Need your advice

[Mark505]

question is whether undergo midface advancement, as suggested by my ortho as well, or I should try with alternative orthodontia first?

The opinions on my case from functinal orthodontist were:
 

-"We don't believe, that orthognatic surgery would give you the results you want. What we believe that you need is a more balanced, symmetrical face with proper dental support and  you could achieve this in the time of 3.5 to 6 years with an ALF appliance, face pull, myo-theraphy and osteopathic methods"

-I advise you not going surgery route. That's potentially dangerous, especially the type of surgery you are in need. I suggest you going biobloc therapy

-What you need is an palate expansion and mandibular repositioning.

-I suggest you palatal expansion, transpalatal bar and braces or you could go with ALF

-You would get your results, but it would take years of work. Firstly maxillary expansion to make space of your tong and then years of work with proper oral posture supported by body posture and results should be there.

Then the classic orthodontists:

-Your bones are grown. You need orthognatic surgery

- You will be come across of many appliances who claim to do this and that, but I haven't seen any results yet. The only known way to improve your concern that I know and that is in literature, is orthognatic surgery. I could expand your maxilla laterally, but this wouldn't touch your problem, because it needs to be brought forward as well

-I can't suggest you orthognatic surgery, but palatal expansion and mandibular repositioning should be beneficial for you

At this moment I am very divided, because I'm not sure who to listen; the quackodontists, who have nothing to show me, yet they are discouraging me from orthognatic surgery and encouraging on adult remodelling methods, or the legit orthodontists who say I should undergo hi-lefort orthognatic surgery?

I was thinking to try quackodontists first, but there are financial and timing constrains. In this scenario I would pay a few thousands euros to my local orthodontist and a few thousand euros to abroad quackodontist, who would mentor my local one. This is like 7-8 thousand euros for a method which has no track record of being effective in adults. This is the same amount of money I'd need for zygomatic osteotomy. On top of this, I'd probably need 6-12 months to evaluate if quack method works and this is the amount of time that my orthognatic surgery would be delayed, if  alternative orthodontics would fail - which highly likely would.

So what's your opinion about this? Should I jump in pre-surgery braces and undergo surgery in 12-24 months or I should delay everything for 12 months and possibly throw 8k€ out of window trying effectiveness of alternative orthodontics?

[JawKid7]

I would say pre surgery braces + surgery

[terry947]

I had the same question a couple of months ago and chose the alternative route first. Its worth trying. I'm still set on having JS in the near future, but in the meantime I have other issues I need to fix like, open mouth posture, tongue posture, etc....

[Rico]

jesus ... i'm  kinda close to LF3 and again see the opinions to not go such surgery :/

is CAS helpful in LF3 ?  CAS -computer assisted surgery
Some here speculate about LF3, but noone consider doing it with navigation
What you think ?

[molestrip]

Orthodontists do typically work on adults in the 4 year timerframe so it's not like movements over this time period haven't been tried. I think getting closer to 10 years there's room for some movements. One of the limiting factors is the amount of time you can be in therapy. The time frame might be reasonable were you willing to wear headgear 24/7 for 7 years. But are you? Instead, you'll be wearing it for 1/3 of the day. That's a long time to be in an appliance too, you'll risk damage to teeth not to mention gums and soft tissue all around. Those osteopathic methods in particular are worrisome. Once you do surgery, of course, your only option going forward is more surgery. If you have a long face now, then you also need to consider that if you don't have TMJ problems already then you are continually at risk for developing them or for them to worsen. Once that starts, a negative vector will seem like such a non-issue to you. There haven't been any studies on jaw surgery as a preventative measure for TMJ problems so no surgeon is going to claim it but, boy TMJ sucks BAAAD. And surgery in general becomes slightly more risky over that time period. I share your enthusiasm, especially since I only need a few mm and I think combined with LIPUS or similar technologies it should be possible. But you don't want to be the guinea pig. I guess I'm in the camp of accept your faults, do the predictable minimally invasive procedure, and move on with your life.

