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Alyssa Luck

Alyssa Luck

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

Alyssa Luck · Nov 12, 2019 · 10 Comments

You guys. I wrote this post in MAY, and somehow managed to not hit publish. So here it is, almost six months later, which means I’m six months into my AGGA treatment, which means I’m way overdue for more updates. Given my track record, I’d say you should expect another update in April, but I will do my absolute best to exceed expectations. 

Ever since I halted my last palate expansion attempt due to bone loss concerns, I’ve been exploring other options and deciding on the best course of action. Now, almost a full year later, I’ve started treatment with a new dentist (Dr. Ed Suh) doing AGGA and CAB.

It wasn’t an easy decision-making process, and it’s not a perfect solution by any means (not that a perfect solution exists), so I wanted to share all of the factors I’ve taken into consideration, and why I ultimately decided that AGGA is the best route for me.

I’ll also share the remaining concerns that I have about the treatment, and how I’m dealing with them (aside from sporadic mild panicking. Only slightly joking.).

 

What problems am I trying to solve?

If you read my post about my first palate expansion attempt, this will look familiar, but as a brief recap, these are the problems I’m trying to solve, roughly in order of priority:

  • Poor occlusion. My front incisors hit end-to-end, which indicates that my upper dental arch isn’t large enough to properly fit over my lower dental arch. Which leads to…
  • TMJ concerns. Because my incisors hit end-to-end, I have to pull my lower jaw backwards in order to chew. This isn’t healthy for the jaw joints, and I want to avoid developing TMD, which I have a family history of. I already get occasional jaw soreness and clicking.
  • Lack of tongue space. I don’t have enough room on the roof of my mouth to maintain proper tongue posture, which is bad for many reasons.
  • Clenching/grinding at night. This is likely caused by my poor bite and lack of tongue space.
  • Poor occlusion (take #2!). Only my right molars touch, so I can only chew on the right side, which creates a vicious cycle of asymmetries and imbalances. (Note: this was fixed briefly with “normal” orthodontics, but relapsed in the first year post-braces.)
  • Bonus! Smooshed profile. My maxilla is pretty underdeveloped from having extraction/retraction orthodontics as a kid, so my bone structure has some room for improvement. Aesthetics are lower on the priority list than all the functional stuff, but who wouldn’t love to be better looking, amirite??

Why did I decide that AGGA is the best fit for me?

After my last failed attempt, I was afraid of pursuing any more expansion, lest I push all my teeth out of the bone and be in dentures at 25. But then I discovered Ronald Ead’s website, and was heartened to see that even though he had similar issues with his acrylic expander, he had good success with AGGA.

After much more investigating, I decided that AGGA would be a good fit for me for three main reasons:

  • I mainly need forward expansion, and AGGA does forward growth better than any appliance out there (that I’m aware of). I could probably use more lateral space too, but my upper palate isn’t really that narrow – it’s just very short. Even if I only got forward expansion, that would mostly solve my occlusion problems (and therefore TMJ problems), tongue space problems (and therefore clenching/grinding problems), and help immensely with my profile.
  • AGGA (purportedly) works by stimulating the nasopalatine nerve, not by pushing teeth. Since thin bone was the reason I stopped my last expansion endeavor, finding a treatment that wouldn’t exacerbate that problem was of paramount importance.
  • My mandible is in good shape. I’ve read stories from some AGGA patients where their mandible hasn’t been able to keep up with the forward expansion of their maxilla because they had an underdeveloped jaw. This is definitely not the case for me. My mandible developed fine, and I don’t have much vertical growth. My jaw wants to be forward. The only thing holding it back is my retracted upper teeth, which AGGA will fix.

What about mewing? Why don’t you stick with safe, gentle orthotropics techniques instead of risking another expansion attempt?

I’m a huge fan of mewing, and think that everyone should be working to develop good myofunctional habits regardless of what other treatments they might be trying.

In my case, I decided that I needed a more drastic solution, for a couple reasons:

  • My upper palate is too short to practice proper tongue posture. If I have the posterior third of my tongue where it should be, the front of my tongue sticks out between my teeth, which is not a posture I can maintain.
  • I need a lot of forward expansion. I’m missing my two upper bicuspids, so ideally, I need enough expansion to where I could replace both of those teeth if I wanted to.
  • Progress with mewing is slow. Maybe with intensive focus, I could eventually fix my problems with mewing. Maybe not. There’s no way to know. But taking that gamble would mean continuing wear and tear on my joints and teeth from poor occlusion and clenching/grinding. If there’s a chance I can fix those problems in less than two years, vs. an indefinite number of years, I want to take it.

How can you trust this treatment when there are no published studies? What if it’s utter quackery?

It could be. I’m not gonna lie. None of this is officially, scientifically proven or endorsed by the American Association of Orthodontists.

But consider this: even treatments that are “officially, scientifically proven” or are officially endorsed can go terribly wrong. Case in point: all the problems created by “proven” and AAO-endorsed treatments like extraction/retraction orthodontics.

That’s not to say I’m willing to blindly subject myself to any fringe treatment that comes my way, but I do feel that AGGA deserves some credit.

Personally, I find it reassuring that the AGGA/CAB system is endorsed and taught by LVI Global. Say what you want about LVI, but spend any time on their TMD Facebook support group, and you’ll see how invested LVI founder Bill Dickerson is in their methods, and how much he cares about helping patients.

LVI might be seen as a fringe/quack organization by mainstream practitioners, but I don’t imagine they’d continue to teach and promote a treatment that didn’t work, or was harming patients. They’d have a lot of angry dentists and patients on their hands.

 

But you still have some lingering concerns?

