Video: Is AGGA dangerous? My thoughts on tooth instability and bone loss

Ramblings on the risks of AGGA, from my personal perspective. Also, yes, not only did I not manage to make this video five minutes, as intended, but the second take was actually LONGER than the first. Video: 1 Alyssa: 0

Below are the blog posts I mentioned in the video that touch more on this topic. And to add – since I published this video a week or so ago, Ronny Ead reached out to me privately with further warnings about the dangers of AGGA. He had a negative experience towards the end, and knows several more people who have had even worse experiences (i.e. losing their front teeth with no chance of implants).

So let this just be a reminder to anyone reading this that AGGA/CAB isn’t something that should be undertaken lightly or without just cause, and I would encourage anyone considering this treatment to check out the videos/posts Ronny has published on the topic for a different perspective. It’s always good to keep in mind that the entities who financially benefit from a treatment may not always be totally unbiased and objective when evaluating the risks.

Palate Expansion Update: Concerning CBCT Scan Results

Why I Decided to Try AGGA (plus some lingering concerns)

Everything You Need to Know about AGGA (but not really because I need to update this page…)

4 Thoughts on “Video: Is AGGA dangerous? My thoughts on tooth instability and bone loss

  1. Doug on July 1, 2020 at 5:23 pm said:

    Hi Alyssa!

    I am also not a concise writer or talker, so I will probably go about as far over on this post as you didn’t want to with your video. But to be fair, these procedures are really out there on the edge of medical/dental capabilities, so I think more discussion is good. Don’t ever feel bad about your 5 minute videos that stretch into 12.

    So first off – disclaimer, I have no medical or dental background. I’m just someone like you, trying to get a problem fixed.

    As far as the pain you are feeling, that is (as I understand it) the normal inflammatory response process of orthodontics. That’s what causes the bone resorption on one side, and (in theory) remodeling on the other side – via inflammation. There are other devices that claim they accomplish movement without traditional orthodontic inflammation, but the science is all still far too new on this.

    In terms of Ronald’s case – well, he’s an interesting one. And to be 100% fair and transparent, I will have to say that I had a lot of concerns with AGGA too … even before I saw Ronald’s case. And Ronald and I are both in the same Facebook group for some of these treatments, so he and I have exchanged messages in the past (and I’ve posted comments on some of his YouTube videos) so I’m not really saying anything that hasn’t been discussed elsewhere. And he might even see this comment, and choose to respond – and that’s all fine … because like I said, discussion is so critical for those of us going through procedures that do not have long established histories. Effectively being a “pioneer” in this space … is anything but fun.

    So let me give you my thoughts on Ronald’s case, and it is a very unfortunate outcome.

    First things first, prior to doing AGGA – Ronald tried an acrylic appliance based strategy for expansion. I’m not sure on the reasons why he stopped that or which appliance he was using, but I think it might be safe to assume that he achieved at least a couple millimeters of expansion off of that.

    Did he tell his AGGA provider that he had already expanded a bit? Who knows. Perhaps he didn’t.

    If you’ve spent any time reviewing Ronald’s history, you’ll see that he’s just a little bit obsessed with getting a lot of expansion. I don’t know why this is, but it’s clear in his videos that he wanted to go big. Now, if AGGA could do maybe 10mm … but he already gained 2 or 3mm from his previous protocol … did that put his provider in the unfortunate position where they would actually be pushing Ronald past his genetic potential? Again, who knows – it’s hard to be sure.

    I had not heard before that he stopped treatment “halfway” through. I know he didn’t complete it, but I thought he was most of the way through the AGGA part. But he did post a good detailed analysis of his before-and-after CBCTs and you can see that yes … his upper front six were not sitting in bone in the front, and now he’s looking at tunnel grafts, SFOT, etc. to try to re-stabilize his teeth. I hope those procedures go well for him – I am keeping an eye on his updates there just so that I can know what protocols might be available if something goes wrong once I start down this path in a couple of months.

    In that video where he posts his CBCT, one of the commenters made a very good point (which I chimed in on) that if AGGA was simply pushing teeth and there was ZERO remodeling happening, then the teeth would have been out of the bone within a month or two, because there’s really only just a couple millimeters of alveolar bone in front of any tooth. If the bone wasn’t remodeling at all and the tooth was just moving forward, he would have had tooth failure in just a couple months. So given how long Ronald was in AGGA, it seems like he did get some remodeling and expansion.

    But did he push it too far, too fast? Once again – who knows. It could be that if he had targeted 5-6mm of expansion (instead of what I assume he was aiming for – more like 10mm) maybe he’d be fine now.

