Orthodontist suddenly wants to camouflage my bite and go non surgical

[djsbelgium]

I'm looking for advice for my situation, i'll keep the story short.

I've been in orthodontic treatment for 1 year and 7 months, in preparation for DJS. I have recessed jaws and the surgical plan sketch has movements around 5,5mm forward for maxilla and 8mm forward for the mandible. Not a small discrepancy.

All well and such, until my orthodontist gave me elastics on my canines. He said "If all goes well, we might not need surgery anymore.", i think he expected relief but i nearly jumped out of my seat out of shock, because that means he wants to camouflage the problem to some extent. I said i want surgery either way. He said: "You can still get the surgery, but the movements will be less extreme.", meaning he gave me these elastics to pull back my upper front teeth (i have gaps between my canines and premolars, and an overjet of about (very roughly) 5 mm).

I want the optimal orthodontic preparation for DJS, which i believe doesn't involve pulling back teeth but rather making space for maximal jaw movements. I lost trust in my orthodontist and i mailed him saying i dont want a camouflage treatment, he disregarded my reasoning and simply replied with one line "you can still get jaw surgery". I cannot reach my orthodontist by mail or by phone.

I managed to get my surgeon (lets call him doc B.) to call me and he said i should trust his expertise but he also said he agrees to go non surgical if that's what the orthodontist plans to do. Now you have to keep in mind that this surgeon gave me a "rant" at our appointment about how jaw surgery is a functional and not an aesthetic surgery so he's not keen on doing it for me. However i've been to other surgeons (doc S. and doc D..q, both 'famous' Belgian surgeons) and they said it's a 100% DJS case.

My questions are:

1. Am i in the wrong that pulling back teeth is not a good idea if i want DJS either way? I believe the surgeon should decide how much to move the jaws, and the orthodontist shouldn't be trying to fix the overjet in surgical cases.

2. What do i do in my situation?

I've been to another orthodontist (and have other orthodontists appointments booked) for a second opinion, but also to maybe continue with another orthodontist. She spewed absolute nonsense and suggested additional camouflage orthodontistry. At the moment it's hard to get an appointment with a well-known orthodontist, they have a backlog due to covid and a waiting list for new patients...

If doc B. doesn't want to do the surgery i'd continue with doc S. Someone suggested contacting doc S. and asking him for an orthodontist recommendation, but he is so busy and hard to reach that i don't think i'd get a reply from him. However he's the only surgeon i've been to that did a perfect analysis of me in 2 minutes (flat cheekbones, both recessed jaws, even mentioned my posture..).

I could also stay with my orthodontist and try to reason with him that he won't pull back my upper front teeth. How do i make this clear to him that i don't want my teeth pulled back and that i want DJS either way? A lot of orthodontists think they're saviors because they "solve" (read: camouflage) a bite non surgically. His reasoning is that i can still get DJS but he doesn't see that he's not optimally preparing me in terms of orthodontics. My next appointment with him is in 2 weeks. I also haven't worn the elastics he gave me.

I've attached a picture of my current orthodontic setup, i don't know if it's clear enough, i can provide other pictures aswell.  https://imgur.com/a/xtbgbxv

[LeFort 3000]

The ortho is decompensating your bite in preparation of surgery, no?

Besides, you dont look like your jaws are recessed at all. Do you have cephs?

But I definitely agree that orthos are usually huge c*nts who completely lack any vision on aesthetics. For them, every issue in the jaw is fixed by pulling the upper and lower teeth on top of each other no matter the consequences.

[GJ]

It sounds like you need a new team.

In Belgium, is healthcare national or private? My concern would be that any ortho you see to get a 2nd opinion will just back the guy doing your current treatment. I'm not sure how you get fair evaluation. Maybe don't mention anything to future orthos and let them diagnose you without knowing if you want surgery or not.

Also, how big are those gaps?

Finally, it is possible they are right, and you're better off not getting surgery. With no records we can't give feedback on that.

[djsbelgium]

The ortho is decompensating your bite in preparation of surgery, no?

Besides, you dont look like your jaws are recessed at all. Do you have cephs?

But I definitely agree that orthos are usually huge c*nts who completely lack any vision on aesthetics. For them, every issue in the jaw is fixed by pulling the upper and lower teeth on top of each other no matter the consequences.

