Following on from the mid-treatment CBCT scan showing that my Vivos mRNA appliance was tipping my teeth, I’ve decided to stop using it altogether after a sleep study showed that 20.5 months use has had no effect on my severe obstructive sleep apnea. I had the sleep study in June specifically to see what permanent impact the appliance has had on my airway during sleep. The polysomnograph was conducted untreated with neither Vivos mRNA Appliance nor CPAP in use so I could compare against my previous untreated sleep study.
The results were disappointing, to say the least.
Here is a summary table comparing the results of the sleep studies before treatment on 27th June 2019 and afterwards on 15th June 2022:
| Measure | Meaning | Before | After |
| RDI | Resporatory Disturbance Index | 39.3 | 40.3 |
| AHI | Apnea Hypopnea Index | 39.3 | 34.8 |
| AI | Apnea Index | 0.3 | 3.5 |
| HI | Hypopnea Index | 39.3 | 31.2 |
| RERA | Respiratory Event Related Arousals | 0 | 5.5 |
| CA | Central Apneas | 0 | 0 |
| Min SaO2 | Minimum Oxygen Saturation | 93% | 93% |
The American Academy of Sleep Medicine’s Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults (2009) uses RDI for categorising severity of OSA, and mine went up slightly between studies. I doubt this is significant given the normal variability between nights and labs.
Ideally, I would have liked to have both before and after studies done in the same lab and scored against the same criteria, but the previous study was done at St Vincent’s Private Hospital who no longer run a sleep lab and I don’t know what software or criteria they used to score it. The latest study was conducted at The Woolcock Institute and scored according to the AASM Manual for the Scoring of Sleep and Associated Events, version 2.2. I don’t know why Australia’s leading sleep and respiratory research organisation isn’t using the latest scoring standard, which is version 2.6.
The American Academy of Sleep Medicine’s more recent Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea (2017) uses AHI to define severity. The small decrease in my AHI between studies is also probably due to inter-study variability, different scoring criteria, or possibly the myofunctional therapy and singing practice I’ve done between studies toning my throat muscles. Even if the Vivos mRNA Appliance did make a small difference, my AHI is still in the severe range, and I still need CPAP to breathe when I’m asleep.
Between studies I also had a septoplasty and turbinate reduction to improve my daytime breathing, but nasal surgery is unlikely to make any impact on obstructive sleep apnea caused by my tongue blocking my airway due to a retrognathic maxilla and mandible.
The relatively high minimum oxygen saturation on all my sleep studies suggests that my problem is not lack of oxygen but respiratory arousal leading to fragmented sleep. Hopefully that means I haven’t sustained significant brain damage during the 10+ years I was chronically ill while my obstructive sleep apnea was undiagnosed and untreated.
Most nights the AHI reported by my CPAP machine is below 5, and the vast majority of events are central, which appear to be induced by CPAP itself since I had no central events on any of my sleep studies. I suspect that the cause of my ongoing daytime fatigue is central events induced by CPAP, although it’s hard to say for sure. Fatigue could also be due to daytime breathing through a compromised airway, or perhaps something else entirely. The machine may also be incorrectly detecting central events. I haven’t had a sleep study with CPAP which may clarify this or dived deep into the data in OSCAR, because I’m more interested in getting rid of the machine entirely and taking it out of the equation.
Since receiving the sleep study results and discussing the failure of the Vivos mRNA Appliance to improve my airway with the sleep specialist Professor Brendon Yee at The Woolcock Institute and one of his retired oral maxillofacial surgeon colleagues, I’ve stopped wearing it.
My Vivos provider said he was disappointed with the sleep study results and it was unlikely a second Vivos mRNA Appliance was going to give me any improvement. I agreed given that the first appliance tipped my teeth and kept winding back during the night when I attempted to expand and advance it any further. He believes that I did get some skeletal expansion from the appliance, but I don’t see it on the CBCT scans, and it’s not reflected in the sleep study results which are more predictive of the daytime alertness and energy levels that really matters to me.
