AGGA Appliance vs DNA? What appliance is better?
The DNA is a better appliance and is more versatile because it promotes growth of the jaws and facial bones forward, wider and taller. In technical terms the DNA increases the vertical dimension of occlusion and promotes growth sagitally and transversely. The AGGA promotes forward growth only. It is really that simple. With airway, TMJ and bite balance treatment, the goal is to increase the volume of the mouth and create more room for the tongue and night time breathing. The tongue is a large U-shaped whale. Growing the jaws only forward will not create much needed lateral width for the tongue to fit in the front part of the mouth. Height of the jaws and airway is important for obvious reasons as well. Additionally the DNA appliance is easier for the dentist to adjust and for the patient to tolerate. The DNA also requires fewer adjustments by the dentist and less frequent trips to the dentist. Finally, the AGGA device almost always requires orthodontic treatment such as braces afterwards to get the teeth in proper alignment.
What Appliance is Best for Airway Growth and Tongue Space?
AGGA, DNA, ALF, Homeoblock, Bioblock appliances. The fact that we are having this conversation is a breath of fresh air. 5 years ago, I could hardly buy a believer or follower. The most common question I get now is “is the AGGA better than the DNA?”
DNA Appliance is a versatile appliance that can:
- palatal expander
- maxillary anterior growth appliance
- occlusal splint – this creates a better more balanced and forward bite position (ideal for TMJ pain relief and lower jaw repositioning) The splint component of this appliance also allows the dentist better control of the vertical dimension of occlusion. Also called the bite plane, is the key to forward growth of the lower jaw when the mandible is retrognathic.
- functional orthodontic appliance or in-other-words it can be used to correct a retrognathic or reversed lower jaw position by promoting forward repositioning of the lower jaw. Again this correction would not be possible without the bite plane or the acrylic over the back teeth.
The DNA is a removable appliance that is worn mostly at night and 10-12 hours per day. It is easy for a dentist with experience to adjust. And typically in the usual course of treatment the patient will need to be seen by the dentist 6-10 times during the course of treatment. Most treatment courses will last 9-18 months and appointments can be spread-out every 2-3 months. Generally, the older the patient and the smaller the facial bones, the longer the therapy will last regardless of the appliance being used.
The AGGA Appliance or “anterior growth guidance appliance.”
The anterior growth guidance appliance does just what it says. It literally grows the upper maxillary jaw forward. And it does a fantastic job at that. In fact such a good job that if time and money and patient compliance were not a factor, I would put everyone into one of these prior to doing the Vivoslife DNA appliance. The only problem is treatment times and costs would be 2-3x greater.
The AGGA is a fixed appliance. Usually removable appliances are easier for adults to tolerate. Adults with busy lives who do not want unsightly metal showing in their smile zones. Additionally, the appliance takes up space in the mouth and interferes with speech or at least will cause the average person to lisp and pronounce sounds differently. The anterior growth appliance will remain in the mouth during eating. It is more difficult to clean and can lead to more dental problems such as cavities and gum problems.
Under development of the jaws is usually not in one direction. People with small jaws are usually not tall enough, wide enough or forward enough in the mouth and nasal passageways. In dentistry, we call height vertical dimension of occlusion or VDO. Width is called transverse growth and forward growth is termed sagittal. It is very difficult to control forward growth of the mandible without a bite plane or plastic covering the back teeth. This allows the dentist to control how the jaws close relative to one another. In short, the strategy to get forward growth is to have the patient bite in a more forward position. Otherwise how is the lower jaw going to move forward? The upper jaw is grown forward by the AGGA. But
The AGGA appliance may be the ideal appliance for people who have had upper adult teeth pulled to address tooth crowding.
Most dentists know it is better to create more room in a growing child, so all the teeth will fit. And there needs to be proper space in the mouth and nasal passageways for tongue function and breathing.
If growth and development in the oral facial spaces is managed optimally during the ages of 3-16, the incidence of TMJ, sleep apnea and UARs would be much less.
The 6 keys to treatment and prevention in children are:
- recognize under development of the face and jaws
- Look for crowded teeth
- poor nasal breathing and stuffiness
- night time teeth clenching
- poor sleep
- bed wetting
ALF and Schwarz and Twin Block Appliances are the best growth appliances for kids
Actually, I lied the DNA appliance is the best one. Seriously, but it is too expensive and the other appliances will work just fine. The DNA appliance has the unique ability to grow bone in adults. Whereas the results with the above appliances will be great with kids. The DNA is a Schwarz appliance with a special proprietary spring system. That is what makes it special and causes it to work so well in adults.
Diagnosing and Removing Tongue Tie in Kids is very important
Tongue tie is an extra attachment between the tongue and lower jaw. The “tie” prevents the tongue from having proper range of motion. It also causes the tongue to taper and have a deformed and smaller shape during outward movement.
The Tongue is responsible for promoting much of facial growth in Children
When the tongue is tied, the result is very poor jaw and facial development. The #1 most important thing for a growing child’s face is proper tongue function. Crowded teeth, and a reverse lower jaw position means there are already problems. Releasing a tongue tie is an easy procedure that can be done in 30 seconds by a dentist with the proper training and a diode laser. There is no bleeding and minimal pain. After a tongue tie procedure, it is important to perform tongue exercises to train the tongue to move properly. For example the tongue should be able to reach the roof of the mouth. Look up “Mewing.” An exercise and concept created by Dr. Mew.
There are many different expanders and anterior growth appliances for kids. The Schwarz, Twin Block and Crozat to name a few.
Lip Ties are less important but may need to be released as well.
My favorite treatment regimen for kids is
- removing tongue ties (frenectomies)
- growth therapy with an appropriate growth appliance such as the ALF, Schwarz, or other appliance.