MSE’s Biggest Risk
From what I have experienced and seen on the Facebook groups, the complete failure of MSE to split the suture is not a huge deal. It sucks, it really does. You get your hopes up, dream of having massive nasal cavities, go through minor surgeries and the bother of having a hunk of metal in your mouth, and you’ll probably deal with a lot of pain and discomfort. But when your ortho concludes that it has failed the MSE comes out, the palate heals, and your screwholes fill in with bone. There could be minor bone or gum issues at the first molar where the bands are, but that should be easily manageable. Basically, the mouth is mostly the same after the failure.
I have read a few horror stories about AGGA complications, where people have major bone loss, wiggly teeth, and will possibly lose their front teeth. Same with jaw surgery, in the small percentage of major complications you can lose multiple teeth or bone. So a failed MSE is a much lower risk than those. I tend to compare MSE to SARPE and jaw surgery, I don’t have the expertise to compare it to growth appliances like DNA and ALF. If I turn out to be wrong about the low risk level of MSE I will readily correct what I say, but from what I have seen so far the mouth stays mostly the same after a failure.
But there is one risk that needs to be accepted: partial success. That is what I have, and it is a tough spot to be. I have had some expansion on the right side, but the left side will need some surgical assistance. The partial expansion has disrupted my occlusion to the point where my teeth barely meet and I have an open bite. Only two of my upper teeth touch my lower teeth. If I got scared and wanted to stop now, my occlusion would be worse than when I started. Going back is not guaranteed, since the generation of new bone has already begun, so I can’t necessarily rewind back to the beginning. I love the nasal expansion, but I am in a situation where there is no alternative other than keep expanding with whatever surgical method is recommended.
Here is a scan of my occlusion, after the partially successful MSE split. My teeth used to fit together nicely, now I have an obvious open bite. If you look at my upper front teeth closely you can see how they have ground down each other fit neatly. Years of night-clenching with a Class 3 will do a number on your wimpy incisors. The only teeth that make contact are the molars, and the cusps now hit each other instead of nestling neatly. If I leave my mouth like this I’ll probably grind half a millimeter off my molars over time.
So my advice to people considering expansion is to seriously consider what you will do if your mouth/skeletal structure changes, but you don’t get the intended result from the initial expansion. I talked to my ortho about this before starting, so I new that if the MSE was partially effective but unable to complete the job I would have to go the surgical route. Good orthodontists should warn you about this, but you need to be clear about the possibility.
I have said this on Facebook, but I’ll say it here as well. Any adult entering expansion orthodontics needs to be mentally/emotionally prepared for two complications and one change of course. I’m happy for you if you get your desired result on the first try, but it is naïve to expect that. Obviously we all want the best results. But we need to accept that people who have major complications went into treatment unaware that they would be the small minority who got hit hard. It’s not like we know what will happen.
