jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Lazlo on October 18, 2012, 02:01:21 PM
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Hi,
I came across this doctor in Australia who is a maxillofacial surgeon, but he also performs "IMDO" which is intermandibular distraction osteogenesis. The idea is that instead of a bi-max or bsso you make a small cut in the bone and it is lengthened with a device 1mm or so each day and then at the end of a few months it is taken out and the bone grows in to fill in the gap. Apparently there is little pain and virtually no trauma associated with surgery. You do need some orthodontic treatment after to just straighten out the teeth but it seems a much, much better option than traditional surgery. I did notice in the video also that the patients who have had IMDO instead of bi-max look much better in their after pictures. Has anyone looked into this or talked to their surgeons about it? Seems relatively new. I am scheduled for bi-max next year but I think I would much prefer this.
Before and After Orthognathic Jaw Surgery Overbite Underbite Profilo Braces (http://www.youtube.com/watch?v=WsDMu-wlqCA#ws)
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Hey people,
it's been a tough day going down even further this terribly confusing hole of jaw surgery. The surgeon I consulted here gave me a fairly bleak view of what could actually be accomplished through this surgery and he told me how having thicker skin and soft tissue and a smaller or more delicate bone structure is kind of like the worst case scenario for noticeably trying to manipulate the aesthetic outcome of the surgery.
I know many of you have been speculating about what causes all of this and when it's best to intervene in the process for young children to optimize their jaw/bite outcomes and I think I've come to some fairly stable conclusions about all of this.
First, many of us have speculated why we may have jaw issues. The answer is simple --our jaw bones didn't grow in the optimal positions. Either they grew too much or one side grew more or less or whatever. That's why our teeth are crowded or spaced. Whatever the reason, most often its just genetics. I know a lot of you think it's something that happened to you as a kid, and in some cases it might be, but more often it's just genetics --inherited --but regardless it doesn't really matter. What matters is when and how to actually fix the problem.
Second, I think I can say with some certainty now that traditional orthodontics is an entirely BANKRUPT and corrupt enterprise and moreover is scientifically unsound. Orthodontics doesn't address the problem at the root, it just tries to make do with what you have and this results in a cascading effect of producing all sorts of other problems, most often at the expanse of you facial aesthetics. Extractions, retracting teeth, etc. etc. are all just very poor techniques and do not address the root of the problem which is the jaw bones themselves. You must induce them to grow properly and most often then the teeth will take care of themselves.
Third, you might not be genetically programmed for whatever reason to have strong symmetric jaw bones, but there is a way to induce them to actually grow. You might still need some minimal orthodontics to straighten things, but not nearly the amount of harmful and long duration manipulation currently used. If you read the following series of explanations on this site you can see that this doctor, who I've posted about before, takes a fairly radical counterposition against orthodontics to solve the problem. He basically argues that if you get the jaws to grow then you don't need the manipulation of the orthodontics.
Just read each of the subheadings and it all makes perfect sense. Grow the jaw bones, then straighten the teeth as needed, not the other way around.
I'm beginning to realize that the jaw surgery first/then braces as practiced in Europe in some places and in Korea is also a better alternative than the traditional braces then surgery approach as well. But ideally having distraction at a formative age would be the gold standard.
For most of us here this knowledge has come too late, but maybe there are people with kids out there reading this stuff and you can benefit. Seeing in fact how problematic the asymmetry I have and how unpredictable the outcome will actually be from my jaw surgery was a difficult thing to realize today.
I don't really know why distraction is not recommended as ideal for adult patients, but it doesn't seem to be offered except in extreme cases.
http://profilo.com.au/jaw-distraction-surgery/.aspx (http://profilo.com.au/jaw-distraction-surgery/.aspx)
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yeah all these articles who that DO has a slight edge over surgery or is on par with jaw surgery in all respects as these tests were for sensory disturbance and relapse rates. But what is significant here is that DO gives you a much more controlled growing of new bone and also that it can produce new bone without graphs or foreign materials and so can lead to stronger results if more bone or advancement is needed. Moreover, all such tests are biased and they may be in the interests of maintaining the status quo. Think about it, DO is a HELL OF A LOT more work for the doctor daily guiding the distraction etc..
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Bumping this to say, as I live in Australia i am going to do a video consult with Dr. Coceancig, and I will ask him about IMDO and report back here.
