Having doubts about getting surgery

[TheDancingQueen]

I will need a linear BSSO and in order to get it I will need to get two of my lower teeth extracted. Sometimes I feel like the extraction is not a big deal and I think I'm 100% going through with it, then on some other days I get very depressed and think about all the complications.

My main concerns are
1. I will need to wear a retainer for the rest of my life because my top teeth will have nothing to rest against.

2. Since the extractions are needed to create space for the BSSO I'm afraid my tongue will not have enough room in my mouth

3. My plate is already very narrow and I'm afraid extractions will make it worse

4. I've had braces in the past for almost 5 years and my teeth were never straight even after all that time. I feel like the majority of dentists and orthodontist are unethical and try to upsell you on everything. I also don't trust orthodontists because I feel like in 90% of cases they are just trying to mask the symptoms of bad jaw growth. I don't know a single person who looks better after braces. Their smiles always look off

5. I'm afraid I will have chewing problems after the extractions. My orthodontist said chewing food would feel normal but I don't trust them.


Sometimes I think I should just grow a beard to hide my lower third and get a rhinoplasty and fillers instead. But I think even with a beard my lower third still looks extremely weak.

The actual surgery itself I'm not worried about at all. I'm fine with the risk of permanent numbness. And I trust my surgeon, even though he won't perform upper jaw surgery on me.

And then I worry about the surgery not making any difference and looking the same. Right now I have some hope that there is some surgery our there that can make me look better, if I get the surgery and it makes no difference I don't have that hope anymore. So that's another reason I'm thinking I should get a rhinoplasty and fillers first and hold off on the jaw surgery. If they make a good difference I won't need to get jaw surgery, but I know it's recommended to get rhinoplasty after jaw surgery because it can change the base of the nose. 90% of what makes me ugly is my lower third, my nose just looks worse because of my weak lower third, so I doubt a rhinoplasty alone would make me look better.

I know I can avoid extractions by getting both upper and lower jaw surgery but there are no surgeons in my area who will perform upper jaw surgery on me. I would have to travel to another country for this and the logistics of it would be too complicated. And the surgery would be covered with insurance in my country I'm not sure if it will be covered if I go to another country.

And then sometimes I think even if everything goes wrong and I look disfigured afterwards it would make literally no difference in my life as I have nothing to lose I might as well go through with it.

[kavan]

I will need a linear BSSO and in order to get it I will need to get two of my lower teeth extracted. Sometimes I feel like the extraction is not a big deal and I think I'm 100% going through with it, then on some other days I get very depressed and think about all the complications.

My main concerns are
1. I will need to wear a retainer for the rest of my life because my top teeth will have nothing to rest against.

2. Since the extractions are needed to create space for the BSSO I'm afraid my tongue will not have enough room in my mouth

3. My plate is already very narrow and I'm afraid extractions will make it worse

4. I've had braces in the past for almost 5 years and my teeth were never straight even after all that time. I feel like the majority of dentists and orthodontist are unethical and try to upsell you on everything. I also don't trust orthodontists because I feel like in 90% of cases they are just trying to mask the symptoms of bad jaw growth. I don't know a single person who looks better after braces. Their smiles always look off

5. I'm afraid I will have chewing problems after the extractions. My orthodontist said chewing food would feel normal but I don't trust them.


Sometimes I think I should just grow a beard to hide my lower third and get a rhinoplasty and fillers instead. But I think even with a beard my lower third still looks extremely weak.

The actual surgery itself I'm not worried about at all. I'm fine with the risk of permanent numbness. And I trust my surgeon, even though he won't perform upper jaw surgery on me.

And then I worry about the surgery not making any difference and looking the same. Right now I have some hope that there is some surgery our there that can make me look better, if I get the surgery and it makes no difference I don't have that hope anymore. So that's another reason I'm thinking I should get a rhinoplasty and fillers first and hold off on the jaw surgery. If they make a good difference I won't need to get jaw surgery, but I know it's recommended to get rhinoplasty after jaw surgery because it can change the base of the nose. 90% of what makes me ugly is my lower third, my nose just looks worse because of my weak lower third, so I doubt a rhinoplasty alone would make me look better.

I know I can avoid extractions by getting both upper and lower jaw surgery but there are no surgeons in my area who will perform upper jaw surgery on me. I would have to travel to another country for this and the logistics of it would be too complicated. And the surgery would be covered with insurance in my country I'm not sure if it will be covered if I go to another country.

And then sometimes I think even if everything goes wrong and I look disfigured afterwards it would make literally no difference in my life as I have nothing to lose I might as well go through with it.

Well, pre-molar extractions are what they do for single jaw advancement surgery (linear BSSO). Since you will be GAINING more 'face space' by the jaw advancement, you'd also be gaining more space inside your mouth for your tongue. You wouldn't be losing it. The space you would be gaining would be in anterior-posterior direction; front to back.

Pre-molar extractions from the LOWER JAW would tend not to have a direct effect on your UPPER jaw which is where your PALATE is.

