By the way, the picture from that FME patent I believe is from a really long time ago. Definitely not an FME-V or FME 4.5 or anything like that. You'd need to check the dates, but you can see the design of it is even earlier than the 3.5.
I think what Lipkin is saying is that the alveolar TADs provide some stability to the midline TADs, so they are less likely to tip out, because when that happens you get the AGGA effect, dental tipping, etc. With that said, alveolar TADs need to be put anteriorly because the bone there is quite thin in the back. This is why Lipkin's expansions are anterior, unlike MSE or FME.
Are alveolar TADs better? Does it make his MARPE better than FME? Well, that depends on whether or not the FME expands the maxilla DESPITE alveolar TADs. If the TADs aren't bending or tipping out, then you don't need them. If anything, alveolar TADs are a liability from a bone health standpoint. You don't WANT to be pushing on the alveolar bone and applying force there, nor do you WANT to be anchoring to the teeth and applying force there either. Essentially what you are doing with that MARPE design is you are including the patient's biological anatomy as a part of the expander. As both Ron and I are familiar with, when you apply excessive forces to the teeth, alveolar bone, etc. it can lead to bone loss, gum loss, root resorption, etc. Therefore, I would argue that the FME way of doing it is the better option ASSUMING it works without it!
Another point is that I'm sure they could stick some alveolar TADs or molar bands to an FME. They clearly don't want to do that lol.
I did a reverse image search on those FME pics that you uploaded and it looks like they’re from a 2017 patent owned by Facegenics. So, it appears that Facegenics was thinking about the oblique TADs before custom MARPE was even a thing.
Why not just a good old MSE, which is standardized and widely tested, with cortical punctures to guarantee a split, and posterior placement for maximum breathing and aesthetic benefits?
I feel like there aren't many arguments against a carefully done MSE expansion.
Main issue in my mind with MSE (Won Moon) is that for the majority of adults, especially males, it's just not going to work. That's why they came up with custom, where the TADs are all right near the front incisors and angled to the side, and the alveolar TADs, molar bands, etc. it's much easier to split if you stick the TADs all at the front and to the side. You also get an anterior expansion pattern that way, which presumably requires much less force.
In terms of putting an expander only along the midline, not the alveolar or molars, and placed posteriorly like an MSE, and presumably much higher success rate in adult males.. that's the FME. In terms of what is more similar to an MSE, custom or FME, I would say the FME.
Corticopunctures are not going to guarantee a split OR successful expansion even if they surgically split the entire maxilla. If the TADs tilt out, it still won't work.
Even though it's not widely tested , corticopunctures procedure has been successful in some 21 - 26 years old male patients.
Regarding the tads tilting, I think it only happens when the split fails, or at least every case I've seen online where it happened was due to that, or expanding too fast, but I might be wrong.
Adult males 18-21 it can definitely work, but beyond that you start to have problems, even with a corticopuncture. That's why people would pay so much for EASE.
I'm not saying this because there is some conspiracy against Won Moon MSE. Trust me.. it's not going to work for the vast majority of adult males, and even females too but especially males.
I know many, many people that got MSE and it failed. Li has even used it with his EASE and in almost every instance it doesn't work. Even if you surgically separate the entire maxilla and give it zero resistance at the MPS, there is also a lot of resistance elsewhere. You have the zygomatic bone, you have the PMS. What happens, is the expansion screw turns but the top of the TADs don't budge.
Corticopuncture is also a thing of the past.. corticotomy is much more effective, and a full separation is much more effective than that. The corticopuncture hardly even does anything.
This is the reason why providers have moved away from Won Moon MSE. Whether that's custom MARPE or FME. Trust me, there's no conspiracy against MSE. It's outdated now.
MSE type 2 does have a bit of dental anchorage, but it's the soft arms to the 1st molars. Could say minimal dental anchorage I think.
The main advantage I would say, based on seeing it in action in people's palates and them turning, this new 4.5 is way stronger than the 3.5. I don't see any bending whatsoever. So, compared to an MSE it's a huge difference.
Hi Ron, and thank you very much for your detailed and straight-forward answer!
Still, I believe most of these features aren't really needed. Except for locking screws (and protraction, for those who want to experiment).
FME can't be as posterior as MSE due to its size (the 6-tads one seems almost twice as long as a regular MSE; the 8-10 would be even longer). This alone for me is enough for MSE to outscore every other structural and logistic (planning, install guides) advantage.
By the way, the picture from that FME patent I believe is from a really long time ago. Definitely not an FME-V or FME 4.5 or anything like that. You'd need to check the dates, but you can see the design of it is even earlier than the 3.5.
I think what Lipkin is saying is that the alveolar TADs provide some stability to the midline TADs, so they are less likely to tip out, because when that happens you get the AGGA effect, dental tipping, etc. With that said, alveolar TADs need to be put anteriorly because the bone there is quite thin in the back. This is why Lipkin's expansions are anterior, unlike MSE or FME.