It is possible in adults, He has two public patients on his website that had this, one was 23 and the other was significantly older, I'm not sure but looked to be in his late 30s.
Its worth stating that IMDO is only done in Australia, by Coceancig. It is not the same as other DO methods published online. I'll be sure to ask him the finer details of what makes it different, but I believe the key difference is right there in the name: Intermolar Distraction Osteogenesis.
Its also worth noting, the younger man who had this also had a genio performed. So the DO is not a magic bullet, it seems to be very capable of making large movements in a 3D manner, but for an ideal aesthetic outcome you would probably still need some form of bony contouring. I imagine you would also need some form of maxillary expansion before as well.
But this is just me talking out of my ass, I will find out.
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(http://www.profilosurgical.com.au/images/IMDO/for-adults/imdo-overbite-correction-surgery-profilo-surgical-1.jpg)
This result is amazing. There is only one surgeon in the world who does this???
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and this!!!!
(http://www.profilosurgical.com.au/blog/Jawline-Surgery/PaperII.png)
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This result is amazing. There is only one surgeon in the world who does this???
Yes.
IMDO is Coceancig's baby and legacy it seems.
Other surgeons do distraction osteogenesis, theres quite a lot of literature published on it, but this particular method of inter-molar distraction is novel I believe.
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Yes.
IMDO is Coceancig's baby and legacy it seems.
Other surgeons do distraction osteogenesis, there's quite a lot of literature published on it, but this particular method of inter-molar distraction is novel I believe.
I can't believe no other surgeons are interested in learning this. I have sleep apnea and if I could be cured of it and have results half as good as the dude I posted I'd be on top of the world!
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I didnt read everything associated with IMDO, is numbness also avoided using this procedure? Id imagine if they also did a sliding genio you would have a chance at some numbness but I wonder if the IMDO itself causes any?
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This is amazing! would be worth the trip to australia if it was legit
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Why is it amazing? Wouldn't a standard bsso be better.
if its legit, lower down time, less invasive, physically stronger etc
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and this!!!!
(http://www.profilosurgical.com.au/blog/Jawline-Surgery/PaperII.png)
Pardon me. But there is a huge amount of photoshopping in those before & after pictures.
There is an ethical issue when doctors post those kinds of non-representative / photoshopped pictures.
There is only one purpose to that sort of thing - - an intention to mislead the potential patient.
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Pardon me. But there is a huge amount of photoshopping in those before & after pictures.
There is an ethical issue when doctors post those kinds of non-representative / photoshopped pictures.
There is only one purpose to that sort of thing - - an intention to mislead the potential patient.
would you like to qualify this?
I dont see any obvious photoshopping other than that which is necessary to have a clean presentation.
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would you like to qualify this?
I dont see any obvious photoshopping other than that which is necessary to have a clean presentation.
No... really, there is no qualification needed. For example, the slope of his forehead above the eyebrows is different, and not as "slopped" backwards. That was the starting point for me.
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Also, look at his gonial. The after has more definition which I don't think this operation alone would bring out. Lighting could explain this though.
If the procedure works as described, then it would definitely bring out the gonial as it is growing the jaw in 3 dimensions. People with poor gonial definition lack width in the mandible.
Also as the jaw gets longer and wider the amount of slack in the skin will be picked up. Just as a lefort 1 can reduce eye exposure, which is not an expected effect if you were just playing around with anatomy models.
EDIT: I just want to clarify, i'm not jumping to the defense here. I just don't see any telltale signs of photoshopping, you guys are bringing up facial changes from a procedure that........changes the face. Normally you'd see some pretty obvious tells, like blurring on the skin or odd or lack of shadows in expected locations.
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Don't quote me on this but i"m almost certain he only does this s**t on growing patientes who are under 14 --He won't do it on adults --he'll just do a basic bsso and waste your time. I'm not sure. Maybe he's advanced give it a shot.
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Looks like he always had gonial definition but they tried to photoshop it away in the before.
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Why can't surgeons just post up on their web sites the standard frontal and profile view photos - - - taken with their standard office background for documenting patients, and taken without hair styling and taken from the same perspective ?
It would be a lot more convincing and a lot less deceiving.
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No... really, there is no qualification needed. For example, the slope of his forehead above the eyebrows is different, and not as "slopped" backwards. That was the starting point for me.
His Forehead is sloped before and after.
