03/07/2026
If you are considering the AGGA, DNA or ALF read this article 1st
The Anterior Growth Guidance Appliance (AGGA) has been marketed as a nonsurgical solution for maxillary deficiency and even sleep apnea, with claims of stimulating forward growth in adults. In reality, its biomechanics mirror those of a distalizing appliance—tipping incisors forward and moving molars distally without producing skeletal change.
In the January issue of JCO, Drs. Neal Kravitz, Claire Shults, Jeffrey Miller, and Kelton Stewart examine the documented consequences of AGGA therapy through the medicolegal records of an adult patient whose treatment resulted in severe bone loss and the eventual loss of all four maxillary incisors. The case is sobering, not only for the periodontal and restorative damage involved, but for the broader questions it raises about biology, scope of practice, continuing education, and patient protection.
The article carefully reviews the appliance design, the claims surrounding it, the role of “Controlled Arch Braces,” and the FDA investigation that followed national media coverage. Most importantly, it reinforces a principle orthodontists know well: toothborne appliances cannot override adult skeletal biology.
If you have been asked about AGGA, DNA, ALF, or other so-called growth appliances in adults, this is an important read in the January issue of JCO.