Dr. Joan Birbe - Spain - First consultation

[Dogmatix]

Can you clarify whether or not your second e mail to him was with the expectation that he give you an indepth analysis of your case VIA E MAIL.

Simply asking if it would be ok to come down and have a cbct done, do some kind of vsp or if he suggests me to involve an orthodontist at this stage and if so how I should go about this. Asking for some guidance what he would propose the best way forward would be for me if I feel I want to get into more details on this. I'll give it another try, maybe just got lost some where.

[kavan]

Simply asking if it would be ok to come down and have a cbct done, do some kind of vsp or if he suggests me to involve an orthodontist at this stage and if so how I should go about this. Asking for some guidance what he would propose the best way forward would be for me if I feel I want to get into more details on this. I'll give it another try, maybe just got lost some where.

Sounds OK to ask in terms of making an in person consult. I guess you would have to go through his secretary to book it.

[Dogmatix]

Sounds OK to ask in terms of making an in person consult. I guess you would have to go through his secretary to book it.

Yep. And you know from previous discussions that I'm a bit anxious about this 'catch-22', wanting to know as much as possible. The only way I see my self moving forward is to actually meet these guys. It may be that it's just a NO when I ask if it's possible to get some kind of vsp before a decompensation is done, which in my opinion is a bit sad if I'm ok with some kind of approximation to ease my mind.

The reason I asked specifically on posterior down grafting was more to know if this is in the toolbox, regardless if it will happen to me. It's a difference if a surgeon can do it but chose not to, or if they can't and are stuck having to solve it in a different way.

[april]

It may be that it's just a NO when I ask if it's possible to get some kind of vsp before a decompensation is done, which in my opinion is a bit sad if I'm ok with some kind of approximation to ease my mind.

When you say some kind of VSP before decompensation, what are you referring to exactly? A 2D ceph plan showing the displacements and a morph?

[Dogmatix]

When you say some kind of VSP before decompensation, what are you referring to exactly? A 2D ceph plan showing the displacements and a morph?

I'm very humble with regard to what can be offered, but what I understand, a cbct can be loaded into a vsp program as below. If I could pay someone to spend an hour in a program like this with me to show roughly how they think about this, I'd be very happy.
I mean, this is a big medical procedure that's being discussed, I can't be the only one feeling like this.

https://youtu.be/EyDUHdyAYQ4

[april]

I completely understand where you're coming from Dogmatix. But I don't think surgeons will bother to do an actual VSP session (between surgeon and engineer) on a non-decompensated bite. it may also be futile for you too because your decompensated bite might require different movements anyway.

But if you're willing to pay $$$ why not ask Antipov and see what he says? He has that option of 3D planning listed on his website here .

The soft tissue is also still going to be unpredictable with VSP. Something to keep in mind.

[kavan]

In that video, he is going over the surgical possibilities with someone CONVERSANT in the software he's using who will be preparing a SPLINT (or a bone buttress material shaped for what ever graft they might need) based on the surgical plan. It isn't a TUTORIAL that a patient is going to get from the doctor using the software.

If you are in any way conveying to Birbe that you expect a long sit down 'show and tell' tutorial session with the software before you decide to have the surgery, he might be thinking in terms of: 'NOT enough TIME to address all the contingencies this patient has in the decision making process.'

As to his doing the posterior down graft, you already had access to that information that was in his toolbox on another part of this forum where a patient relayed the posterior downgraft was offered to her.

ETA: If another doctor offers such, (I see that the doc in the video is asking over $600 for that sort of consult), then you have option of paying for it with doctors who offer that option. But one doctor's plan might  not be the same plan of another doctor.

[april]

^There's actually no price listed for the 3D surgical planning which he offers upon request. The $600+ consult is for 2D planning (plan and morph) like in this video of his https://www.youtube.com/watch?v=h72Lt4hclUA

[kavan]

^There's actually no price listed for the 3D surgical planning which he offers upon request. The $600+ consult is for 2D planning (plan and morph) like in this video of his https://www.youtube.com/watch?v=h72Lt4hclUA

I bet the price quote would be HIGHER than the $600+ and maybe a function of TIME in the event the patient wanted/needed a tutorial out of the session.

[Dogmatix]

In that video, he is going over the surgical possibilities with someone CONVERSANT in the software he's using who will be preparing a SPLINT (or a bone buttress material shaped for what ever graft they might need) based on the surgical plan. It isn't a TUTORIAL that a patient is going to get from the doctor using the software.

If you are in any way conveying to Birbe that you expect a long sit down 'show and tell' tutorial session with the software before you decide to have the surgery, he might be thinking in terms of: 'NOT enough TIME to address all the contingencies this patient has in the decision making process.'

As to his doing the posterior down graft, you already had access to that information that was in his toolbox on another part of this forum where a patient relayed the posterior downgraft was offered to her.

ETA: If another doctor offers such, (I see that the doc in the video is asking over $600 for that sort of consult), then you have option of paying for it with doctors who offer that option. But one doctor's plan might  not be the same plan of another doctor.

Yes of course, there are many ways I can be interpreted. The above was not my intention with such question, just have seen how the surgeons seem to work with this and think it's a fair question, not with any intention to be tutored or educated, just see some rough simulation. Any way, let's not over analyse this.

[kavan]

Yes of course, there are many ways I can be interpreted. The above was not my intention with such question, just have seen how the surgeons seem to work with this and think it's a fair question, not with any intention to be tutored or educated, just see some rough simulation. Any way, let's not over analyse this.

I'm just trying to help with the 'mystery' of why he didn't get back to you.

[Dogmatix]

I'm just trying to help with the 'mystery' of why he didn't get back to you.

Yep, noted. I still have high thoughts about him and have contacted the service desk, and it seems like the clinic is closed during August. So for now I'm giving it some time.

[kavan]

Yep, noted. I still have high thoughts about him and have contacted the service desk, and it seems like the clinic is closed during August. So for now I'm giving it some time.

Yes. Good idea to give more time.

[haven]

^There's actually no price listed for the 3D surgical planning which he offers upon request. The $600+ consult is for 2D planning (plan and morph) like in this video of his https://www.youtube.com/watch?v=h72Lt4hclUA

The base price for the initial consult with Antipov is $500 and includes a CTScan, as well as some photographs and he sits with you to go over some them using a computer program for 2D planning (the software also generates morphs). Your insurance might cover some of the cost if you have the right plan. He doesn't do 3D planning on the first consult from what I gathered so I cant comment on how much that costs.

[april]

Thanks; so he charges more for online consults then.