Orthodontic preparation vs surgery planning

[kubabuk]

Hi, I'm hoping you guys could help me with the following problems.

I have a surgeon that I would like to be operated by, but he refuses to give me any plan of surgery without my bite being ready for the surgery. So I would only know what his plan and vision are roughly a month before surgery!
Is it normal for surgeons to work like that? He said that all the other ways of planning are too unreliable in his experience. But I would still want to know what I'm getting myself into before starting the whole orthodontic treatment.

Another question would be - how limiting is a ready-for-surgery bite when it comes to choosing a surgeon? That is: let's suppose that my bite is ready for the operation, but the plan given to me by the surgeon doesn't satisfy me. Would it be possible for me to change the surgeon at this point, or would my bite be a limiting factor and would have to be significantly changed again to fit the new surgeon's plan?

I would really appreciate your help, because I'm really confused at this point. :s

[LeFort 3000]

you can change your surgeon anytime when your bite is ready. they prepare the bite for a general optimal bite in regards to your case. for example, someone has protruding bite due to previous camouflage ortho treatment in the past and decides to do djs, the ortho will decompensate the teeth in a most neutral state and fit the teeth back onto each other. when its time for surgery, the surgeon advances/retracts the jaws by how much they personally think is optimal. you can have, with the same bite, one surgeons who thinks the jaw must be moved back and one who thinks the jaw should be moved forward for optimal results. you can chose the plan you like better

[kubabuk]

Thanks!
What you're saying does sound weird though - intuitively it seems to me like the bite would force a certain movement of the jaws so that you can have a correct overjet and a proper cusp-to-groove allignment; but of course my intuition could be wrong.

[LeFort 3000]

what you said is not in conflict what i said. the bite forces the jaw movement. but thats why you have surgery, to change the jaw relations. the braces adapt the jaw to teeth relation. the surgery then adapts the jaw to jaw/jaw to skull relations. if the bite doesnt fit after the surgery your ortho will adjust.
the main question: can you change the surgeon with a ready-for-surgery bite? yes

[kubabuk]

My bad - my main question was meant to be "Can you change the surgical plan with a ready-for-surgery bite?".
So you're saying that the post op orthodontics could help, but would that really make that much room for the surgeon to change the operation plan?

[GJ]

To me it's weird. Red flag, actually.

[kubabuk]

The surgeon said that he used to plan the surgery before any orthodontics, but that the results were too unreliable. It seems to make sense to me, especially with today's very precise 3d-model planning - small deviations in bite could make a significant difference.
He did give me a "very rough" plan (verbally) - lefort 1 + BSSO + genio, probably 4-6 mm mandibular and 2-3mm maxillary advancement.
Could you tell me how should it look like with a good, aesthetically-oriented surgeon?

[Breakingbad]

The surgeon said that he used to plan the surgery before any orthodontics, but that the results were too unreliable. It seems to make sense to me, especially with today's very precise 3d-model planning - small deviations in bite could make a significant difference.
He did give me a "very rough" plan (verbally) - lefort 1 + BSSO + genio, probably 4-6 mm mandibular and 2-3mm maxillary advancement.
Could you tell me how should it look like with a good, aesthetically-oriented surgeon?

I’ve had the exact same experience with all the surgeons I’ve seen. However, I didn’t push them hard on this, so it’s possible that if I did, they would have been willing to provide a preliminary plan and mock up. My understanding is that doing this is time consuming for them, so they may just be reluctant to doing this for a patient who is far from being committed to working with them—I’ve read that some even charge a significant fee if a patient wants plans and simulations before they are committed.

[kubabuk]

Could you tell me whether the surgeons you were talking to were considered good & aesthetically-oriented?
What is the procedure like with famous surgeons like Gunson, Alfaro etc. ? What is the surgeon-ortho cooperation like with them? Could the ortho be from abroad (f.i. your home country) ?

[Breakingbad]

Could you tell me whether the surgeons you were talking to were considered good & aesthetically-oriented?

Yes, I have consulted with a few very well known surgeons who are all supposed to be aesthetically-oriented.

What is the procedure like with famous surgeons like Gunson, Alfaro etc. ? What is the surgeon-ortho cooperation like with them? Could the ortho be from abroad (f.i. your home country) ?

My experience is that most surgeons are willing to work with an overseas orthodontist if you live abroad, but it depends on the case and if there is a good enough orthodontist in your area to do what is required.