I have officially begun the adult maxilla protraction treatment a week ago.
It is an experimental treatment requiring a small surgical procedure that took 2 weeks to heal up before I could begin.
I’ve taken good before pictures and I also have CT scans of my skull. Surreal looking at your whole skull in 3D imaging…I want to see actual bone changes, pictures can be very deceiving.
What I’ve done for the past 3 years is adult palate expansion and reversing extraction orthodontics, and what is now being called “Mewing” which is short for adopting the tropic premise of “teeth together, lips together & tongue on the roof of your mouth”
When I see pictures of myself from 3 years back I have definitely changed my facial shape for the better as Mike Mew has confirmed because we talk on skype video chat from time to time.
Yet last time we spoke like 2 months ago, he noted I am still leaving my lips slightly apart few mm between syllables or when I’m thinking.
Just goes to show it is not easy changing posture, it is almost as if you need to put in consistent effort for a long time till the muscles change (shape & size).
Mew has made me a stage 3 biobloc of new design which I am going to go pick up on Wednesday. (please do not hit him up for this if you are not under care with orthotropic doctor)
Why biobloc stage 3? Why it is superior to sleep apnea mouth pieces?
According to Mike, wearing the biobloc stage 3 is infinitely better to use as a retainer than those clear ones which was what I was using. I really didn’t like how those clear retainers kept your jaw slightly open because that acrylic can be bit thick especially when you wear the top and bottom.
What biobloc stage 3 does is to force the wearer to keep their lower jaw shut because of the flanges that extend down into the lower jaw. Mike says wearing it will cause my whole jaws to drive upwards overtime from the effect of my masseter muscle holding that jaw shut long term.
Only time will tell if stage 3 biobloc will cause further changes even though I have been chewing gum and strengthening my jaws on my own. I have noticed that even with stronger jaw muslces, at times my jaws are held apart even though the lips are sealed. So at night while sleeping, I doubt they are staying completely closed 100% of the time. 2 months ago I even woke up from a itchy throat and got sick from it for a few days, and I am willing to bet was caused by my mouth falling open at night.
What I have started doing after that night, was to tape my lips shut with paper tape and it seems to really help. I used to do this before but I stopped. I feel it’s a very underrated practice that should be incorporated by everyone if you don’t have stage 3. I also feel it seems to encourage one to keep that jaw closed, not just the tape forcing the lips shut. I thought my face looked better in the mornings after I started doing it.
Some people with sleep apnea wear mouth pieces that encourage you to jut the lower jaw forwards. But the difference is, every time you push on something there is always equal force pushing back. By pushing the lower jaw forwards, the muscles will pull the upper jaw back. My orthodontist’s dentist friend has been wearing this mouth piece for few years now because he has sleep apnea and can’t do the CPAP machine, but what has happened after few years wear is that his entire upper teeth & jaw has retracted back and now has an edge to edge bite, near class 3 occlusion.
And because lower jaw is connected to upper jaw, essentially it has pulled everything back, worsening the underlying condition.
Biobloc is different because it forces the wearer to use the masseter muscle to hold the jaw closed (NOT push it forward), it seems similar but the long term consequence is vastly different.
Here is a girl that used biobloc stage 3.
after 3 years wear of stage 3 biobloc, caused her entire midface and jaw to drive upwards.
This is Mike Mew’s Diagnosis and Case Report
No relevant medical history
Hypomineralisation of Upper 65+56, otherwise no relevant dental history.
Age, 12yeas 5 months female
2 elder sisters and one brother all treated with conventional orthodontics, with fixed appliances some with extractions and wearing permanent retention. Parents were dissatisfied with the results and wanted to find something different.
Good family support, mother not working, three elder siblings grown up and left home. Mum and daughter committed to treatment. Sophie is very conscious of her appearance and is very motivated to do anything that may improve this.
Indications and measurements
Body posture, good, can slouch when relaxed
Head posture, forward much of the time, finds it slightly difficult to move head back to fully upright position.
Head shape, slightly brachyfacial,
Facial Planes, ears eyes, occlusal, mandbibular planes, all level
Indicator lines, i 38.5mm, ¯i 42.5mm (ideal at age 32mm and 30mm)
Maxillary position, moderate lack of support under the eyes with a flat area under the lower eye lid that is a little darker where venous pooling could occur demarcated by a slight line running down from close by the inner canthus of the eye, at about 45° running inferiorly and laterally. The alar of nose wide with good nasal openings, nose looks slightly large, especially at bridge, giving high angle of cheek line.
