EASE Breakdown, Custom MARPE & FME Controversy & More - Kasey Li | JawCast #56
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- Опубликовано: 12 июн 2024
- Kasey Li is an oral surgeon well known for his EASE procedure, which is the only treatment to do a thorough surgical split beforehand and subsequently achieve parallel expansion from anterior to posterior palate. In this JawCast, he shares a vast amount of knowledge on a multitude of Jaw related topics, including an EASE breakdown backed by evidence & cases, Custom MARPE controversy, his thoughts on FME, Assymetry, Sleep Apnea, how Jaw Surgery & 3 Peice Lefort affects Nasal Breathing, Custom plates, Protraction, his conservative treatment approach, Tooth-borne expanders, and much more.
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TIMESTAMPS
00:00:00 Intro
00:02:21 Official Start
00:03:51 Dr. Kasey Li's First EASE Patient Was His Son
00:05:14 Diastema Is Usually Less Than 3mm W/ EASE
00:07:50 Kasey Li's Opinion on Toothborne Expanders
00:10:53 Kasey Li Is Not an Orthodontist
00:14:01 The Toothborne Appliance Bone Growth Fallacy in Ron's Ebook
00:18:26 EASE Common Questions Answered - Powerpoint
00:20:12 6 Consecutive, Most Recent EASE Cases - Analyzing Quality of EASE Expansion, Swelling, etc. No Cherrypicking
00:31:17 EASE Splits from ANS to PNS
00:38:17 68yro Patient Gets EASE and Is Okay W/ Avoiding Surgery and Doing CPAP
00:41:54 Kasey Li Doesn't Aim for an Arbitrary Intermolar Width on Everyone
00:45:12 1mm Expansion Is a Significant Amount W/ EASE
00:48:11 Sleep Studies Before & After EASE - Patients Can Reduce CPAP Pressure After Expansion
00:56:36 Lack of MSE/Custom Marpe Data
00:59:27 What Is SARPE?
01:07:15 EASE Procedure Breakdown
01:18:09 PIEZO Cut is Shallower & Made Blindly While Kasey Li Can Cut All the Way Through to the Nasal Floor.
01:27:01 Screws Perpendicular to Bone in MARPE vs Parallel with Bone in EASE
01:30:41 Managing Asymmetries
01:39:25 Sinus Surgery Before EASE?
01:52:55 Kasey Li Reacts to Paul Coceancig Saying Expanding Nose Doesn't Do Anything
02:05:25 Shuikai's Alternative Segmental Lefort Question & Why EASE Is Better Than Segmental 3 Piece Expansion for Nasal Breathing
02:13:57 It's Never a 1:1 Expansion Ratio from Palate to Upper Midface
02:20:18 Does Kasey Li Do Pterygomaxillary Release for EASE?
02:22:13 Kasey Li Thinks FME Will Have More Failures Than MSE
02:29:04 FME Won't Fundamentally Change How Expansion Works
02:35:29 How to Decide If Patient Should Go Straight to MMA or Do EASE First?
02:42:31 Kasey Li Doesn't Believe in Huge Advancements Because Sleep Apnea Is More Than Just the Anatomy
02:47:29 Kasey Li's Patient Coming Back 14 Years Later After MMA Wondering If He Could Get EASE
02:53:22 Kasey Li's thoughts on Protraction & Bollard Plates
02:57:21 Does Kasey Li Use MSDO?
03:10:25 Does MSDO Improve the Airway by Pulling Lower Jaw Tissues More Taut?
03:16:42 Would Kasey Li Even Bother Turning this Custom Marpe?
03:25:34 Surgeon in Germany Calling Her Procedure EASE
03:28:10 Downsides of Custom Plates & The Experience Level of a Jaw Surgeon 
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We asked and he delivered. Next get Lebron on the show.
THAnk you for speaking the truth, I am an orthodontist who has been doing tissue and bone borne expansion for over 25 years. I taught at U Penn for over 20 years and we studied and treated alot of these patients. So blessed to have trained some of the best orthodontist in the world who are experts in treating patients with expansion. Keep up the good work
Can you please help explain what happened to me? I wore my invisalign in reverse (I only got to the second aligner. I did it cheap overseas and regretted it). I wore an aligner as a retainer for 6 months part time, then wore my old retainer of my pre-treatment bite to fully reverse treatment. Now I have very little tongue space and my smile is really narrow. I'm assuming the alveolar bone changes weren't possible to reverse but my teeth adapted to the old retainer- so the alignment is similar but I didn't reverse the retraction?
can you name a few orthodontists that you recommend? I had a naso-maxillary expansion and my orthodontist put me in Invisalign and I had full body pains from it!! who can I go to that won't cause this much pain!?
