New implant imitates bone structure

[april]

^ Could you do multisegment lefort, lazlo? or did you already have that as part of 1st surgery? I'm in same boat with no room in my mouth and it all comes back to extractions. Did you ever consider reversing them?

Generally it seems older patients who do jaw surgery for sleep apnea come out of it pretty happy. Being able to breathe outweighs any other complications.

[Lazlo]

^ Could you do multisegment lefort, lazlo? or did you already have that as part of 1st surgery? I'm in same boat with no room in my mouth and it all comes back to extractions. Did you ever consider reversing them?

Generally it seems older patients who do jaw surgery for sleep apnea come out of it pretty happy. Being able to breathe outweighs any other complications.

Hi April, remind me of your surgery details? How old are you? I'm sorry you also need a revision.

Well Sinn said he did a multisegment lefort. But the problem is that that because i had both upper and lower bicuspid extractions my lower dental arch is very narrow and pushed significantly back.
And the lower dental arch determines how much the upper arch can be expanded.

Also, the tongue movies with the lower jaw when brought forward so the amount of space you have never actually changes even though your jaws are advanced.

I'm seeing some surgeons over the next several months to ask about what can be done. Maybe Sarpe or some form of CCW rotation. I've been advised NOT to have the extractions reversed because moving the teeth again that much may be very detrimental for the roots and could involve losing teeth eventually.

I can't believe something like this has basically ruined my life. There is not a minute during the day that I'm not aware of my tongue sitting between my teeth and being curled back because of the lack of space. I never had any of these problems before orthodontics/extractions. I didn't even have that much crowding. He could have left it well as it was, I could have had the surgery and I'd be fine. Instead he ended up elongating the bloody treatment by almost four years (I was in braces forever) and causing all these problems.

If anyone has any idea of what can be done in such a situation, please let me know.

[jusken]

Hi April, remind me of your surgery details? How old are you? I'm sorry you also need a revision.

Well Sinn said he did a multisegment lefort. But the problem is that that because i had both upper and lower bicuspid extractions my lower dental arch is very narrow and pushed significantly back.
And the lower dental arch determines how much the upper arch can be expanded.

Also, the tongue movies with the lower jaw when brought forward so the amount of space you have never actually changes even though your jaws are advanced.

I'm seeing some surgeons over the next several months to ask about what can be done. Maybe Sarpe or some form of CCW rotation. I've been advised NOT to have the extractions reversed because moving the teeth again that much may be very detrimental for the roots and could involve losing teeth eventually.

I can't believe something like this has basically ruined my life. There is not a minute during the day that I'm not aware of my tongue sitting between my teeth and being curled back because of the lack of space. I never had any of these problems before orthodontics/extractions. I didn't even have that much crowding. He could have left it well as it was, I could have had the surgery and I'd be fine. Instead he ended up elongating the bloody treatment by almost four years (I was in braces forever) and causing all these problems.

If anyone has any idea of what can be done in such a situation, please let me know.

Yeah I had 10 years of braces (including a round of extractions, in addition to my wisdom teeth), which caused my palette to change drastically and my tongue to have very little room in my mouth.  For the last 3 years of treatment, my orthdontist very subtly expanded and moved my teeth forward.  It created a small bit of space, but my roots are extremely short because of all this work.  It obviously would have been better to get 1 round of braces with jaw surgery, but growing up in a small town, everyone was completely against surgery.

[Lazlo]

I don't understand why it's not possible to somehow detach the tongue from the lower jaw and move it forward and then re-attach the tongue further back.

I could only go through orthodontics again if it was a short treatment --like 6-12 months and was done so that I could have a surgical solution to my problem.

I basically need my upper arch expanded by like 10mm and my lower and upper arch moved forward 5-7mm. Then I'd have enough space.

My sympathies are with you Jusken. People don't realize how f**king horrible this trapped feeling is. It affects every element of your physiology and your psyche.

[april]

Hi April, remind me of your surgery details? How old are you? I'm sorry you also need a revision.

Well Sinn said he did a multisegment lefort. But the problem is that that because i had both upper and lower bicuspid extractions my lower dental arch is very narrow and pushed significantly back.
And the lower dental arch determines how much the upper arch can be expanded.

Also, the tongue movies with the lower jaw when brought forward so the amount of space you have never actually changes even though your jaws are advanced.
 

Sorry I haven't had surgery yet - I'm still navigating my way through this, trying to figure the best route to go. I'm 34.  I just meant the same boat with no space in my mouth. My arches are ridiculously small too with upper/lower extractions and also all wisdom teeth out. It's a real sick joke if you ask me. I need space in all dimensions, but mainly forward I think. There's a book whose title explains the feeling well - six-foot-tiger, three-foot-cage.

That sucks. I assumed that advancing the jaws would provide more tongue space, but given what you're saying from your own experience with Sinn and what you've explained, it doesn't sound like the answer is that simple. I want to open up the spaces in my upper arch, but I don't think I can either because I have bad roots as a result of all the braces work. I feel trapped as well- physically with the lack of space, emotionally trying to figure all this out, and trapped financially too.

I have heard something about the 'AGGA' appliance helping with all this, but I don't know much about it, it might just be the same as opening up the spaces. I'll have to do some digging.

[CCW]

I saw her result before. Wow it's so heartening to see someone who actually came out happy and with a clearly great result.

I have so many questions about someone getting that done at her age.

How did she go through the orthodontic treatment? Her teeth look fine and her papilla look present. Or did Alfaro do a surgery first approach with her?

I think I asked her about whether she had any numbness and she evaded the question saying something like I love my results I don't care about that. But I forget.

