Am I still in crossbite?

[Dogmatix]

Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.

"Tomorrow you gonna wish you had started yesterday"
This is true for so much, not least myself and this orthognatic work. I want nothing else than getting out of this and never have to think about it again. Putting myself in a situation where I can't feel done and close this book would not be an option. Getting out in a situation I don't believe in to wait for some robots or what ever would be my last option. Fixing it later would probably mean to get in braces again and start it all up at a higher age where you tolerate surgery even less.

[Post bimax]

Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.

1. Age concerns and the (increasing) related recovery/damage risks

2. I’ve read that the best time for revision is within 1-2 years because of progressive ossification (I don’t know much about this)

3. Fixing his issue and getting on with his life

Waiting around for technology and techniques to progress could mean waiting a very long time

[GJ]

Yeah those are valid takes, but it really depends on the case. If revision isn't 100% required might be better off waiting for more precise techniques and technology.

Age isn't a big deal at all. It's more your health. If you're 60 and a cyclist/ripped on a great diet you'll be better off and recover faster than an overweight 20 year old eating fast food. I recovered much faster than people half my age because I ate an all superfood diet during recovery and was in shape going in.

I asked Gunson about this, and he said health, not age, is the limiting factor (up to a degree...you don't want to be 80, but 50s or 60s is fine).

[ODog]

There will never be a better time to have surgery, than now. So saving it for later sounds like a bad option. Either now, or never.

I'm actually having similar movements done. Angling the canines out to allow the mandible to come forward without getting a crossbite. Gunson also included this in the preop adjustments for me on his consultation. So it can't be totally unreliable. So I don't think you should get totally caught up in the instability horror stories, even if there's of course reasons people say it. Actually all teeth in both upper and lower jaw are unstable alone. Class II patients often have div II bite because nothing stops them from tilting inward etc. The stability comes from good occlusion and interaction between the lower and upper jaw while biting etc. I don't know, but if they get the bite to fit, it might be stabilizing it self?

I guess neither your surgeon or orthodontist is pushing or entertaining the thought of a revision? If they were you would probably already had it done. This is the problem with this field, you have 2 professionals who are supposed to look after you, but still you need to get advice here, and I'm certainly not the best one to know what to do. The only thing I feel strongly about is if you're gonna do it, don't wait.

Well why would my surgeon push for a revision? That wouldn’t make sense for him unless his mistake was blatant and there were a potential lawsuit at hand. No surgeon wants to remove hardware and redo a surgery again for free.

My ortho is of course supporting in my decision RE revision, I’m consulting with Caminitti in 2 weeks, and Antonyshyn shortly as well but no consult date booked.

Once I hear these opinions, I’ll decide how to approach my surgeon about it.

I completely 100% agree about getting the surgery done and over with so it’s not hanging over your head. You can see from the pics though that it meshes good, my smile is fine now, so I was just saying since there’s no blatant pressing need for revision (like a weird smile or w.e or chewing issues)  other than for the potential of relapse, I COULD put it off for now and see what happens. But I of course would always choose to take care of things in the now.

Oh and no my surgeon said you have to wait 1 year for revision. Was that a lie ?

[ODog]

Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.

This is true but he’s right. Better to do it now. My surgery will be extremely easy now. He did a lot in my surgery. This one would entail ONE thing to correct.

Surgeons are human. I should have asked to be the first patient scheduled that day. He made some comments/ jokes about how being the last patient isn’t ideal or something. And with the surgery, he brought both jaws forward, making sure it wasn’t too much or too little. He did great there. He did a genio with bone shaving to re-contour my deep labialmental fold. Great job there. He had to tilt my upper jaw CW enough to give more tooth show but not so much as to give gum show. He did that perfectly. I guess when it came to widening the upper jaw, that took a backseat.

It’s only common sense that the less a surgeon has to do, the more they can make sure that that aspect is perfect. Maybe the above is nothing to an American surgeon but I think it’s actually considered a LOT of work in one surgery in Canada.

