all feeling nervous about things since Ronny‘s experience and now the lawsuit against a NY dentist. So it’s very nice to hear that you are still ok and trusting your doc. Please continue to update us.

    Reply
    • Alyssa Luck says

      October 28, 2020 at 5:51 pm

      Thanks Beth! I hadn’t heard about that lawsuit, but just looked it up (here’s a NY Post article about it for anyone curious). It sounds like an extremely unfortunate outcome; I’d be very interested to know the details, but I don’t imagine we’ll get anything close to the full story publicly. I’m still doing well and will certainly continue to update you all!

      Reply
  5. Susan says

    November 2, 2020 at 9:48 am

    Glad to here you are doing okay. Like Beth I have been reading about other people’s experiences and getting very nervous. I have 10mm on each side from AGGA and now one year into CAB. Unfortunately I can’t get implants according to my dentist so I will have to move those back teeth forward. I have lots of things to sort out in my bite having had a number of teeth extracted to make room as a child.

    Reply
    • Alyssa Luck says

      November 3, 2020 at 7:22 pm

      One year into CAB, wow! I’m curious, these bad experiences you’re reading about – at what point in their treatment are they starting to have issues? Is it usually during the CAB phase? I’m also curious why you aren’t able to get implants, if you don’t mind sharing! I’m sure that’s disappointing, especially since you had teeth extracted.

      Reply
      • Terri Rasmussen says

        November 8, 2020 at 4:59 am

        I’m finding it hard to get anyone to tell me any horror stories of their Agga/Cab failure. Like what really went down. So sad.

        Reply
        • Alyssa Luck says

          November 8, 2020 at 4:01 pm

          Hmm, interesting. It’s frightening to hear people having bad outcomes, but if they aren’t transparent about their experience, it certainly makes me wonder.

        • Susan says

          November 10, 2020 at 11:37 am

          If they are undertaking legal action the lawyers tell them to be quiet so they remove all social media posts and leave FB and stop talking about their experiences. Another I don’t want to post here about it here.

      • Susan says

        November 10, 2020 at 11:34 am

        Two cases was at end of agga going into cab. Others don’t publish details as they are seeking legal action and lawyers tell them to go quiet. One ditched treatment as it didn’t give any change to airway at end of agga I don’t understand the implant thing but something to do with my bite. I would love to hear some good stories if you happen to know of any finished cases. They are hard to find.

        Reply
  6. Omar says

    November 23, 2020 at 1:18 am

    Helloo Alyssa,

    I have just come across your Blog and was recently thinking of getting AGGA. How are you doing? My main concern is that do they give you a heads up of the expectations before hand or after pictures of what you might look like before agreeing to the AGGA appliance? Is there a guarantee of their work?

    Reply
    • Alyssa Luck says

      November 25, 2020 at 2:06 am

      Hi Omar – I’m doing well! I’m not sure about other practitioners, but no, my dentist didn’t do that. They let you know how much growth they’re aiming for based on an analysis of your face, but they didn’t create projected “after” pictures or anything like that. Ans as far as a guarantee of their work – I don’t think so. In fact, I think most practitioners doing orthodontic work probably have some kind of “there’s no guarantee” clause in whatever contract you sign up front. You’d really just have to ask the specific AGGA practitioner you’re interested in though!

      Reply

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Hi! I’m Alyssa. I like thunderstorms and cats, hate wearing shoes, and enjoy devising extensive research projects for myself in my free time. This is me in Bali with a monkey on my shoulder. And this is my blog, where I muse about health-related topics and document my relentless self-guinea pigging. If you want to know more about me, click here!

alyssa.luck

alyssa.luck
Photo dump from the last year. Thanks to everyone Photo dump from the last year. Thanks to everyone who made 28 the best yet - excited for 29🥰

(PS. In case anyone wants to know what it’s like in my head, I was going to write something like “year 28” or “my 28th year” but then I realized that the year between your 28th and 29th birthdays is not your 28th year of life, it’s your 29th year. I am turning 29 because I have been alive for 29 years. So then I had a whole thing about how to word it without being inaccurate and ended up going with what you see above which is vague and weird but the point is it was a good year and I love all the people in my life dearly)
Biology of Belief (2005) was written by Bruce Lipt Biology of Belief (2005) was written by Bruce Lipton, who earned a PhD in developmental biology in 1971 and was an anatomy professor and academic researcher in the 70s and 80s. Despite the book's presentation and Lipton's background, this is not a science book. It is an exposition of an ideology, supported by haphazard and poorly contextualized nuggets of evidence, rhetorical leaps, and a mind-boggling overuse of analogies. 

The book largely failed to deliver on its promised content. What it does is argue for the primacy of the environment over DNA in controlling life; propose that the cell membrane rather than the nucleus is the "brain" of the cell; invoke quantum physics to explain why modern medicine fails; explain that our behavior is largely controlled by our subconscious mind; inform parents that they therefore have a great deal of control over the destiny of their children; and conclude that humans must become nonviolent protectors of the environment and of humanity because Everything Is Connected.

It’s not that these points aren’t relevant to the topic at hand - they are. But they were not connected in a coherent way that would explain how “belief” actually works (like…biologically), and the treatment of scientific concepts throughout was careless, or perhaps disingenuous.