When I asked my provider for a refund of the A$9000 I paid for the appliance due to the lack of any improvement in my sleep apnea, he declined citing the amount of time and effort he had put into supporting my treatment. This seems to be the norm in the medical industry: you pay for a treatment, not for a result.
To say I’m disappointed in my Vivos experience would be an understatement.
I wasn’t sure if the Vivos mRNA Appliance could cure severe sleep apnea, but my provider said I looked like an ideal candidate and Dr Singh has published studies showing it to be effective in some severe cases. To get no improvement at all is extremely disappointing.
I wore the Vivos mRNA Appliance for a little over 16 hours per day prior to the CBCT scan showing that my teeth were tipping, and about 14 hours per day after that. My overall average was 15.1 hours per day. My average facemask use was 4.5 hours a day. Unfortunately, I never managed to sleep well with the facemask, but I doubt that was going to make much difference given that the time I wore it during the day didn’t seem to achieve anything.
Here’s my final usage graph:
My CPAP machine is really an APAP since it’s set to automatically adjust to the minimum pressure required to prevent apneas and hypopneas. If the Vivos mRNA Appliance was being effective, I would have expected the APAP pressure to be reducing over time as it had to work less hard to keep my airway open. This is why I tracked the pressure every month in my treatment updates. However, my pressure trend graph showed only a very slight increase over the time:
So what went wrong? As far as I can tell I did all the right things. I wore the device religiously. I did 750 sessions of myofunctional therapy. I chewed mastic gum. I cycled the appliance hourly during the day. I confirmed that I didn’t have a tongue tie. I expanded the screws at one turn per week as advised by my provider, until the appliance wound itself back each night. At first, I didn’t notice this, so my actual rate of expanding the appliance was about half what I thought. My early updates on this site measured expansion by tracking screw turns and ended up exaggerating my actual appliance expansion. Once I realised it was winding back, I got a taper gauge to measure the gap in the appliance. By then my provider said I had reached the limit of my biological capability and advised me to stop expanding the appliance, which was just as well given that it was actually tipping my teeth rather than growing new bone for them to expand into.
I’ve reported that the Vivos mRNA Appliance tipped my teeth as an adverse event with the Therapeutic Goods Administration’s Database of Adverse Event Notifications (DAEN) – medical devices using the Users Medical Device Incident Report. The Australian Register of Therapeutic Goods (ARTG) number for the Vivos mRNA Appliance is 389679 and my Device Incident Report (DIR) number is 81170. It should be accessible in the DAEN – medical devices search using these two numbers after 13th November 2022, but in the meantime you can read my summary of the TGA’s response here.
While my provider may be content that the appliance failed for me due to my individual biology, regulators look for safety and effectiveness when approving medical devices, and this requires results to be repeatable between patients. The Vivos mRNA Appliance appears to work for some people but not for others, and it’s not clear to me what criteria can be used to predict who it will or won’t work for. I had two Vivos Airway Intelligence Reports done and neither of them suggested that the appliance wouldn’t work for me; otherwise I wouldn’t have pursued treatment with it.
I have created a Facebook group to support people whose Vivos treatment has failed.
So where to from here? I don’t want to feel fatigued for the rest of my life. I don’t see much scope for tweaking CPAP and don’t want to use stimulant medication, so I’ve started consulting with orthognathic surgeons about maxillomandibular advancement (MMA) surgery. I doubt that soft tissue surgery alone is going to cure severe obstructive sleep apnea, and the first orthognathic surgeon I went to said that MMA should be done first since soft tissue procedures like uvulopalatopharyngoplasty (UPPP) can impair the ability to move jaws during orthognathic surgery due to tension of the remaining soft tissue.
The treatment plan from the first orthognathic surgeon I have consulted confirms the tipping of my teeth caused by the Vivos mRNA Appliance that now needs to be corrected. Fortunately, I can do this as part of the orthodontic treatment required to prepare for MMA surgery. Nevertheless, having to correct damage done by a failed appliance is annoying.
Frankly, the thought of having MMA scares the crap out of me, but if I’d started down that path instead of doing Vivos I’d probably be recovered by now. On the other hand, if MMA goes horribly wrong at least I’ll be able to say I excluded Vivos as a possibility by trying it. Obstructive sleep apnea is one nasty mother#&%er. Things that work for one person don’t seem to work for another and whatever you do to treat it there is a risk involved.