No idea what ELSE you would 'need'or if anything other than single BSSO is also needed. But if you wanted to explore the option of more involved and complicated surgery such as surgery to make the palate wider, 3 piece leforts, downgrafting, no pre-molar extractions, braces after surgery and not before..etc it would be SELF PAY and a trip outside of your country.

If you have 'nothing to lose' by getting the surgery EVEN IF you looked 'disfigured' afterwards, then THEREFORE, you also have nothing to lose by NOT getting any surgery at all.

[GJ]

Regarding extractions, Lazlo and myself both had this treatment, and we both agree the tongue feels more cramped after extractions, even after jaw surgery.

The problem is this: you likely need extractions because of a narrow arch that can't fit all the teeth safely in the bone. The discrepancy is probably something like 4mm. Well, when you pull a premolar, which is about 8mm, you then have to close that space -- pulling all the teeth back and in. That's 16mm of excess space to close now on each side, which is twice the space you needed to fit all the teeth. So the arch narrows more, and the front teeth come back and in. Anterior molars will not move forward at all due to their massive root structure. If they could, that would help alleviate the problem.

This is why braces/widening needs to be done when young and bones are malleable.

[Dutcherhatcher]

Regarding extractions, Lazlo and myself both had this treatment, and we both agree the tongue feels more cramped after extractions, even after jaw surgery.

The problem is this: you likely need extractions because of a narrow arch that can't fit all the teeth safely in the bone. The discrepancy is probably something like 4mm. Well, when you pull a premolar, which is about 8mm, you then have to close that space -- pulling all the teeth back and in. That's 16mm of excess space to close now on each side, which is twice the space you needed to fit all the teeth. So the arch narrows more, and the front teeth come back and in. Anterior molars will not move forward at all due to their massive root structure. If they could, that would help alleviate the problem.




This is why braces/widening needs to be done when young and bones are malleable.

Sorry to drop in, is that relevant if I had teeth extracted in my lower jaw to create the overjet needed for BSSO? Thanks

How would extraction of lower teeth for BSSO movement effect tongue space?

@kavan

If I remember you are generally not against lower teeth extraction in case of needed overjet creation for BSSO? The only alternative I can think of is rotation in order to create the needed distance.

But if someone had a perfect occlusion plane, a perfect compensated bite and needed to move the lower jaw something like 10+mm, I see no other way.

Sorry for the rambling.

[Dutcherhatcher]

Well, pre-molar extractions are what they do for single jaw advancement surgery (linear BSSO). Since you will be GAINING more 'face space' by the jaw advancement, you'd also be gaining more space inside your mouth for your tongue. You wouldn't be losing it. The space you would be gaining would be in anterior-posterior direction; front to back.

Pre-molar extractions from the LOWER JAW would tend not to have a direct effect on your UPPER jaw which is where your PALATE is.

No idea what ELSE you would 'need'or if anything other than single BSSO is also needed. But if you wanted to explore the option of more involved and complicated surgery such as surgery to make the palate wider, 3 piece leforts, downgrafting, no pre-molar extractions, braces after surgery and not before..etc it would be SELF PAY and a trip outside of your country.

If you have 'nothing to lose' by getting the surgery EVEN IF you looked 'disfigured' afterwards, then THEREFORE, you also have nothing to lose by NOT getting any surgery at all.

Sorry to drop in, is that relevant if I had teeth extracted in my lower jaw to create the overjet needed for BSSO? Thanks

How would extraction of lower teeth for BSSO movement effect tongue space?

@kavan

If I remember you are generally not against lower teeth extraction in case of needed overjet creation for BSSO? The only alternative I can think of is rotation in order to create the needed distance.

But if someone had a perfect occlusion plane, a perfect compensated bite and needed to move the lower jaw something like 10+mm, I see no other way.

Sorry for the rambling.

[GJ]

Sorry to drop in, is that relevant if I had teeth extracted in my lower jaw to create the overjet needed for BSSO? Thanks

How would extraction of lower teeth for BSSO movement effect tongue space?

Yes it's relevant, and as I explained it means the arch has to contract more than it should. Just reread my post and do the math. You go from a problem of not enough space to a problem of too much space, with extractions.

I'm not against lower only in some cases (e.g. good width to the arch). But it's rare I'd say it's a good idea.

Likely it makes your tongue more cramped. If a tooth is angled a certain way the tongue could bump into sharp cusps, too, as it's looking for space.
In short, "solving" a small arch by extracting teeth and making it smaller is not a genius idea.

[Dutcherhatcher]

Yes it's relevant, and as I explained it means the arch has to contract more than it should. Just reread my post and do the math. You go from a problem of not enough space to a problem of too much space, with extractions.

I'm not against lower only in some cases (e.g. good width to the arch). But it's rare I'd say it's a good idea.

