Wisdom tooth extractions destroyed my face! What can be done?

[Lefortitude]

I had wisdom tooth extractions about 4 years ago and looking at before and after pictures my midface has flattened and elongated considerably!

Ive looked into bone grafts to replace the resorbed bone and re implant the extracted teeth (i had 4 wisdom teeth extracted, and about 12 years ago one premolar extracted during orthodontic treatment).  It wont be cheap, but if it will make me look the way i did before id be willing to scrape together the cash.

Does anybody know if this will even work? is there anything I can do that will work?!

[ditterbo]

Were they impacted?  I noticed a change in my cheeks post wisdom teeth extraction too but wasn't microscopically cued in like I am now.

[Lefortitude]

only one was impacted, and it wasnt even causing any problems.  my dentist gave me a referral to a maxfac who highly recommended i have them all removed.  Didnt mention any possibility of future aesthetic problems.  Browsing the internet i see im not the only one with this issue!

I hope i find an answer soon

[zygotic]

I had two wisdom teeth taken out of one side and it has given me an asymmetrical face.

[Lefortitude]

I had two wisdom teeth taken out of one side and it has given me an asymmetrical face.

Are you looking into fixing it?  One doctor said placing a bone graft and implanting the teeth back will fix it, although im skeptical.  my other option is to just cover up the aesthetic damage via plastic surgery

[zygotic]

Are you looking into fixing it?  One doctor said placing a bone graft and implanting the teeth back will fix it, although im skeptical.  my other option is to just cover up the aesthetic damage via plastic surgery

I would like to fix it yes, as it feels very uneven at the moment. The side with the wisdom teeth connects much better and the masseter is larger on that side. I know in my case that with cosmetic surgery I would never get that feel of equilibrium back.

I had wondered whether something could be done with the next molar along to compensate for the lost wisdom teeth. I have read it would be very difficult to implant so far back in the mouth (not aware of anyone that does that).

In any case I need a CCW rotation and maxillary cant correction which might get me part way there. Have you had any jaw surgery before?

[Lefortitude]

no jaw surgery yet, and my occlusion is good so everyone ive consulted with has advised against any sort of orthognathic surgery, because of the morbidities associated and the associated cost.

My understanding is that in the mandible its difficult to implant that far back because theres a nerve that runs upwards along the mandible which increases the risk of damage the further back you go.  the maxillary alveolar ridge bone gets thinner and less dense the further back you go so implantation becomes exceedingly difficult.  my hypothesis was that with a bone graft my maxillary third molars can atleast be replaced.  not sure if it will bring back my midface projection but i have some consultations coming up which will shed some light on the situation

have you considered just getting the other sides third molar removed to achieve some sort of symmetry and then proceeding to mask the aesthetic deficiency with a simpler cosmetic surgery?

[ditterbo]

no jaw surgery yet, and my occlusion is good so everyone ive consulted with has advised against any sort of orthognathic surgery, because of the morbidities associated and the associated cost.

My understanding is that in the mandible its difficult to implant that far back because theres a nerve that runs upwards along the mandible which increases the risk of damage the further back you go.  the maxillary alveolar ridge bone gets thinner and less dense the further back you go so implantation becomes exceedingly difficult.  my hypothesis was that with a bone graft my maxillary third molars can atleast be replaced.  not sure if it will bring back my midface projection but i have some consultations coming up which will shed some light on the situation

have you considered just getting the other sides third molar removed to achieve some sort of symmetry and then proceeding to mask the aesthetic deficiency with a simpler cosmetic surgery?

Yep this also holds true for wisdom teeth removal.  Quite the freaky risk doctors sign you up for just because the wisdom teeth "may" become problematic in the future.

[zygotic]

have you considered just getting the other sides third molar removed to achieve some sort of symmetry and then proceeding to mask the aesthetic deficiency with a simpler cosmetic surgery?

I had thought about it, but then did wonder if removing the other side was taking me further away from the ideal situation. I had the extractions on one side back in 2003 at age 20. Immediately afterwards I developed post nasal drip and couldn't breathe through my nose when sleeping. I developed condylar resorption on the extracted side and it seems like over the years my body compensated for these changes (e.g. eating and sleeping on one side) and my looks were affected.

I recently had orthodontic work and the best I felt was wearing a splint 24/7 for 9 months. So I'm hoping to replicate that through surgery, possibly bimax with CCW rotation.

It's interesting that you say your midface became elongated. Have you noticed a difference in your ramus length following removal? With my condyle problems and maxillary cant I have a less defined jaw on that side, I can't say for sure if it was like that before surgery as it was so long ago. I'm just hypothesising that the longer midface could actually be a lack of height in the mandible, due to changes in the position of the condyles in relation to the socket.

[Lefortitude]

damn you had it bad! maybe just get a really good cosmetic surgeon to fix the aesthetic issue and account for the symmetry, via custom implants etc

Im not sure if the ccw movement of a bimax would cause further projection of the midface as the lefort 1 portion seperates the maxilla and repositions it, although im far from an expert. perhaps @lestat or @lazlo can chime in on the full aesthetic impact of the ccw rotation during bimax

Im not sure about the ramus, but you hypothesis seems plausible.  its hard to say since it was so long ago, but the one thing i see for sure is that my midface has lost considerable projection 9 particularily the zygomatic body and inferior orbital rims) and since all 4 third molars were removed i can only imagine theres also been an impact on the mandible. 

[Deformed_Human]

Can you show me a pic of what you mean, op? I'm curious.