49 Comments
Ravi · February 1, 2024 at 9:47 PM
Do you have any measurements to say if vivos was at all successful in “expanding” (in any form) your jaw beyond just the amount from the tipping?
Graham Stoney · February 3, 2024 at 1:40 PM
I tried to convince myself that there was skeletal growth by comparing internolar width measurements on my before and after CBCT scans but in hindsight I was kidding myself.
Joe · November 30, 2023 at 9:22 AM
So glad I stumbled upon this while I was researching the efficacy of Homeoblock, you probably saved me considerable wasted time and money, thank you. The belief from my dental friends was that it may just tip the teeth and nothing more at my age; 52 and would have little positive effect on my Severe Apnea. My CPAP is not completely ineffective however I often awake with heart palps due that corresponds to my O2 saturation level below 90- I have a WellU Oximeter which tracks that number. So I am considering more drastic measures as well. All signs point to Mandibular Advancement Surgery.
Jason · October 9, 2023 at 5:08 AM
Your documentation is remarkable. It seems like you accounted for every technical variable in the equation with assumption that you had a mechanical issue requiring a mechanical fix. And since it failed, the device proves failure. But the thing that all doctors know (being one myself) is that when they decide on who should perform their spouse’s or child’s procedure, they pick the most talented surgeon, not the best technology. And that’s really what determines outcomes. I believe you choose a novice provider. Did they even have 10 cases taken to completion successfully? If not, how could they have possibly known how to deliver forces in the face with such an incredibly complex device that it simulates growth in not 1 but 3 directions simultaneously? The different between an amateur and an expert in medicine is that both know how to start treatments, but the latter actually knows how to screen patients and manage complexities as they arise. And everything in your case (numerous failed interventions) screamed complex. The same happened with the lawsuit with the agga appliance – tons of poor outcomes. But the lawsuit was thrown out because closer investigation revealed all cases were performed by non trained providers. It’s not the tech, its the provider that generates the results. Same reason why you know feel comfortable in the hands of those orthognathic surgeons.
Danielle Carr · October 7, 2023 at 11:01 AM
We’re tongue/lip ties addressed during your treatment, and did you undergo myofunctional therapy during treatment?
Graham Stoney · October 8, 2023 at 7:37 AM
Yes. I saw a myofunctional therapist, did the exercises daily for several months, and don’t have a tongue/lip tie.
Ted · July 5, 2023 at 2:06 AM
What is wrong with your teeth tipping? Surely that is a good sign?
Graham Stoney · July 5, 2023 at 7:42 AM
No it is not a good sign; it meant that the appliance wasn’t expanding my jaws at all and made no improvement to my sleep apnea. Plus it causes my teeth to bite into my cheeks, which is a problem I didn’t have before using the appliance.
Laurel · March 8, 2023 at 8:43 AM
Any chance I can join your FB group for failed Vivos? I am halfway through my DNA Vivos appliance and a mid-treatment CBCT shows tooth tipping. I am anxious about whether to continue or not so would really appreciate being able to talk to someone.
Graham Stoney · March 10, 2023 at 8:36 AM
I want to keep the group for people whose treatment has failed, but I’m happy to talk to you. The appliance is not supposed to tip teeth so something is wrong if that’s happening. I understand your anxiety and I wish I’d stopped treatment when I realised mine were tipping. Contact me if you’d like to chat.
Graham Stoney · March 17, 2023 at 1:49 PM
I want to keep the group for patients whose treatment has actually failed for the time being, but I’m happy to talk to you. The Vivos DNA Appliance should not be causing tooth tipping, so I’d suggest taking it up with your provider. After my experience with the appliance, I wish I had stopped when I saw the tipping and accepted that it wasn’t going to work for me.
