What You Need to Know about ALF, AGGA, and Jaw Expansion Devices

Considering the ALF or AGGA appliance? Learn more about these dental devices and why it is important to choose valid orthodontic jaw expansion treatments backed by science.

Behind the Appliance: ALF and AGGA Treatment

Imagine being told that a simple wire device could reshape your face, improve your breathing, and fix your TMJ or bite as an adult – without surgery. Sounds promising, right? Appliances like the Advanced Lightwire Functional (ALF) appliance and Anterior Growth Guidance Appliance (AGGA) have gained attention for claims like these.  In the field of orthodontics and dentistry, they are often marketed as cutting edge alternatives and promoted for their “holistic” approach to addressing dental and jaw imbalances. Behind the buzz lies controversy – one filled with legal battles, patient injuries, and devices that challenge safety and science. 

Before trusting any device to grow your jaw, expand your smile, or reshape your face, it’s essential to understand what these appliances actually do, and what risks may be hiding behind the promises. Let’s explore appliances like the ALF and AGGA, how they work, and what makes them different from other orthodontic appliances.

What is the ALF Appliance?

The Advanced Light Force (ALF) – which is also known as the Advanced Lightwire Functional (ALF) appliance – is a dental appliance that consists of a wire that runs along the inside of the teeth where it applies pressure.  It was designed with claims to “encourage jaw and cranial changes.” ALF is particularly aimed at children and claimed to help “guide facial growth.” ALF was created by a dentist, Dr. Darick Nordstrom, and is distributed by ALF-dedicated labs, with dentists training on it via short courses (not orthodontic residency programs).

What is the AGGA appliance?

The Anterior Growth Guidance Appliance (AGGA) – which has been renamed, and also known as the Osseo-Restoration Appliance (ORA) – consists of wires, an acrylic pad pressing against the palate, and springs that push against teeth. It has been marketed as enabling adult maxillary (upper jaw) growth. The AGGA was developed by a dentist, Dr. Steve Galella, with dentists training on it through short courses (not orthodontic residency programs).

Image reference of the AGGA appliance:

How are AGGA and ALF different from other Orthodontic Appliances?

Many people don’t realize that the AGGA and ALF are actually similar to already existing, well-known orthodontic appliances, such as the Crozat and Quad-helix. However, these orthodontic appliances are well known for their dental (tooth) movements, and are not considered treatments for skeletal growth, TMJ problems, cranial movements, or sleep apnea.

The Crozat is an orthodontic appliance that utilizes wires behind the teeth that gently apply force to gain dental expansion and additional space for crowded teeth. It can be made with different designs, and used in children or adults for tooth movement.

The Quad-helix is an orthodontic appliance consisting of wire with loops behind the teeth, often used to gain dental expansion to create space for crowded teeth or correct a crossbite. It can be used in children or adults for tooth movement. Research has shown that the quad helix does not open the palatal suture in children during mixed dentition like traditional maxillary expanders do (eg. Rapid Palatal Expander, Rapid Maxillary Expander, Hyrax). 

ALF and AGGA: “Holistic” Approaches to Orthodontics?

When it comes to holistic approaches, most orthodontists are considerate of the whole person – taking into account mental factors, social factors, the TMJ, breathing and airway factors. The ALF and AGGA appliances have been marketed as a more holistic approach to orthodontics. However, both of these appliances are a wire-type device that is similar to already existing orthodontic appliances.

Users of ALF have claimed that it: 

• • Improves breathing
  • Reduces TMJ symptoms
  • Enhanced facial symmetry
  • Improves posture
  • Promotes growth
  • Promotes head alignment
  • Relieves cranial stress patterns
  • Leads to spontaneous corrective changes in the craniofacial complex

One of the most crucial aspects to understand when discussing orthodontic expansion, and particularly the ALF and AGGA appliances, is the difference between dental expansion and skeletal expansion.

Dental Expansion vs. Skeletal Expansion

• • Dental Expansion: This refers to moving teeth by tipping or flaring them. This can be very useful when there is mild crowding or a mildly narrow dental arch. While it can create the appearance of more space in the dental arch, it doesn’t physically widen the jawbone. Inappropriate dental expansion can create stress within the bone and gums. Excessive dental expansion can even push teeth or tooth roots out of the bone, leading to serious complications like gum recession, dental nerve death, bone recession, instability, and long-term bite problems.

