Dr. Arnett - Santa Barbara - Anyone been there?

[asaewert]

I am going to see Dr. Arnett for a consult in a few weeks.  I am traveling from out of state to see him.  I have condylar resorption.  I originally had jaw surgery when I was 20 to close my open bite.  I have relapsed over the past 15 years or so.  My jaw in now in a position that obstructs my airway.  I have OSA and show no response to CPAP (CPAP doesn't stop my apnea's).  I am extremely exhausted all the time from the sleep apnea.  Due to the relapse, my face has gotten much longer and the original genioplasty I had done looks horrible now...my face is all out of balance.  I am looking to see if anyone has been to Dr. Arnett and how it works with him being from out of state and all?  Any insight would be helpful.

[molestrip]

Let me guess, your last surgeon rotated your maxilla up to close your open bite?  Sounds like your apneas could be central and obstructive or maybe you need to increase the pressure. Anyway, Dr Arnett is exactly the right guy to see right now. They'll explain the process to you.

[molestrip]

It was the standard of care for a long time. The appeal is that the movement is very stable, solving the functional problem, and less invasive. However, the result is an increased occlusal angle that increases load on the TMJs. At some point the excess load overwhelms its adaptive capability and that's when degeneration starts. When an open bite is addressed properly with advancement and CCW rotation the odds of developing TMJ or even not stabilizing the joint is very low.

[molestrip]

Another redditor here I see It's really simple. Look at a cephalogram of your face taken from your right side. It's literally just an x-ray, showing the nose, maxilla, and mandible. Draw a box around the teeth, which are usually higher in the back of the mouth than the front, and rotate it counter clockwise. In the case of an anterior open bite, you need to rotate the back of the mandible down to close the bite and then rotate both even further together to level the occlusal plain. That is, make the mandible look even flatter. That's why so many surgeons screw it up, it's so unintuitive until you frame it the right way.

[ForeverDet]

Thanks!  I got it now.  Whats a redditor? lol

Ha! He's referring to users that post at reddit.com.

There's a subreddit (like a subforum) called "explain like I'm five" where people ask questions about stuff they can't comprehend and other people give them simple explanations that a five year old could understand. Your previous post said "explain it like I'm a five year old" so I think that's why he assumed you were also a redditor.

Obviously, I'm a redditor! lol

[Lazlo]

OP Arnett's the man to fix all this. So you're doing the right thing.

[zygotic]

How did your consulation go? I think I might need the same as you.

Is there a reason you went to see Arnett? I noticed on their website that Gunson specializes in sleep apnea.

[molestrip]

Just reading this again. @asaewert, I am you but took the alternate path. 15 years ago I was recommended a partial glossectomy and posterior impaction. I declined. Didn't know I had sleep apnea until many problems later. My open bite has destroyed my molars and created facial pain. So here I am again. No joint problems to date, I''m told that's a miracle. My bite has been stable otherwise. CPAP is also semi-effective for me.

Dr Gunson knows a lot about sleep apnea. He attends all the conferences I think and they have some research on the topic. I think they get a lot of sleep apnea patients but not a lot who are there trying to fix their sleep apnea, if that makes sense. Dr Kasey Li gets most of that business and works near the sleep apnea mecca (Stanford). He does revisions as well. They're both excellent choices, way superior to common surgeons.

How does it work? You do braces, stay 2-3 weeks for surgery, then visit once a month for the next year.

[terry947]

Molestrip you doing to do anything about your growned down teeth?

[molestrip]

Yes I'm basically getting a whole mouth reconstruction. 18 crowns and some composite restorations. That's part of what precipitated this whole mess, my dentist told me they need to rebuild some teeth but I need to decide first if I'm going to fix my bite. I'm still somewhat uneasy about the ordering of things.