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His Forehead is sloped before and after.
Yes. Agreed. But look closer. The orbital rims are different and the posterior slope of the forehead is less pronounced in the "after" picture.
I am pretty sure that those aesthetically pleasing image changes are a result of either (non-disclosed) complex craniofacial forehead surgery, or photoshopping.
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Yes. Agreed. But look closer. The orbital rims are different and the posterior slope of the forehead is less pronounced in the "after" picture.
I am pretty sure that those aesthetically pleasing image changes are a result of either (non-disclosed) complex craniofacial forehead surgery, or photoshopping.
But you don't know how much time there is between photos? The distance to the camera, angles etc is also probably different.
An accusation of deliberate 'photoshopping' shouldn't be taken lightly.
Would you say this is also photoshopped?
https://www.facebook.com/profilosurgical/photos/a.358119377569695.76662.358073987574234/925462037502090/?type=3&theater
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But you don't know how much time there is between photos? The distance to the camera, angles etc is also probably different.
An accusation of deliberate 'photoshopping' shouldn't be taken lightly.
Would you say this is also photoshopped?
https://www.facebook.com/profilosurgical/photos/a.358119377569695.76662.358073987574234/925462037502090/?type=3&theater
It is not just a question of photoshopping the digital image. The problem extends to such things as make-up / no make-up , and / or hair styling.
In this case, the object of the comparison is to sell the surgeons jaw surgery skills and results. But it looks like there has also been some undisclosed rhino work, as well as lipstick added, change in hairstyles .... multiple details.
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But it looks like there has also been some undisclosed rhino work, as well as lipstick added, change in hairstyles .... multiple details.
But really you have no idea and are directly accusing Dr C of
There is only one purpose to that sort of thing - - an intention to mislead the potential patient.
These are teenagers he is operating on, the second photos can be a year or more later, they grow, they change.
In this case there is no lipstick, no undisclosed rhino work and no other tricks or illusions. Time has passed, the lighting is different, the photo is taken in a different location.
Better picture here perhaps
http://www.profilosurgical.com.au/jaw-surgery/imdo-overbite-surgery
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But really you have no idea. These are teenagers he is operating on, the second photos can be a year or more later, they grow, they change.
In this case there is no lipstick, no undisclosed rhino work and no other tricks or illusions. Time has passed, the lighting is different, the photo is taken in a different location.
There is a mandate from the plastic surgeons board certification that the surgeons not use deceptive pictures for demonstrating results.
To the intellectually honest surgeons, that means before and after pictures taken in the same lighting, in the same poses and postures, and without unnecessary make-up/ hair styling, etc.
Yes, kids change. Which makes it all the more important to NOT change the lighting. Her lips are RED in the after picture. They are pale flesh/native vermilion toned in the before picture.
Her change to her teeth and jaw are spectacular success for that young girl. That should have been "good enough" for the surgeon posting pictures of her. But there is a good likelihood there was some other work done with the nose, for example, that can be misleading. If he had simply disclosed any of the additional work and held the imaging to a same-same standard, then there would be no objection. He did not need to gild this Lily.
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But there is a good likelihood there was some other work done with the nose, for example,
Bollocks. She hasn't had any nose work.
The photo was taken in a different office, at a different time of year, well over a year later, be close to impossible to get the lighting exactly the same. It's just his receptionist who takes the photos with a standard camera.
What if one photo is taken after winter and one after the summer break? skin colour can be quite different.
Problem is you're accusing Dr C of being misleading and just making assertions when really you don't know.
Frankly I can't see what can possibly be misleading in the third picture down here (or the others for that matter)
http://www.profilosurgical.com.au/jaw-surgery/imdo-overbite-surgery
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have to agree with jol, there really is not indication of extensive photoshop work, which is why i asked you to qualify it to begin with.
I just don't see it. The only one that looks even remotely suspect is the adult man on the previous page who looks to have had some brow growth - this can be explained by other mechanisms however. The male brow does grow well into the early 20s.
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so can this imdo be done if your have normal bite but going for aesthetic gain? anyone know if he performs regular bimax with rotations? be good to have someone in australia instead of having to travel to see sinn or zarrinbal all the time.
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so can this imdo be done if your have normal bite but going for aesthetic gain? anyone know if he performs regular bimax with rotations? be good to have someone in australia instead of having to travel to see sinn or zarrinbal all the time.
