Has anyone heard of IMDO as a way to fix a big dental overbite and weak chin?

[OrthodontistExpert]

I'm just wondering if anyone has heard of IMDO as a way to fix dental overbite or dental overjet.

[sean89]

I have a rough idea of what it is, but not sure of its point.

For a child who is happy to undergo surgery/money isn't an obstacle, they'd get BSSO, wouldn't they (seen as though it would be quicker and would cost the same (if not cheaper)?

For a child who doesn't want surgery/can't afford it, they'd get twin blocks/herbst appliance.

Maybe the place of IMDO is for adults who want to fix their lower jaw before they get braces and so are prepared to pay for IMDO (even if it costs more/takes longer).

But seen as though you're the orthodontic expert, isn't it the case that the majority of adults can and will get braces to fix their overbite. 

[OrthodontistExpert]

A BSSO and IMDO are totally different.

BSSO stands for "bilateral saggital split osteotomy". This is done by dental specialists called "oral surgeons" who act secondary to the primary carer being the dental orthodontist.

IMDO stands for "intermolar Mandibular distraction osteogenesis". This is performed by medical specialists called maxillofacial or Craniofacial surgeons. The dental orthodontist is secondary.

BSSO is done in adults. Oral surgeons cannot easily operate in children as they are not medically qualified. It follows on from an attempt by the orthodontist to retract the overbite by use of splints (usually from age 10 or 11) then braces... All of which can take several years. Finally, if the overbite hasn't been reduced enough, either teeth are extracted to enable further orthodontic retraction... Or the braces are used by an oral and maxillofacial surgeon to advance the mandible surgically... Of course the expense of this is actually quite expensive...

Overall, classic dental treatment of the big overbite involves splint therapy by a Herbst or Twin Block, over a few years... Then it involves orthodontics which means full upper and lower banding... And if premolars are extracted that is an additional cost too. Also the BSSO is an expensive operation in itself, and often also needs impacted wisdom teeth to be removed... Which is itself a jaw operation (if you think about it).

By contrast, IMDO is a medical treatment of the small lower jaw. It does not in itself rely upon dental orthodontics. By "growing" the lower jaw between lower molar teeth, it creates room for lower buckled teeth to "unwind" and self straighten. Even developing wisdom teeth eventually can erupt into the bigger lower jaw.

Because the lower jaw is made bigger, the dental overbite is corrected. And because it does not rely upon braces, it is cheaper and quicker over all.

The best thing about it is that it actually corrects the real problem... A small lower jaw... And it does so at 12. I believe the whole procedure takes about 30 minutes or so.

I'm just wondering if anyone has had the treatment themselves? It just seems you are all trying to explain the mathematics of how the sun revolves around the earth. It's simpler if you consider that the sun is the centre of the whole solar system, and then the maths becomes far easier.

I think this cartoon explains a little more.

http://m.youtube.com/watch?v=pTiL4g8PEv0&list=PLjC4hIwmyQfjXgckxslgVI9BPkh6wcv-a

[sean89]

I assume though that, in the majority of cases, braces are going to be needed to fix the bite and finish the IMDO treatment. Is this not true?

If it is, then the costs of BSSO/IMDO will be the same. Braces + Surgery = Surgery + Braces. That might change only where the patient has impacted wisdoms, but in every other circumstance, BSSO will be a faster treatment to complete and therefore preferential.

[Tiny]

None of us here are 12.   Most of us are in our 20s and 30s and have had prior orthodontic work as teens instead of the surgeries we needed

Many of us looked into DO, but were not eligible for various reasons (often age, or needing rotation).  I'd love to have DO on my ramus and mandibular body but I'm in my mid 20s

[OrthodontistExpert]

Apparently... No... The braces are not required

The IMDO treatment cycle does not specifically require braces. It can work with them... But most cases don't have them... Apparently the bite self corrects.

