Weak and recessed lower jaw-health problems.

[Dutcherhatcher]

Gj post 21
But he claimed the roots were destroyed and i am looking at an extraction anyway. it was 75/25. And it was after both crowns and root treatment.
3 Months? so as far as i understand any damage that was suppose to be done was already done? If that is the case i didnt notice any change, i guess that is good. Would you say that post surgery with implants the damage (if it is there) is 100% fixable?


Kevan post #23

1.Ye no thanks. The doctor was really insisted on removing them and said any option to save them was very hopeful at this point. I guess i could have them removed and replaced with implants and then removed the wisdom, but it seems like too much of a hassle for something with a much simpler solution.

That is great to hear and i am already very geared towards the plan he suggested. I see that going into upper jaw surgery when you only need to advance only 3 mm is moot unless there is a pressing health issue.

Kevan post 24# I understand, another good reason to extract the damaged infected teeth and try and keep the normal healthy one. As the other doctor said, there was no easy solution here, Both option had downsides and upsides.

Kevan 25# i got kinda scared to be honest for a moment that i made a mistake that would lead to a collapse of the face. Maybe the other option that was to put implants where the teeth were, remove the wisdom and than push the jaw was better since it would lead to a better structural integrity but after reading your posts i understand it was not the correct course of action.
There is one thing i am still confused about and its the point i raised in the other post, wont the final outcome will be the same, since the place of the first molars are taken by the second and the second by the third? Wont the outcome be exactly the same as simply removing the wisdom? I mean sure we are talking about a longer process of braces but the end position of the teeth is the same.

Kevan+Gj final posts. I have the picture up. As you can see i am already post canal and crown on them. And of the roots failed. So it was much much worse than a cavity

[kavan]

Gj post 21
But he claimed the roots were destroyed and i am looking at an extraction anyway. it was 75/25. And it was after both crowns and root treatment.
3 Months? so as far as i understand any damage that was suppose to be done was already done? If that is the case i didnt notice any change, i guess that is good. Would you say that post surgery with implants the damage (if it is there) is 100% fixable?


Kevan post #23

1.Ye no thanks. The doctor was really insisted on removing them and said any option to save them was very hopeful at this point. I guess i could have them removed and replaced with implants and then removed the wisdom, but it seems like too much of a hassle for something with a much simpler solution.

That is great to hear and i am already very geared towards the plan he suggested. I see that going into upper jaw surgery when you only need to advance only 3 mm is moot unless there is a pressing health issue.

Kevan post 24# I understand, another good reason to extract the damaged infected teeth and try and keep the normal healthy one. As the other doctor said, there was no easy solution here, Both option had downsides and upsides.

Kevan 25# i got kinda scared to be honest for a moment that i made a mistake that would lead to a collapse of the face. Maybe the other option that was to put implants where the teeth were, remove the wisdom and than push the jaw was better since it would lead to a better structural integrity but after reading your posts i understand it was not the correct course of action.
There is one thing i am still confused about and its the point i raised in the other post, wont the final outcome will be the same, since the place of the first molars are taken by the second and the second by the third? Wont the outcome be exactly the same as simply removing the wisdom? I mean sure we are talking about a longer process of braces but the end position of the teeth is the same.

Kevan+Gj final posts. I have the picture up. As you can see i am already post canal and crown on them. And of the roots failed. So it was much much worse than a cavity

Sorry, I'm confused by the way you ask your question you're confused about. Bottom line is to keep the spaces of the removed first molars so they can push the other teeth backwards. The remaining molars wisdom and second molar leave you with 2 molars. Put an implant in there now INDEPENDENT of your final selection of surgeon and screw up plans involving ortho preparation to prepare for surgery with 'at home' doctor if you decide on him and/or need a pre-molar extraction to replace the space you filled with an implant.

[Dutcherhatcher]

Sorry, I'm confused by the way you ask your question you're confused about. Bottom line is to keep the spaces of the removed first molars so they can push the other teeth backwards. The remaining molars wisdom and second molar leave you with 2 molars. Put an implant in there now INDEPENDENT of your final selection of surgeon and screw up plans involving ortho preparation to prepare for surgery with 'at home' doctor if you decide on him and/or need a pre-molar extraction to replace the space you filled with an implant.

I am sorry Kevan, here is a picture to better ilustare my point.
https://imgur.com/a/Li7aCGf

As you can see, there is now a hole were the first molars were removed, i assumed that the braces move (as the arrow goes) the other molars into the place the first molars was, and the final cut is made were the wisdom teeth were. Am i wrong?

[kavan]

I am sorry Kevan, here is a picture to better ilustare my point.
https://imgur.com/a/Li7aCGf

As you can see, there is now a hole were the first molars were removed, i assumed that the braces move (as the arrow goes) the other molars into the place the first molars was, and the final cut is made were the wisdom teeth were. Am i wrong?

The space is there for the teeth anterior to it to be retroclined backwards and maybe for the teeth posterior to it to be pushed forwards. I don't think it's a thing where one tooth jumps into the other slot.  TBH, I don't feel like thinking about or describing the displacements. All you need to know is to keep the space there in preparation for the teeth to be moved so they can do the surgery.

[Dutcherhatcher]

The space is there for the teeth anterior to it to be retroclined backwards and maybe for the teeth posterior to it to be pushed forwards. I don't think it's a thing where one tooth jumps into the other slot.  TBH, I don't feel like thinking about or describing the displacements. All you need to know is to keep the space there in preparation for the teeth to be moved so they can do the surgery.

