Class II overbite surgery in Italy questions

[Salemare]

Hi All,

I am new to this forum and would like to ask some questions about the treatment I am having in Italy. English is not my first language and my friend is helping me translate so apologies in advance.

I am a 29 year old female and have a class II overbite/overjet of 1cm, with a very small upper and lower palate like a child. I have breathing problems at night, sinusitis and swallowing problems. Overcrowding on both upper and lower jaw.

It was suggested by my maxillofacial surgeon to expand my palate, but it was then decided against doing this because my lower jaw is so small. I will have orthognathic surgery to move my lower jaw forward.

In preparation for surgery I have had 8 teeth removed, which were the wisdom teeth and the 2nd premolars from upper jaw and same again for the lower jaw. I have been wearing a brace for the upper jaw for 2 years and lower jaw approx 14 months.

My orthodontist has told me I will soon be ready for surgery. Uptil now the focus on my treatment has been purely functional, but now as my pre-surgery treatment has progressed, I have concerns about the aesthetic aspect and have the following questions:

1. My cheeks look more sucked in the area where the teeth have been removed, as there is now a large space behind my teeth where the wisdoms have been removed. My teeth seem to have all moved forward and now there is a large area of gum where normally there would be teeth. Is this normal and will my teeth then be moved backwards somehow post surgery, or will the gap become even bigger post surgery?

2. Since having the additional teeth removed, my lower third of the face and jaw looks even smaller/more compressed and worse than before. Again is this normal?

2. Originally my two front teeth were prominant rabbit teeth, since wearing the braces, these have now been pulled in and far less prominant but they have moved off center to the point one of my front teeth is positioned centrally. Is this normal due to all the teeth being shifted about and will be corrected over time?

3. Are there any Italian citizens on here who had treatment in Italy and was any aspect of their treatment covered by Italian National health, especially if they had pre-existing breathing issues or similar? I dont have a lot of money, so opting for travel abroad and the most expensive surgeons is not an easy option.

4. I would like to get a second opinion about my treatment and would like to know who are other good surgeons in Italy and any recommended orthodonists also. I have seen a few Italian surgeons mentioned on here already but also would be interested in orthodontists which people had good experiences with.

5. Is it possible to change to another surgeon easily at this late stage if I wanted to?

Any advice appreciated. Many thanks.

[GJ]

1. My cheeks look more sucked in the area where the teeth have been removed, as there is now a large space behind my teeth where the wisdoms have been removed. My teeth seem to have all moved forward and now there is a large area of gum where normally there would be teeth. Is this normal and will my teeth then be moved backwards somehow post surgery, or will the gap become even bigger post surgery?

Yes it's pretty normal to have space behind the wisdom teeth. It's pretty much impossible for your molars to move forward, so you might have an optical illusion, or you might be stressing so much you're developing BDD or some other type of perception issue. Molars are double rooted and will not even move with headgear/braces easily if at all.

2. Since having the additional teeth removed, my lower third of the face and jaw looks even smaller/more compressed and worse than before. Again is this normal?

This could be true. We'd have to see photos. But yeah, extractions are awful for this reason, and they should only be used in cases where linear advancement of the lower jaw is the only movement, IMO.


2.

Originally my two front teeth were prominant rabbit teeth, since wearing the braces, these have now been pulled in and far less prominant but they have moved off center to the point one of my front teeth is positioned centrally. Is this normal due to all the teeth being shifted about and will be corrected over time?

It's possible they did this on purpose and will center everything during surgery. It's hard to say with the info you gave. We'd need to see images of you and then also see the plan.

5. Is it possible to change to another surgeon easily at this late stage if I wanted to?

In the US you can change surgeons or bow out of surgery entirely at any time. I'm not sure how it works in Italy. You have public health care? If so, you might go to the back of the line if you bow out. If you're not comfortable you should probably take more time, but realize excessive time in braces does ruin the teeth. So you might want to get out of braces if you decide to research more and/or find a new surgeon. In general, I'd say changing surgeons last minute is not a great idea for a host of reasons, but it is possible to do if you're not comfortable.

[kavan]

If your braces are to PREPARE for a SURGERY (you say they are there towards that goal), it is normal to look WORSE via what the braces do to prepare you for a surgery. It is called; 'decomensation'. Your braces are pulling backwards and making your face look smaller because they want the surgery to PUSH your face FORWARD.

They often remove the wisdom teeth before a surgery (usually the lower jaw). But they may have elected to remove from upper jaw to prevent a possible infection from them which would not be good to have during the year after your jaws were healing from the surgery.

So, the unfavorable appearance changes from the braces to prepare for surgery will get better AFTER they push your jaw bones FORWARD and outward when they do the surgery. You should look better after the surgery.