And it seems the IMDO operation is very different to the BSSO. The surgeons put the appliances in... And the parents "wind out" the small lower jaw at home. The jaws are not wired together either, and there are no extra costs like wisdom teeth removal surgery.

This video helps explain the "process" involved with IMDO surgery

http://m.youtube.com/watch?list=PLjC4hIwmyQfjXgckxslgVI9BPkh6wcv-a&v=xtgbaFy3bWk

[OrthodontistExpert]

 I can see that a large number of people here is in their 20's or 30's... And likely that is because you are all forced to wait into adulthood to have corrective jaw surgery... Often after years of orthodontics, and only after advice given to you by orthodontists that surgery can only be performed in adults... If it is required at all.

There is another subgroup here though... And they are 30-40 years old, and are parents of children who have dental overbites.

It seems a bother, but most people get angry, including orthodontists, when you hear that orthodontics doesn't work to fix overbites.

Overbite is a primary small jaw issue. The teeth are only secondary.

[sean89]

It seems a bother, but most people get angry, including orthodontists, when you hear that orthodontics doesn't work to fix overbites.

I agree that jaw surgery can fix overbites. But I'm not sure all orthodontic work is destined to fail.

You can flare the lower teeth forward and bring the upper teeth back so that the upper teeth rest on the lower teeth.

You can also shave off a small amount of enamel from the maxillary incisors so as to make the teeth shorter and reduce the overbite that way.

I am going to use both methods rather than choose jaw surgery because I think the end results will be similar (given that the jaw movements would be so small)- and while my airway size might not improve (it is already big enough), I know that I don't risk permanent numbness in my chin/lower lip.

I think, in my case, orthodontics is the best solution for my overbite.

[OrthodontistExpert]

So irreversibly shaving down the enamel of teeth isn't invasive?

Proclining lower front teeth must have an anatomical limit... And doesn't it lead to periodontal problems later in adulthood?

And bringing "back" upper front teeth also brings them "down"... Which means a gummy smile, poor lip competence, and a seriously weird facial and "smile" look.

And how do you assess their airway anyway? Are you an ENT surgeon or a respiratory physician?

And apart from that, you're still leaving the wisdom teeth to naturally develop in a small lower jaw, leading to future surgery anyway...

So who are you trying to kid by saying "I think it looks good anyway", and that you don't believe surgery is the fix when as an orthodontist you're acting so paternalistically... And in your own self interest and bias.

The more clinically mature way of thinking is "how can my orthodontics enhance surgery", rather than "how can I avoid surgery and rely only on my orthodontics and me?"

You haven't done medicine. You aren't a surgeon. You arent a doctor. You're an orthodontist! And that means you don't know everything, and if you don't know everything and your patients know less... All living in fear of an unknown evil alternative... Isn't that just the nearly blind leading the frankly blind?

And these are kids after all! They rely upon parents and astute adults to protect them... And this forum is full of adults who were wrongly and badly treated as children.

Our orthodontic specialty faces annihilation in the face of public perception, if we don't come to start accepting and absorbing other sciences, and if we don't stop thinking we are all knowing self-serving Gods.

What risk of nerve damage from surgery? If you or I operate as non-surgeons, I'd expect the risk would've been  as great as my next door Neighbour plumber operating. I mean for gods sake... Talk about scare mongoring to align your patients to your "benign" treatment. It is so self serving, it's unethical and its frankly wrong.

You know nothing, but as an orthodontist you think you know everything and that the advice you offer is unquestionable. Oh my God are you just so wrong on so many different levels.

[Modigliani]

Wow.

[sean89]

So irreversibly shaving down the enamel of teeth isn't invasive?

Proclining lower front teeth must have an anatomical limit... And doesn't it lead to periodontal problems later in adulthood?

And bringing "back" upper front teeth also brings them "down"... Which means a gummy smile, poor lip competence, and a seriously weird facial and "smile" look.

And how do you assess their airway anyway? Are you an ENT surgeon or a respiratory physician?

And apart from that, you're still leaving the wisdom teeth to naturally develop in a small lower jaw, leading to future surgery anyway...

