MSE or no MSE before surgery?

[Penguin88]

So I’ve found my surgeon and orthodontics but the main thing they don’t agree on is the MSE. My surgeon says it doesn’t really matter since he does multiple splits in the maxilla during surgery.

My orthodontist says it would be good to do and because they made a mistake while writing the financial agreement they said they’d give it to me free of charge.

My smile isn’t particularly narrow but their is definitely some room that could be filled in (dark space).

MSE would be purely for aesthetics.

So should I get MSE or not?

[Breakingbad]

If I were you, I would strongly consider doing MSE, since you do have black triangles that could stand to be filled in.

The bigger questions are:

-Would you need a permanent retainer after doing MSE?

-Can the width of your mandibular dental arch handle a wider maxillary dental arch? The mandible can’t be expanded easily like the maxilla can with MSE.

-MSE widens your entire maxilla, not just the Lefort 1 area. This can have some aesthetic and functional benefits that a multi-piece Lefort 1 may not be able to achieve. Are you in need of those extra benefits?

-What is your surgeon actually offering that he says would be equivalent to an MSE? It sounds like a multi piece Lefort 1, but would it be equivalent to the effect of the MSE for you?

Maybe someone with more knowledge can chime in with more information.

[GJ]

If I were you, I would strongly consider doing MSE, since you do have black triangles that could stand to be filled in.

Well, those aren't black triangles, but buccal corridors.

They really aren't a big deal; I wouldn't do widening just for that reason. The reason to widen would be lack of tongue space or to get the bite right.

[kavan]

Defer to what your surgeon says. Multi-piece leforts can widen the area as he's indicated.

[TWGOAT]

I spoke with Dr. Chamberland who is an orthodontist specialized in expansion and he mentioned that order of expansion based on stability he recommends is:

1) MSE/MARPE (for 5mm or more) - most  stable
2) SARPE (for 5mm or more)
3) Lefort 1 2 or 3 piece (for 4mm or less, realistically he said net gain of 2-3mm) - less stable

[Penguin88]

That’s really interesting. My ortho says I need 8-10mm of expansion. I think the extra tongue space will be helpful in making sure my djs doesn’t relapse. My logic is that it’ll provide good support to my bone structure. Also,  my upper maxilla is rather v shaped,  though not extremely so. Rounding it out will have some aesthetic benefits.

[TWGOAT]

yes more than 5mm, if you can get an ortho specialized in MARPE / MSE, it's the best option, and will be before the braces

[downwardgrowth]

anyone looking at you and telling you not to do an MSE is scamming you imo

[LeFort 3000]

your dental arch is a joke. you need expansion

-Can the width of your mandibular dental arch handle a wider maxillary dental arch? The mandible can’t be expanded easily like the maxilla can with MSE.

mandibula can easily expanded up to atleast 1cm with expander, no problem whatsoever.

[Breakingbad]

mandibula can easily expanded up to atleast 1cm with expander, no problem whatsoever.

I acknowledge your point and I know you had this done so you speak from experience. However, the only methods I know of are MSDO (distraction) and SFOT (layering bone paste onto the alveolar area in order to allow maxillary arch widening with braces).

I’ve gotten the impression that doctors in the US aren’t willing to do MSDO for non-syndromatic cases. Doctors in Europe seem to be more open to doing it on non-syndromatic patients.

As for SFOT, there aren’t too many doctors doing it in the US.

Overall, in the US, it’s theoretically easy to do but unfortunately not so easy to get it done unless you happen to live near a doctor who does SFOT or are willing to travel to another state.

If OP is in Europe, he might have an easier time trying to expand his mandible if it’s at all needed.