Do I need jaw surgery?

[fangletooth]

Some context: I know I have a Class II malocclusion. I have to strain my mandible back to bite down. I have been to two orthodontists: one orthodontist two years ago and the other just recently. The first orthodontist told me that my jaw was extremely small and would appear even smaller after orthodontic treatment, and that I needed double jaw surgery. The second one pretty much laughed when I asked about jaw surgery, and he told me that I was a "functional" class II and that my profile looks perfect (which I don't really agree with).

Regardless, I ended up starting my invisalign treatment with orthodontist #2 because he is considered the top cosmetic dentist in the area, and I trusted his judgment. However, after 1.5 months of treatment, I am having second thoughts. The treatment is going great, and I should be finished by March 2016, however I am developing soreness in my jaw (at the joint) and I've been noticing that I'll be clenching and grinding my teeth when I wake up. This has made me contemplate, again, the need for surgery, which is why I have come to you all.

I've called two maxillofacial surgeons, and their secretaries told me that I need a referral from my orthodontist to schedule a consultation. I'm pretty sure that all of the invisalign trays have already been made for the entire treatment, so I don't think there can be any deviations or mid-course corrections to accommodate for a change in plan if surgery is warranted.  I'm not really sure how to proceed.

Below are my front and profile pics, as well as a mock-up of my teeth pre-treatment and post-treatment with invisalign. Orthodontist #2 has chosen not to move my molars at all. The right mandibular wisdom tooth is impacted, hence its absence from the invisalign projection. Also, I am at a very healthy weight in these pics, and have been down to 10% body fat in the past, but the fat beneath the chin remained. I'm not sure if that is a product of my small jaw or just "baby fat".

Any insight would be greatly appreciated.

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[fangletooth]

Thanks FaceNit for your reply.

You have an overbite on the dental model that covers over half of your lower teeth, where are they going with that?

From what the ortho told me, I will still be a functional class II after treatment. He told me he can try elastics, but I will never truly be class I without surgery. This may be a stupid question, but as I said previously, I have to move my mandible back to bite down. Will the extra room given by moving the maxillary incisors forward allow me to bite down without recessing my chin, thus resulting in less of an overbite?

I have not heard of max-fac surgeons requiring a referral, is that an insurance thing?  Or a regional thing?

The receptionists of the surgeons I've called asked me for a referral before any mention of insurance. I am military, but the military dentist that I saw also laughed at me when I mentioned surgery, so I cannot go that route. Also, I am in a unique situation that would take several pages to explain, so to make a long story short, I have to pay for everything out of pocket (I realize the costs). I am in SoCal.

Adipose under the chin can be genetic or can correlate with tummy fat.  If genetic, it can be removed IF it bothers you--I have a friend who is a serious lifter with low bodyfat and has the same genetic issue storing fat under the chin which drives him nuts. It is not abnormal or something people on the street would point out.

Hmm. No one in my family has this issue from what I can tell, but I know that doesn't really exclude it from being genetic. I have an identical twin, and even he doesn't have it. Granted, his mandible is wider than mine, so that may be the reason why. Which leads me to another question: would gonial angle implants be a possibility? The 1st ortho I saw several years ago mentioned this as an option after getting my teeth fixed. He told me that the width of my mandible is very narrow, but surgery can't really fix it.

My suggestion is to get evaluated by a max-fac surgeon, if for no other reason than to put your mind at ease.

That's all I really want, some peace of mind. Thanks again for your help, and I'll try to get some cephs done when I can.

[notrain]

You look exactly like I did before surgery, including the neck/chin fat issue (cervico mental angle). My bite was also fully functional (after having had teenage orthodontics) but aesthetically speaking my profile was s**tty - mostly b/c of double chin.

To cut a long story short: I had double jaw surgery with aggressive movements and it improved me considerably. If you can afford it, you should consider doing it. Bear in mind you are going to need large movements to improve your profile (at least 1cm BSSO).

[jesterofmalice]

You kind of have similar issues to me. A deep bite, and what looks like a general lack of bone.
I think I need my jaws moves forward, but I also would look better with a 'wider' jaw. I think that's possible with implants, but I can't think of how anything else would achieve that.
People talk about chinwings, but I don't think it can make anything wider...only longer?

Wider:



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[fangletooth]

Hey all. Sorry for the late reply. I've been traveling for work and haven't had much time to respond. Thanks again for all of your replies. Also, special thanks to jesterofmalice for putting in the time to shop that photo.

I've called to schedule an appointment with Drs Arnett and Gunson, and their secretary sent me a consultation packet for me to fill out. I am supposed to send this back along with molds of my teeth. My question is: can I send in molds if I'm in the middle of orthodontics? There will be discrepancies in the positions of my teeth between now when the molds will be made and the future when the consultation will take place (most likely in March, when my current orthodontic treatment is finished).

Also, does anyone know if Arnett and Gunson are opposed to invisalign for pre-surgical orthodontic treatment? I know that traditional braces are ideal, but I can only use removable aligners since I am in the military.

Final question: I read that A&G use HA grafts. Are those better than traditional gonial angle implants? Can they widen the gonial angle?

[april]

I've called to schedule an appointment with Drs Arnett and Gunson, and their secretary sent me a consultation packet for me to fill out. I am supposed to send this back along with molds of my teeth. My question is: can I send in molds if I'm in the middle of orthodontics? There will be discrepancies in the positions of my teeth between now when the molds will be made and the future when the consultation will take place (most likely in March, when my current orthodontic treatment is finished).

Hey, did you figure the mold thing out?

Have you had your consult?

[fangletooth]

Bee,

I decided to forego the consult with A&G. They are a bit outside of my price range. I asked their office secretary about the mold thing via email, but it was never addressed. Though on their initial pre-consultation forms that I filled out, they asked if I was currently undergoing orthodontic treatment. So from that, I would assume that it is fine.

[JimmyTheGent]

Bee,

I decided to forego the consult with A&G. They are a bit outside of my price range. I asked their office secretary about the mold thing via email, but it was never addressed. Though on their initial pre-consultation forms that I filled out, they asked if I was currently undergoing orthodontic treatment. So from that, I would assume that it is fine.

I'm not an "expert" like a lot of the members on this forum but your face looks normal to me EXCEPT for the excess fat under your chin.  There is a woman on RealSelf who had a similar problem to what you have and she got liposuction.  Never in a million years did I think Liposuction alone could do the trick but she looks like a different person and a million bucks.  Go check it out and if you cant find it PM me and I will find it for you.  Its a pretty easy procedure and costs about $2K. 

[strongjawman]

lol at getting liposuction for your neck. Go to the gym and get shredded.

[Kingray]

The content of the material has a very good heart