- What is AGGA?
AGGA = Anterior Guided Growth Appliance is a fixed orthopedic appliance developed over 28 years ago and is one of the safest orthopedic appliances used to remodel or grow the face and jaws to their full genetic potential…non-surgically. The AGGA allows us to fully develop and relocate the entire nasomaxillary complex, including the upper jaw to its ideal size, shape and position, which in turn allows the trapped lower jaw to develop to its most relaxed, comfortable physiologic position. In addition, the nasal cavity, floor of the orbits and cheek bones are reshaped. AGGA is all about facial orthopedics and remodeling/growth and not about just straight teeth. We are developing faces and straight teeth just happen to be part of the package.
- What causes the face or jaws to be underdeveloped in the first place?
Modern day diets and environmental allergens have contributed to inadequate face and jaw development in 85% of children today. More on Orofacial Development…
- How does the AGGA work?
The AGGA stimulates growth in children and a 3-dimensional remodeling of the entire nasomaxillary complex (midface and upper jaw) in adults. Unlike all other expansion devices, the AGGA is NOT a tooth borne appliance. The acrylic pad on the palate applies pressure on the nasopalatine neurovascular bundle under the pad which creates a microtrauma response that induces bone to be laid down over the nerve as an insulating effect to mitigate the irritation to the nerve. The stimulation from the AGGA remodels the entire nasomaxillary complex (including the midface and upper jaw) in the direction of optimum forward facial growth, correcting jaw size, shape and location which in turn, creates adequate space for crowded teeth.
- Who benefits from AGGA?
AGGA has been shown to be beneficial in children ages 6-10 (removable AGGA), and teens/adults (Fixed AGGA).
People with the following characteristics or symptoms may benefit from AGGA:
Craniofacial disharmonies (facial asymmetries or cranial strains)
Severe dental crowding
Prior history of bicuspid extractions and now TMD symptoms or sleep disordered breathing OSA
Underbites (lower jaw appears to be overgrown)
Overbites (lower jaw appears to be too small or too far back, upper teeth flare too much)
Chin appears to be too prominent
Chin appears to be too small
Mid-face deficiency (upper jaw is too far back)
Flat face appearance (AGGA develops fuller definition of lips and cheeks like a non-surgical face lift!)
Appearance of a poorly defined jaw line or “turkey neck”
Phase 2 option for TMD patients
The Facial Beauty Institute currently has a data base of almost 5000 cases being used in research at this time. The preliminary assessment of the prevalence of midface deficiency (underdeveloped upper jaw) is above 85%. The deficiency in forward jaw growth is 6-8mm in these patients which means the lower jaw in these people has compensated by being pushed back 6-8mm in order to function behind the upper jaw.
- What are the benefits of AGGA?
The benefits of Jaw Development Orthodontics with AGGA + Controlled Arch Orthodontics include a robust horizontal, face forward development of the entire nasomaxillary complex (mid-face and upper jaw) which is key to unraveling the entrapped mandible which alleviates compressed TM joints resulting in resolution of most TMD symptoms.
The result of the mandible now being in the correct physiologic position is a dramatic improvement of the posture of the head over the cervical spine, resulting in complete improvement of body posture.
What will also happen is the entire face develops forward horizontally, allowing the lower jaw to come forward, significantly opening the airway at the back of the tongue which can be measured on before and after treatment CBCT scans.
We see remarkable changes to the architecture of the nasal cavity, which also includes remodeling of the palate, which is, of course, the same structure as the floor of the nose. These changes in the nasal cavity improve nasal patency and most patients will have significantly improved nasal breathing. The remodeling of the palate facilitates more room for the tongue and a more complete seal of the tongue in its proper position in the roof of the mouth.
Improvement of facial esthetics and profile are observed, like a non-surgical facelift.
Overall, the improvements we see are synergy of function, health and facial esthetics.
- How do you determine how much jaw development will be needed with AGGA orthopedics?
LVI trained dentist, Dr. Tracey Hughes, will submit a 3-D CBCT scan and photographs to the Facial Beauty Institute. An oral maxillofacial radiologist and orthodontic specialists evaluate and diagnose the scans and photographs utilizing the OrthoMatrix Total Diagnositc and Treatment Design system. Recommendations are made by the Facial Beauty Institute and comprehensive treatment plan guidelines are provided based on the OrthoMatrix analysis.