Are alveolar TADs better? Does it make his MARPE better than FME? Well, that depends on whether or not the FME expands the maxilla DESPITE alveolar TADs. If the TADs aren't bending or tipping out, then you don't need them. If anything, alveolar TADs are a liability from a bone health standpoint. You don't WANT to be pushing on the alveolar bone and applying force there, nor do you WANT to be anchoring to the teeth and applying force there either. Essentially what you are doing with that MARPE design is you are including the patient's biological anatomy as a part of the expander. As both Ron and I are familiar with, when you apply excessive forces to the teeth, alveolar bone, etc. it can lead to bone loss, gum loss, root resorption, etc. Therefore, I would argue that the FME way of doing it is the better option ASSUMING it works without it!
Another point is that I'm sure they could stick some alveolar TADs or molar bands to an FME. They clearly don't want to do that lol.
Hi Shuikai, thanks as always. I updated the article to show ACTUAL images of FME 4.5, which are the first ever to be published (thanks to Dr. Newaz).
Going to send you a photo of a 4.5 that someone has in their palate atm. Looks a bit different from what you're showing actually.
I did a reverse image search on those FME pics that you uploaded and it looks like they’re from a 2017 patent owned by Facegenics. So, it appears that Facegenics was thinking about the oblique TADs before custom MARPE was even a thing.
Good catch and thanks for the feedback. Check out the updated images above, now showing the first ever published photos of FME 4.5.
Also interesting to note then that Facegenics thought about angled TADs back in 2017, which is way before Lipkin's MARPE.
Why not just a good old MSE, which is standardized and widely tested, with cortical punctures to guarantee a split, and posterior placement for maximum breathing and aesthetic benefits?
I feel like there aren't many arguments against a carefully done MSE expansion.
Main issue in my mind with MSE (Won Moon) is that for the majority of adults, especially males, it's just not going to work. That's why they came up with custom, where the TADs are all right near the front incisors and angled to the side, and the alveolar TADs, molar bands, etc. it's much easier to split if you stick the TADs all at the front and to the side. You also get an anterior expansion pattern that way, which presumably requires much less force.
In terms of putting an expander only along the midline, not the alveolar or molars, and placed posteriorly like an MSE, and presumably much higher success rate in adult males.. that's the FME. In terms of what is more similar to an MSE, custom or FME, I would say the FME.
That's exactly why I mentioned posterior placement and cortical punctures
Corticopunctures are not going to guarantee a split OR successful expansion even if they surgically split the entire maxilla. If the TADs tilt out, it still won't work.
Even though it's not widely tested , corticopunctures procedure has been successful in some 21 - 26 years old male patients.
Regarding the tads tilting, I think it only happens when the split fails, or at least every case I've seen online where it happened was due to that, or expanding too fast, but I might be wrong.
Adult males 18-21 it can definitely work, but beyond that you start to have problems, even with a corticopuncture. That's why people would pay so much for EASE.
Also another note is that the FME is probably put more posterior than MSE, based on the CBCTs I've seen. There's nothing more posterior than the FME.
I'm not saying this because there is some conspiracy against Won Moon MSE. Trust me.. it's not going to work for the vast majority of adult males, and even females too but especially males.
I know many, many people that got MSE and it failed. Li has even used it with his EASE and in almost every instance it doesn't work. Even if you surgically separate the entire maxilla and give it zero resistance at the MPS, there is also a lot of resistance elsewhere. You have the zygomatic bone, you have the PMS. What happens, is the expansion screw turns but the top of the TADs don't budge.
Corticopuncture is also a thing of the past.. corticotomy is much more effective, and a full separation is much more effective than that. The corticopuncture hardly even does anything.
This is the reason why providers have moved away from Won Moon MSE. Whether that's custom MARPE or FME. Trust me, there's no conspiracy against MSE. It's outdated now.
The other resistances would be easily overcome by turning very slowly in theory (which nobody does so we don't have empirical evidence).
I would love to see some of these failed cases , but I can guarantee they all failed to split and/or turned too fast
What MSE Type 2 shares with FME: guide rods, posterior bias, no dental anchorage. These are all good things!
What MSE 2 does NOT have: 1) ability to have OEM 6, 8, or 10 TADs, 2) oblique TADs 3) locking TADs, 4) 2 piece construction, 5) OEM cephalometrics (for symmetry) 6) surgical install guide, 7) direct attach OEM facemask, 8) rounded edges (and no exposed TAD heads)
That's 8 arguments in favor of FME over MSE Type 2!
MSE type 2 does have a bit of dental anchorage, but it's the soft arms to the 1st molars. Could say minimal dental anchorage I think.
The main advantage I would say, based on seeing it in action in people's palates and them turning, this new 4.5 is way stronger than the 3.5. I don't see any bending whatsoever. So, compared to an MSE it's a huge difference.
Hi Ron, and thank you very much for your detailed and straight-forward answer!
Still, I believe most of these features aren't really needed. Except for locking screws (and protraction, for those who want to experiment).
FME can't be as posterior as MSE due to its size (the 6-tads one seems almost twice as long as a regular MSE; the 8-10 would be even longer). This alone for me is enough for MSE to outscore every other structural and logistic (planning, install guides) advantage.