The orthodontist was decompensating my bite in preparation for surgery, and that for 1 year and 7 months. Now i'm not sure what he's doing. Last appointment he didn't give me a new wire top or bottom.

Keep in mind i am overall considered attractive despite my recession, which kind of camouflages it. Plus my recession is camouflaged by slight forward head posture. So the average person looking at me wouldn't see anything wrong. However i do strongly believe i would benefit from DJS.
Ceph and Arnett sketch: https://imgur.com/a/amdYf8F

About ortho's... tell me about it...

[djsbelgium]

It sounds like you need a new team.

In Belgium, is healthcare national or private? My concern would be that any ortho you see to get a 2nd opinion will just back the guy doing your current treatment. I'm not sure how you get fair evaluation. Maybe don't mention anything to future orthos and let them diagnose you without knowing if you want surgery or not.

Also, how big are those gaps?

Finally, it is possible they are right, and you're better off not getting surgery. With no records we can't give feedback on that.

Hospitals are all public, 95% of jaw surgeons work at a public hospital, 95% of orthodontists have their private practice though. The average orthodontist is beyond incompetent it seems. HOWEVER, the very first orthodontist i went to, said that it's a 100% jaw surgery case. Back then i was delusional and not well informed about it (and i found her beyond arrogant, i asked her why its a surgical case and she said "Therefore you need to study 9 years to become an orthodontist"), so i didn't continue with her. I could schedule an appointment with her, should i just in case? In terms of other ortho's i have an appointment around november and around january, waiting lists...

The gaps between my canines and molars are big enough that i could partially fit my tongue inbetween if it were not for the wire. So pretty big gaps.

My current ortho/surgeon will call each other next week and get back to me through mail and tell me what the plan is. Either way my ortho should understand that pulling back teeth is not the way in preparation for surgery, and that MAXIMAL movements are DESIRED.

Do i need the surgery? Maybe not. Will i benefit from it aesthetically and functionally? Yes.
HOWEVER, either way, i have an overjet of about 5mm right now (and before he decided to pull back, it felt like an even bigger overjet). What kind of an ugly orthodontic result would it be if he tries to fully camouflage a 5mm overjet? He even said before the treatment that he believes BSSO is the way to go here.

In terms of records i posted my ceph and arnett sketch in another reply, i can provide other pictures if you want. Though i remember my very first post on this forum was about if i would benefit from jaw surgery, people agreed that i would. Can i view my own previous posts somewhere?

[LeFort 3000]

The orthodontist was decompensating my bite in preparation for surgery, and that for 1 year and 7 months. Now i'm not sure what he's doing. Last appointment he didn't give me a new wire top or bottom.

Keep in mind i am overall considered attractive despite my recession, which kind of camouflages it. Plus my recession is camouflaged by slight forward head posture. So the average person looking at me wouldn't see anything wrong. However i do strongly believe i would benefit from DJS.
Ceph and Arnett sketch: https://imgur.com/a/amdYf8F

About ortho's... tell me about it...

Now that you are already so far you should pull though with surgery no matter what. You seem to have good jaw and tooth relations, but the jaw seems to be a bit into a backwards position.
If your ortho gives you more trouble, just bite bulled and look for another one. You already have the wires in place, tell any new ortho you changed places and need a new Dr to pull through with the surgery or something like that. I think its often good to not tell a new Dr anything about previous treatments plans of another Dr. They often trust their colleagues alot more than their patients and if they hear their colleague has been reluctant to do xyz, they often get reluctant too because they dont wanna touch into a bees nest.

[kavan]

You mention 2 other surgeons who said you were 100% bimax case as to bring in what they said to cast doubt on what your surgeon said. You even have a Gunson displacement proposal that clearly shows a case for bimax surgery. OK fine. But you didn't choose any of the other surgeons. You chose the doc who isn't keen on doing surgery for you and now you need advice on how to make your BELIEF clear that your teeth shouldn't be pulled back.  You were impressed and chose Dr. 'B' because he was able to do an analysis in 2 minutes. So, there's another BELIEF of yours that a legit analysis can be done in 2 minutes (when it takes much MORE time and THOUGHT than that). If you don't believe that it takes more than 2 min to do a legit analysis, then cross reference that with Dr. B concluding from it that you had bimax recession. YET, he hesitates to do the bimax surgery. Why? Because his 2 minute analysis that you had bimax recession was that impressive OR because pulling your teeth back will address the bimax recession he analyzed.