I want to thank Dr. Kasey Li for speaking the truth, regardless of the consequences.
Indeed.
Thanks Ron for posting the whole interview. Thanks Dr. Li for sharing your wisdom, opinion, and experience.
My pleasure.
Holy smoke, 3h of Kasey Li stream of consciousness!!
Indeed!
Ron. I highly recommend you look into Christian Guilleminault, he was the Lewis and Clark of sleep apnea and airway restriction. Dr. Soroush Zaghi is the medical director of the Breathe institute and he has INCREDIBLE amounts of airway health and knowledge directly from CG.
Ok. I am at the 3hr 20 something minute mark......Dr. Li is definitely sounding like the most experienced, forward thinking surgeon.....to date.....who is trying to develop the most effective, least invasive outcome for maxillary expansion and other surgeries....he is trying to work with the natural anatomy so to speak. Thankyou for your tennacity and patience and thoroughness with your research and what you keep presenting.xx
I'm grateful to Ron for asking amazing questions. Dr. Li, not so much, he's inaccessible.
“Ron I’m starting to like you”
Ron:😊
Just had my EASE Procedure last week and I have NO REGRETS. Dr. Li is the GOAT. After working with him, you can consider me his biggest fan. I could immediately breathe better and while I had some slight complications, there is no one else I would go with in hindsight.
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54:40 I feel like he’s not allowed to say but most doctors get a fat paycheque from it so they won’t tell you somethings not that effective. I think that’s what he wanted to say
So EASE is the best way currently to improve nasal volume and nose breathing.
But, isn't Dr Li the only person offering the treatment ? I read on reddit that it costs like $30K !
@@nouyed no dr. coppelson in la does it.
@@teethree141no coppleson does MIND. But mind and ease are the best expansion methods
In Dr. Li's opinion, yes. How many are providing his technique, though? Why isn't it more widely available?
As always Ron, thanks for your wonderful research and sharing it with us.
So what i like about Dr. Li is that he recognizes that each case is 'unique'. He loves his work......this says it all. xx
Wow!!! Ron, amazing interview with Dr. Li. This video is a wealth of information. Thank you for continuing these talks that are so needed in this space with so many great providers. 🔥🌟🔥🌟🔥🌟 Jen Mason
Thank you!
I'm Korean and I'm listening to the Google Caption feature and there are so many mistranslations. Can you please provide the correct English captions?
I love the truth of your channel......keep up the great work. Thanks for bringing Dr. Li onto your channel. xx
Thank you for the kind feedback.
Hi Ron - Does EASE help with maxilla cant? I didn’t hear this being covered.
fascinating, truly
Can you get neuromuscular dentistry who uses splint and stuff with MSE to interview? ❤
Jawhacks I just wanna say you have increased my knowledge a lot and help me to properly mew. I’m 15 and I have been mewing for 2 months now I’m gonna be 16 in 3 months is it possible to fix what my braces did to me I used to have a protruding chin and good forward growth I haven’t got any extractions
I am curious as to why Dr. Li is not interested in sharing the EASE procedure with other surgeons........this is the question i asked him.....being that i am from Australia....i would love to have been able to have the operation in my own country..
Did you watch the video? He answers that in detail..
At what time point in the video did he explain in detail why he is not prepared to train other surgeons? Thankyou.@@dinobambino21
He has responded to that in another interview. He thinks it's a difficult surgery and that if he comes across a surgeon he thinks he can trust, he can teach it to them. I don't think that's a very convincing reason of not teaching the procedure though. He can't be the only person in the world who can do the cuts he does.
Thankyou Ron and thankyou Dr. Li.........Happy New Year 2024. xx
Ron big fan of your content I was wondering if I could book a call with you. About the Orthognathic industry. I couldn’t book one on your website.
oh man that was a chuncky one. I appreciate you for posting the full thing in go (i wonder if the vid would perform better if it was broken into parts as mentioned in the video itself)
I wish I had the funds to go with Dr. Li. As I don't believe the Canadian/ontario options will get me "what I'm looking for" in terms of MMA due to surgeons available .
Glad you enjoyed the interview!
Ron, At 28:50 you claim to see a faint black line “indicating separation”….How do you know this black line isn’t just the typical linear radiolucency as one would expect to see from post surgical use of piezoelectric device (or any thin bone cutting tool)? It doesn’t necessarily mean there has been a “palatal widening” . The black line just indicates there is no longer the same bone density in this region.