    It is also worth noting that it is believed that Ronald’s AGGA provider is not actually a member of the LVI or FBI or whatever the institute’s name is. I have not checked into this personally, but there is that to consider as well.

    And then, after noticing that he had a bone issue when he saw his CBCT – what did he do next, consult a specialist that could potentially fix the issue? Nope, he went right into MSE (and facemask, I think).

    So Ronald is a bit of an interesting case. But nevertheless, it is one that people should be familiar with. There are other cases which seem to have gone along just fine – have a look at Dental Dork on YouTube, her process so far seems to have been rather uneventful (as I assume many – if not most – AGGA procedures probably are).

    Having said all of that (phew!) one of my biggest gripes in this little niche of dentistry/orthodontistry … is that there doesn’t seem to be a strong inclination towards periodic safety check procedures. I mean, I don’t know what’s a safe amount of X-Rays for the body … but I would think that if it’s not associated with any significantly increased health risks … then doing something like a new CBCT every 3-4 months to check for safety concerns would be a HUGE help to all of the providers and all of these new procedures. But It just doesn’t seem to happen all that often. I think I’ve spoken to one other patient (in a different protocol) who said her provider does a new CBCT every six months.

    So unfortunately, it falls on us – the patients, in this wild-west segment of the market – to be our own best advocates for safety. If you’re working with a provider, ask to see before-and-after CBCTs. Have them show you that patients have alveolar bone in front when the procedure is done. Have them show you that the teeth are not tilting/flaring, that they are mostly keeping the same angle. Have them show you that patients are not getting root resorption. Whether a provider will spend time with a patient and show them all of that, I think varies widely from one provider to the next … and it’s just so frustrating.

    Thanks again for all your videos. Come find us in our Facebook group “Adult non-surgical palate expansion ALF/AGGA/ControlledArch Ortho/Vivos/MSE” – 750 members strong and growing!

    • Hey Doug,

      Well thank you! I’ll take justification for my long-winded videos/posts any day 🙂 And I totally agree – more discussion is better!

      Really appreciate the additional context on Ronald’s case and the conversations you’ve had with him. As far as stopping halfway through – I believe he fully finished the AGGA portion, but then stopped after only a short time in CAB. He reached out to me privately after seeing this video to express concern that I’m not taking the risks seriously enough, and cautioning me against staying in CAB, which I really appreciated. It’s clear he just wants to keep others from experiencing his same fate! One piece of clarification I got from him that was helpful was the risks of CAB specifically. In my head, AGGA was the “dangerous” part, since that’s where the expansion is happening; now that I’ve made it to CAB with my front teeth intact, I assumed it would be more or less smooth sailing. But Ronald pointed out that using those front teeth as anchors puts additional stress on them, even though it’s in the opposite direction, and there’s also a torquing force (which makes sense when you think about it).

      With that in mind, I feel even more confident in my decision to do implants, rather than pulling all the molars fully forward to fill the gaps. This will at least keep the anchoring forces as minimal as possible. I also plan to discuss risk management/safety checks with my dentist next time I go in, because like you said – this really should be a routine part of treatment, and it’s disconcerting that it isn’t.

      I believe I’m already part of that Facebook group, as a matter of fact, but I haven’t been active on there! Perhaps I need to pay it another visit. Thanks again for this comment and sharing your thoughts, and I look forward to keeping these discussions going as we all learn more!!

  2. Doug on July 7, 2020 at 5:24 pm said:

    Interesting. I would have thought the same – that the AGGA part is what was considered most dangerous, since you’re pushing forward.

    I did see another data point that Ronald had gotten just over 9mm of expansion on one side. That definitely seems to be approaching the outer ranges of what any of these protocols aim for. It just makes me wonder if he still had a little bit of expansion left over from his acrylic … and the two combined were just too much for his body’s genetic blueprint.

    To the point that you raise, “using those front teeth as anchors puts additional stress on them, even though it’s in the opposite direction” … it makes me ponder whether or not that would potentially help address any “pushed teeth out of alveolar bone” situations in the front, if you were then pulling them backwards a bit? If Ronald had stuck through CAB, would he have ended up better off? Even movement of just 1mm backward … would that get them mostly re-seated in the bone?

    I think the implants are a wise choice. And certainly, having those in-place will help with lifetime retention of your gains!

    Looking forward to your next update!

    • It’s so hard to say! From what I can tell, most of the discussion on what’s really happening with AGGA expansion is largely speculation, although I must admit I’m not tuned in enough to the LVI community to know what information/research I might be missing.

      For reference, I got 10mm expansion on both sides with AGGA, and also had a bit of leftover expansion from an acrylic appliance. But, I was also quite a bit more recessed to begin with than Ronald was. Either way, I’ll be an interesting data point once my treatment is concluded!


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