I do still have some lingering concerns, dear reader. How astute of you.

I’ve discussed these with my dentist, and we both feel like my odds of a successful treatment are good, but he and I both agree that my concerns are valid.

Our primary concern is the risk of buccal bone loss, which in extreme cases could lead to tooth loss. Supposedly AGGA creates forward expansion by stimulating the nasopalatine nerve, which creates new bone. Cool.

But lateral expansion (on both top and bottom) is achieved solely through the FRLAs during CAB. These are tooth-borne, and I’ve seen no indication that they do anything other than move teeth through bone.

And while forward expansion is supposed to happen thanks to nerve stimulation, there’s still pressure on those front teeth.

It would be silly to claim otherwise – some patients experience tipping of the front teeth and the upper molars, the teeth get sore after an activation, and I personally feel far more pressure on my front teeth than on the acrylic pad on my palate.

My dentist said that he’s not yet had a patient lose a tooth from AGGA and CAB. He does have one patient who might need bone grafts on his front canines after completing CAB, but they’re waiting to see if it heals on its own.

So most likely I’ll be fine. Absolute worst case scenario is that I lose a tooth, and that’s what implants are for, right? (internally screams)

 

Conclusion

Long story short, the potential benefits outweigh the potential risks for me, and I feel that I personally am a good candidate for AGGA based on the specific problems I’m trying to solve. And there’s no perfect solution, so at a certain point, ya just gotta pick something and go for it.

If you’re considering AGGA, I hope that my thoughts here give you some extra data points to base your own decision off of, but please don’t decide to do it just because I’m doing it! Just because AGGA is a good fit for me doesn’t mean it will be for you.

If you have any questions or comments, drop ’em below!

Related

Functional Orthodontics & Orthotropics AGGA, mewing, orthodontics, orthotropics, palate expansion

Reader Interactions

Comments

  1. Sweet Mochi says

    December 13, 2019 at 3:31 pm

    Hi, Alyssa! Because of you’re blog posts, I’m thinking of trying AGGA myself. Do you mind sharing how much the treatment cost for you? I have a choice between regular braces & AGGA, and I’m trying to get some more info on pricing (some providers seem to charge upwards of 10k, which seems high to me). Any insight you have on that, or anything else about the treatment would be helpful! 🙂

    Reply
    • Alyssa Luck says

      February 2, 2020 at 9:31 pm

      Hi Mochi! My treatment cost $15k (I know, ouch). I agree that it seems high, but when there are so few people offering this treatment, there just isn’t enough competition to bring it down! On this page, I list out a few other practitioners’ costs that I found last April: http://truthbutter.com/agga/#agga-cost

      Reply
  2. naga swetha b bhuma koppula says

    December 29, 2019 at 3:47 pm

    May I know who your Dentist if is it from FBI or lVI ?

    Reply
    • Alyssa Luck says

      February 2, 2020 at 9:25 pm

      Hi! Yes, Dr. Suh is an LVI dentist!

      Reply
  3. Jeff says

    January 3, 2020 at 6:34 am

    Hi! Will u be making a update soon?

    Reply
    • Alyssa Luck says

      February 2, 2020 at 9:24 pm

      Hey Jeff! I really need to!! I’ll try to find the time soon.

      Reply
  4. Visitor says

    September 2, 2020 at 2:53 pm

    I caution you against AGGA/CAB. Have you seen any COMPLETED cases? All I see are photos of the end of AGGA, where there is a giant gap at the molars. I have not been able to find ONE fully complete AGGA/CAB. I do not believe it is possible to drag the molars forward to resolve the gap created – it’s just not mechanically possible. Get the jaw surgery instead.

    Reply
    • Alyssa Luck says

      September 28, 2020 at 2:48 pm

      Thanks for your comment! You actually raise a good point – I believe most of the cases I’ve seen are still in process as well. That said, my plan is to only drag one premolar on each side forward, then fill the gaps with implants, so my molars won’t need to be brought forward much or at all. Given how far I already am (premolars are already a few mm forward), abandoning now for jaw surgery would be a bit silly, not to mention the significant risks of surgery.

      Reply
  5. Franzi says

    January 15, 2021 at 9:26 pm

    I am starting AGGA in about 4 months and am pre-empting potential issues with teeth moving through the bone by getting bone grafts ahead of time. My lateral width is great, but I do have a crossbite which will need bone as well in order to be treated (regardless of AGGA). Surgery for the bone grafts is next Friday, and after 4 months of healing I start AGGA. I only need 4mm of anterior growth which seems minimal compared to what others have needed, but after reading about Ronnie’s experience and other failed cases I have to say I’m pretty nervous.

    Reply
    • Alyssa Luck says

      January 16, 2021 at 8:13 pm

      Hi Franzi,

      Wow – thanks for sharing! To be honest, I’m surprised to read that you/your doctors feel bone grafts are necessary even for 4mm, but I suppose if you’re doing it anyway to fix your crossbite, it makes sense to play it as safe as possible. I got about 10mm of growth with AGGA and am several months into CAB now with no tooth looseness or other concerns, but I realize others haven’t been so lucky. I very much hope that between the bone grafts and the relatively small amount of growth you need, you’ll be absolutely fine. If you think of it, please keep us posted! Would love to hear how you progress.

      Reply

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Hi! I’m Alyssa. This website is where I house all of my musings and investigations and pet research projects – topics ranging from autoimmune disease to nutrition to adult palate expansion to psychology and nervous system therapy. I hope you enjoy this awkwardly cropped poor resolution photo of me playing mini golf. If you want to know more about me, click here!

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alyssa.luck

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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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