That said what you are experiencing is normal for a 'decompensation' period to prepare a class 2 for double jaw advancement surgery. But they should have told you to expect to look worse during the brace period in preparation for surgery.

[Salemare]

Yes it's pretty normal to have space behind the wisdom teeth. It's pretty much impossible for your molars to move forward, so you might have an optical illusion, or you might be stressing so much you're developing BDD or some other type of perception issue. Molars are double rooted and will not even move with headgear/braces easily if at all.

This could be true. We'd have to see photos. But yeah, extractions are awful for this reason, and they should only be used in cases where linear advancement of the lower jaw is the only movement, IMO.


2.
It's possible they did this on purpose and will center everything during surgery. It's hard to say with the info you gave. We'd need to see images of you and then also see the plan.

In the US you can change surgeons or bow out of surgery entirely at any time. I'm not sure how it works in Italy. You have public health care? If so, you might go to the back of the line if you bow out. If you're not comfortable you should probably take more time, but realize excessive time in braces does ruin the teeth. So you might want to get out of braces if you decide to research more and/or find a new surgeon. In general, I'd say changing surgeons last minute is not a great idea for a host of reasons, but it is possible to do if you're not comfortable.

Thanks for your reply GJ.

Regarding extractions, for sure my lower jaw will be moved forward, he said he doesnt know whether he will operate on the upper jaw until the surgery but they have removed the same number of teeth from the upper and lower jaw. I have very little informaton, as my procedure is being done on the Italian healthcare and I dont have much communication with my surgeon. Not the best situation I know....

Do you know anything about bone grafts? I was reading they can help prevent some of the long term effects of the bone loss from the extractions.
I presume bone grafts would not have been an option in my case for preparing my jaw for surgery, but it seems bone grafts can be done at a later date. Wondering if this would be a good option to do post surgery, or is this something they can do this during orthognathic surgery?

As mentioned above I am getting the surgery done on Italian healthcare, as I cant afford to pay for a private treatment. Only the orthodontic treatment I am paying for. Unfortunately I dont have a plan from my surgeon, but I have some x-rays if they are of any benefit.

I have attached some photos, the 3rd photo is not very good as I have taken it from an upward angle, to try to show the narrowing of my lower jaw and sunken cheekbones, I also have a twisted nose and deviated septum for a bothched surgery to correct sinus problems.

*I cant seem to upload photos, I have made sure they are all less than 500kb, anything else I need to do?

[Salemare]

If your braces are to PREPARE for a SURGERY (you say they are there towards that goal), it is normal to look WORSE via what the braces do to prepare you for a surgery. It is called; 'decomensation'. Your braces are pulling backwards and making your face look smaller because they want the surgery to PUSH your face FORWARD.

They often remove the wisdom teeth before a surgery (usually the lower jaw). But they may have elected to remove from upper jaw to prevent a possible infection from them which would not be good to have during the year after your jaws were healing from the surgery.

So, the unfavorable appearance changes from the braces to prepare for surgery will get better AFTER they push your jaw bones FORWARD and outward when they do the surgery. You should look better after the surgery.

That said what you are experiencing is normal for a 'decompensation' period to prepare a class 2 for double jaw advancement surgery. But they should have told you to expect to look worse during the brace period in preparation for surgery.

Thanks for your explanation!

[kavan]

Thanks for your reply GJ.

Regarding extractions, for sure my lower jaw will be moved forward, he said he doesnt know whether he will operate on the upper jaw until the surgery but they have removed the same number of teeth from the upper and lower jaw. I have very little informaton, as my procedure is being done on the Italian healthcare and I dont have much communication with my surgeon. Not the best situation I know....

Do you know anything about bone grafts? I was reading they can help prevent some of the long term effects of the bone loss from the extractions.
I presume bone grafts would not have been an option in my case for preparing my jaw for surgery, but it seems bone grafts can be done at a later date. Wondering if this would be a good option to do post surgery, or is this something they can do this during orthognathic surgery?

As mentioned above I am getting the surgery done on Italian healthcare, as I cant afford to pay for a private treatment. Only the orthodontic treatment I am paying for. Unfortunately I dont have a plan from my surgeon, but I have some x-rays if they are of any benefit.

I have attached some photos, the 3rd photo is not very good as I have taken it from an upward angle, to try to show the narrowing of my lower jaw and sunken cheekbones, I also have a twisted nose and deviated septum for a bothched surgery to correct sinus problems.

*I cant seem to upload photos, I have made sure they are all less than 500kb, anything else I need to do?

Bone grafts (or material used instead of your own bone), in particular the type associated with tooth extractions are used right after an extraction BUT WHEN they want to replace with with a tooth implant. They are placed in the empty tooth SOCKETS so a tooth implant has bone material for a successful 'take' of the implant. However, that was NOT your particular situation when you got the extractions