A better indication of palatal widening would be to measure an increase in distance from structures that haven’t been altered. Ie inter molar distance, an enlargement of sinus size, etc.
In other words, this black line could be just the result of SURGICAL REMOVAL of bone; the “pathway” of bone cutting instrument.
In any case…I commend you on having such a distinguished guest to your channel 👍😊
Your assessment would be valid if Dr. Li didn't include the pictures of the alveolus/teeth. These pictures showed that the jaw is slightly wider, which means it was expanded. That means the suture was split.
Thank you so much for getting Dr. Li on here Ron. It’s so confusing trying to navigate through all this information of differing opinions. The orthodontists/doctors u have on ur channel all seem to do well with good results, I just wish there was definitive proof of what is truly the best option. I like what u said before, u can do mse + msdo first and then double jaw surgery later if needed. I have no idea how much expansion I actually need. I don’t want to put providers against each other, but it’s frustrating hearing different claims and stressful knowing I ultimately have to make the call on who to see.
I agree. Just take your time and keep on learning. I am personally learning at a rapid rate. Give it another year maybe.
For me the only option is probably the EASE because i am missing the teeth that Dr. Marianna Evans Device attach to. I would love to do expansion without surgery under general anaesthetics. I can't wait to see if Dr. Li comes up with something where there is no general anaesthetic.
It does make sense to split the maxilla surgically. Dr. Mew said that expansion can take place successfully right up to 62. I would then factor in or ask......once a woman goes through menopause and the adrenals take over from the ovaries with estrogen production.....the bones may weaken? So maybe just maybe they would be easier to seperate?
What app is Ron using to take notes and show his pictures
Streamyard
1:49:44 they cut out all of his turbinates? wow
2:35:30 - 2:53:00 is particularly interesting to me, IN ADDITION to Dr. Li's comment about MMA further upturning his patient's already upturned nose. I've noticed that my hook nose, as we discussed in our JawCast episode, can improve my nasal breathing drastically if I either A. manually lift my nose with my finger or whatever, or B. wear nose strips (both of these methods "lift" my hooked nose). So im VERY curious to say the least if I am one candidate who may be able to get away with going straight to MMA, lifting my down swung nose and thus subsequently improving sleep apnea and breathing issues in addition to the aesthetic. Going to consider this before I get back with Dr. Yousefian to start my treatment plan.
Good luck with your treatment Robby, keep us posted
You da man Robby
@@JawHackshey Ron can I combine face mask with EASE? Or how else can I get forward growth without surgery. I’m 16 btw
Since the TPD has no molar arms, I don't see how you would build in "facemask hooks" the way they do with MSE and custom MARPEs. Perhaps if you did EASE surgical assist combined with a custom MSE or MARPE with facemask hooks.
Theoretically you could use infrayzgomatic bollard plate implants as anchorage for the facemask, it's mainly done for younger people, like how Kasey Li mentioned @@JawHacks& the complete split/sutural disarticulation caused by the EASE surgical split and subsequent expansion would certainly mean a lot less maxillary & midface resistance to the protraction forces, making it easer to pull than something like a toothborne based facemask in a young person
Excellent interview. You should have Dr Soroush Zaghi.
Would love that.
You finally talked to the boss, Ron. Fantastic interview. Well done, brother.
Yessir. Thank you for the feedback.
The surgeon he was referring to is likely Wolford given he is US based and on the older end of the spectrum. Brilliant interview and really interesting take on the 3D printed plates, especially having listened to the Alfi interview where he was selling it as revolutionary. I think I am siding on Kasey Li's take.
Do you know when that was?
Yeah I came to the same conclusion as you before reading this comment. He’s probably talking about Wolford. Awesome interview and much respect for Dr. Li. Wish he has given his thoughts on good surgeons to go to but all the info he shared was super informative
@@shuikai272I believe it was around 3:37:15
Thanks for sharing.
I thought it was Relle
Bro @jawhacks you literally asked ALL the questions I had on my mind. I can’t wait to listen. You’re doing god’s work, thank you !
Awesome. Thanks bro
There is a patient of Li's that ended up with vision problems after EASE. Have you heard about this? It's happened in MSE patients too.
is the 30K cost for all the journey with EASE? or does each analysis via phone 3x a week cost also?
I believe it's the whole treatment, start to finish.
Mine was $30k all in, and I had text access to Dr. Li the entire treatment. He was extremely responsive.