• • Skeletal Expansion: This involves the actual widening of the jawbones. In the upper jaw (maxilla), this is achieved by widening the two maxillary bones at the midpalatal suture. True jaw expansion is possible in growing children, as their sutures are not yet fully fused, allowing for actual orthopedic changes. Fusion of the upper jaw suture takes place during puberty. In adults, the maxillary suture is already interdigitated and fused, making true jaw expansion anatomically and physically impossible without surgery (Surgically Assisted Rapid Palatal Expansion or SARPE) or additional implant anchorage (eg. Maxillary Skeletal Expansion (MSE) or Maxillary Assisted Rapid Palatal Expansion (MARPE)).

Dental expansion can be performed using braces, clear aligners, or wire-type appliances such as the Quad-helix or Crozat. Skeletal (jaw) expansion requires an orthopedic orthodontic expander, which is an orthodontic appliance used to widen the upper jaw, creating more space for teeth, widening the upper jaw, and correcting jaw alignment issues. Examples of orthodontic expanders include: the Rapid Palatal Expander (RPE or RME), Hyrax and Haas. 

Evidence for ALF or AGGA and Skeletal Expansion?

While some proponents claim the ALF appliance achieves skeletal expansion, a significant amount of literature, research, and expert opinion suggests otherwise, particularly in adults and even pediatric cases. 

The forces exerted by the ALF appliance are considered insufficient to open the midpalatal suture, especially in older children and adults, making it impossible to achieve true skeletal separation or jaw expansion. Instead, it is highly likely that the expansion seen is dental, where teeth are gently tipped or flared outwards. This difference is extremely important, because if genuine jaw expansion is needed (e.g., to address a narrow upper jaw that compromises breathing or proper bite), relying on an appliance that tips teeth can be ineffective and potentially detrimental.

To achieve true jaw expansion, especially in cases of significant narrow jaw, orthopedic orthodontic appliances (like rapid palatal expanders – RPE, RME) that apply sufficient and appropriate forces to the palate are necessary, particularly during the growth window of childhood. 

AGGA (aka ORA) has also not proven that it can achieve jaw expansion. Many patients that have undergone this treatment have been exposed to serious and permanent harm. AGGA research clearly shows that it primarily causes tooth movement in the form of dental tipping (protrusion) and not true jaw expansion. This has led to tooth flaring, bone loss, gum recession, and even tooth loss.

Risks Associated with AGGA and ALF Treatment

Despite claims of gentleness and holistic benefits, the use of certain dental devices, including those with similar mechanisms to ALF and AGGA, has raised significant safety concerns. 

Potential risks and complications associated with devices that primarily achieve dental tipping when skeletal expansion is actually needed can include:

• • Tooth dislocation: Teeth being pushed out of their supporting bone.
  • Flared teeth: Unnatural outward tipping of teeth.
  • Damaged gums and exposed roots: As teeth move out of the bone, the gums can recede, exposing the tooth roots, leading to sensitivity and increased risk of decay.
  • Bone loss: Erosion of bone that supports the teeth.
  • Chronic pain: Persistent discomfort in the teeth, jaws, or face.
  • Uneven bite (malocclusion): Worsening of bite problems.
  • Difficulty eating: Impaired chewing function due to bite changes.
  • Tooth loss: In severe cases, the damage can be irreparable, leading to either root canals or tooth extraction.
  • Unresolved underlying issues: If the primary issue is skeletal, dental expansion alone will not resolve the root cause of the problem, potentially leading to relapse or the need for more complex treatment later.

The FDA has issued warnings regarding the unestablished safety and effectiveness of such devices for uses like jaw remodeling in adults or treating conditions like OSA (Obstructive Sleep Apnea) and TMD (Temporomandibular Joint Disorder).

Real-World Risks and Patient Harm

There have been legal alerts and lawsuits concerning dental devices that claim to “remodel” jaws, particularly the Anterior Growth Guidance Appliance (AGGA), similar to how the ALF has been marketed. Lawsuits typically allege that the devices displaced teeth instead of expanding bone, causing severe and sometimes irreversible damage. 

Legal & Media Alerts Around Similar Appliances:

• • FDA Safety Bulletin: The agency warns that unvalidated adult expansion devices (continuously applied palatal pressure) may result in chronic pain, bone erosion, tooth loss, and other serious complications in adults.