Christina · March 3, 2023 at 8:44 AM
Hi Graham! Wow thank you so much for all of this amazing information. I’m so sorry that DNA didn’t work for you. I’m 34, female, in Canada and have had my life ruined by CFS and fibromyalgia since I was 21 and had to drop out of university. It’s only been the last few months that I finally figured out that it was all coming from my mouth! I don’t have OSA, but super narrow jaws due to extensive orthodontics as a 5 yr old to 12 yr old. 28mm molar width of maxilla. I’ve been a jaw orthotic made by a neuromuscular trained tmd dentist for 6 months, which has hugely helped with pain and I can actually chew and open my mouth now, but of course I still can’t sleep or breathe very well. I need expansion ASAP but he won’t stert it until my jaw muscles are stabilized with physio and exercise. Not OSA, but I must have UARS because of my narrow airway and hifh arched palate, plus probably a tongue tie. Just started myofunctional therapy. I can’t figure out which type of expansion to go for, dentist I talked to today thought Alf or DNA would work for me, but I’m afraid after hearing your and others experiences!
Graham Stoney · March 17, 2023 at 1:56 PM
Hi Christina. Sorry to hear you’ve had your life ruined by CFS and fibromyalgia. I hope addressing your breathing and sleep can resolve both. Given my experience with the DNA Appliance, I wouldn’t use a tooth-borne expander as an adult if I had a narrow maxilla. A surgical technique like SARME, DOME or EASE is more likely to work, or MARPE/MSE if you’re willing to risk asymmetry.
Denis quaid · February 5, 2023 at 7:40 AM
Hello Graham, I’d like to ask for your opinion if I may. I have had retrusive orthodontics done to me as an adult and since them many health issues occured. Im talking assymetry, TMJd, forward head, postural problems , difficulty breathing etc etc. Ok , so I’ve been on the mission of finding someone who could help me fix the issues and the only option I was able to find thus far is ortotropics, Biobloc. I know it’s rarely used on adults but the ortho is determined that they could do it. Essentially their plan would be to expand laterally thereby widening the arch which would create some spaces around the teeth and gaps would open up behind premolar. All this would be done at a slow rate with turns everyday of about 1/16mm per day. Following this, there would be next stage of myofunctional therapy and training the tongue with stage 3 Biobloc . According to orthodontist trained by john mew there would be much space for implants. But I am just not quite convinced that tooth borne device can do such wonders in such short time and open spaces unless it’s done at the expense of teeth flaring tipping. But then again I had never tried. I’ve seen pics in my orthos office of an adult who formed large gaps from using Biobloc in quite a short time. What are your thoughts on this, and Biobloc ortropics in particular? Looking forward to your reply. Thanks
Graham Stoney · February 6, 2023 at 8:19 AM
Hi Denis,
There’s not a lot of difference between the Biobloc and the Vivos mRNA. I was turning my appliance at 1/4mm per week, or about 0.0357mm per day vs your ortho’s plan of 0.0625mm per day, which is almost twice as fast. All my appliance did is tip my teeth, so I’d be skeptical about whether a biobloc can really help you as an adult. I’d be asking for case reports from previous patients he’s treated with the same complaints who have been successful, and talking to them in person for advice.
Good luck!
Graham
Denis · February 7, 2023 at 6:41 PM
Hello Graham, thank you for your reply, very helpful one more thing if I may: do you believe in the notion that the roots of the tipped teeth can somehow follow the teeth if the posture, the tongue function is developed? They say that at the power force of cheeks lips, the roots will follow and bring flared teeth at the vertical dimension. I think it’s quite a magical thing if that’s possible in adults. Do you believe tongue function has any role play in this at all whether you feel better. Did your DNA appliance give you much of lateral expansion at all? Im quite narrow at 30mm and supposedly Biobloc can do 40mm in just 10months or so thereby not only expanding but also forming gaps including those for premolar implants if needed..I just think this sounds tooooo good to be true. What do you think? Shame I can’t attach a few photos with this post.
Graham Stoney · February 8, 2023 at 9:37 AM
I think it’s possible in a growing child or adolescent for forces from the cheeks and lips to influence bone growth, but I’m skeptical that it will make any meaningful difference in an adult within any reasonable period of time. I don’t think my flared teeth shifted much until I started wearing my appliance again and winding it back. I did myofunctional therapy exercises but I didn’t perceive any benefit from them. No I didn’t get any lateral expansion from my DNA appliance. I don’t know how old you are but if you’re young, female and lucky and your interpalatine suture hasn’t fused you may get lateral expansion from a Biobloc but 10mm is a lot and I’d be skeptical.