Typically jaw surgeries here are absolute bare minimum. I just found out that my initial surgeon was JUST going to do posterior impaction and nothing else, to fix the bite and gum show. No concern for aesthetics, my dished in lip area, my chin fold, poor submental area, etc. None of that would’ve been even considered.

[ODog]

"Tomorrow you gonna wish you had started yesterday"
This is true for so much, not least myself and this orthognatic work. I want nothing else than getting out of this and never have to think about it again. Putting myself in a situation where I can't feel done and close this book would not be an option. Getting out in a situation I don't believe in to wait for some robots or what ever would be my last option. Fixing it later would probably mean to get in braces again and start it all up at a higher age where you tolerate surgery even less.

Amen. Also you waste your youth having jaw and bite problems. Holding out for a hypothetical ideal future surgery is insane. You will waste your life.

[Dogmatix]

Well why would my surgeon push for a revision? That wouldn’t make sense for him unless his mistake was blatant and there were a potential lawsuit at hand. No surgeon wants to remove hardware and redo a surgery again for free.

My ortho is of course supporting in my decision RE revision, I’m consulting with Caminitti in 2 weeks, and Antonyshyn shortly as well but no consult date booked.

If the surgeon is serious he should be honest about the situation and tell you that you need a revision if he thinks you do. Why? Because his entire profession and his position is a joke else and it would make no sense for him to practise at all. If you're ready to help patients with a bad situation before surgery, you should insist on helping your patients if they have a bad situation after surgery.

I know this is not always true and how it works, but this is what I have to believe to not lose faith in humanity.

If you mean that your orthodontist is supporting you in a way where he tells you it's in your best interest to have a revision, then I'd say it's a no brainer.

I don't think you have to wait 1 year for revision. Different surgeons may have different safety margins and it may depend on what you're redoing though. I've heard patients having the bsso adjusted pretty soon after surgery. I'm not sure what your revision would require, is it a full lefort fracture and then splitting the palate, or can they manage without lefort to distract it? If it's a full mobilization of the maxilla and a 3 piece lefort, it's actually a pretty big surgery. It seems like a small issue to fix, but it might involve breaking it all up.

But again, it might be that stability is fine with the orthodontic work. Try to have a good discussion with your orthodontist and understand the situation.

[Dogmatix]

One thing I don't understand is why these issues cant be easily addressed after surgery. What's the reason you're not allowed to chew etc after surgery? Because of stability issues and that things might move around. So why not use this instability and use
an activatorator or something to work small forces where you want to adjust. After surgery you've created all these cuts that allow it to move in the directions you want. With SARPE this is actually what you sometimes do, install a device where you turn a wheel to expand until satisfied. Would be very neat if this was standard for all movements. Fine tuning the bsso advancement, palate width etc daily the weeks after surgery and make sure the occlusion gets right, just as the orthodontist work with the braces.

Edit: Maybe this is also something that has happened to some extent, having the crossbite pulled with braces during healing.

[april]

And with the surgery, he brought both jaws forward, making sure it wasn’t too much or too little. He did great there. He did a genio with bone shaving to re-contour my deep labialmental fold. Great job there. He had to tilt my upper jaw CW enough to give more tooth show but not so much as to give gum show. He did that perfectly. I guess when it came to widening the upper jaw, that took a backseat

Have you posted a before & after ceph? I'd love to see the changes from those movements.

Typically jaw surgeries here are absolute bare minimum. I just found out that my initial surgeon was JUST going to do posterior impaction and nothing else, to fix the bite and gum show. No concern for aesthetics, my dished in lip area, my chin fold, poor submental area, etc. None of that would’ve been even considered.

Yeah, it's a completely different level of standards. It's the same in my country. the bar is set way too low. It becomes just like a bullet-dodging exercise. Glad you dodged that one.

[ODog]

If the surgeon is serious he should be honest about the situation and tell you that you need a revision if he thinks you do. Why? Because his entire profession and his position is a joke else and it would make no sense for him to practise at all. If you're ready to help patients with a bad situation before surgery, you should insist on helping your patients if they have a bad situation after surgery.

I know this is not always true and how it works, but this is what I have to believe to not lose faith in humanity.