Likely it makes your tongue more cramped. If a tooth is angled a certain way the tongue could bump into sharp cusps, too, as it's looking for space.
In short, "solving" a small arch by extracting teeth and making it smaller is not a genius idea.

I will pose you the same thing I asked Kevan. How would you suggest creating the needed overjet for a BSSO instead?

[kavan]

Sorry to drop in, is that relevant if I had teeth extracted in my lower jaw to create the overjet needed for BSSO? Thanks

How would extraction of lower teeth for BSSO movement effect tongue space?

@kavan

If I remember you are generally not against lower teeth extraction in case of needed overjet creation for BSSO? The only alternative I can think of is rotation in order to create the needed distance.

But if someone had a perfect occlusion plane, a perfect compensated bite and needed to move the lower jaw something like 10+mm, I see no other way.

Sorry for the rambling.

Yes. YOu remembered correctly and you read what I told the OP of this thread as to my take on HIS situation. You may address your questions about what others on this thread said to him to those others.

[Lazlo]

Regarding extractions, Lazlo and myself both had this treatment, and we both agree the tongue feels more cramped after extractions, even after jaw surgery.

The problem is this: you likely need extractions because of a narrow arch that can't fit all the teeth safely in the bone. The discrepancy is probably something like 4mm. Well, when you pull a premolar, which is about 8mm, you then have to close that space -- pulling all the teeth back and in. That's 16mm of excess space to close now on each side, which is twice the space you needed to fit all the teeth. So the arch narrows more, and the front teeth come back and in. Anterior molars will not move forward at all due to their massive root structure. If they could, that would help alleviate the problem.

This is why braces/widening needs to be done when young and bones are malleable.

Exactly correct. Teeth extractions are a cop-out for not doing a more progressive job in widening the palate. Don't do it. Find another doctor, maybe double jaw surgery is what you will actually need to accomplish this. even though the jaw moves out, your lower teeth will move back and the lower arch will be narrower so your tongue will definitely have less space to rest with relaxed.

No bicuspid extractions under any circumstances should be the new rule amongst all orthos.

[kavan]

Exactly correct. Teeth extractions are a cop-out for not doing a more progressive job in widening the palate. Don't do it. Find another doctor, maybe double jaw surgery is what you will actually need to accomplish this. even though the jaw moves out, your lower teeth will move back and the lower arch will be narrower so your tongue will definitely have less space to rest with relaxed.

No bicuspid extractions under any circumstances should be the new rule amongst all orthos.

Could you guys clarify the circumstances as to your extractions. I ask because IMO, extractions are more problematic when they are done ONLY to get the 'bite right' but not in preparation for a surgery. That's because often the face gets pushed backwards with ortho only to get the bite right. I view that as a different circumstance from one where the extractions are done in order to push the face forwards in preparation for a surgery.

That said were your (and GJ's) extractions initially done to get the 'bite right' by an ortho who did NOT deem the situation as a surgical case OR were they done in preparation FOR a surgery?

[Lazlo]

Could you guys clarify the circumstances as to your extractions. I ask because IMO, extractions are more problematic when they are done ONLY to get the 'bite right' but not in preparation for a surgery. That's because often the face gets pushed backwards with ortho only to get the bite right. I view that as a different circumstance from one where the extractions are done in order to push the face forwards in preparation for a surgery.

That said were your (and GJ's) extractions initially done to get the 'bite right' by an ortho who did NOT deem the situation as a surgical case OR were they done in preparation FOR a surgery?

good question, I'm not sure. my bite and surgery prep were done simultaneously --but I know that if, for example, your lower bicuspids are taken out and the spaces closed, then your lower arch will be narrower and the front lower teeth will necessarily be pushed back somewhat. even if that lower arch is brought forward with surgery, the tongue moves with the lower jaw, so you will always have a smaller arch that will constrict your tongue.

[GJ]

Could you guys clarify the circumstances as to your extractions. I ask because IMO, extractions are more problematic when they are done ONLY to get the 'bite right' but not in preparation for a surgery. That's because often the face gets pushed backwards with ortho only to get the bite right. I view that as a different circumstance from one where the extractions are done in order to push the face forwards in preparation for a surgery.

That said were your (and GJ's) extractions initially done to get the 'bite right' by an ortho who did NOT deem the situation as a surgical case OR were they done in preparation FOR a surgery?

Yeah mine was done to try to fix the bite with orthodontics.
So maybe that's a valid argument for getting them with surgery prep. So you could argue lower only if prepping for surgery from the start, but even so, it seems to be a valid approach only for certain cases where that's the only way to get additional needed space. I used to be strictly against all extractions, but I've actually recommended that plan a few times on the forum for those cases. There are no records with the OP's case, so I'd error on the side of no extractions until given a reason to think otherwise. Especially since he already has a narrow arch.

I'd argue pulling the 2nd premolar makes more sense in surgical cases, though, because that premolar has a less dense root structure compared to the 1st, so you wind up with less bone loss at the extraction site. It could result in slightly less space to close, too, for a case like this with narrow arches.