They definitely do bimax. I feel it should be pointed out that bimax is literally the bread and butter of maxfacs, every single one of them does it. I would take any notions about only so and so doctor being able to perform a particular movement with a fistful of salt, most of that stuff reeks of self-marketing. Obviously when looking for a surgeon you want someone with a lot of experience but in so far as technical considerations, its pretty objective and uniform I feel.
I've got the consult on wednesday, so I'll be sure to ask about IMDO specifically vs bimax for aesthetic outcome.
re: zarrinbal sinn et al, I would not travel to these guys specifically for a bimax because again its a limited operation, its not like plastic surgery where you have to take artistic considerations into account, all maxfacs use objective measurements and analysis for their work, and the capabilities of the operation are very black and white per my understanding. You travel to guys like Zarrinbal or sinn for operations that aren't widely performed, like bony contouring surgeries (ZSO, chin wing etc). If its just bimax i would start very local. The only reason I'm not starting local is because I believe I'm a candidate for surgery first approach, and that hasn't caught on here in australia yet as far as I can tell (its big time popular in south korea though, which is very close!)
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I read the website and I do not see anything about the maxilla. Does that mean IMDO is only done in lieu of a BSSO and you still have to have the Lefort or can they do IMDO on the maxilla as well?
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. . . all maxfacs use objective measurements and analysis for their work, and the capabilities of the operation are very black and white per my understanding.
You might think about that some more. There are world class Ortho's who have repeatedly changed the surgeons doing the jaw surgeries for their patients - - because of unsatisfactory surgery results - - until they found one they could consistently recommend to their patients with expectations of a good outcome.
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So I had the consult with Dr Coceancig today
Nice guy, very well spoken, informative and good sense of humor. I asked him a bunch of different questions which probably made me look confused about what I want - because i am ;D
Regarding IMDO, it is performed in adults, but its not commonly done, he said it would not be cost effective for what I wanted to achieve. Anyone here with children/young teens however who are worrying about their facial development, IMDO looks stellar, and it reduces the amount of orthodontic work needed significantly.
Sorry if it wasn't what people were expecting, but I can come away recommending Coceancig as an option for any kind of face surgery, they've got a world class facility down in newcastle, lot of premier digital imaging technology and he takes careful consideration of the desired goal and all options available instead of just rigid diagnosis-treatment manner of many maxfacs.
And yes, they do PEEK implants for those interested. He rubbished silicone.
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Do you think he'll do surgery on people with decent bite but terrible aesthetics? My mandible is clearly recessed but my bites functional. I don't have sleep apnea and my forward head posture being caused by my jaw is hard to prove. Although lying on my back makes it slightly harder to breathe. And thank you for reporting back. Can't wait to talk to him myself.
my bite is decent and the whole purpose of my talk with him was largely aesthetic related, so yes. He said its very common for jaw surgery to be done for aesthetic concerns.
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Thanks ppsk. Settles a lot of my anxiety I get about that. :)
Do you live in Australia? If so it would be very worthwhile seeing him.
I'm still not sure If I'm going to go with Coceancig, but only because i might be moving to europe for business reasons. If that wasnt the case I can honestly say id be on the next flight to Newcastle.
Its worth noting if you are Australian you save a LOT on equipment cost through our healthcare system.
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im also very interested in seeing him for the peek implants (getting bimax done first is probably just a pipe-dream... unless he does it very cheap which i doubt). i have sent a question asking if the jawimplants can be done wraparound style. hopefully i can get it done shortly, as it really is inconvenient traveling internationally to go to eppley or yaremchuk for them done.
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im also very interested in seeing him for the peek implants (getting bimax done first is probably just a pipe-dream... unless he does it very cheap which i doubt). i have sent a question asking if the jawimplants can be done wraparound style. hopefully i can get it done shortly, as it really is inconvenient traveling internationally to go to eppley or yaremchuk for them done.
Listen something ive learned over the past two years is that "wraparound" is just a marketing term. It still has to be sectioned into 3 pieces to get it into position (chin, jaw angle, jaw angle) no matter what, otherwise they would have to use a wildly different surgical procedure to get it placed.
The implants can be custom designed, so I'm sure you could bring up with him the possibility of having "wings" on the implants to achieve the total jawline effect.