If you mean that your orthodontist is supporting you in a way where he tells you it's in your best interest to have a revision, then I'd say it's a no brainer.

I don't think you have to wait 1 year for revision. Different surgeons may have different safety margins and it may depend on what you're redoing though. I've heard patients having the bsso adjusted pretty soon after surgery. I'm not sure what your revision would require, is it a full lefort fracture and then splitting the palate, or can they manage without lefort to distract it? If it's a full mobilization of the maxilla and a 3 piece lefort, it's actually a pretty big surgery. It seems like a small issue to fix, but it might involve breaking it all up.

But again, it might be that stability is fine with the orthodontic work. Try to have a good discussion with your orthodontist and understand the situation.

I feel like I’ve said this over and over, but my orthodontist and surgeon, as are probably all orthodontists and surgeons, are very vague regarding my bite. My orthodontist said it was a crossbite after surgery and is edge to edge now. My surgeon said “there is no transverse deficiency” at the last meeting. Now that my bite has improved even further with more time in orthodontics, how can I expect him to admit NOW that the bite is bad. It was worse a few months ago and he never admitted anything.

My ortho, on the other hand, finally told me straight up, but then he will say “well work on it.” They are not going to elaborate on that. They are trained to be positive, to manage patient expectations, to keep patients happy, and to work with the result given to them by the surgeons.

Why would he say “You need a revision now”. Professionals do not talk bad of other professionals’ work. Basically it is completely up to me to read between the lines and to decide if a revision is worth it. I do not expect anything else of my orthodontist. I understand now how the game works. You will only be given hints.

Also, just because my bite isn’t perfect doesn’t mean I NEED a revision. The question is more, how much do I personally WANT a revision. So my ortho has absolutely nothing to gain by convincing me I need a revision. In his mind, he probably sees this as encouraging perfectionist tendencies in his patients which can bring him headaches and lead to an unhappy patient who starts making a stirr and uses his name as the so called witness or expert testimony.

NEEDING a revision is a very subjective thing, nobody needs anything.

I’m trying to clarify because you keep thinking my ortho or surgeon is supposed to be not only 100% honest with me, but also 100% a perfectionist. Only in that case would they ever tell me I need a revision. But in their view, the bite is probably something more along the lines of “good enough.”

[ODog]

Have you posted a before & after ceph? I'd love to see the changes from those movements.

Yeah, it's a completely different level of standards. It's the same in my country. the bar is set way too low. It becomes just like a bullet-dodging exercise. Glad you dodged that one.

I’ll PM you b/a’s

[Dogmatix]

I feel like I’ve said this over and over, but my orthodontist and surgeon, as are probably all orthodontists and surgeons, are very vague regarding my bite. My orthodontist said it was a crossbite after surgery and is edge to edge now. My surgeon said “there is no transverse deficiency” at the last meeting. Now that my bite has improved even further with more time in orthodontics, how can I expect him to admit NOW that the bite is bad. It was worse a few months ago and he never admitted anything.

My ortho, on the other hand, finally told me straight up, but then he will say “well work on it.” They are not going to elaborate on that. They are trained to be positive, to manage patient expectations, to keep patients happy, and to work with the result given to them by the surgeons.

Why would he say “You need a revision now”. Professionals do not talk bad of other professionals’ work. Basically it is completely up to me to read between the lines and to decide if a revision is worth it. I do not expect anything else of my orthodontist. I understand now how the game works. You will only be given hints.

Also, just because my bite isn’t perfect doesn’t mean I NEED a revision. The question is more, how much do I personally WANT a revision. So my ortho has absolutely nothing to gain by convincing me I need a revision. In his mind, he probably sees this as encouraging perfectionist tendencies in his patients which can bring him headaches and lead to an unhappy patient who starts making a stirr and uses his name as the so called witness or expert testimony.

NEEDING a revision is a very subjective thing, nobody needs anything.

I’m trying to clarify because you keep thinking my ortho or surgeon is supposed to be not only 100% honest with me, but also 100% a perfectionist. Only in that case would they ever tell me I need a revision. But in their view, the bite is probably something more along the lines of “good enough.”