Mandible position, relatively horizontal (tipped slightly downward which in part may be due to head orientation), overall length to chin point good in relation to face in general, deep mentolabial fold with some activity in the mentalis to maintain lip seal.
Perioral and buccinators– lip shape, relative lip size, lips to aesthetic line.
Dental; Molar class I, canine class II ½ unit, incisal class II div 1. Centre lines coincident. Slight retroclination of lower incisors. Summary; mild class II div 1 with some upper anterior spacing. OJ- 8.2mm, OB- 4.0mm and inter-molar width- 36.3mm (wide for modern standards).
Postural; lip opening at 7mm rest, with lower lip dropped at rest and using mentalis to close.
Functional; inter-syllable rest position 7mm, mild enlargement of buccinators, some perioral activity on swallowing with lip catch. Tongue crossing lingual surfaces of the lower molars on talking. Masseter on palpation, good level 2.
Considering Sophie’s age, sex and physical development, she is a little old for treatment.
Personal motivation very high and good family support that is well informed of alternative therapies.
Maxilla down and back, mandible good relative position to maxilla. i increased 6.5mm ¯i increase 12.5mm (upper reduced less due to large overjet and lower more due to retroclination of lower incisors), about 8mm average- which is rmoderate. Good muscle tone (noted from brachyfacial face shape, molar width and masseter on palpation). Mandibular position relatively well related to maxilla.
Mild dental malocclusion. Large overjet overstates the actual malocclusion.
Tongue between tooth swallow with lips apart 7mm much of the time using mentalis to maintain closure.
Additional method of investigation
Radiographs- deemed unnecessary,
Moderate craniofacial dystrophy with large overjet but mild malocclusion. Lips 7mm apart at rest with good muscle tone and tongue between tooth function. A little old with good motivation and family support.
Not a perfect case but a good one to try.
Standard orthotropics with no additional features, except possible elastics for anterior segment. 6 months preparation, expanding to 42mm or more. 18 months full time training then active retention until 16-18 yoa, with oral myology training.
Limitation of Treatment
Age- over the age of 9 it is unlikely that there will be much change in the area of the maxilla supporting the eye (unless two cycles of treatment occurs or excellent motivation). Also there is no possibility to extract the deciduous dentition, which has already been lost.
Risks in Orthotropics treatment
Failure to fully modify her posture and function.
Lower labial recession. Problems associated with stopping treatment midway (residual upper expansion, lip catch and scissor bite).
Damage to upper incisors during to their prominent position during the first stage of treatment.
Generally orthotropics is very fail safe and even if the treatment is not completely effective or finished early the effect is positive.
6 months, 7mm or more upper expansion, open 6-8mm anterior open bite. Procline lower incisors and upper to less extent (as already proclinced).
Increase muscle tone with exercises.
20hr a day wear of the training brace with spring components to move the teeth into position. Frequent active adjustments of the anterior and posterior locks and lower expansion using the hard locks to match the upper expansion in the lower arch.
Observing the reduction in overjet and overbite till normal incisor relationship is gained.
Approximately 18m wear, possibly more as she is a little old.
Active retention phase
Once normal incisal relationship is achieved (and held for 1-2months) decrease the wear from 20hrs to 1/3 of time (all time but school) for 2 month, then night plus 2hrs for 2 months, then night plus 1hr for 2months (the hours should be before they goto bed to gain some conscious time before the night which is unconscious time.
NB when ever additions to anterior locks are made the brace should not be worn that night, with the time made up with day wear, both that day and the day after especially before bed time.
Once you are sure that everything is settled go to night only wear.
Treatment progression and difficulties
18,06,09 Fit stage 1 upper and lower, instructions given
20,08,09 Rezeroed 41.5mm 6+6 width
03,09,09 Imps for stage 3
OJ 4.6mm, OB -3.6mm, i 37mm (1.5mm less), ¯i 41mm (1.5mm less), 6+6 42.4mm.
This phase was far shorter than expected, with 6.1mm expansion in 47 days, which is 0.9mm per week (close to desired expansion). In reflection it may have been better to gain more expansion initially to maximise the treatment effect especially the eye support or cheek bone area.
17,09,09 Fit stage 3
22,10,09 Start wearing a night (sooner than usual as patient older)
10,12,09 Ulcer on right Al, letter to dentist who is worried about lower incisal gingival level. In discussion frenectomy was made of the lower labial frenum which was contributing to the situation.