Kelly · January 17, 2023 at 6:28 PM
My husband and I used DNA appliances from May 2018 – Jan 2020. I had a tooth missing and wanted braces before I had an implant placed. We read a lot about broad arches through interest in Weston Price. My husband found the DNA and suggested we try it. I get mixed up whether it was $6000 or $7000 per each of us, since two of our children were put into expansers (yes, rather than expander) prepping for the Biobloc at the other price per child. Different dentists for the two appliances. At the same time we had learned about the importance of breathing through the nose, rather than mouth. When I used the DNA for the first night I couldn’t close my mouth at all. Thick plastic covered my top and bottom molars. Each visit our dentist shaved more off of the plastic covering our molars. We were faithful about using the appliance, but my husband was more aggressive in turning the screw. By January 2020 I started pulling out my appliance in my sleep from pain. At this point in time, 2023, the tooth/crown that caused me pain has had the root canal it needed. The result of wearing the DNA was that I had two bites, both were so off that I couldn’t chew my food. After I stopped wearing the DNA I had Damon braces put on by a reputable orthodontist. Best decision ever. If I had a do over, I would have not used the DNA. I would not recommend DNA/Vivos to anyone.
My husband continued with the same dentist who experimented with Fast Braces on him and then Ortho Snap. My husband was overall happy with his DNA result, because he says it fixed his cross bite (even though we don’t think our dentist really knew what he was doing.) My husband says he thinks the DNA is all about the practitioner.
Victor · January 11, 2023 at 5:14 AM
I enjoyed your post.
I’m considering the homeoblock from dentist friend, and now need to do more research after your post.
Dr Mark Cruz a specialist in this field doesn’t recommend appliancesfor
Ali Patton · December 14, 2022 at 12:53 PM
Hi Graham,
I’m exploring Vivos and also ALF to address moderate sleep apnea. Appreciate very much the time you’ve put into your blog to help others. My question: Have you heard of ALF– do you know anything about it? It seems to be an alternative to Vivos, and Dr. Singh who invented Vivos supposedly got the idea from Dr. Nordstrom who invented ALF decades before. I keep meeting dentists (since I’m in California) who know Dr. Singh and know Dr. Nordstrom and everyone has an opinion. I’m going through the process everyone goes through while looking at options like Vivos and ALF—and getting so much conflicting and different information. Some dentists say one thing, some say others, and my kids’ orthodontist says it’s impossible to expand the pallet and grow bone in my fifties and Vivos/ALF are just moving teeth, not expanding pallet any other way. Anyway, any input on ALF (or more about Vivos) from you and others would be much appreciated. Thank you.
Graham Stoney · December 14, 2022 at 3:00 PM
It sure is confusing alright. ALF is a fixed appliance so you don’t have to put it in and out but I doubt it would be much more effective than Vivos for a 50 year old. My treatment with Vivos didn’t expand my jaws at all. It seems to work for some people but in hindsight I can’t see it working for people with retrognathia who need 10 mm of advancement which is only possible with maxillomandibular advancement surgery. Aside from that it doesn’t seem clear how to predict who adult palate expansion by tooth borne appliances will or won’t work for ahead of time. One maxillofacial surgeon I spoke to said the idea that you can grow bone in an adult is bullshit, and that was consistent with my Vivos experience.
Igor · October 30, 2022 at 6:13 AM
Graham
Thanks for creating this blog. It helps others considering going down this path.
Thanks
Harry · October 11, 2022 at 7:11 AM
As many others have mentioned, I would consider getting the EASE surgery before MMA. I got the EASE surgery with an MSE appliance for about 7-8 thousand euros, in Germany, so maybe you can avoid the costs of getting it with Kasey Li himself. I’m only a couple weeks post-op and have only done about 4 turns and I can already feel an improvement in nasal breathing. Hopefully this continues and there won’t be any complications.