- I have been told jaw surgery is the only option for me. Is AGGA an alternative?
If you have been told you need jaw surgery or TMJ surgery, please seek another opinion preferably from Dr. Tracey Hughes who is trained to use jaw development orthopedics with Controlled Arch orthodontics. There are very few indications for jaw surgery and AGGA is a non-surgical alternative available today.
- What happens to the lower jaw once the upper jaw is developed forward with AGGA?
The beauty of the AGGA growth appliance, when properly coupled with correctly placed lower physiologic molar pads, is a synergistic activation of remodeling in the Nasomaxillary complex (mid-face and upper jaw), which in turn, signals significant activation of the ramus and condylar remodeling centers in the lower jaw. The lower jaw follows the upper jaw beautifully as it is unlocked from being entrapped behind a deficient, retruded upper jaw. The body goes where physiology dictates, and the lower jaw wants to be in a position where the muscles are relaxed and the TM joints decompressed. The jaw will follow where the teeth need to interdigitate to function, so as the mid-face and upper jaw develops forward, the lower jaw remodels and follows, in most cases, uprighting to develop a desirable beautiful, strong jawline. AGGA is the only appliance that stimulates this robust forward remodeling of the upper jaw, in conjunction with physiologic molar pads, stimulates growth centers in the lower jaw to develop to its maximum genetic potential.
- Does AGGA expand my lower jaw too?
Indirectly, yes. Space is made in the lower jaw in 3 ways. In response to AGGA, the lower jaw uprights and remodels during the jaw development process which creates additional length of the lower jaw and makes additional room for crowded teeth to align. The second way, is the lingual wire FRLA placed on the lower teeth will upright the molars that are almost always tilted inward, and this creates space to alleviate crowding. This third way space is made in the lower jaw relates to the Controlled Arch braces anchorage system used which allows us to gently widen the space available for the lower front teeth. In the vast majority of cases, we can create space for straight teeth on the bottom. No other orthodontic system can do this much to create room for crowded lower teeth. Other conventional orthodontic systems utilize IPR (interproximal reduction) or sandpaper strips or discs to narrow the teeth in the front to make room, or even more drastic, extraction of teeth to make space. Jaw development orthodontics with AGGA + Controlled Arch braces does not utilize these techniques.
- But what about my underbite? My lower jaw is already too big!
In the case of an underbite the lower jaw is usually the correct size, but it’s the upper jaw that is underdeveloped (too far back or too small). The lower jaw is already ahead of the upper jaw, AGGA stimulates the midface and upper jaw to develop, but the mandible has already fully developed so it does not develop beyond the genetic potential it has already reached. AGGA corrects the underdeveloped upper jaw beautifully to catch up with the lower jaw in the case of an underbite, creating a beautiful, physiologic balance of the face.
- Will my face look different after Forward Face Orthodontics with AGGA and Controlled Arch braces?
In a good way, yes! Most people who are appropriate for AGGA treatment may have a short mid-face, a mid-face that is too far back, a step lower jaw and long face look, a “big nose” (which really isn’t, it just looks like that relative to the deficient midface), a sunken in look or flat look to their face, facial asymmetries, too prominent of a chin, or not enough chin. All these things improve with forward face orthodontics using AGGA followed by Controlled Arch braces. Also, more forward maxilla and mandible support the soft tissues of the face better to diminish wrinkles which gives a younger appearance.
- Does AGGA provide lateral expansion as well as forward development of the maxilla?
The AGGA is not just about linear forward growth, rather, it produces 3-dimensional remodeling of the entire upper jaw including laying down new bone on the area outside the molars. This development of new bone allows the bodily placement of molars out to the ideal physiology when in Controlled Arch braces following the AGGA development.
The AGGA is a far safer way to develop the arch form after it’s use and conversion to controlled arch braces because of the newly formed bone that is laid down in this remodeling process. All other methods of “expansion” involve pushing on teeth which challenges the biology of the system and can partially work, but at a much higher risk of recession. With the AGGA, we can almost always get to the full genetic potential width of the arch form.
- What is done with the space after the AGGA development is complete?
