DNA Appliance vs. Jaw Surgery? Which gives better results? Which is faster? Which is safer?

Question

I have a dished in profile due to premolar extractions and also an underdeveloped maxilla and mandible. When I smile I have shadows over my teeth and it makes it look very narrow. My teeth are slanted in and I want them in a normal position and would also like more than 6 teeth to show. I want to fix this problem but I would like to know which treatment would be best for my case. Thanks!

Ira Shapira, DDS (in memoriam) · Answer

There are many methods of doing maxillary expansion, some are primarily dental while others are orthopedic.  If there are braces and brackets chances are you are primarily moving teeth.
In children Rapid Maxillary Expansion is amazing but by 12 years old that window is closed.
For over 20 years my first choice was Rapid Maxillary Expansion with a surgical assist, now called the SARPE Procedure.  It is still an excellent procedure and offers rapid expansion.  This is faster than the DNA Appliance.
Orthognathic Sugery is fastest approach but carries considerably more surgical risk!
Non-surcical maxillary expansion can be done with a functional appliance like a Schwartz or Crozat, again something I used to employ but there are now better treatments in my opinion.
My first Choice is the DNA Appliance and Epigenetic Orthopdeics/ orthodontics and the mRNA version for sleep apnea/ snoring patients and patients who need advancement of the chin to create a better profile and airway.  Best results but requires some patiences.  Ideally appliance is worn 16 hours/day.  Less wear time equals longer treatment times.
I also utilize the ALF Appliance but feel I get the best maxillary  expansion with the DNA Appliance.  For a patient like you I might consider initial DNA and then switching to ALF but that increases total cost compared to just using DNA.
These can be used in combination starting with DNA and then an ALF for the next stage.  The ALF is very comfortable and works well with OMT
Regardless of the technique consider working with an Oral Myofunctional Therapist (OMT) for best results.
Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Past Chair, Alliance of TMD Organizations
Diplomat,  Academy of Integrative Pain Management
Diplomate, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member Cranio Editorial Board, Journal of Craniomandibular and Sleep Practice
Member, American Equilibration Society
Member, Academy of Applied Myofunctional SciencesMember, 
Academy of Cosmetic Dentistry
Life Member, American Dental Association

DNA Appliance vs. Jaw Surgery? Which gives better results? Which is faster? Which is safer?

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