Akraf · November 10, 2022 at 11:12 PM
Hi Harry,
Can you share the name of the surgeon and institution that provided your EASE procedure? The possibility of EASE in Europe could be a revelation for those of us who cannot access Dr Kasey Li in the States.
Akraf · November 10, 2022 at 11:15 PM
Ah, I think I found it?
https://www.medizinundaesthetik.de/en/procedures/ease.php
Jaynee · October 6, 2022 at 10:09 AM
I say for 30 days because it takes that long for your body to recover from the inflammation wheat and dairy causes (based on today’s farming practices) – and you can’t cheat for those 30 days – to see how your body responds to doing this. It will be profound. Same with removing all EMF at the very least while you sleep and at least 2 hours before going to bed. These three things cause massive inflammation – something that none of the doctors or experts you’ve explored are looking at. You can go back to these three things after your 30 day experiment, but I predict you won’t want to because you’ll feel like it would be a crazy thing to do if you get a great response from eliminating all three.
Graham Stoney · October 6, 2022 at 10:42 AM
Thank you for the suggestion. I have tried all these things over the years. None of them address retrognathia, so I didn’t find them successful at treating my obstructive sleep apnea.
Jaynee Brown · October 6, 2022 at 10:03 AM
Graham, this may sound ridiculous, but you can try these three things and they are all free, non-invasive, and have profound effects: 1) For a minimum of 30 days stop eating all dairy. All of it of every type. Don’t try to substitute, just stop eating anything that comes out of the rudder of a cow. 2) Stop eating all wheat and other grains that contain gluten again for 30 days. Same as dairy, don’t try to substitute it, just stop eating it completely including sauces and a host of foods that use wheat as a thickener. You have to get good at reading ingredient labels. 3) Turn off all WIFI routers, Bluetooths, cell phones, computers and laptops, TVs, and any device that emits any signal whatsoever. Turn phones and computers to airplane mode and then turn them OFF and get them OUT of your sleeping space as far away as possible. EMF signals disrupt brainwave activity and damage cells at the DNA level. They disrupt other bodily functions. If you live close to a cell tower or antennas try going camping for a couple of nights away from all EMF exposure while you are not eating wheat and dairy. When I did these three things I FINALLY started sleeping through the night, dreaming regularly, feeling rested upon wakening, and my brain fog went away. I got my life back.
Luc · September 8, 2022 at 12:29 AM
Hello Mr. Stoney. It sucks that the DNA appliance did not work out for you. I’m 25 and have sleep apnea and looking to try out the DNA appliance. Or maybe I will see Mike Mew and see if he can help me but my maxilla is a little bit asymmetrical so maybe I will have to do an ALF appliance to straighten it out first. What do you think is the reason the DNA appliance did not work out for you? Maybe it is because of your age and your maxilla maybe harder to expand, but I don’t know about that because I seen a guy in his 70’s get expansion with a homeoblock on youtube who showed his x-ray. Have you considered doing EASE? https://drkaseyli.org/ease/
If I were you, doing MMA would be a last resort after trying all other options, it seems like quite an invasive surgery.
Graham Stoney · September 29, 2022 at 4:13 PM
I can’t really explain why it didn’t work for me, but I’ve been contacted by a few people with similar results since. One of the oral maxillofacial surgeons I’ve consulted said that the idea that you could grow adult jaws was “bullshit”. EASE is a fancy name for a particular surgical technique that many OMFs routinely do.
Common sense · August 28, 2022 at 2:40 AM
Before you go chopping yourself in half , I would recommmend some cranial oestopathy. Did you know that strains around the jaw and neck muscles can lead to breathing constriction.
It’s entirely possible you have cranial strains or torsions contributing to your apnea. Something to read into and completely invasive. Also note like mse any surgical work which exaggerates them will make you worse.
Are your arches canted, one side higher. Does facial midline match dental. Do you have a head tilt. Maybe one side of maxilla is wider.
These are things you should investigate as they can lead to severe muscle and breathing constriction.
Enjoy
Graham Stoney · August 28, 2022 at 8:54 AM
Thanks for the suggestion. I don’t believe cranial osteopathy can correct retrognathia.
