Jaw Surgery Necessity?

[Dreich]

This summer my dentist referred me to an orthodontist as my front teeth have shifted a bit in the past few years, just to see if I could get a retainer or something to keep them from moving any more. To my surprise, the orthodontist had a lot more to say, and recommended orthognathic surgery because of my overjet (4mm to 5.5mm, depending which side) and deficient chin. I'd never heard of it before that appointment, and since I don't have any functional problems, it had never crossed my mind. I had braces as a kid, from age 10 to 12, so my teeth are straight but I've always had the overjet.

I saw another orthodontist and he recommended the same thing. So I met with the surgeon and he said it was my decision, but that I was taking a risk by not getting the surgery, since people with jaw/tooth positions like mine can end up with sleep apnea or losing their teeth (since the bottom teeth are at an angle to compensate) once periodontal disease sets in around age 45.

My question is whether, in your opinion, I'm a glaringly obvious case for jaw surgery or if I can wait a few years to make a decision. If the recovery weren't so difficult, I would have already gladly signed up for it as a precaution, but sometimes it seems crazy to go through with such a big surgery when I don't have any functional issues. Of course, I know that's probably just a "yet." I should also mention that I have some bruxism and occasional TMJ popping (painless) that has appeared in the past 5 years or so. I'll also be in my 30's by the time I get this done, if I get it done, so I don't want to spend too much time thinking since recovery gets harder with age.

Thanks for your input! I've posted some recent x-rays and photos from different angles here:

[CCW]

Based on your ceph and what you told, I'd say you're a clear jaw surgery case. Your jaws are rotated clockwise, and you have a steep occlusal plane, so you'd need double jaw surgery with counterclockwise rotation for optimal results and to fully correct your deformity. If you're going to get it done, you should get it done now that you're still young. The risks are minimal for someone your age, and the "difficult recovery" is exaggerated and shouldn't be a reason for you not getting it done. Bruxism is often a sign of sleep apnea, so you should maybe get a sleep study although your airway looks decent. I'd get surgery if I were you.

[ditterbo]

Same problems as me except I already went through hell to attempt to camaflouge my deformities and got botched in the process.  I've kept up use of my retainer from like 10 years ago, which I think has kept me under the radar from the basic dentist types. GL with your decision, I can't make up my mind and probably similar age as you.  I already had a small taste of what bimax was like after having 4 wisdoms removed with an excruciating recovery (almost a month before fully normal again). I think that and the plastic surgery results permanently darkened my outlook on all surgeries, especially ones where I can't eat!

My advice, if you are swayed more towards medical surgery than cosmetic types, is to get a sleep study done to see if you have sleep apnea.  You're probably mild, BUT I've found even treating mild sleep apnea (mines like 10 events/hr) can give the affect as if you've been on coffee all day. Also they say if you have mild OSA at a young age, you're going to get it bad when your older.

[Dreich]

Thanks everyone for your input!

CCW, functionally, what's the risk of having a steep occlusal plane?

Also, the orthodontists said I would just need lower jaw surgery but the surgeon said not to rule out double jaw surgery if braces can't fix the problem. It seems like double is much more common than just one jaw, from what I read. If I got just lower jaw surgery, would it just make my face look flat, or is there more to worry about? I know my upper and lower sets of teeth are at a slight angle to one another and the only way to fix that is by touching the upper, but it's so small that it doesn't bother me if it's not a problem otherwise.

ditterbo, I'm afraid of surgery too (isn't everyone?)! That said, I had four wisdom teeth extracted surgically, didn't get sick from the anesthesia, stopped taking pain killers after the first day, and never swelled. I was much, much younger then so I can't count on bouncing back so quickly, especially with a major surgery like this one, but hey! A month recovery from the wisdom teeth extraction definitely doesn't seem normal. Sorry it happened to you. And good luck with your decision, too. I'm nowhere closer to feeling confident either way, soI won't jump the gun on this until I'm sure I want it. More research and thinking ahead!

[CCW]

It puts more strain on your joints and increases the risk for sleep apnea since clockwise rotated jaws decrease the pharyngeal airway space. Your lack of chin projection isn't really caused by a deficient chin but rather by your downward and back rotated lower jaw. You also seem to have some lip incompetence which counterclockwise rotation would fix along with the chin projection. Lower jaw surgery alone would make your face longer.

You should see Dr. Gunson for a consultation. He'll give you a surgical plan which you could then shop around even if you don't end up having surgery with him.