Contrary to the typical retractive mechanics of traditional orthodontic braces, the physiologic Controlled Arch phase of orthodontics following AGGA pulls the back teeth forward into the space behind the canines which has newly developed bone from the remodeling process stimulated by the AGGA.
In the case of prior 4 bicuspid extractions, one may choose to restore the space with new teeth in the bicuspid space with dental implants, or fixed bridges.
- Will my teeth move or tip during the AGGA treatment?
The front 6 teeth are bonded to a wire, which specifically prevents any movement of teeth. The teeth are effectively relocated passively as the bone remodels forward. The entire front segment of the upper jaw and the 6 front teeth move along with the remodeled bone. After the AGGA development has completed, following controlled arch orthodontic alignments create the final proper root torque, level the dental arches and widen the dental arches laterally to give you an esthetic beautiful smile.
- How long has AGGA orthopedics been around? Is this new?
There have been thousands of growth appliances used for the past 28 years with stunning success. It is one of the safest orthodontic appliances ever developed. It has gained more momentum in the most recent past 3 years when the Las Vegas Institute for Advanced Dental Studies added it to their orthodontic training program. Now over 150 LVI trained dentists across the US, Canada, Australia and the UK are providing this treatment as an option to their patients.
- How is AGGA different from other types of orthodontic “expansion” appliances?
Expanding the palate with other types of orthodontic expansion appliances is only a minor part of a larger problem that is going to be left unaddressed which is mid-face deficiency.
The stimulus of all other types of orthodontic “expansion” appliances is transmitted from pressure on the teeth to the bone. This does create a remodeling response and can do some good things, but it is a much slower process, takes much longer and not as robust as the remodeling activation of AGGA. In contract, AGGA is not a tooth borne appliance. Rather, AGGA works by stimulating bone remodeling sites in the upper jaw from pressure on the palate.
Additionally, the “expansion” appliance approach uses conventional mechanics in braces after the expansion and does not allow the mandible (lower jaw) to remodel properly. This means, among other things, the TM joints are not going to have maximum opportunity to heal, and there will not be significant improvements to the airway.
You cannot compare this form of full facial orthopedics and facial rejuvenation of AGGA with any other form of orthodontics. Face forward remodeling of both jaws is far more therapeutic and physiologic by any measure and the profound ability of the AGGA to heal TMD is also unparalleled.
- Does AGGA correct facial asymmetries/cranial strains?
Yes, the remodeling response to AGGA stimulation incudes sutural activity in the Pterygoid plates behind the upper jaw which interface with the sphenoid bone. The induced dynamic state of an actively remodeling nasomaxillary complex allows for cranial release in the sphenoid even without osteopathic manipulation, however, it is more predictable with adjunctive treatment.
Once the cranial release in the sphenoid occurs, the body is free to correct all kinds of distortions in the face and upper jaw, including width of the upper jaw, twisting of the upper jaw, a tilt in the upper jaw and so on.
While in AGGA treatment, there are significant benefits in patients with cranial strains working with an osteopath which further reduces pain and symptoms by reducing cranial strain patterns. As mentioned, the AGGA allows for profound cranial releases to occur during treatment. These strains impact the toughest outermost membrane of the brain and spinal cord which create tension and inadequate movements of fluid around the brain and spinal cord, creating a myriad of symptoms and facial asymmetries. Combining the AGGA treatment with Craniosacral Therapy, or even more effective, NeruroCranial Restructuring can profoundly unwind these cranial strains, improving facial symmetry unlike any other type of orthodontic expansion appliance.
- Will AGGA cause gum recession?
The AGGA does not move teeth, rather it stimulates bone remodeling and the teeth follow along for the ride. It is far safer than putting pressure on the teeth as in conventional orthodontic mechanics. However, in the presence of pre-existing recession or bone loss under the gum which may not be visible at the start of treatment, ANY orthodontic movement can increase the degree of recession. AGGA will stimulate bone deposition on the outside surface of the teeth, considering that some bone is already there to remodel. It may be appropriate to consider grafting of the gum tissue to cover roots before orthodontic treatment, an in some cases, it can also be done after orthodontic treatment.
- How long does Forward Face Orthodontics take?