So who are you trying to kid by saying "I think it looks good anyway", and that you don't believe surgery is the fix when as an orthodontist you're acting so paternalistically... And in your own self interest and bias.

The more clinically mature way of thinking is "how can my orthodontics enhance surgery", rather than "how can I avoid surgery and rely only on my orthodontics and me?"

You haven't done medicine. You aren't a surgeon. You arent a doctor. You're an orthodontist! And that means you don't know everything, and if you don't know everything and your patients know less... All living in fear of an unknown evil alternative... Isn't that just the nearly blind leading the frankly blind?

And these are kids after all! They rely upon parents and astute adults to protect them... And this forum is full of adults who were wrongly and badly treated as children.

Our orthodontic specialty faces annihilation in the face of public perception, if we don't come to start accepting and absorbing other sciences, and if we don't stop thinking we are all knowing self-serving Gods.

What risk of nerve damage from surgery? If you or I operate as non-surgeons, I'd expect the risk would've been  as great as my next door Neighbour plumber operating. I mean for gods sake... Talk about scare mongoring to align your patients to your "benign" treatment. It is so self serving, it's unethical and its frankly wrong.

You know nothing, but as an orthodontist you think you know everything and that the advice you offer is unquestionable. Oh my God are you just so wrong on so many different levels.

I don't know why you're getting so animated. I'm just questioning whether you think surgery is appropriate for every single patient who has an overbite/overjet. I am not an orthodontist.  I'm someone with an overbite and overjet but don't think that they are sufficiently serious to justify surgery. I feel that braces can achieve a result that is indistinguishable from surgery because my overbite and overjet is minimal.

I have consulted with surgeons and they reckon that my jaw is receded by a maximum of around 4mm. My overjet is 5.5mm. I also have a big chin so the facial cosmetic benefit to advancing my mandible is negligible. It would be purely for dental aesthetics in which case I think braces are the best option for me since there is no risk of nerve damage, it is significantly cheaper, the bite can be controlled better/less risk of posterior open bite, it is faster, there is no decompensation phase, there is no liquid diet, there is less pain, there is no anasthesia, I don't have to spend weeks off work, I have no airway issues, I have no TMJ problems etc. The only possible benefit that jaw surgery might provide is that it could create more room for my tongue because I have some minor speech problems, but when I asked a surgeon that same question, he said that it wouldn't help my speech problems. 

So irreversibly shaving down the enamel of teeth isn't invasive?

In tiny amounts, it is acceptable. If people need crowns on their front teeth due to discolouration that isn't responsive to bleaching (for example), and veneers are not an effective substitute (too translucent), then more can be removed and it can be a more effective tool in reducing overbites but I don't want to focus on this point since the discussion is about braces vs braces + surgery.

Proclining lower front teeth must have an anatomical limit... And doesn't it lead to periodontal problems later in adulthood?

 
I agree. So I wouldn't advocate flaring the teeth beyond that anatomical limit but it remains an option where the teeth are uprighted/tilted inward.

And bringing "back" upper front teeth also brings them "down"... Which means a gummy smile, poor lip competence, and a seriously weird facial and "smile" look.

I don't know that bringing teeth back brings them down. Do you have any sources for that?

And how do you assess their airway anyway? Are you an ENT surgeon or a respiratory physician?

I have no respiratory problems and have consulted with an ENT surgeon (for different reasons) and he mentioned no problem with my airway.

What risk of nerve damage from surgery? If you or I operate as non-surgeons, I'd expect the risk would've been  as great as my next door Neighbour plumber operating. I mean for gods sake... Talk about scare mongoring to align your patients to your "benign" treatment. It is so self serving, it's unethical and its frankly wrong.

There are many people on this forum who have had serious problems with jaw surgery performed by qualified maxfac surgeons, and I think they'd be pretty pissed off for you to label the identification of potential risks as being 'scare mongering'. Also, on another note, the majority of orthos I have spoken to have suggested jaw surgery as an option so I think your generalisation is unfair. 

