Double Jaw Surgery Relapse

[Ben]

Think about your teeth and jaws, consider the angles involved. Look at attractive people and see how there teeth fit together. Look and think about your teeth and bite, then workout what needs to be done.
There is more to a bite, as I'm sure your aware, than just where the front teeth meet. I have a friend who has an edge to edge bite at the front but his front teeth meet at exactly the same time as all his other teeth so he finds his bite comfortable and really likes it.
Surgeons and Orthodontist can be quite ignorant when it comes to the function of a bite.

[elysium87]

The attached pic shows my bite before the operation, as you can see it was pretty severe.

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[elysium87]

I had a consultation in London with an orthodontist and I am going to see his recommended surgeon, Piet Haers, in a couple of weeks. I am happy with my aesthetics and the orthodontist said I looked great and that aesthetically the op had been a success. He felt I may need upper jaw advancement to close the bite but he felt this was an extreme solution and it may be best to just leave things where they are. I guess I have to weigh up the risks of a second surgery against just dealing with an edge to edge bite. I am not prepared to take any of the orthodontic options without a surgery because they involve removing teeth and attempting to "mask the problem". I would rather leave my bite where it is than just patch things up with a half hearted orthodontic attempt. I am not really sure why I had this slight relapse as the post surgical result was excellent, my teeth meshed together so well that I had doctors visiting my hospital room and commenting on how excellent the results were. Other maxillofacial surgeons were giving me winks and thumbs up as I lay in my bed recovering. I think that a large part of relapse is down to the individual and how the body deals with, I had a very severe bite pre-op and this operation has improved things 85%, I have lost 15% through the relapse. It is a shame when after the operation, my teeth and bite were so damn perfect, I fail to see what else could have been done.

The only thing the ortho did comment on was why I did not have SARPE before my BI-max, he felt that using the quad helix to expand upper arch was not the same and that this may have compromised stability. Like I said, it is such a shame considering how excellent my post operative bite was.

[Ben]

Can you have your other teeth built up so that they all hit at about the same time as the clashing front teeth? This would at least make your bite functional/comfortable.

[elysium87]

Can you have your other teeth built up so that they all hit at about the same time as the clashing front teeth? This would at least make your bite functional/comfortable.

Orthodontist has recommended a consultation with professor Piet Haers and himself to review me and give me all the options. They have taken an X ray of my current bite which I am waiting for the clinic to email over to me. One of the options is an SAPRE of my pallet and an op to bring my upper jaw forward to resolve the bite.

[elysium87]

Are there many people who have had a second surgery? Am I likely to suffer severe nerve damage?

[Modigliani]

Are there many people who have had a second surgery? Am I likely to suffer severe nerve damage?

I don't know but I'll find out. Have another couple of consults coming up so I'll ask.

[elysium87]

I don't know but I'll find out. Have another couple of consults coming up so I'll ask.

Who are you seeing? I have a consult with Piet Haers coming up.

[Modigliani]

Who are you seeing? I have a consult with Piet Haers coming up.

He's supposed to be good but make sure you get him to nail down exactly what's achievable. Your case seems pretty straightforward so that probably won't be in issue.

I'm seeing Paul Johnson, again and Sneddon at East Grinstead...and praying for a miracle 

[elysium87]

He's supposed to be good but make sure you get him to nail down exactly what's achievable. Your case seems pretty straightforward so that probably won't be in issue.

I'm seeing Paul Johnson, again and Sneddon at East Grinstead...and praying for a miracle 

Cool, thanks for the advice. I will be seeing him in 8 days.

[elysium87]

He's supposed to be good but make sure you get him to nail down exactly what's achievable. Your case seems pretty straightforward so that probably won't be in issue.

I'm seeing Paul Johnson, again and Sneddon at East Grinstead...and praying for a miracle 

I have had my meeting with Professor Haers. I found him to be very good and an extremely nice man. He believes that I have had an orthodontic relapse, mainly on my top jaw in the transverse direction. Basically, when I had my previous orthodontic treatment they did not expand my upper jaw. I have a fairly narrow upper jaw and instead of doing a SARPE, the NHS orthodontist decided to expand the arch with an orthodontic appliance known as a helix, unfortunately this appears to have relapsed within 18 months of the braces coming off. I don't think he was impressed with my orthodontist using this approach. The collapsing of the upper arch has resulted in a cross bite and my top jaw now biting within the bottom, front teeth are edge to edge.