18,02,10 start using tape on lips at night
13,05,10 start using elastics from hooks across anterior teeth
16,06,11 Reduce wear to 2/3, Oral myology
Time 19 months, small residual OJ and OB, associated with mentalis action and tongue between tooth function with tongue moving to lower lip
L numbers over this period were L-0;1 L-1;4 L-2;11 L-3;2 L-more;2
Active retention phase
15,09,11 Reduced wear to 2/3 time with oral myology
15,12,11 Fit new stage 3,
Time 27 months so far, patients now 16 years 8 months, will review commitment at 17th birthday.
L numbers over this period were L-0;0 L-1;3 L-2;10 L-3;0 L-more;0, NB the last 2 have been L-1
Final result satisfaction
There is a small diastema between the upper incisors, which has been discussed with the patient and mother. Explained tha the final position of the teeth are dependant on the rest position of the lips and tongue, it would be possible for us to move the teeth into perfect alignment closing this gap but it would then need to be held permanently. She still continues to leave her lower lip open some 3-4mm at rest closing using the mentalis muscle, leaving the lower lip looking larger than the upper (although this is actually relative and if you notice the lips is actually just everted, being curled over with more vermilion border showing). Also notice that she is able to maintain a lip seal without mentalis effort- this is a major change that will have long-term implications.
Generally there is a very nice facial change, with a reduction in the anterior facial height, a very nice improvement of the maxillary eye support (which is not usually expected at this age). We were not using timers when we treated her and I suspect that her wear was far from perfect, however the treatment times were roughly kept to and the treatment went well. It would be nice to maintain her in active retention until she is 18 and finished school, at which point we will still want to follower her as we are a teaching centre.
You can see that the mentalis muscle is no longer active in the after picture. This is from age 12 to 16, 6 months of expansion to 42 mm or more, then 18 months of training phase (long time wear of stage 3 biobloc)
To the untrained eye, you may say she just grew up but there is change in bone shape taking place. While some kids during these years may get worse looking, she has improved. What’s important is she is really happy with the results and loves to continue to wear her stage 3 every night.
You can begin to see what Mike means when he says that the whole jaw will drive upwards.
Maxilla Protraction in Adults?
There’s a guy at facepulling.com that is coming up with his own way of attempting to protract the maxilla, will be interested to see how he does but it is not the same as what I’m doing. Anyway he posted a pretty interesting study that shows that displacing adult maxilla is most definitely possible.
Significant forward displacement was seen after 3 months of 24 hour wear, 500 G force.
The force was applied on more at the teeth level and it still worked with 24 hour wear.
24 hour wear is not feasible for humans but with better application of force it could compensate, which could be why it is working for Neymar. Time will tell for me, because I’ve tried the crane & pull forces on my oral appliance already and didn’t see enough changes taking place to continue.
Right now I am protracting and I feel the forces on my entire mid face and at times in the zygos and even behind the zygos, and from time to time some pull feeling from inside the skull which rather feels good.
The reason why we may need some kind of extra oral device to pull the maxilla forward might be that as adults we no longer have the momentum of growth on our side.
Same reason why orthotropics only works well on growing children at around age 8, by training these kids to keep their mouth shut, you change the direction of the jaw growth. As the kid’s face develops now with jaws shut, the maxilla is able to grow forwards. And its when the maxilla displaces forward in the face, the dramatic change in facial aesthetics is seen.
You begin to understand how silly orthodontists are trying to move teeth around, they are in complete ignorance to the much more profound effect of the maxilla on patient’s life. When you understand that teeth sit in the balance of the soft tissue and maxilla is really what needs to be treated, it could make orthodontists obsolete in the near future.
The reason why I am a good test for this new technique is that I am someone that has done everything else from palate expansion, face pulling with hockey helmet and 1.5 years of “mewing”. For me focusing on the posterior tongue is what made the most difference during that time, but now can these changes be enhanced or sped up by anyway?
As adults that already grew down, you may need extra towing to get that big bone to come forwards again.
Mike’s comment regarding the 12 year old girl was, “Age- over the age of 9 it is unlikely that there will be much change in the area of the maxilla supporting the eye (unless two cycles of treatment occurs or excellent motivation).”
I can see how this can be true, even with lots of palate expansion the area below the eyes did not change much for me. However there is still a lot of sutures in those areas which tells me it all has the potential for change.
But just like the lateral forces caused my palate to widen, surely if we can get direct forward forces as close to that area as possible, the surrounding sutures will have to displace & change over time.
I am hopeful yet conservative with my observations at this stage, because I’ve seen / experienced other treatments not live up to its hype.
I know the mind can play a huge placebo effect whenever you are dealing with these sorts of things because you being looking for it. I’m here to check for more definitive results, not blow sunshine up your arse.