AGGA/Control (Anterior Growth Guidance appliance)
What defines a beautiful face?
· Balance of function and growth
What is AGGA?
AGGA stands for Anterior Growth Guidance Appliance.* You might also see “FAGGA,” where the “F” specifies that it’s “Fixed,” or cemented to your teeth. There’s also a removable version of AGGA, but that one is mainly used in children, so this page will deal with the fixed version of AGGA.
Anyway, the AGGA is an orthodontic appliance that is intended to prompt forward growth of the premaxilla/maxilla and create space in the upper dental arch. It’s mostly wire, with a small acrylic oval that presses lightly on the upper palate behind the front teeth.
This oval may look inconsequential, but it’s actually the important part of the appliance (more on that in the “How does AGGA work?” section).
The AGGA. Source: springfieldsmiledoctor.com
(*Fun fact: AGGA also stands for the Australian Glass and Glazing Association. Who knew.)
Who came up with AGGA?
The ControlledArch Treatment System, which encompasses both AGGA and the Controlled Arch braces used in conjunction with it, was developed by Dr. Steve Galella, DDS.
Dr. Galella has a background in facial trauma surgery, and after developing the ControlledArch System, is now known as an authority on facial beauty and facial growth modification. He is the Clinical Director of the Facial Beauty Institute, co-founder of OrthoMatrix Corp, and speaks and trains other dentists all over the world. (Source 1, 2, 3)
What is involved in AGGA treatment, and how long does it take?
Dr. Kundel (Ronnie’s dentist) has a good outline of this on his website. The below is an abbreviated compilation of that information plus various other tidbits I’ve read from other practitioner websites and patient experiences.
Phase 1: The Growth Phase (usually about 1 year)
§ The AGGA is cemented to your upper teeth
§ Acrylic “bite plates” are stuck to your lower molars
o This is done to make the surface of your molars flat so that instead of securely biting together, your lower jaw is free to slide around
o This allows the jaw muscles to relax and find their natural resting position
o Supposedly this also prompts the jaw to remodel forward; this makes sense if the jaw was initially being held back by an underdeveloped maxilla, which is probably the case in many (most?) AGGA patients. I don’t quite understand how this helps in patients who already had an overbite
§ The appliance is adjusted monthly so that the acrylic oval continues to press on the soft palate as the palate expands forwards
§ Gaps are created behind the canines
Here’s Ronnie’s final photo before having the AGGA removed, so you can see what the gaps look like.
After the desired amount of forward growth has been achieved…
Phase 2: Controlled Arch Braces (usually about 1 year; less if implants are chosen)
§ The AGGA is removed
§ Full braces are placed on all upper and lower teeth
§ Metal arch wires (the “controlled arches” are cemented to the backs of the upper and lower teeth along the gums
o This is what makes these braces different from regular braces!
o These arch wires supposedly are stiff enough to provide a gentle widening stimulus as well, so some lateral palate expansion may be achieved during this phase
§ Back teeth are pulled forward to fill the newly created gaps, OR implants are placed in the gaps
§ The braces are tweaked to achieve proper occlusion and alignment of the upper and lower teeth
Optional: Myofunctional Therapy
Many practitioners recommend undergoing myofunctional therapy concurrently with AGGA treatment. This involves exercises to improve oral posture and develop good habits, such as nasal breathing, lip seal, proper tongue posture, and proper swallowing technique.
How does AGGA work?
The closest I’ve found to a specific physiological explanation for how AGGA works is that the small acrylic oval presses on the nasopalatine nerve*, which somehow elicits a growth response throughout the entire midface.
In the words of several dentists who use AGGA (emphasis mine):
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.
–Dr. Leonard Kundel