Chadnie · December 24, 2022 at 9:46 AM
Common Sense- you mention head tilt. My husband who suffers from apnea has a slight head tilt. Can you explain a little the relevancy of that?
Jeremy · August 26, 2022 at 2:59 AM
Hey Graham. Thanks for your thorough documentation and commitment to treating your OSA. I found your experience quite helpful in guiding my own recovery. I had the MMA last month and I similarly attempted to document my experience videographically on youtube. The MMA was quite brutal but you improve fast. I would recommend getting MARPE with corticopuncture assist and orthodontic expansion and possibly getting premolar extraction sites reopened and implants put back in before getting the MMA, however. I still have residual symptoms post-mma and it’s likely because my lingual space and dental arches are too small so the tongue still falls back into throat. My youtube channel is called Health with Jeremy https://www.youtube.com/channel/UCBrDC3BBdgGjuP5SxEhR5Fw
Graham Stoney · August 27, 2022 at 10:00 PM
Thanks for the heads-up. I want to get expansion with my MMA but it’s more likely to be SARPE or surgical expansion because it gives the surgeon greater control than MARPE. I’ve heard a lot of cases lately of asymmetrical expansion with MSE and I don’t want to end up in that situation. I don’t see any way to reopen the extraction spaces without moving all my teeth back and I doubt that would improve my airway anyway. Thanks for the link to your channel; I’ll check it out. Cheers, Graham
Jeremy · September 10, 2022 at 8:04 AM
That sounds like a good idea. Kinda wished I had some transverse expansion during the procedure so I don’t have to deal with this BS. I think that MARPE has more nasal benefit than SARPE however? And my nasal breathing has gotten really bad after the mma. I’ve been watching Jawhacks youtube videos lately and the ones about combining marpe with mmdo interest me. I’d been advised incorrectly by many orthodontists and surgeons that transverse expansion isn’t that effective for osa and theyre kinda wrong. I wish I’d done it before or during as now I’ve got plates holding my maxilla, a rectangle cut in my chin, and healing bones that may take up to a year or more to heal all complicating future treatment. My tongue still feels like it’s squeezed too tight. I’ve started myofunctional therapy and have been diagnosed with forward tongue posture, tongue thrust swallow, and short frenulum, and it’s been helping lately, but I just don’t have enough room to keep my tongue on the “spot”. Things are better but still quite poor. Hindsight 20/20. If you get transverse maxillary expansion during the surgery how will you match the lower arch with the upper? For assymetric marpe expansion I’ve heard tooth tipping and orthodontically correcting it is possible so it doesn’t seem that bad?
D · August 25, 2022 at 6:30 AM
Thanks for your blog. I was just talking to a dentist about the DNA device and another orthodontist about palatial expansion with braces alone. I had some success with a mandibular jaw advancement device in 2017, but I suspect I’ve got regression because I’m getting more tired all the time.
Unlike you my sleep apnea is moderate, and supposedly eliminated by the device I have, but I never felt like I was normal even then.
Clark · August 15, 2022 at 9:08 AM
I managed to salvage some portion of Vivos fee because I ended treatment early
Find me any other industry where goods & services are only paid “for the attempt with no guarantee of outcome”, airway dentistry is a scam, I’m interested in leveraging the healthcare ombudsman through your blog, maybe even a class action
I saw Lydia Lim last week who offered me a 8mm counter clockwise rotation MMA as well as DOME, however the plan looked very linear, she also performs DOME with a KLS Martin expander, I’m booked in for EASE in October and, jury is still out on MMA because I’m after 15-18mm where the industry standard is 8-11mm
Come join us at the seething incel looksmaxxer r/UARSN discord, we’ve got jackets
Graham Stoney · August 15, 2022 at 7:44 PM
Thanks for the heads-up. I’m booked to see her in a couple of weeks. I believe the idea of counter clockwise rotation is that it lets the mandible swing further forwards than the maxilla gets advanced, so the advancement you seek may be achievable. A propellor genioplasty should also help if the blockage is behind your tongue. Thanks for the invite, those incels sound like a fun crowd. Cheers, Graham
Graham Stoney · August 27, 2022 at 10:05 PM
Hi Clark. Yes, I’m with you on that. I have a few questions: Is the 8 mm maxilla or mandible? I’m curious what you mean by “the plan looked very linear” if it included counter clockwise rotation? Who are you doing EASE with? How did you arrive at your 15-18 mm figure? Are you also having a genioglossus advancement? Are you up for a chat to discuss? Cheers, Graham
Jeremy · September 10, 2022 at 8:11 AM
The first and third surgeon I consulted with said they do 8-9 mm to “preserve aesthetics”. One systematic review I read found every additional mm advancement doubles the odds of success or cure of OSA, so I asked my surgeon to advance me as far forward without making me look disfigured, and that I was fine with a slight negative outcome. He said he’d do his best but advancement is limited by soft tissue.