Depending on how many millimeters of forward growth is prescribed for you by the Facial Beauty Institute evaluation and treatment plan report, average growth occurs at a rate of 1mm/month for adults and 2mm/month for teens. For example, if you need the average 6-8mm of growth seen in most patients, it will take 6-8 months in treatment with the AGGA. Once the full forward AGGA development is complete, we then transition into the protractive Controlled Arch braces to torque the roots to proper angulation, protract the premolars and molars forward into the space developed behind the cuspids, and align the teeth to a straight, beautiful smile. Once the forward development has taken place, there is plenty of space to move the teeth where they need to be, and the teeth know where they need to be, they go to their ideal space in the newly developed jaw quite easily. The Controlled Arch braces phase takes much less time than conventional braces, so you can expect the post AGGA braces phase to last anywhere from 12-18 additional months, on average, to finalize the forward face orthodontic treatment.
- What about retainers? What type of appliance is best indicated during sleep?
Once the Controlled Arch orthodontic treatment is complete, a fixed mesh wire is typically bonded to the back surface of the lower 6 teeth, and in some cases the upper 6 teeth. A physiologic sleep appliance is recommended for anyone undergoing this treatment that has TMD (temporomandibular joint disorder) and/or OSA (obstructive sleep apnea). This nighttime appliance has little to no acrylic thickness to avoid taking up tongue space and helps to stabilize the correct physiologic position of the lower jaw during sleep when one lays on their back and their muscles relax during sleep. It also acts as a “retainer” to prevent tooth movement during sleeping hours. A “nightguard” or any other type of appliance worn that impedes tongue space is contraindicated as these types of appliances have been shown to take up tongue space and do not stabilize the jaw in a physiologic position during sleep.
- Where do I start if I want to schedule a consultation for Forward Face Orthodontics with Dr. Hughes?
Your first visit in our office will be a 90 minute consultation with Dr. Tracey Hughes and her treatment coordinator. During this appointment, photos will be taken, computer EMG scans will be run to evaluate your muscle health and a T-scan computerized bite analysis will be completed. Dr. Hughes will review, in detail, the history of your concerns and symptoms and ask many questions about your ultimate goals for treatment. She will review the photos, EMGs and T-scan with you and discuss her clinical impressions for a tentative diagnosis and preliminary treatment plan options. You will leave with a rough estimate of treatment costs. The consultation fee is $250, all of which will be credited toward your treatment fee should you proceed with Jaw Development Orthodontic treatment in our office.
At the completion of this initial consultation, should you decide you would like to move forward with a definitive diagnosis and treatment plan, additional scans and testing may be required. You will likely be referred to a radiologist for a CBCT scan (approximate fee $300-400) and be sent home with a home sleep testing device to rule out any potential sleep disordered breathing issues (approximate fee $175). Dr. Hughes will review the CBCT scan and upload it to the Facial Beauty Institute for final evaluation, jaw tracings, airway assessment and treatment plan recommendations for AGGA and/or Controlled Arch Braces. (approximate fee $475)
- Will there be any additional adjunct therapies or referrals to other specialists be needed during treatment?
It is crucial to have the Big 3 in place for orthodontic treatment to be successful.
The Big 3 include:
1) Nasal Patency
2) Lip Seal (absence of mouth breathing)
3) Proper tongue position and absence of tongue habits and improper swallow.
If any of the Big 3 are compromised, you will be given additional recommendations to correct the compromises. If you have a tongue thrust or tongue tie, you may be referred to a myofunctional therapist to help retrain your tongue to be it the correct position during rest and swallowing. If a tongue tie is severe enough, you may be referred for a tongue tie release by an oral surgeon. If you have nasal patency issues, you may be referred to an ENT to evaluate your nasal sinus including turbinates and nasal septum. Often with children who snore, referral for tonsillectomy and adenoidectomy may be indicated to allow for optimal breathing and oxygenation.
Depending on your symptoms and results of your CBCT scan, it is possible you will be referred to other specialists for adjunct therapies during your treatment with Dr. Hughes. If you have facial asymmetries, you may be referred to an osteopath for adjunct cranial therapies. AGGA, in conjunction with Neurocranial Restructuring have a profound effect on releasing cranial strains and improving facial asymmetries. If your scan shows issues with your neck or posture, you may be referred to a chiropractor or physical therapist for adjustments and/or neck and posture exercises. Dr. Hughes has very good working relationships with many of the above mentioned specialists and will direct you in the right direction for optimum adjunctive care.