I see now! Thank you! I will update once i get the rest of the consultation done. Thank you so much guys

[Dutcherhatcher]

Ok guys, huge update.

First of all, the consultation was awsome, he took his time to answer every question i had, explain everything in layman terms and generaly was very down to earth.

As far as the consultation itself.

He said my lower jaw was defenitly recessive and needed to be brought forward by about 8-10mm

He was surprised however and noted that was the only thing he recommened.

The suprising thing was that he said that he has done 5000 cases, and only in around 10% he would recommend only doing a lower jaw, saying that usually if one jaw grew wrong the other would too. However he said that my upper jaw grew correct in every dimension be it width, vertical or saggital. He said i should be very thankful.

So he gave my 2 options.
The first to only move the lower if the braces will allow it. Which he said is ideal and what i should strive for.
The second is to do a CCW if there wont be enough space. He made sure to comment that the CCW will only be used if there is not enough space for my lower jaw to come forward and ideally i would avoid from the upper jaw. Since less is better.

He said he saw nothing wrong with removing the first molars and using the wisdom teeth to take their place and he dismissed any concern i raised about bone absorption.

Also talked about surgery first, he said only 15% are fit for it, and it requires either you to be very very not pretty or suffer from a major health issue. Idealy a surgery later is better and i am not fit because of it.

Beside that we talked a bit more about surgery and prices, which i would avoid out saying out of respect.

[kavan]

Kind of resolves to what I told you in the first place which is that the surgical suggestion of your surgeon in your country was a good one. So, it does look like you are getting some cross reference validation for that.

[Dutcherhatcher]

Kind of resolves to what I told you in the first place which is that the surgical suggestion of your surgeon in your country was a good one. So, it does look like you are getting some cross reference validation for that.

Yes you are correct. I have to admit that a big part of it is psychological. Knowing my plan is the correct one and having several high profile surgeons review it. I would be very happy to do one jaw surgery and be done with it.

If we are talking about a simple lower jaw moment, is there any difference in skill between my local surgeon and high profile surgeon from Europe?

[kavan]

Yes you are correct. I have to admit that a big part of it is psychological. Knowing my plan is the correct one and having several high profile surgeons review it. I would be very happy to do one jaw surgery and be done with it.

If we are talking about a simple lower jaw moment, is there any difference in skill between my local surgeon and high profile surgeon from Europe?

  No idea.

[Dutcherhatcher]

  No idea.

Sorry, i will phrase the question again. Do you think the extra money is worth it to go to a high profile surgeon when a simple jaw movement as compared to a complex plan? Or in other words will the more skillful surgeon produce better results if the movement is the same?

[Lefortitude]

Sorry, i will phrase the question again. Do you think the extra money is worth it to go to a high profile surgeon when a simple jaw movement as compared to a complex plan? Or in other words will the more skillful surgeon produce better results if the movement is the same?

Im of the school in which its not worth cutting corners when it comes to jaw surgery.

[Dutcherhatcher]

Im of the school in which its not worth cutting corners when it comes to jaw surgery.

Hmm even when its such a simple thing? In my country it ia almost free but in Europe i have to pay full premium price

[Dogmatix]

Hmm even when its such a simple thing? In my country it ia almost free but in Europe i have to pay full premium price

It's definitely not only top surgeons who can be great. Sometimes it's like selling bottled water, with a nice enough bottle you can sell same thing much more expensive. What you get with a well known surgeon is just that he/she is well known and you can easily look up results and patient stories, compared to at your local surgeon where the patients hardly know or care who the surgeon is. As in all professions, there are both good and bad professionals and with a well known name you know who it is. At least if it's a "simple" surgery with no rotations or multipiece, it's a good chance that more than the big names can give a great result. But sure, if you have the money, why not go with the best.

[kavan]

Sorry, i will phrase the question again. Do you think the extra money is worth it to go to a high profile surgeon when a simple jaw movement as compared to a complex plan? Or in other words will the more skillful surgeon produce better results if the movement is the same?

I'm not thinking in the terms you are asking me to think in. I don't think in terms of 'high profile doctor = best and worth it'. With the high profile docs, I think in PRAGMATIC terms of things they can do that others don't, in particular, significant DOWN GRAFTING and WHEN such looks to be applicable to someone. Recognition of them, by me, is usually based on capacity to do a significant down graft because that's a key factor in setting them apart from the others.

AS to 'skill', I think in terms of TIME needed to produce SAME outcome. The doctor who could produce the same outcome FASTER than the other one would be considered more 'skilled'. But so what.

It depends on whether or not you have money burning a hole in your pocket. People who think in terms of high price = 'the best' can afford to go to a high profile doctor for a straight forward thing other doctors could do whether or not a lesser know doctor could produce same/similar. If that's the case, I don't need to think for them.

I've already thought about this and I think the doctor who advised you (your local one) is on target for your case based on his assessment. I don't need to think about the high profile doctors for your case. If you do, there are plenty of others who think in terms of high profile, high $$$= best to engage.

[Dutcherhatcher]

Guys thank you again for taking the time. And huge thanks for Kavan. I had a few more questions.

My surgeon offered me to give some feedback so i had a few questions.

Is there an ideal saggital projections of the jaw/chin?
An ideal vertical and width of the chin?
Or should i just tell him to do what he thinks.