My Custom Maxillary Skeletal Expander (MSE)
Dr. Newaz’s Modified MSE
MSE (Maxillary Skeletal Expander) was installed on July 15, 2019 with Dr. Zubad Newaz, an orthodontist at the Gelb Center in Manhattan.
Cortical Punctures
As part of the install Dr. Newaz also performed a cortical puncture of the mid-palatal suture, which weakens that suture and increases the odds of MSE successfully splitting the suture.
This basically involves drilling small holes in the suture prior to MSE install.
Acrylic Pads
In order to increase the odds of splitting the suture, he also worked with the lab to develop a custom MSE that includes acrylic pads that help to distribute the appliance’s force across a wider area of the maxilla.
Even with these added pads, the appliance is still almost entirely bone-borne (i.e. it applies force to the maxilla itself and not the teeth, which is important because pushing on teeth causes teeth flaring and not bonafide skeletal expansion).
Tongue-facing side of my custom MSE.
Face-mask (FM)
The appliance also contains hooked attachment points for a face-mask, which I will use in conjunction with the MSE to attempt to move my A-point forward (bonafide forward skeletal expansion).
The face-mask hooks are on the outer sides of the bands that wrap around the molars.
This modified appliance can be seen in the two images below.
Maxilla-facing side of my custom MSE.
My Successful Split
It is known that MSE is not able to successfully split the mid-palatal suture in every patient. Sometimes the a failure occurs before the suture splits.
For example, the strength of the suture, combined with the softness of the maxillary bone or the inadequacy of the screw-grab into that bone, can result in a phenomenon called screw drag in which rather than splitting the suture, the MSE screws simply drift through the maxilla, like chopsticks being dragged through pudding.
However, the cortical puncture combined with the custom acrylic pads resulted in a successful split for me, after only 3 days of MSE-screw turning, and 20 total turns.