Also, there's no requirement for impacted wisdoms to be removed.

[OrthodontistExpert]

Impacted wisdom teeth are always pathological. Whether in terms of predicted or expressed risk.

"Qualified" maxillofacial surgeons are either medical or dental or both. So if they are all the same, why the differences? And very few are trained in orthognathic surgery, and complication rates are usually published.

And how do you know the anatomical limits to proclination? Do you peel the gums back everytime to see if the tooth roots have escaped the bone? Usually where the teeth have erupted is where the anatomy lies. Proclining ALWAYS escapes the anatomical limits.

And examples of pullng "down" upper front teeth as you pull them back... Think about it. How else is it done? It's called a fulcrum, & orthodontically it is called torqueing.

And ALL dental crowding and bad bites are caused by the way the face and facial bones grow.

And if you didn't go to an ENT surgeon about airways, what was it for? Allergies, polyps? Tonsils? Isn't that all airway? Don't you see the relationship between a narrow upper jaw and a retruded lower jaw?

And no snoring now doesn't mean you won't later in life. We all put on neck fat. As the neck gets bigger the tiny donut hole in the middle just gets smaller.

Whether you are a dentist practicing orthodontics, or a patient seeking treatment. Your insights seem unusually biased towards an anti-surgical premise, & a very unilateral orthodontic treatment pathway.

What you are promulgating as treatment for yourself is very restricted, bandaid like therapies... That just look at teeth or aesthetics... And forget the reasons why you have the issues the first place.

[Gregor Samsa]

Do you think that the risks of surgery are always negligible compared to the benefits?

[sean89]

Impacted wisdom teeth are always pathological. Whether in terms of predicted or expressed risk.

That's a different point. You said impacted wisdoms always require surgery. They don't.

"Qualified" maxillofacial surgeons are either medical or dental or both. So if they are all the same, why the differences? And very few are trained in orthognathic surgery, and complication rates are usually published.

Some of the most qualified orthognathic surgeons on the planet have caused some of the biggest f**k-ups on this forum. Go to the emotional support forum and you will find plenty of threads. Humans make mistakes. Surgeons are humans. Orthognathic surgery is a significant risk, not only in terms of functions, but in terms of aesthetics (overprojected jaw/flared nostrils etc).

And how do you know the anatomical limits to proclination? Do you peel the gums back everytime to see if the tooth roots have escaped the bone? Usually where the teeth have erupted is where the anatomy lies. Proclining ALWAYS escapes the anatomical limits.

Proclination does not remove the teeth from the root so it does not escape the anatomical limits so I don't know why you've used that language. It is fine is sensible amounts. It is a question of degree.

And if you didn't go to an ENT surgeon about airways, what was it for? Allergies, polyps? Tonsils? Isn't that all airway?

Nothing that is effected by the size of my airway.

Don't you see the relationship between a narrow upper jaw and a retruded lower jaw?

I see a lot of people with those features, but do you think it's all to do with airway? In any case, increasing the airway via BSSO isn't going to change the size of the upper jaw for an adult.

And no snoring now doesn't mean you won't later in life

Well yeah, but that doesn't mean I will snore later on in life.

Your insights seem unusually biased towards an anti-surgical premise, & a very unilateral orthodontic treatment pathway.

What you are promulgating as treatment for yourself is very restricted, bandaid like therapies... That just look at teeth or aesthetics... And forget the reasons why you have the issues the first place.

At this point in time, there's not a single functional justification for me to get jaw surgery. My dental aesthetics can be addressed with braces without the potential problems I described in my last post. Braces are a risk, but jaw surgery is a bigger risk and I think you are naive to think otherwise.

[sean89]

Here's my airway anyway orthodontic expert. I am very active (used to run 1500m - come to think of it, a lot of long distance athletes are class 2 mouth breathers), don't snore, and I have no symptoms other than mild seasonal hay fever.



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