• • Major Lawsuits (AGGA/ARA):
    
    • • Clarinetist Boja Kragulj sued after the AGGA caused her teeth to protrude and eventually lose four teeth, leading to extensive surgery. Experts concluded the device displaced teeth, not bone.
    • • Numerous lawsuits allege devices like AGGA—sometimes promoted as similar to ALF—lack FDA approval, cause irreparable damage, and have led to legal action in California and other states.
    • • Numerous patient complaints and lawsuits alleging severe harm from these devices. Patients have reported:

• • Irreparable dental damage: Including loose and sensitive teeth, flared teeth, damaged gums, exposed roots, and erosion of the bone.
  • Tooth loss: Some patients have lost teeth and, in some cases, do not have enough healthy bone left for dental implants.
  • Unresolved health issues: Despite claims of improving breathing or TMJ, patients reported that these issues either remained or worsened, while their dental health significantly deteriorated.

These are significant reminders of the importance of evidence-based dentistry and orthodontics. 

Patients seeking treatment for jaw or dental problems should:

• • Seek opinions from experts: Consult with board-certified orthodontists who understand how dental appliances work, and can provide a range of safe, effective treatment options. 
  • Understand the science: Ask for evidence supporting claims made for any appliance.
  • Be wary of “miracle cures”: Be cautious of treatments promising broad health benefits beyond established dental outcomes without valid scientific backing.
  • Team approach: For cases involving concerns such as TMD, sleep apnea, or skeletal/growth imbalances, it is important that a team approach is embraced. This team may involve pediatricians, ENTs, myofunctional therapists, and oral and maxillofacial surgeons to work together to address the associated skeletal or dental discrepancies.

 

TL;DR Summary:

Appliances like the ALF (Advanced Lightwire Functional) and AGGA (Anterior Growth Guidance Appliance) are marketed as holistic, non-surgical ways to reshape the jaw, improve breathing, and fix bites. However, their safety and effectiveness—especially in adults—are highly controversial.

• • ALF uses light, flexible forces aimed at guiding natural growth, especially in kids. It’s claimed to help with breathing, posture, and TMJ, but there’s limited evidence that it achieves true skeletal expansion—which is crucial for certain jaw issues.

• • AGGA applies stronger forces and is promoted for adult jaw growth, but it’s linked to severe complications like bone loss, tooth flaring, and even tooth loss. It’s currently under FDA scrutiny and subject to multiple lawsuits.

• • Both devices may only cause dental tipping (moving teeth) instead of true bone expansion, which can be dangerous if skeletal correction is actually needed.

• • Experts stress the need for evidence-based treatment, proper imaging to confirm skeletal needs, and caution against “miracle” orthodontic solutions without FDA approval or scientific backing.

Bottom line: Always consult a board-certified orthodontist, demand scientific evidence, and approach claims of jaw remodeling in adults—especially without surgery—with skepticism.

About the Authors:

Henna Kim – Board Certified Orthodontist and Owner at LA Smile Co. Orthodontics in Glendale, CA

Dr. Brittany Ang – Board Certified Orthodontist and Owner at Curve Orthodontics in Linwood, NJ

Danielle Godley – Board Certified Orthodontist and Owner at Godley Family Orthodontics in Zionsville, IN

Further Reading & Resources:

1. 1. FDA communication on adult palatal expanders: Be cautious of chronic pain, bone loss, tooth mobility: https://www.fda.gov/medical-devices/safety-communications/evaluation-safety-concerns-certain-dental-devices-used-adults-fda-safety-communication

1. 1. CBS/KHN investigations into AGGA/ARA lawsuits: reports of tooth loss, legal cases underway: https://www.cbsnews.com/news/agga-dental-device-lawsuits-teeth-damage/

1. 1. Lawsuit Information: Agga Appliance Lawsuit: https://www.lawsuit-information-center.com/agga-appliance-lawsuit.html

1. 1. News Medical Life Sciences: Agga inventor testifies his dental device was not meant for TMJ or sleep apnea: https://www.news-medical.net/news/20231222/e28098AGGAe28099-inventor-testifies-his-dental-device-was-not-meant-for-TMJ-or-sleep-apnea.aspx#:~:text=In%20the%20AGGA%20lawsuits%2C%20about,out%20of%20their%20original%20position.%22

1. 1. Hansson S, Josefsson E, Lund H, Miranda-Bazargani S, Magnuson A, Lindsten R, Bazargani F. Skeletal effects of posterior crossbite treatment with either quad helix or rapid maxillary expansion: a randomized controlled trial with 1-year follow-up. Angle Orthod. 2024 Sep 1;94(5):512-521. doi: 10.2319/010424-9.1. PMID: 39230018; PMCID: PMC11363985.
      https://pubmed.ncbi.nlm.nih.gov/39230018/