Author Topic: Surgery First  (Read 625 times)

Lefortitude

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Surgery First
« on: August 01, 2017, 03:10:33 PM »
Hey friends,

Wondering if anyone knows about the Surgery First method for bimax as practiced in Europe and South Korea.  It involves forgoing orthodontic movements for certain patients. 

1)  Why do the big name american surgeons not practice surgery first (A&G, Wolford).  Is it just a profit thing?

2) Disadvantage of Surgey First?  Symmetry, Stability, Relapse risk etc.


GJ

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Re: Surgery First
« Reply #1 on: August 01, 2017, 04:46:59 PM »
Much less precision.
The odds of coming out of surgery with a good bite if you don't have ortho is slim to none.

It could be warranted if is the patient had severe apnea or something equally serious, so that's probably why some European surgeons do it (some US surgeons do it as well for apnea cases).

Ps. What would the "profit thing" even be? They are doing surgery either way. How is doing it before more profitable?

Milli_Meters

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Re: Surgery First
« Reply #2 on: August 02, 2017, 12:11:20 AM »
What if one's bite is already fine?

UKMaxfac

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Re: Surgery First
« Reply #3 on: August 02, 2017, 01:48:22 AM »
Much less precision.
Why?

The odds of coming out of surgery with a good bite if you don't have ortho is slim to none.

Sounds overdramatic

It could be warranted if is the patient had severe apnea or something equally serious, so that's probably why some European surgeons do it (some US surgeons do it as well for apnea cases).


But they do it frequently on patients without.

Lefortitude

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Re: Surgery First
« Reply #4 on: August 02, 2017, 04:24:47 PM »
I had 5000 dollars worth of ortho done as a child.  If i opt for a bimax im looking at an extra 5k of ortho on top of surgery and everything else. 

Wrt coming out with a bad bite; my understanding was that ortho is usually required post op.  This would correct the bite.  However i have heard cases which were off midline, canted etc.

MyTimeIsNow

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Re: Surgery First
« Reply #5 on: August 02, 2017, 10:05:43 PM »
I had 5000 dollars worth of ortho done as a child.  If i opt for a bimax im looking at an extra 5k of ortho on top of surgery and everything else. 

Wrt coming out with a bad bite; my understanding was that ortho is usually required post op.  This would correct the bite.  However i have heard cases which were off midline, canted etc.

Different jaw surgeons and orthos working with jaw surgery patients have ALL told me that they strongly prefer surgery early (2-8 months braces)  to surgery first protocol.

You can read Alfaro's papers for the overview of advantages/disadvantages of surgery first method.

UKMaxfac

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Re: Surgery First
« Reply #6 on: August 03, 2017, 12:48:23 AM »
I was told in no uncertain times that the longer you go in braces the more potential damage to the roots of the teeth etc. Surgery first with post-op elastics and fine tuning sounds fine to me.

Funnily enough I consulted with a prominent surgeon in East Grinstead in the UK and he told me I'd probably be looking at 1-2 years in braces and 1-2 years post-op, whereas Haers, Alfaro, Defrancq and Marianetti all offered either no braces or minimal wires. Guess many surgeons are just stuck in the past.

ppsk

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Re: Surgery First
« Reply #7 on: August 03, 2017, 11:36:48 AM »
What if one's bite is already fine?

then you spend no time in braces at all. My bite is exactly the same as it was pre surgery, just advanced. Only orthodontics was 2 weeks in elastic bands, which is debatable if its even necessary but hey, its only 2 weeks.

Lefortitude

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Re: Surgery First
« Reply #8 on: August 03, 2017, 12:10:59 PM »
then you spend no time in braces at all. My bite is exactly the same as it was pre surgery, just advanced. Only orthodontics was 2 weeks in elastic bands, which is debatable if its even necessary but hey, its only 2 weeks.

This would be ideal for those with a good bite.  Certainly an advantage of marianetti siblings doing ortho consult and surgery together to ensure such a result.  Wonder why the prominent americcan surgeons rarely offer it

ppsk

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Re: Surgery First
« Reply #9 on: August 03, 2017, 01:49:53 PM »
This would be ideal for those with a good bite.  Certainly an advantage of marianetti siblings doing ortho consult and surgery together to ensure such a result.  Wonder why the prominent americcan surgeons rarely offer it

AFAIK its a paradigm shift that is relatively new... as with all things in medicine it takes time to become to replace the old paradigms. Europe and Asia are early adopters, in fact a lot of the literature on surgery first approaches seems to come out of asia. South America are also doing it to the best of my knowledge, at the very least Colombia and Brazil.

I cant remember what percentage of people Marianetti told me were candidates for surgery first approaches, but it was very high. People with less than ideal bites are still candidates but they have post-op ortho work, reducing the treatment time to anywhere from 6 months to 12 months, much better than having potentially 2 years of treatment.

He also told me the international statistics on patients who are primarily aesthetic are increasing rapidly, so I dare say surgery first protocols are going to become widespread. I simply would not have got this operation if braces were necessary, the recovery from bimax is so ridiculously long and makes you vulnerable, I can't imagine having to deal with braces on top of that.

Milli_Meters

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Re: Surgery First
« Reply #10 on: August 04, 2017, 12:04:57 PM »
then you spend no time in braces at all. My bite is exactly the same as it was pre surgery, just advanced. Only orthodontics was 2 weeks in elastic bands, which is debatable if its even necessary but hey, its only 2 weeks.

You make my dreams come true <3

Bowie

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Re: Surgery First
« Reply #11 on: August 04, 2017, 02:25:01 PM »
If your bite is roughly ok then surgery sans braces is the way to go, makes the whole process less daunting.

Lefortitude

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Re: Surgery First
« Reply #12 on: August 04, 2017, 05:32:50 PM »
If your bite is roughly ok then surgery sans braces is the way to go, makes the whole process less daunting.

Yeah it would be if the results were equally good.  However id like to reduce the risk of asymetry or canted jaws as much as possible, IF possible.  This is, after all,  peoples faces were talking about.

ExtractionsRuinFaces

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Re: Surgery First
« Reply #13 on: August 04, 2017, 06:16:28 PM »
I was told in no uncertain times that the longer you go in braces the more potential damage to the roots of the teeth etc. Surgery first with post-op elastics and fine tuning sounds fine to me.

Funnily enough I consulted with a prominent surgeon in East Grinstead in the UK and he told me I'd probably be looking at 1-2 years in braces and 1-2 years post-op, whereas Haers, Alfaro, Defrancq and Marianetti all offered either no braces or minimal wires. Guess many surgeons are just stuck in the past.

Just what in the hell? is he trying to shift your teeth into the back of your skull? to the north pole perhaps?

PloskoPlus

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Re: Surgery First
« Reply #14 on: August 04, 2017, 06:24:35 PM »
Just what in the hell? is he trying to shift your teeth into the back of your skull? to the north pole perhaps?
He probably didn't want to take on OP's case. From my experience surgeons like to low ball the braces estimate to get you committed.