I totally hear you. Sure I've told you how I spent 2 years with invisalign, compensating against my will, being promised on numerous occasions that we will discuss my questions on next appointment, lying to me, giving deceiving answers. I was even told he was decompensating my bite when he did exactly the oposite.
I just don't want to believe this is as common and it scares the s**t out of me hearing I'm not unique.

I would actually want to work in this field, because it's really not hard to be nice and honest to your patients and it makes such difference. Some doctors seem to think they do you a favour by not giving you full insight, but it's just opposite when you understand they avoid the question and you have no idea what their actual opinion is.

[ben from UK]

I feel like I’ve said this over and over, but my orthodontist and surgeon, as are probably all orthodontists and surgeons, are very vague regarding my bite. My orthodontist said it was a crossbite after surgery and is edge to edge now. My surgeon said “there is no transverse deficiency” at the last meeting. Now that my bite has improved even further with more time in orthodontics, how can I expect him to admit NOW that the bite is bad. It was worse a few months ago and he never admitted anything.

My ortho, on the other hand, finally told me straight up, but then he will say “well work on it.” They are not going to elaborate on that. They are trained to be positive, to manage patient expectations, to keep patients happy, and to work with the result given to them by the surgeons.

Why would he say “You need a revision now”. Professionals do not talk bad of other professionals’ work. Basically it is completely up to me to read between the lines and to decide if a revision is worth it. I do not expect anything else of my orthodontist. I understand now how the game works. You will only be given hints.

Also, just because my bite isn’t perfect doesn’t mean I NEED a revision. The question is more, how much do I personally WANT a revision. So my ortho has absolutely nothing to gain by convincing me I need a revision. In his mind, he probably sees this as encouraging perfectionist tendencies in his patients which can bring him headaches and lead to an unhappy patient who starts making a stirr and uses his name as the so called witness or expert testimony.

NEEDING a revision is a very subjective thing, nobody needs anything.

I’m trying to clarify because you keep thinking my ortho or surgeon is supposed to be not only 100% honest with me, but also 100% a perfectionist. Only in that case would they ever tell me I need a revision. But in their view, the bite is probably something more along the lines of “good enough.”

Very realistic and yes, that's how it probably works.

[ODog]

I totally hear you. Sure I've told you how I spent 2 years with invisalign, compensating against my will, being promised on numerous occasions that we will discuss my questions on next appointment, lying to me, giving deceiving answers. I was even told he was decompensating my bite when he did exactly the oposite.
I just don't want to believe this is as common and it scares the s**t out of me hearing I'm not unique.

I would actually want to work in this field, because it's really not hard to be nice and honest to your patients and it makes such difference. Some doctors seem to think they do you a favour by not giving you full insight, but it's just opposite when you understand they avoid the question and you have no idea what their actual opinion is.

It’s not uncommon. Some people, when they get a hold of a kind of power, say through specialization in one subject, will have a need to control the information they’ve learned because it is their sole source of power, identity, purpose, etc. They are the expert in this field, not you. It makes them uncomfortable giving you too much info. You will know these types if they talk in a condescending way you, using very elementary terms, and then if you use technical terms to join them in the conversation on a more in depth level, they will be shocked by it rather than excited by it.

The type of person who you would want to be in this field, who genuinely is honest with their patients about everything, gets excited when a patient uses a technical word or shares a more in depth idea with them, because they can then teach what they know and have more impact - and that’s what these types are, teachers, not gatekeeers of specialized information, which is how your previous ortho sounds.

I’m not even really judging btw, it’s just how people are. Better to just recognize what you’re dealing with rather than get angered by it.

[ODog]

Very realistic and yes, that's how it probably works.

I bet orthodontists and even surgeons are trained, or maybe they probably learn through experience, to use language carefully. If my ortho advises me to get a revision because my bite is not perfect, and then I suffer nerve damage in my upper lip, and I later find out my bite was “good enough” and there was no revision that NEEDED to be done, he would be screwed and potentially liable to lawsuit.

So instead of saying directly “you have a transverse deficiency,” they might say “I know YOU have concerns about the transverse.” That way they can never be accused of leading the patient, only responding to the patient.