My maxillaa was advanced 12mm, close to 13mm, and lower jaw advanced to match, with slight CCW rotation. I’m still quite symptomatic, although things are better than before. I think there was some relapse subjectively. I’ve read relapse rates are higher in further advancements. In hindsight, I don’t think I needed such a large anterior advancement, I’ve got a bit of a lip closure problem now I’m working on with mouthtape and myofunctional therapy exercises and stretches. I think transversely expanding to fit my tongue and widen dental arches, perhaps opening up premolar extraction sites for implants would’ve increased the odds of cure.
Akraf · November 10, 2022 at 11:05 PM
Having been trying to solve this problem in and off for the last 13 years, I’m coming round to the idea that – while tooth position is relevant and even important in some cases – what really matters for most victims of “Witchdoctor Orthodontics” is the one-two punch of:
1) Getting the lower jaw forward at least 10mm either though MMA or a MAD, and
2) Increasing the upper airway by expanding the nasal volume from the palate (not quite the same thing as maxillary expansion, which in some cases fails to address nasal volume)
Tongue space may be overrated: in deep sleep with your mouth open the tongue is going to fall back to at least some extent. It’s in this case that having an optimised airway from top to bottom will be crucial.
Graham Stoney · November 10, 2022 at 11:12 PM
Yes, I agree; except that sleeping with your mouth open will result in oral breathing, which isn’t ideal. It’s normal to sleep with our mouths closed.
Kevin · August 14, 2022 at 11:40 PM
Thanks for the update Graham. It has been quite a journey
Emma Cooksey · August 14, 2022 at 8:24 PM
Looks like it’s time for a follow up podcast interview if you’re willing? I’m so so sorry that you’ve been through all this with no improvement. Sending love ??
Christine · August 14, 2022 at 7:02 PM
Hi Graham,
I can understand your disappointment. Apparently there’s a new development in expansion called EASE. I’m going to get the MSE appliance as soon as I can save the money for treatment, but if I’m able to find a practitioner who can expand using the EASE treatment, I’m going with that.
Never give up. It’s frustrating, but there has got to be a better treatment option out there.
Graham Stoney · August 14, 2022 at 7:25 PM
Thanks Christine. I’ve heard a few people lately report problems with MSE like asymmetry which ends up being hard to correct. I suspect EASE may be more reliable because the surgeon is making cuts that are well controlled, whereas MSE is relying on sutures cracking open. Good luck however you go, and thanks for the encouragement. Cheers, Graham
Linda Horn · August 15, 2022 at 4:16 AM
Hello Graham,
I enjoy reading your email progress reports. But this one is particularly disappointing! So sorry Vivos hasn’t worked out for you. I also want to get rid of my cpap. I’ve been wearing the vivos appliance for 20 months so far with some modest improvement. I still need the cpap, but at a lower pressure, which is more comfortable. Have you considered the Inspire surgery? That’s been in the back of my mind as plan B if I give up on vivos. Keep up your spirits. Something has got to work! Best wishes!
Graham Stoney · August 15, 2022 at 7:41 PM
Thanks Linda. I have considered Inspire but it’s a bit of a hack and it doesn’t improve daytime breathing at all. I think I have to face the scary fact that I need MMA surgery. Cheers, Graham