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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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Primary Sidebar

 

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
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
I first stumbled upon polyvagal theory during the I first stumbled upon polyvagal theory during the course of my heart rate variability research. I was surprised to encounter it again "in the wild" shortly after, in the book "Accessing the Healing Power of the Vagus Nerve." Before long, I saw it popping up everywhere, (Baader-Meinhof, anyone?) 
 
Digging deeper, I discovered scientific controversy bubbling just beneath the smooth surface of polyvagal theory's popular presentation. Three months later, I posted a 13k word analysis of the topic. 
 
The technical details are far below the level of practicality for the average person, but the way polyvagal theory has propagated outside of academia has some important ramifications for clinical and scientific progress. 
 
In the wake of a wave of health complaints that our current medical model is poorly equipped to treat, it's clearer than ever that a new paradigm is needed. The grassroots push to emphasize diet and lifestyle factors has been a huge step in the right direction, but it's becoming more and more common to see people who have done everything "right" and are still struggling with persistent health complaints that could range anywhere from mildly annoying to debilitating. 
 
What we need is a genuine integration of mind and body in medicine – not the weak lip service that our current paradigm pays to "stress reduction," like the vague suggestion to relax more and maybe try meditation. And if we're going to develop a sophisticated mind-body medicine, we need a sophisticated mind-body science. And if we want a sophisticated mind-body science, we must subject such topics to the same standards of inquiry as we expect from molecular biomedicine. And that means rejecting pseudoscience like polyvagal theory. 
 
Full analysis and references at alyssaluck.com/polyvagal-theory-a-critical-appraisal
To continue my recounting of the health things I'm To continue my recounting of the health things I'm experimenting with, let me tell you about DNRS: the slightly cheesy, arguably outdated “brain rewiring” program that has changed my life. 

I found it because I was looking for ways to “retrain” my nervous system. I watched some success stories. None of the “target” health conditions matched mine, but I went for it anyway. Probably the best decision I’ve ever made for my health. 

The core of DNRS is built on the principles of neuroplasticity. They call it "brain rewiring" because you intentionally take triggers that would normally stimulate a negative response in your body or mind, and associate them repeatedly with neural signals of safety. If that sounds pseudosciencey, I hear ya – one of my goals with future posts is to bring some concreteness and specificity to the topic. I imagine there are lots of people who could benefit from this type of thing who are turned off by the overly abstract or touchy-feely language. 

There are tons of "brain rewiring" programs like DNRS, but they're all built on similar ideas. Most bring in elements of other popular approaches, ranging from the scientifically validated (cognitive behavioral therapy, mindfulness, acceptance and commitment therapy) to the type of new-agey stuff I always scoffed at (shadow work, inner child work, parts work). 

For me, DNRS has provided the perfect framework to finally achieve what meditation experts and therapists and mystics alike are always advocating – the ability to step into the role of “curious observer.” It's given me everything therapy and meditation promised but could never deliver, helping me recognize my own patterns of thought and behavior and consciously redirect unhelpful ones. If this sounds vague, that's because there isn't a single area of my life that hasn't been improved by using this framework. 

I spend far more time in states of joy and peace and gratitude, and less time in states of anxiety or depression or frenzy. Many chronic worries that used to occupy my mind or keep me up at night – whether related to health, relationships, or my future – have disappeared, and the others are on their way out. (Cont. in comments)
Isn’t it crazy how something can be so easy and Isn’t it crazy how something can be so easy and natural for one person, but so hard for another? 

Me doing food: I can totally cook everything I eat from scratch, no prob

Me doing mental health: just doing my hour of daily mindful cognitive gratitudinal journalization

Me doing physical therapy: I can’t do it I don’t have that muscle

I’ve done many hard things in the name of health, but I think they’ve all been the types of hard things that come naturally to me. And frankly, that hasn’t gotten me where I want to be. 

So I’ve decided to finally tackle something that feels very unnatural: developing a real relationship with my muscles and bones, and learning - through experience, not from a book - how they coordinate with each other and how to use them. 

I never really considered my musculoskeletal system a key player in autoimmune or digestive woes, but now I realize it’s naïve to think dysfunction in one part of the body doesn’t affect another. And since this is so obviously my weakest link, it’s high time to make it a priority!

Even though I’ve done strength training in the past, I never dedicated the time and focus to figure out what my body actually needed to function better, and workouts often felt awkward or led to injury. 