Some people are just really lucky with surgery. I'd say more often than not you end up with lifelong complications. I'm really coming down to that view. I need a revision for sure. But the things I need like expansion of the upper jaw and somehow making more space for the tongue --I don't know if there are surgeons who know how to do it.

It was surgery first, and she said she doesn't have any numbness at all.

[CCW]

Hi April, remind me of your surgery details? How old are you? I'm sorry you also need a revision.

Well Sinn said he did a multisegment lefort. But the problem is that that because i had both upper and lower bicuspid extractions my lower dental arch is very narrow and pushed significantly back.
And the lower dental arch determines how much the upper arch can be expanded.

Also, the tongue movies with the lower jaw when brought forward so the amount of space you have never actually changes even though your jaws are advanced.

I'm seeing some surgeons over the next several months to ask about what can be done. Maybe Sarpe or some form of CCW rotation. I've been advised NOT to have the extractions reversed because moving the teeth again that much may be very detrimental for the roots and could involve losing teeth eventually.

I can't believe something like this has basically ruined my life. There is not a minute during the day that I'm not aware of my tongue sitting between my teeth and being curled back because of the lack of space. I never had any of these problems before orthodontics/extractions. I didn't even have that much crowding. He could have left it well as it was, I could have had the surgery and I'd be fine. Instead he ended up elongating the bloody treatment by almost four years (I was in braces forever) and causing all these problems.

If anyone has any idea of what can be done in such a situation, please let me know.

It sounds as though your issue is you didn't get enough CCW. Have you consulted with Gunson/Relle/Wolford?

[Lazlo]

It sounds as though your issue is you didn't get enough CCW. Have you consulted with Gunson/Relle/Wolford?

Yes, I too think a strong CCW may be able to slightly relieve my issues a bit. Like does that mean that if the front part of my upper arch moves up and is angled out then they'd be able to bring the lower jaw more forward without the tongue coming forward as well? I mean why do YOU think it would create more space in my mouth/for my tongue. If CCW would bring the back of the upper arch DOWN wouldn't that then trap my tongue or does it not bring it that far down. Thanks.

Do you think GUnson is a good fit for this or would Alfaro be better? After all, this problem has taken me to the brink of suicide so I really do need to get it right this time.

[kavan]

....the tongue movies with the lower jaw when brought forward so the amount of space you have never actually changes even though your jaws are advanced.

....

It's the chin movement with the genio that has more of an effect on the base of tongue. But what ultimately gives more room for the tongue is the displacements of the maxilla, eg. forward advancement if that's what is cramping it and/or making it wider if narrowness is a factor.

[Lazlo]

It's the chin movement with the genio that has more of an effect on the base of tongue. But what ultimately gives more room for the tongue is the displacements of the maxilla, eg. forward advancement if that's what is cramping it and/or making it wider if narrowness is a factor.

So because teeth were taken out on the bottom arch and pushed back (maybe some minimal forward movement of the back teeth, i doubt it) if my tongue lies on the base of my mouse i have to either curl it back or have it lie ON TOP of the bottom teeth with my mouth slightly open). So I need some kind of forward space there.

And yes, the maxilla is narrow so I lay my tongue on the roof of my mouth, as well as forward. I either keep my tongue curled back in my mouth or i keep my teeth slightly ajar and let my tongue rest between them as if i was going to bite my tongue. Both options are horrible and I need to discover a way to fix this. It is truly driving me mad.

[kavan]

So because teeth were taken out on the bottom arch and pushed back (maybe some minimal forward movement of the back teeth, i doubt it) if my tongue lies on the base of my mouse i have to either curl it back or have it lie ON TOP of the bottom teeth with my mouth slightly open). So I need some kind of forward space there.

And yes, the maxilla is narrow so I lay my tongue on the roof of my mouth, as well as forward. I either keep my tongue curled back in my mouth or i keep my teeth slightly ajar and let my tongue rest between them as if i was going to bite my tongue. Both options are horrible and I need to discover a way to fix this. It is truly driving me mad.

I'm just saying the forward movement of the maxilla is the more salient aspect of tongue space given your statement of: "...the amount of space you have never actually changes even though your jaws are advanced."

[Post bimax]

So because teeth were taken out on the bottom arch and pushed back (maybe some minimal forward movement of the back teeth, i doubt it) if my tongue lies on the base of my mouse i have to either curl it back or have it lie ON TOP of the bottom teeth with my mouth slightly open). So I need some kind of forward space there.

And yes, the maxilla is narrow so I lay my tongue on the roof of my mouth, as well as forward. I either keep my tongue curled back in my mouth or i keep my teeth slightly ajar and let my tongue rest between them as if i was going to bite my tongue. Both options are horrible and I need to discover a way to fix this. It is truly driving me mad.

I don't know much about how moving the mandible affects tongue position but FWIW I feel like I have much more space in my mouth after my bimax advancement.

[Lazlo]

I don't know much about how moving the mandible affects tongue position but FWIW I feel like I have much more space in my mouth after my bimax advancement.

can I ask you your movements again? That might help me know what is lacking...

[Post bimax]

can I ask you your movements again? That might help me know what is lacking...

about 10mm advancement for both jaws plus small genioplasty and either slight impaction or downgraft to close my open bite.  I didn't have tongue problems before but my mouth always felt a bit 'small' on the inside, and I feel as though I have more space now.  I don't know how applicable this is to your case; I just thought I'd offer my experience.

[Lazlo]

about 10mm advancement for both jaws plus small genioplasty and either slight impaction or downgraft to close my open bite.  I didn't have tongue problems before but my mouth always felt a bit 'small' on the inside, and I feel as though I have more space now.  I don't know how applicable this is to your case; I just thought I'd offer my experience.

Thanks I appreciate that. Out of curiosity did the large maxilla advancement cause unwanted facial changes?