Optimal result, long time orthodontic work vs suboptimal result surgery first?

[bimaxsoon]

Hello everyone,

I have recessed jaws and (I think) a (somewhat?) narrow palate and a mild open bite. I had a consultation with Defrancq and his plan is bimax, sliding genioplasty and SARPE. He initially said he could do it surgery first but reconsidered and changed his mind.

So I consulted with the orthodontist he works closely with and he says I need 12 months orthodontic treatment pre-op and 6 months post-op (which seems like a lot considering that my teeth are very straight and normal apart from a mild open bite. Is it possible that he uses a conservative estimate to avoid underestimating the amount of time it takes?).

Dr. Defrancq and the orthodontist he works with both seemed very meticulous and professional, and I'm confident in their ability to produce a good result aesthetically and particularly orthodontically (Defrancq seems very concerned with a good and stable orthodontic result).

The problem is having to wear braces for a year. (I'm not as concerned about wearing braces post-op because my more harmonious face will neutralize the negative effect the braces have on my appearance, so I don't count that time.) I absolutely dread having to wear braces as a young man in my 20s. However, if I'm ever going to go through with it the next 1.5 years happen to be the least bad time to do it.

My question is basically if I should go for the DeFrancq solution (optimal result) or try to find a surgeon that can do surgery first (Dr Z or Dr Raffaini perhaps). I don't know if this is even possible since DeFrancq says he can't/won't do it. On the other hand I had a consultation with Moammerts and his plan was surgery first so it may be possible (I know Moammerts is debatable on here but I think he's alright.) Defrancq seems almost obsessed with a perfect, stable orthodontic result (which may be why he won't do surgery first) - which is good, but I'm willing to settle for a decent orthodontic result as long as the aesthetic result is good. Again, I just have a mild open bite which doesn't bother me.

Time is also a factor, consulting with different surgeons is going to take a few months whereas I can get started with the Defrancq plan relatively quickly.

So.. what to do?

[ArtVandelay]

Do you have any high quality pics from the ortho of your bite?

[bimaxsoon]

Do you have any high quality pics from the ortho of your bite?

Here's a picture from the orthodontist
https://imgur.com/a/Lv06NC9

And here is a screen recording of a 3D model of my teeth
https://streamable.com/84nwa

[PloskoPlus]

Surgery first might leave you with a bite worse than you started with. Then you may end up spending eternity in braces anyway trying to salvage a poor surgical outcome. Surgery first is a dumb idea. It can only be justified if you have severe sleep apnea which must be resolved immediately.

[Gadwins]

Are you sure that you didn't mix up the numbers? Normally it is 6month pre op, after palate expansion and 12month after bimax.

[PloskoPlus]

Are you sure that you didn't mix up the numbers? Normally it is 6month pre op, after palate expansion and 12month after bimax.

Depends on the case, but typically pre-op braces take longer. If all goes well, post-op braces should be taken off within 6 months.

[Kadath]

I don't think your bite is all that bad if I'm being honest, but I'm not an expert at all. The thing with braces is that it provides more guidance and structure for the surgeon to work with. That said, I know for a fact, that even "surgery first" docs like Z still want you to have brackets placed so that they can use rubber bands to stabilize the bite and keep your jaws together. Wiring and splints are very old style.