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you are right. it doesn't need to be wraparound style, as long as these implants can add vertical length to the whole mandible as well as width then it doesn't really matter if they need to be 'modular' in design as opposed to one single piece. i will look into getting a consult with him.
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i got a reply from them, and they confirmed they are fully customization and can even be placed on the zygomatic arch.
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Can you please elaborate on what you mean by it's not cost effective for what you want to achieve? Cost isn't an issue for me and I'm quite interested in what he offers. The downside is he's on the other side of the world to me.
Did he suggest what mm movements are possible? I want to significantly widen my mandible.
Did he show any before/after of his PEEK implants to back up his assertion they are superior to silicone?
He didn't elaborate. He had seen a morph of what I wanted to achieve. I'm guessing what I wanted to achieve was more readily and cost effectively achieved by bimax and genio etc.
No before/afters for implants, but then i didnt ask to see any.
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Thanks. Do you know if IMDO is only for overbites? I don't have an overbite. It will be good to know before I potentially waste money on a paid Skype consult :P
I dont know.
Its for growing the lower jaw, not the upper jaw, so make of that what you will.
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He can distract the upper jaw as well.
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What do you mean by adding 6 to 8 mm to each side of the jaw? Is that ramus length or mandible length? Why can the ramus not be lengthened? Thank you.
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yeah all these articles who that DO has a slight edge over surgery or is on par with jaw surgery in all respects as these tests were for sensory disturbance and relapse rates. But what is significant here is that DO gives you a much more controlled growing of new bone and also that it can produce new bone without graphs or foreign materials and so can lead to stronger results if more bone or advancement is needed. Moreover, all such tests are biased and they may be in the interests of maintaining the status quo. Think about it, DO is a HELL OF A LOT more work for the doctor daily guiding the distraction etc..
Lazlo, did you see coceancig and have IMDO? I have an overbite and a retruded mandible. I had orthographic surgery 25 years ago and my lower jaw relapsed. I have only just learned that my mouth breathing could have triggered the relapse. So am seeing an ENT soon. Why didn't anyone mention this? I am on my orthodontist's Review list. I may see coceancig. Its a chicken and egg thing about the mouth breathing. Do I mouth breathe because my jaws are small, or are they small because I breathe? Do I have a head forward posture because I can't get enough air or does pushing my head forward reduce the size of my jaws over time? I also have very loose joints, or hypermobility. And my short lower jaw is genetic - I can see the shortfall in photos of me aged 2. I think any attempt to change this may fail if my body simply reverts back over time...
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Lazlo, did you see coceancig and have IMDO? I have an overbite and a retruded mandible. I had orthographic surgery 25 years ago and my lower jaw relapsed. I have only just learned that my mouth breathing could have triggered the relapse. So am seeing an ENT soon. Why didn't anyone mention this? I am on my orthodontist's Review list. I may see coceancig. Its a chicken and egg thing about the mouth breathing. Do I mouth breathe because my jaws are small, or are they small because I breathe? Do I have a head forward posture because I can't get enough air or does pushing my head forward reduce the size of my jaws over time? I also have very loose joints, or hypermobility. And my short lower jaw is genetic - I can see the shortfall in photos of me aged 2. I think any attempt to change this may fail if my body simply reverts back over time...
When did you relapse? No Lazlo did not have IMDO.
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Hopefully my post brings this thread back up to the top. I am just now finding IMDO and I think its a great option but Im 34. I am post bimax by 10 years and a have had a ton of ENT procedures for sleep . Still small lower jaw and now a very pronounced maxilla, I dont look good and still sleep apnea(UARS and sleep breathing disorder). Im another product of a terrible surgeon. A few things Im confused about were mentioned earlier.
-This is lower jaw advancing. My teeth are aligned since Ive had braces 3x broken up over 6 years. Im thinking since the length comes between 1st and second molar that its an advance and then orthodontics to bring the leaning forward teeth back upright and back to a good bite again. Thats allot of movement for a what.... 25mm gap?
-Has anyone found an equal setup in the states? Ive had many consults done from many backgrounds and no one has mentioned this. The states equivalent might be neromuscular dentistry but the drawback there is the lack of jaw expansion. Id like to see a combination of the two. Neuro using k7 for correct TMJ positioning and IMDO for expansion and later ortho(hesitantly).
-Also, where did all the pictures on these threads go? Pictures are pretty vital in this subject.