Ron out here pitting the orthodontic/orthognathic world against each other @1:53:09
Haha not my intention, just looking for answers
@@JawHacks yeah of course that's what is most important. Just cracking jokes
Can you do a video on mandible expansion in future.
Plz
There was a really important discussion about mandibular expansion in this interview. Check the timestamp for MSDO
I will go with sfot for correcting arch since it is faster and read articles it has less chance of relapse of teeth .
will you have scars on your palate because of MSE expander, or will they go away?
how much money is really needed for EASE? is the 30-35k all in one? with all the support after the operation?
Yes
I honestly don't know.
thanks man!!!@@UsamaKhan-xs9do
Yes, that's all in with follow up contacting multiple times per week by text.
2:37:20 I’m confused how did lack of nasal resperation Change his face that much? It looks like it did relapse from mouth breathing didn’t it??
Mouth breathing is the death of facial structure
@@JawHacks his face actually went back to how his original face looked before mma
Great vid. Could someone please provide access to the discord servers (shuikai or jawshanks)? Dumbear here lost access to my old acc
Link is in the description
Going to share my thoughts on a few topics in the video.
02:22:13
"Anatomy doesn't change"
> Say you're expanding a 50 year old male then sure I would agree that there will always be a lot of resistance to expansion. There are a lot of differences when it comes to anatomy though, such as a 16F is very different from a 50M in how much resistance there is. Some people have thin bone at the hard palate, some people did AGGA or alveolar bone damage, or problems with the teeth, etc. So I think the anatomy varies individual to individual. Now say you have an expander that is completely anchored to the hard palate, what is the rate of hard palate expansion that is possible for what ages of people per week or month or whatever? I don't really know, but it seems to me that due to the anatomy you would want to limit the rate of expansion so that you do not have excessive resistance to expansion.
"FME is going to have more failures than custom MARPE"
> I guess it depends on your definition of success. If the definition of success for custom is >1 mm at the incisors, or any dental expansion, then it's very successful! In fact every expansion is successful.. I think that the entire premise that custom MARPE is very successful, isn't very accurate, or it's inflated at the least, even though that is the perception. So I would agree that doctors who currently use custom MARPE and consider it 100% success, would likely perceive FME as less successful than custom MARPE, assuming FME doesn't have a spectacular success rate similar or better than EASE.
The main issue I have with that perception though, is that you can have a custom MARPE do a 1 mm expansion with the rest dental, and someone will say that's a success, but if another expander had 1 mm of expansion without dental expansion, are they going to say that is a failure? Even though dental expansion doesn't really help the airway and let's say it's done specifically for airway? Correct me if I'm wrong, but I don't understand how that makes sense.
The big question though (besides ethics), are customers and doctors going to have the same perception of quality, given the customers are the ones receiving it? If they're sold an airway treatment and in the end they're not better because it just tilted or pushed the teeth out, and they have to get a revision, then because of how online people are these days word of mouth will inevitably spread, especially if doctors aren't doing refunds, agreements, etc. to mitigate that, and so all of a sudden it begins to explain the supply-demand scenario that we have right now with custom or MSE, and EASE, where the wait list and price of EASE is a lot more than custom or MSE, because there's a lot of demand but little supply. In the end marketing quality in the long-term is not very effective, if it isn't of a high quality. Quality is a valuable asset to have when selling something, it increases demand. So as a customer I would hope doctors would want to provide an expansion that their customers want and will be satisfied with.
Thanks for taking the time to chime in on RUclips comments. Many of the viewers here probably don't access the Discord where most of your thoughts are shared.
For about two years after my consultation with Paul.....i observed the patients who had a Le Forte and or double jaw surgery and i noticed that the patients jaw ended up moving back to its original position....doing what it had been doing for most of its live. There was no other supportive work being suggested.....Mewing...Cranio Sacral work ect......which was another reason i didn't go down that path.......so it wasn't just Paul.....but his response did alarm me. The answer i wanted to hear i guess was how passionate he was about his work and that he wanted to help his patients.
The only issue is the $40K+ he charges for EASE and the lack of training others
$40,000? Holy Moley....It is no wonder he only does three operations per week!!
it is 30k i think??
I was quoted $40k. That did not include surgery room cost if done at the hospital and not at his office. In addition there is the added cost of staying near his office for an additional 10 days to 14 days post surgery.
When were you quoted this price? Maybe he has increased the price now because it was $30k until recently.
also what is “AUGA”
AGGA?