I'm not going to opine on what ortho you may or may not need. But I will tell you that the best way to TEST one's 'beliefs' (yours included), especially beliefs that go into making a decision, such as your present belief that ortho should not be pushing your teeth back, is to REFLECT on whether or not your beliefs led you to the right decision in the first place.

Did your beliefs lead you to right choice when you ruled out 3 others in favor of Dr. B on the basis of being impressed with his 2 minute 'analysis'?

No need to answer this question to me. It's meant to be an introspective question for you to ponder as to how reliable are the beliefs you're using in the decision making process.

[djsbelgium]

Now that you are already so far you should pull though with surgery no matter what. You seem to have good jaw and tooth relations, but the jaw seems to be a bit into a backwards position.
If your ortho gives you more trouble, just bite bulled and look for another one. You already have the wires in place, tell any new ortho you changed places and need a new Dr to pull through with the surgery or something like that. I think its often good to not tell a new Dr anything about previous treatments plans of another Dr. They often trust their colleagues alot more than their patients and if they hear their colleague has been reluctant to do xyz, they often get reluctant too because they dont wanna touch into a bees nest.

Keep in mind i have a 5 mm overjet right now (or more) so i think it's a surgical case 100%.

Surgeon will contact my ortho and will keep me up to date on what their plan is.
I'm afraid of switching orthodontists because they will most certainly ask why i switched places. Like you said, saying "ortho didnt want surgery" isn't the way to go. However, what if i say my jaw surgeon agrees on jaw surgery? Will the orthodontist follow the jaw surgeons decision? Good thing i went to multiple surgeons just in case.

[djsbelgium]

You mention 2 other surgeons who said you were 100% bimax case as to bring in what they said to cast doubt on what your surgeon said. You even have a Gunson displacement proposal that clearly shows a case for bimax surgery. OK fine. But you didn't choose any of the other surgeons. You chose the doc who isn't keen on doing surgery for you and now you need advice on how to make your BELIEF clear that your teeth shouldn't be pulled back.  You were impressed and chose Dr. 'B' because he was able to do an analysis in 2 minutes. So, there's another BELIEF of yours that a legit analysis can be done in 2 minutes (when it takes much MORE time and THOUGHT than that). If you don't believe that it takes more than 2 min to do a legit analysis, then cross reference that with Dr. B concluding from it that you had bimax recession. YET, he hesitates to do the bimax surgery. Why? Because his 2 minute analysis that you had bimax recession was that impressive OR because pulling your teeth back will address the bimax recession he analyzed.

I'm not going to opine on what ortho you may or may not need. But I will tell you that the best way to TEST one's 'beliefs' (yours included), especially beliefs that go into making a decision, such as your present belief that ortho should not be pushing your teeth back, is to REFLECT on whether or not your beliefs led you to the right decision in the first place.

Did your beliefs lead you to right choice when you ruled out 3 others in favor of Dr. B on the basis of being impressed with his 2 minute 'analysis'?

No need to answer this question to me. It's meant to be an introspective question for you to ponder as to how reliable are the beliefs you're using in the decision making process.

I re-read my original post and see that my wording wasn't clear sorry

Doc B: Made the Arnett analysis (before i showed up at the appointment, so i don't know how long it took him)
Doc S: Analysed me correctly in 2 minutes by looking at me physically (instantly noticed flat cheekbones, forward head posture, recessed jaws)

The original plan was to go with doctor B but i was considering other aesthetic surgeries (doc S is also a plastic surgeon) so i went to doc S. Doc S mailed my orthodontist to say i had an appointment with him. My orthodontist asked me to clarify why i went to a second surgeon. He said it doesn't matter for him which surgeon i choose but he said that he has a bit better experience with doctor B (he used to go to doctor S before they had some kind of disagreement). So my choice in surgeon isn't really set in stone.

[InvisalignOnly]

If your ortho gives you more trouble, just bite bulled and look for another one.

