Do I Need Jaw Surgery or Genioplasty? (With Pic)

[Kristen]

Wow ...braces on a week before surgery ...lucky you.
Wo is your surgeon and ortho?

[sanddunes]

I am using a Doctor at UM Hospital in Miami that is in-network with my insurance, which is the only way I can afford the surgery.
 
The doctor I really wanted to use was Dr. Richard Joseph in Jacksonville.  I had an amazing consult with him, and think he would do a great job, but he charges 23k for double jaw surgery (insurance would reimburse him maybe 5k and then I would have to pay the 18k difference since he is out of network).

All the other doctors in private practice wanted to charge between 10-20k cash up front for the surgery in addition to insurance reimbursements.

[sanddunes]

I think they told me my overjet is about 4mm, with a 4mm open bite

[sanddunes]

They said they were doing a rotation.  They didn't mention whether it was CW or CCW, I guess I should have asked them to be more specific.  They said the 1mm impaction will allow them to rotate the bottom jaw forward.  At first they thought they would need to do a 3mm impaction, but then after using the dolphin software they came to the conclusion that 1mm would be enough to do the rotation they wanted.

[x]

open bites are closed with CW rotation

[Kristen]

Pay for dr. Joseph. .... My opinion.

[sanddunes]

Pay for dr. Joseph. .... My opinion.

If only I could afford him.  His office doesn't do loans, they suggested putting the surgeon fee on credit cards.  The braces will cost over 5k also.  And my parents won't help at all.  I am just hoping they University Of Miami doctors are good.  You would think as professors of surgery they should know what they are doing. 

[x]

They said they were doing a rotation.  They didn't mention whether it was CW or CCW, I guess I should have asked them to be more specific.  They said the 1mm impaction will allow them to rotate the bottom jaw forward.  At first they thought they would need to do a 3mm impaction, but then after using the dolphin software they came to the conclusion that 1mm would be enough to do the rotation they wanted.

I'm really surprised that 1mm impaction would allow a significant enough amount of rotation. do you have the dolphin imaging on hand?

I have read that cw rotation offers more natural mandibular advancement than ccw rotation so with that you're in luck

[sanddunes]

I'm really surprised that 1mm impaction would allow a significant enough amount of rotation. do you have the dolphin imaging on hand?

I have read that cw rotation offers more natural mandibular advancement than ccw rotation so with that you're in luck

No, I don't have the dolphin imaging on hand....so is the amount of rotation you are able to do directly related to the amount of impaction?  Would someone who had no impaction done be able to have rotation done for example?

I guess I need to do some more research on CW vs CCW rotations because I still don't fully understand the difference between them.

[x]

No, I don't have the dolphin imaging on hand....so is the amount of rotation you are able to do directly related to the amount of impaction?  Would someone who had no impaction done be able to have rotation done for example?

rotation is impaction. basically you're cutting a piece of the maxilla off (think like a slice of pie) which allows the mandible to move further up vertically, because in cases like yours and mine our maxilla grew too long and pushed the mandible downward and backward.

whether it's ccw or cw depends on which part of the maxilla is too long, front or back. because you have an open bite the back of your maxilla is too long, so they'd cut out more of the back than the front which is a clockwise rotation, this picture illustrates what the cut looks like:

[sanddunes]

rotation is impaction. basically you're cutting a piece of the maxilla off (think like a slice of pie) which allows the mandible to move further up vertically, because in cases like yours and mine our maxilla grew too long and pushed the mandible downward and backward.

whether it's ccw or cw depends on which part of the maxilla is too long, front or back. because you have an open bite the back of your maxilla is too long, so they'd cut out more of the back than the front which is a clockwise rotation, this picture illustrates what the cut looks like:

Yeah you are right, they did mention to me that my mandible was being pushed downward by the maxilla.  My front teeth are not gummy at all, but my rear teeth have just a little too much gum show which makes sense.  So you think 1mm might be enough if it is a CW rotation? 

[x]

Yeah you are exactly right, they did mention to me that my mandible was being pushed downward by the maxilla.  My front teeth are not gummy at all, but my rear teeth have too much gum show which makes sense.  So you think 1mm might be enough if it is a CW rotation?

I have no idea to be honest, it's odd that they would be able to close a 4mm open bite with 1mm impaction tho

your workup would take into account your occlusion and soft tissue makeup and help them figure out how much is needed

[pekay]

too many variables to consider

how old are you?
are you doing this primarily because you want to see an aesthetic improvement?
any functional issues?
sleep apnea?
trouble breathing? deviated septum?

[sanddunes]

So this is it...my surgery is tomorrow.  I have to be at the hospital by 6:30am.  I would be lying if I said I wasn't nervous about all of it...I just hope everything turns out the way it is supposed to.

[Kristen]

Good luck Sand Dunes!    Please keep us posted.