[Mark505]

Orthodontists do typically work on adults in the 4 year timerframe so it's not like movements over this time period haven't been tried. I think getting closer to 10 years there's room for some movements. One of the limiting factors is the amount of time you can be in therapy. The time frame might be reasonable were you willing to wear headgear 24/7 for 7 years. But are you? Instead, you'll be wearing it for 1/3 of the day. That's a long time to be in an appliance too, you'll risk damage to teeth not to mention gums and soft tissue all around.

8-12h/day might be bearable over a period of few years, but problem is that face pulling can not help my recessed infraorbital rims and zygomatic bones and If it would advance only maxilla, it would just worsen my face. one doesn't do maxillary advancement on already recessed midface, it just makes a face look like open drawer.

Those osteopathic methods in particular are worrisome. Once you do surgery, of course, your only option going forward is more surgery. If you have a long face now, then you also need to consider that if you don't have TMJ problems already then you are continually at risk for developing them or for them to worsen. Once that starts, a negative vector will seem like such a non-issue to you. There haven't been any studies on jaw surgery as a preventative measure for TMJ problems so no surgeon is going to claim it but, boy TMJ sucks BAAAD. And surgery in general becomes slightly more risky over that time period. I share your enthusiasm, especially since I only need a few mm and I think combined with LIPUS or similar technologies it should be possible. But you don't want to be the guinea pig. I guess I'm in the camp of accept your faults, do the predictable minimally invasive procedure, and move on with your life.

it's not that much about long face, but it's more about recessed face. i can only wish it was just about long face, because in such scenario impaction/rotation should do the trick, but since recessed midface is the core problem, i have to solve that at high priority - thus a midface advancement methods. i mean, a have longer face for whole my life, yet it didn't appear that long, because significant amounts of facial fat on relatively wide bone structure made it appear wider; it gave some anterior projection which i'm in need.

also, i'm not that informed about how orthognatic surgery would cause TMJ, especially in midface advancement, where a relation lower jaw - upper jaw stays the same. i hope i was clear so far that my whole face need to be moved, not only zygo-infraorbital complex without maxilla, as it was in the Earl's case.

[molestrip]

I would imagine face pulling would advance the mid-face too. These bones are all connected, move one and the rest move to accommodate it. Long faces typically have recessed midfaces, same problem. The two outcomes for long faces are vertical maxillary excess and skeletal open bite (I'm the latter). The steep angle puts extra stress on the TM joints, hence the TMJ problems. Surgery itself can damage the joints too but I think mostly that's people with pre-existing undiagnosed problems. My point was that surgery can prevent TMJ problems from developing. You mean you want your forehead moved forward too? You're asking for a lot of work, don't think it's gonna happen.

[Mark505]

I would imagine face pulling would advance the mid-face too. These bones are all connected, move one and the rest move to accommodate it. Long faces typically have recessed midfaces, same problem.

this is theory, but what i'm telling you (e.g. that face pulling can't affect midface), is a finding  from some people who actually tried this stuff by themselfs. 27F is one of them, to bad she doesn't speak up about this issue.

 

The two outcomes for long faces are vertical maxillary excess and skeletal open bite (I'm the latter). The steep angle puts extra stress on the TM joints, hence the TMJ problems. Surgery itself can damage the joints too but I think mostly that's people with pre-existing undiagnosed problems. My point was that surgery can prevent TMJ problems from developing. You mean you want your forehead moved forward too? You're asking for a lot of work, don't think it's gonna happen.

what? No, I'm not asking that. No way.
 

[terry947]

Mark from a profile view does your face line up straight or is the lower third recessed?

Because if the lower third is recessed a lf1 and bsso would still improve your looks.

[Mark505]

Mark from a profile view does your face line up straight or is the lower third recessed?

Because if the lower third is recessed a lf1 and bsso would still improve your looks.

flat face (orthognatic maxilla) and retrognatic lower jaw; this is how functional orthos interpret it. originally i was suggested Lefortiii and BSSO, because I already have 6-7mm overjet and advancing my midfacial complex would probably just increase it.

however, it is funny how classic orthodontist intepreted my problem - they said i have prognatic maxilla and orthognatic lower jaw, and they would extract 3 teeth in my upper and 1 in lower jaw, then they would pull eveything even more back so my jaws match. i was shocked how their plan sucked.

[terry947]

@mark - that f**king scary man. Imagine if you didnt know any better, youd be worse off.