UK → US Jaw Expansion Guide

Jaw Expansion

It's hard to find an orthodontist in the UK who understands orthotropic principles (as described and advocated by Dr Mike Mew) and will provide expansion treatment accordingly.

In my own case I've made enquiries with 3 providers in the US, 2 in the UK, 2 in Europe, one in Australia and one in India. In the end my research efforts landed on the US as the only viable option.

This guide covers the whole process of getting treatment, from overall logistics to specific, up-to-date detailed advice. Many hours of research, planning, consulting with different providers, and the experience from 3 successful trips are condensed into an organised and easy to reference form.

It includes:

• My providers (orthodontist and oral-maxillofacial surgeon).
• 8 other potential providers in the US and 2 not in the US.
• One provider that I don't recommend and one who doesn't treat international patients (for information).
• My complete case history, assessment, treatment plan and timeline, with pictures.
• A full breakdown of all costs including treatment, 3 trips to the US so far, and projected costs.
• Details of my surgical assist with local anaesthetic only.
• Medical insurance providers.
• Specific notes and tips for getting to my providers and where to stay, if you decide to go with them.
• General tips, checklists, and information on:
  • medical travel insurance (not the same as "travelling with an existing medical condition");
  • scheduling flights (how much time to allow before appointments), car rental, and accommodation;
  • recovery, eating, and cleaning your expander.
• Updates as I find more information, and at treatment milestones.

Where I'm At

• I completed the turning phase of lateral expansion with a custom MARPE + surgical assist in January 2024. Along with this I've been expanding the lower jaw with a tooth-borne expander.
• I was originally planned to do Invisalign on the upper in parallel with expansion to avoid a diastema; I found doing it all at once to be a bit much and my orthodontist was happy to let me postpone Invisalign until after the turning phase. I've started it as of my last visit in January.
• My orthodontist also fitted a wire to attempt to upright an impacted third molar, which isn't often attempted. I was reluctant to have my third molars removed as part of treatment, as I want to keep as many healthy teeth as I can, and both my orthodontist and surgeon agreed to keeping them in.
• I'm planning to see my oral surgeon for MMA surgery to achieve forward growth and counter-clockwise rotation once lateral expansion is stabilised and my teeth are in position.

Case History

I had four healthy premolars extracted aged around 10, in order to "make room for wisdom teeth". The gaps were allowed to close naturally. My bite was reasonably comfortable and functional, but over the years I noticed several persistent symptoms and eventually connected them to jaw underdevelopment:

• Snoring and occasional sleep apnea.
• Psoas (hip flexor) tension which I perceived at various times as functional or actual leg length discrepancy.
• Tinnitus.
• Sudden episodes of vertigo or feeling like I’m on a ship that’s just rolled in heavy seas.
• Forward head posture.
• Tooth damage from grinding and traumatic occlusion.
• Mild TMJ disorder.
• Back, neck & shoulder issues.
• Aesthetics--small, set-back jaws, large buccal corridors, long, narrow face, dark circles under eyes, etc.

I saw at least 5 different UK dentists and orthodontists over the years and all of them claimed that my bite was basically OK, and that any improvements that could be made were not worth pursuing. Assessments from two different growth-focused US orthodontists in 2023 confirmed that all these issues were caused by jaw underdevelopment, and my oral surgeon recommends a full 13mm of advancement to address sleep apnea caused by lack of tongue space.