AGGA Kadabra
Thanks for doing this. Informative but i still dont have much clarity on EASE and how it really stacks up against MMA and custom MARPE. His answers tend to be meandering and full of insinuation rather than direct.
Do you know how old he is?l
Well done. Now after this video prices are gonna increase drastically just like Lipkins ‘100% succes rate’ MSE
Lipkins priced have not gone up significantly as far as I know. All he has done is stopped subsidizing the initial consult. The first meeting is $1,500 but that rolls into the cost of treatment which is still sub $13K for MARPE + Invisalign last I heard
What is this discussion even about ??😂 I was watching a different video while doing chores and somehow RUclips played this video next. Sounds like two very intelligent people are talking about something related to teeth, and bone expansion, and some crazy treatment people do to expand their...bones?? What???
Are we talking about braces? Are adult braces BAD?
I am 26 mins in and I am still not sure about the exact topic.
FYI, Dr Paul Coceancig was suspended from practising in Australia by medical authorities in 2024. He's mentioned in this video
Why?
@@nicholasbrown3443 Sorry, I'm not sure. I searched for him because he was mentioned in this video and I'm looking for a jaw surgeon - I live in Australia. His profile on the Australian Medical Board site says he's been suspended
I'll stick with the MSE and Dome for maximum jaw expansion.
DOME is over bro
@@JawHacks , what does Dr. Joseph Yousefian use to expand the mandible? That's what I was referring to.
@@profortunebaron I believe he uses DAME (Distraction Assisted Mandibular Expansion) = mandibular distraction similar to MSDO
@@marissa7680 oh yes, thank you. That's what I meant to say. DAME, not Dome. 😁✌🏻
Ron, At 2:15:40 you try to clarify Dr Li’s statement by saying EASE has the best ratio of nasal change to dental change. Highlighting the fact they EASE may have greater result in changing nasal volume without dental change.
But…isn’t a large part of the benefit of MSE “arch expansion”? Most of us that are seeking out maxillary expansion are SEEKING FOR SKELETAL ARCH EXPANSION…seeking for more space for our tongues. We want larger nasal volumes, ALONG WITH increasing ORAL volume.
So, to just focus on “nasal” volume is only focusing on half of the issue. We need extra room for our tongues to sit against the roof of our mouths.
I don’t completely trust this guy. He spends too much time “trying” to prove what he is doing is beneficial, with radiographic scans that don’t prove much. He spends much time trying to degrade others. He never answers your questions with clear answers (too much dancing around issues instead of giving solid answers)
If there’s one thing this interview did was allow me to cross someone off my list of potential providers.
May be you don't like his style but is he wrong?
Are there good research publications on MARPE or custom MARPE in helping sleep apnea and breathing?
I see a decent series that he published on EASE with sleep study results.
About the roof of the mouth widening, if the floor of the nose is widened, which is the roof of the mouth, isn't the oral volume increased?
He said he has a lot of CBCTs and pictures of his patients in his past lectures so we can all verify it with our own eyes.
If you want improvement in oral volume, you want to expand the mucosa of the palate, which is attached to the hard palate, not the teeth. Dental expansion will provide less improvement to intraoral volume than expansion of the basal bone. The bite can be maintained using Ting's "spiderchain" method to decompensate the angulation of the teeth. That's how you achieve a maximal increase to intraoral volume. Parallel expansion will also provide not only expansion of the oral volume, but also increase the nasal airway dimensions and expand the lateral pharyngeal walls. Expansion of the hard palate is far superior.
To bad its like 35k
$35-60K with almost zero bonus aesthetic benefits
Isn’t it 30k?
@@hazexo1131 i mean mse doesn’t have much asthetic either
@@Sunrise-fr9jb doesn’t it widen the smile, every patient I’ve seen after results they have a wider smile
@@Sunrise-fr9jb regardless its still pricey af
I appreciate Dr. Li's knowledge and experience, but I think he doesn't want to debate because he doesn't like to be challenged. Good try though Ron.
Funny....i have had a zoom consultation with Paul Cocranerge......years ago when i was looking at having double jaw surgery for my class III......I asked him why did he choose to become a surgeon....he said he wanted to be an engineer but his father talked him into becoming a urgeon because he would make more money.......i crossed him off my list immediately. He is narrow-minded and not progressive thinking Like Dr. Li and Dr. Evans.....always looking to do better and get better results. I am in Australia in Northern NSW and Paul is also in NSW Sydney Australia.
You cannot blame yourself for asking the wrong question.....you are vey neutral and non-political...........