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)
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!
Sweet Mochi says
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! 🙂
Alyssa Luck says
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
naga swetha b bhuma koppula says
May I know who your Dentist if is it from FBI or lVI ?
Alyssa Luck says
Hi! Yes, Dr. Suh is an LVI dentist!
Hi! Will u be making a update soon?
Alyssa Luck says
Hey Jeff! I really need to!! I’ll try to find the time soon.
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.
Alyssa Luck says
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.
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.
Alyssa Luck says
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.