I think he's correct about many things, some of them being common knowledge. For instance, the "new" science of epigenetics is now old news, as is the critical role of parenting and early environment in shaping a child’s future. But however important these and attendant concepts may be, the book did not do a good job explaining, supporting, or connecting them. 

As far as practical guidance, he refers the reader to a list of resources on his website, which is fine, but I expected some scientific insight into how/why those modalities work. None was given. 

On the plus side, the book was quite thought-provoking, and I came away with loads of references and topics to follow up on. My favorite line? "There cannot be exceptions to a theory; exceptions simply mean that a theory is not fully correct."
Friedrich Nietzsche, The Gay Science (section 382) Friedrich Nietzsche, The Gay Science (section 382), as quoted in the introduction to Thus Spoke Zarathustra because I like the translation better.
This paper totally changed the way I think about e This paper totally changed the way I think about early nervous system development and the relationship between physiology and sociality. 

The authors propose that newborn babies are not inherently social, and have just one goal in life: physiological homeostasis. I.e. staying alive. This means nutrients, warmth, and regulation of breath and heart rate, i.e. autonomic arousal (it’s well-accepted that newborns sync their breathing and heart rate with caregivers through skin to skin contact). 

All these things are traditionally provided by a loving caregiver. So what the baby experiences during the first weeks of life, over and over, is a shift from physiological perturbation to homeostasis (a highly rewarding event inherently) REPEATEDLY PAIRED with things like the sound of a caregiver’s voice and seeing their face. Thus, over time, the face/voice stimuli become rewarding as well. 

The authors argue that THIS is the beginning of humans’ wiring for sociality, and may explain why loving social interactions can have such a profound regulating effect on physiology throughout life: because the brain was trained for it at an early age. 

This framework holds all kinds of fascinating implications for what happens if that initial “training” isn’t so ideal. What if the return to nutritional homeostasis via feeding is paired with negative expressions and vocalizations rather than loving ones, perhaps as could occur with PPD? What happens if the caregiver has poor autonomic regulation, such that social stimuli become paired with cardiorespiratory overexcitement in the baby? Could that have potential for influencing later introversion vs extroversion? (Because if social interaction is paired with autonomic overexcitement, that could lead to social interaction literally being more energetically draining, which is what introverts experience. Thoughts?)

For my energy metabolism enthusiasts: Table 1 in the paper draws a link between metabolic rate and sociality across species. Swipe for a screenshot. 

Anyway, check out the paper! It’s free, just google “growing a social brain pdf.”
I’ll be under general anesthesia in a couple day I’ll be under general anesthesia in a couple days to have two tooth implants placed, and I think I’ll take the opportunity to have a little heart-to-heart with my subconscious mind. A bit of medically-assisted self-hypnosis, if you will. 

I randomly stumbled upon these papers a couple months ago - an RCT showing reduced post-op pain in patients who listened to recorded positive messages while under general anesthesia, plus a post-hoc analysis of the same data that found reduced post-op nausea and vomiting in a subset of high-risk patients. 

The full review paper from the first slide is unfortunately in German, but it has long been recognized that even when unconscious, the patient is listening (for better or for worse). 

It boggles my mind that it isn’t standard of care to have patients listen to recordings like this while under sedation, considering that almost nothing could be easier, safer, or cheaper, and we have at least some evidence of significant efficacy. I mean c’mon, what more could you want from an intervention? 

(Yeah, I know. Profit. If anyone still thinks that our medical system operates with patient well-being as the foremost goal, you’re deluding yourself.)

“There should be a fundamental change in the way patients are treated in the operating room and intensive care unit, and background noise and careless conversations should be eliminated.”

“Perhaps it is now time to finally heed this call and to use communication with unconscious patients that goes beyond the most necessary announcement of interventions and is therapeutically effective through positive suggestions. When in doubt, assume that the patient is listening.”
If you've seen "vagus nerve exercises" that have y If you've seen "vagus nerve exercises" that have you moving your eyes or tilting your head, you've probably encountered the work of Stanley Rosenberg. The exercises he created and introduced in his 2017 book now appear in instructional videos all over the internet. 
 
The book itself has much to recommend it: it's accessible, it's practical, it's inspiring. But it has one major flaw: the solid practical and informational content regarding the cranial nerves is framed in terms of the scientifically dubious polyvagal theory. 
 
I particularly enjoyed the book as an introduction to the therapeutic arena of bodywork, of which Rosenberg is a skilled practitioner. His book is full of case reports that demonstrate how immensely powerful extremely subtle movements and physical manipulations can be. These do need to be kept in perspective: it's a small sample size of the most remarkable cases, and the results were achieved within the supportive clinical environment of a skilled practitioner. You can tell from his descriptions how refined his technique is. But nevertheless, it was a paradigm-shifting read for me, and the exercises give you something concrete to play around with. 
 
The book also brought the cranial nerves and the concept of “social engagement” to the fore as arbiters of health. Rosenberg has a solid background in cranial nerve anatomy and shares many interesting tidbits and considerations that you don’t typically hear; for instance, the potential impact of dental and orthodontic work on cranial nerve function.
 
So, is it worth reading? If any of the above piques your interest, go for it! Just read my post on polyvagal theory first – you can use the book to practice separating the wheat (solid informational content) from the chaff (pseudoscientific framing). If nothing else, the book is a nice reminder that genuine healers who get lasting results for their patients do exist.

But if you just want to try the exercises, you can easily find them all on YouTube. 

“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.” -Stanley Rosenberg
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