It's typically very difficult, if not impossible, to find an orthodontist willing to take over treatment halfway through, even if it is for a simple case, let alone a surgical case. There is also the question of the cost - you would most likely have to pay the full cost of the treatment to both orthodontists, even if you manage to find a new one. It can be even difficult and costly to find an ortho to do something as simple as to glue back a bracket that has fallen off if you are unable to get to your regular ortho for some time. Taking over someone's entire treatment is on a whole other level - not many orthos are willing to do that. 

[kavan]

I re-read my original post and see that my wording wasn't clear sorry

Doc B: Made the Arnett analysis (before i showed up at the appointment, so i don't know how long it took him)
Doc S: Analysed me correctly in 2 minutes by looking at me physically (instantly noticed flat cheekbones, forward head posture, recessed jaws)

The original plan was to go with doctor B but i was considering other aesthetic surgeries (doc S is also a plastic surgeon) so i went to doc S. Doc S mailed my orthodontist to say i had an appointment with him. My orthodontist asked me to clarify why i went to a second surgeon. He said it doesn't matter for him which surgeon i choose but he said that he has a bit better experience with doctor B (he used to go to doctor S before they had some kind of disagreement). So my choice in surgeon isn't really set in stone.

Well then..you can adapt my response to which ever doctors you mixed up given the wording of your original post. It doesn't change the point I was making which was to self reflect on whether or not what ever beliefs you had were on target with with your decisions based on them.

As to belief concerning:
"How do i make this clear to him that i don't want my teeth pulled back and that i want DJS either way?"
I'd say that's also something you need to self reflect on as to WHY you believe that having GAPS between your canines and premolars 'should' PRECLUDE an ortho from pulling the teeth back to CLOSE the GAPS (or why you believe it's contingent that that gaps need to stay open in order to have DJS.). I have no idea why you believe that. Hence, it's a question you need to ask yourself as to how that belief came about rather than something that others on here need to help you make clear so you can use it to tell the ortho and surgeon what to do.

[djsbelgium]

As to belief concerning:
"How do i make this clear to him that i don't want my teeth pulled back and that i want DJS either way?"
I'd say that's also something you need to self reflect on as to WHY you believe that having GAPS between your canines and premolars 'should' PRECLUDE an ortho from pulling the teeth back to CLOSE the GAPS (or why you believe it's contingent that that gaps need to stay open in order to have DJS.). I have no idea why you believe that. Hence, it's a question you need to ask yourself as to how that belief came about rather than something that others on here need to help you make clear so you can use it to tell the ortho and surgeon what to do.

Pulling back/flaring teeth to fix a bite is not an aesthetically pleasing result. Since i'm going with DJS either way my orthodontist should optimally prepare me with DJS in mind. If he pulls back my teeth to close gaps (instead of pulling my molars forward), the surgeon will have less space for the lower jaw to move and the result won't be aesthetically optimal, since forward grown faces are more attractive.

[kavan]

Pulling back/flaring teeth to fix a bite is not an aesthetically pleasing result. Since i'm going with DJS either way my orthodontist should optimally prepare me with DJS in mind. If he pulls back my teeth to close gaps (instead of pulling my molars forward), the surgeon will have less space for the lower jaw to move and the result won't be aesthetically optimal, since forward grown faces are more attractive.

If it's the front UPPER teeth they are pulling back, then they have the option of moving the maxilla forward and displacing it in accordance with the planned advancement of the BSSO. Other than that, it's sounding like you might need a new surgical team where your contention that pulling your teeth back will be 'sub optimal' aesthetically is validated by the new team given that your present team does not appear to be validating that contention.

[djsbelgium]

If it's the front UPPER teeth they are pulling back, then they have the option of moving the maxilla forward and displacing it in accordance with the planned advancement of the BSSO. Other than that, it's sounding like you might need a new surgical team where your contention that pulling your teeth back will be 'sub optimal' aesthetically is validated by the new team given that your present team does not appear to be validating that contention.

Why would that be desirable over pulling the molars forward to close the gaps? The only explanation i see is that my orthodontist is lazy.

How do i look for a new team? What do i tell the new orthodontist?

[InvisalignOnly]

It's not as simple as either moving front teeth back or back teeth to the front; pulling front teeth back is relatively fast and straightforward, while moving molars towards the front would probably take years and might not even work. The orthodontist should have explained this to you. Even if you change orthos, it's unlikely that many would agree to move molars forward to close a gap, and the gap does need to be closed so you will have to decide  - together with your team - what options you have for surgery.