The only way to correct this, should i opt to, is to perform a SARPE to properly laterally expand the upper jaw. This will then cause the top teeth to fall behind the bottom, opening up an underbite. We will then advance just the top jaw. He also recommend a slight reduction in the vertical height of my chin to correct lip incompetence. Furthermore, a further 3mm of impaction of the top jaw was recommended to reduce length of the lower third (i had 3mm impaction during the first operation).

If I choose not to do anything, I risk losing my front teeth within the next 10-15 years, which is sad. I am annoyed at myself for not being so disciplined with my retainers, but ultimately I blame the incompetence of the NHS surgeon/ortho team who agreed not to perform a SARPE on me in the beginning, even though was this best option for long term results. Professor Haers does not believe that my jaws have actually moved, although he has not measured them. It clearly points to orthodontic relapse of top jaw in the transverse direction. I believe had I continued wearing my retainers, that this would have still happened as the only way to increase width of upper jaw in an adult is to perform SARPE. He did say that the helix devices only really work on growing patients.

I am having another meeting with him in August and then I will make my final decision.

[Modigliani]

What a pisser that the whole thing was compromised due to ortho incompetence, these guys are something else!

This sounds like a sensible plan that will, most importantly ensure stability in the long term. The only thing I'd be a bit wary about is having another 3mm impaction - that's 6mm in total, quite a lot. How much tooth show do you have currently when the lips are at rest? Ideally you want a good 3 or 4mm showing, it's youthful so be careful with anymore impaction.

Are you planning on seeing anyone for another opinion?

[elysium87]

What a pisser that the whole thing was compromised due to ortho incompetence, these guys are something else!

This sounds like a sensible plan that will, most importantly ensure stability in the long term. The only thing I'd be a bit wary about is having another 3mm impaction - that's 6mm in total, quite a lot. How much tooth show do you have currently when the lips are at rest? Ideally you want a good 3 or 4mm showing, it's youthful so be careful with anymore impaction.

Are you planning on seeing anyone for another opinion?

Yes it is frustrating to say the least, however, he did say I have a very large tongue also and that a strong tongue push on the bottom incisors has also pushed them outwards contributing to an edge to edge bite. He feels that the NHS surgeon has moved my jaw back a couple of mm too much as this has further reduced space for my very large tongue and exacerbated the problem. I am to blame to a degree for stopping wearing my retainers, although medical records show that I had relapsed when they took pictures of my bite 2 years after my operation, nobody noticed it though until I finally saw those photographs back in May!! I guess they just got filed in to my medical records without ever being studied.

I agree with your point about the impaction to a degree. I did have 2 mm at the front and 3 mm at the back impaction (open bite). I did have quite a long face because of this and I still do to a degree. I have quite a bit of tooth show still and I have very long teeth. He feels my face is still a bit concave in this region and I will benefit from further advancement of the top jaw. Decompensation will arise from expanding my pallet with a SARPE and then pushing the top teeth backwards. I will discuss this further in the second meeting. I am not thrilled about a revision surgery but I am less thrilled about leaving it and losing my front teeth.

Professor Haers did mention that if we do all of this, I will need to be carefully monitored and if the strong tongue push is still forcing my bottom incisors out....I may need a tongue reduction surgery. He recommends this for less than 1% of his patients. He showed me results of patients who had severe underbites but where he had only moved the bottom jaw back 2mm and moved the top jaw forward much more, the results were impressive. I had 5.5mm of net movement backwards, he feels this should have been limited to 2 or 3mm and then top jaw moved forward significantly. When I look back at my case, we were all under the impression my bottom jaw had overdeveloped significantly, but actually I feel that my top jaw had majorly underdeveloped. He says that we should be able to avoid touching the bottom jaw, which is good news. He described my bottom jaw as short and I cannot afford any further backwards movement.

[Modigliani]

'Tongue reduction surgery' sounds f**king horrific!

 

[Gregor Samsa]

'Tongue reduction surgery' sounds f**king horrific!

 

WTF!