Frequently Asked Questions

Growth Appliance (AGGA) FAQs

How does AGGA work?

In a sense, AGGA is a kind of palatal expander. But AGGA is much different than other types of traditional palatal expanders which have been around for a long time.

In most cases, those expanders work by applying mechanical force to the teeth and attempting to “push” the jaws wider. This approach is outdated and even in the hands of careful dentists is capable of achieving only negligible amounts of growth. Furthermore, this type of development tends to be unstable and physiologically unfriendly.

AGGA does not push teeth. In fact, you can barely feel it (I am an AGGA patient myself, so I know).

What AGGA does is stimulate a very particular spot on the upper palate which triggers the
body’s own built-in bone-building response.

In particular, AGGA presses gently atop a nerve located in the incisive foramen on the roof of the mouth, and by doing so sets in motion a rapid bone-depositing effort throughout the entire craniofacial region.

How is AGGA different from other palatal expanders?

As mentioned above, AGGA operates by means of an entirely different mechanism than traditional palatal expanders: it takes advantage of an innate physiological process rather than using brute mechanical force.

But what really makes AGGA different is its effect. AGGA is capable of achieving dramatic amounts of forward maxillary growth, whereas traditional acrylic expanders tend only to be able to achieve mostly side-to-side expansion, or “width,” and only minimal forward development.

And it is forward growth that most patients need. It is forward growth that is going to uncollapse the airway.

In my practice I have had patients achieve as much as 15mm of forward maxillary growth, this occurring in about one year’s time. I have developed myself forward 12mm in a matter of twelve months.

What are the stages of AGGA treatment? How long will it take?

There are 2 stages of treatment, each lasting about a year.

Phase 1:

The Growth Phase – for up to a year you will wear AGGA, visiting me once a month to have the appliance adjusted. It is during this first phase that the bulk of forward facial growth occurs.

During this stage you will develop a sizable gap between your canines and premolars on each side of your upper jaw, providing visual evidence of the rapid forward advancement of your maxilla. These are the famous “AGGA gaps.”

At the beginning of Phase 1 when I install AGGA, I will also adhere bite plates onto your lower molars. These are flat acrylic buildups that transform those molars into flat, neutral biting surfaces. These flat surfaces allow your lower jaw (mandible) to slide itself constantly into new, more-forward positions in synchrony with your forward-growing maxilla. While the upper jaw develops forward, the lower jaw remodels itself forward.

This forward-repositioning of the lower jaw, made possible by the forward expansion of your upper jaw, is a critical step in decompressing the airway and your jaw joints, which is the ultimate goal of treatment.

Phase 2:

The “Controlled Arch” Braces Phase – Once sufficient growth and remodeling of the upper and lower jaws has been achieved, we will tidy up the teeth with braces. This finishing phase allows further development of the dental arches while guiding all teeth to their proper positions.

In particular, we will need to bring the back teeth forward to occupy the new frontal real estate created by AGGA in your upper jaw. You will have the option to place implants in the spaces normally occupied by your second premolars as an alternative to bringing the molars all the way forward. This, however, is not necessary, especially for those patients who never had premolars pulled as part of a prior orthodontic procedure.

Those who have had the misfortune of having some permanent teeth removed (or are missing teeth for another reason) might choose to replace those teeth with implants. Patients who opt for implants will be referred to an implant specialist.

There is a second goal of the Controlled Arch braces phase of treatment: widening of the arches. While AGGA achieves a dramatic amount of forward growth, it is during the Controlled Arch phase that special metal arches are installed along the gums behind the upper and lower teeth. These arches provide a widening stimulus which works in harmony with the stimulus of the braces.

Together, AGGA and the Controlled Arches provide forward and sideways growth.

How do I know if I’m a candidate for AGGA?

You will need to come in for a consultation at which time I will perform a physical examination and imaging that will reveal, among other things, the size of your airway.

How will AGGA affect the way I look?

Anyone who is a candidate for AGGA will almost certainly experience cosmetic enhancement with this treatment.

While it is not possible to predict what changes exactly will take place, it is safe to say that you will still look like you but healthier. And in the end, you will have perfectly straight teeth.

It is true that form follows function and vice versa. With AGGA you will not only become healthier but more physically beautiful too.

Do you suggest any treatments to be pursued alongside AGGA?

The results of AGGA treatment can be enhanced and accelerated if an effort is made to develop proper oral and tongue habits while the appliance is being worn (see The Big Three above).

After all, it was poor oral habits that may have resulted in abnormal facial growth in the first place, and it will take fixing those habits to accelerate, fortify and preserve any results achieved with AGGA.

To this end, I recommend that patients pursue formal orofacial myofunctional training with a certified myofunctional therapist.

Myofunctional exercises must be done only under the supervision of a professional myofunctional therapist. Do NOT take myofunctional advice from online videos and forums. Every patient has unique needs and a tailored approach is recommended.

What about tongue tie release?

During your consultation, I will determine whether or not you are a candidate for tongue tie release (frenectomy). If you are tongue-tied, then releasing that tie will be a necessary and beneficial component of treatment.

Proper function and range of motion of the tongue are essential to long-term development and maintenance of the facial structure. Many (but not all) patients experience a substantial reduction in symptoms immediately following frenectomy.

Timing of frenectomy is determined during the initial consultation.

Should I expect any pain or discomfort during treatment?

Oral appliances are always a bit of a nuisance. Thankfully, both AGGA and Controlled Arch braces are relatively minimalistic compared to other appliances.

Your first few days with AGGA will be awkward as your tongue and lips become acquainted with their new roommates. You may talk a bit funny, especially for the first week. After that, you will develop new muscle memories and will have very little trouble eating and talking with the appliance.

It’s possible that your speech will be slightly altered for the duration of your treatment, but for many patients, this is not the case at all.

Will I be able to eat and drink anything I want?

You’ll want to avoid eating hard and sharp foods so that you don’t break your appliance. For example, one of the places AGGA will be bonded is behind your front teeth, so you will want to avoid biting into whole, crisp apples so as not to break that bond.

Tough but soft foods like leafy greens and meat will not be a problem. Sticky, hard and crunchy foods will be.

How do I brush and floss with AGGA?

Just like other oral appliances, a bit of extra care is needed to manage oral hygiene while wearing AGGA.

It will be impossible to floss some teeth due to interference with the appliance, so you’ll want to find an alternative way to floss, such as with a Waterpik. Also, finding the right toothpicks that fit well between your teeth can be great for maintaining hygiene while away from home.

One of my patients has done a video on brushing and flossing with AGGA which you may find helpful.

How does AGGA compare with ALF and DNA?

Although growth appliances like ALF and DNA are better options than archaic, dangerous acrylic expanders, they cannot achieve nearly the amount of forward growth that AGGA can achieve.

They are significantly slower than AGGA and there is no guarantee that substantial forward growth will ever be achieved with them. This is especially true for adults.

What’s the next step?

Please email or call at (203) 487–6020 about scheduling your consultation.

Changing lives with these growth appliances is the most satisfying work I do. I look forward to serving you in whatever way I can.

Are Skype consults available?

Although legally I am unable to provide dental consultation outside the states of Connecticut and New York, I am happy to discuss general information about AGGA via Skype or any other video chatting platform that you prefer.