I’ve always dreaded PT-type exercises because they felt simultaneously like “not enough” and also SO HARD, especially when there’s no way to confirm whether I’m doing them “right” (my nightmare). 

But I’m pretty sure the fact that targeted “mind-muscle” work is so hard for me means it’s what I need the most. (That’s how that works, right?)

Anyway, I’m happy to report that I’m finally through both the initial phase of being a giant baby because I have to do something I’m bad at, AND the second phase of neurotically worrying about doing it “wrong.” And hopefully I’m on my way to better posture, improved breathing, and greater strength! 

Super thankful to have people in my life who remind me to have fun and stay curious, when my natural disposition is to write a 27-step plan to “fixing” everything “wrong” with me. And to remind me that it is, in fact, a JOY to be a novice at something (as @_john_the_savage_ would say).
"If your nervous system is balanced, your heart is "If your nervous system is balanced, your heart is constantly being told to beat slower by your parasympathetic system, and beat faster by your sympathetic system. This causes a fluctuation in your heart rate: HRV." (whoop.com) 
 
This statement is a formidable example of one of the biggest misconceptions about heart rate variability (HRV). 
 
HRV is highest during rest or sleep, when sympathetic input is lowest. If HRV was the result of an autonomic “tug-of-war,” why would it be greatest when one of the contenders has entirely dropped the rope? 
 
Part of the misunderstanding may stem from failure to recognize that the heart has an intrinsic rate, well above the resting heart rate maintained by the vagus nerve. Varying vagal impulses create HRV without any sympathetic input at all. 
 
There are many other common misconceptions, such as the notion that HRV metrics measure autonomic tone, or that HRV itself is a metric with one interpretation. 
 
Such misconceptions aren’t only found in layscience – they also pervade academic and clinical literature. For instance, you’ll see LF used as a measurement of “sympathetic tone” and LF/HF as a measurement of “sympathovagal balance,” even though it’s been clear for decades that those interpretations are not physiologically accurate.
 
This post (and the associated article at alyssaluck.com/hrv101) can be thought of as “foundations for understanding HRV research.” And it provides a good example not only of the insufficiency of “sound-byte” science, but also of real science in action. 
 
The unfortunate reality is that we can’t always take researchers’ conclusions at face value. Few have the time to adequately assess a field before adopting one of their metrics, and once a misinterpretation has taken root it can easily become an accepted fact that propagates through repetition, becoming more entrenched with each published paper.
 
Thankfully the ramifications in this case are not very serious - misdirection of experimental design and analysis, and many false statements, but no dire consequences. Nevertheless, it’s a good reminder that science is a human institution, and it never hurts to question oft-repeated “facts.”
My latest diet experiment: the bean protocol! This My latest diet experiment: the bean protocol! This was one of the changes I made immediately prior to my drastic increase in HRV. 

Brief background: the bean protocol entails eating lots of soluble fiber (particularly beans) as a way to support detox. It rests on the assumption that most chronic health issues are the result of fat-soluble environmental toxins, excess hormones, and other fat-soluble things being recirculated in the body rather than eliminated. 

There is some scientific merit to this: the liver does eliminate many toxins and other compounds through the bile, these things can be subject to reabsorption via enterohepatic recirculation, and certain types of fibers do interrupt this process by binding bile, preventing reabsorption and allowing excretion in the feces.

That said, there are many unanswered questions that would need to be answered for me to be on board with that as the sole or even primary explanation for the anecdotal success of those on the protocol. I think there are almost certainly other mechanisms at play, and I doubt things work exactly as proponents of the protocol describe. 

But at the end of the day, what matters is not mechanisms, but practical outcome. And whatever the reason, it works for many! It seems especially popular and effective for hormonal issues and acne, but the preeminent bean spokesperson @uniquehammond cured her severe Crohn’s with it. 

For me, I experienced better digestion and clearer skin, among other benefits (like not having to wear deodorant). On the less-good side, I lost weight I didn't need to lose, had cold hands and feet, and developed some dry patches on my skin. 

(The dry patches [and perhaps weight loss] were probably because I kept fat too low – mostly because their favored fat source, nuts, is a no-go for me.)

I'm continuing to experiment, hoping to find a balance that lets me reclaim the benefits (which I lost after returning to my normal eating pattern) while avoiding the pitfalls. I’ll share any exciting developments, and will eventually dig into the science behind it too. 

For info about what the protocol entails, you can visit alyssaluck.com/the-bean-protocol-for-ibd!
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