Can you have palate expansion after jaw surgery?

[kavan]

tell us more please. i had bimax advancement for class two. But I also had premolars taken out before. Can i get lower and upper expansion done during surgery? And is this safe, low risk and no further potential for nerve damage (my lower right lip is numb for years after double jaw surgery).

See the link provided in reply #13 if you want to know more about mandible expansion.

[Breakingbad]

My feeling is if you flair the lower teeth to match the MSE in the upper arch, then you run a high probability of the lower teeth relapsing. Basically that it wouldn't be stable. This opinion is based off many consults and discussions. I'm not saying what I write is 100% fact, but it's an educated opinion.

My understanding on expanding the lower jaw is that it can torque the condyles, so it's only done in deformity/syndrome type cases.

Thank you very much for explaining. It’s quite interesting and slightly alarming to hear that, since the surgeon who suggested this is very well known. It makes me wonder whether this treatment with MSE done on the upper arch and the lower teeth flared outwards might only be stable when done by certain doctors who know the right way to do it, or perhaps only on patients who meet certain criteria. I realize this is a bit of an obscure topic, but I’m wondering if to you that sounds like a likely, or even possible explanation for this?

About torqueing the condyles: According to some videos from his YouTube channel, it seems that Dr. Paul Coceancig routinely rotates the ramus laterally outward at the condylar to increase the bigonial width. I’ve attached a picture showing how he does it—note that it was originally posted on this forum by Louis_Mclovin. Wouldn’t this torque the condyles in much the same way as a mandibular expansion would?

[kavan]

What is the surgeon in the US known for and how familiar is he to the mods of JSF? We don't know because he isn't mentioned by name. However, there is a doctor in Australia we are familiar with who's marketing procedures resolve to a type of subterfuge. But we shan't name him here. 

Also the 'explanation' the doctor gave you doesn't resolve to the NAME or TERM the procedure/modality suggested to you is called or much info at all. So, little way to research it further. It sounds a little like 'teeth tipping' to the BUCCAL side. But it might not be that or if it is, teeth tipping to the buccal side might not be a bad thing if your lower teeth are presently tipped toward the lingual. You should find out from the doctor, what the ortho procedure is called and if it's something requiring a permanent retainer. You have already established from the doctor that it's NOT mandibular expansion.

[Breakingbad]

What is the surgeon in the US known for and how familiar is he to the mods of JSF? We don't know because he isn't mentioned by name. However, there is a doctor in Australia we are familiar with who's marketing procedures resolve to a type of subterfuge. But we shan't name him here.

Also the 'explanation' the doctor gave you doesn't resolve to the NAME or TERM the procedure/modality suggested to you is called or much info at all. So, little way to research it further. It sounds a little like 'teeth tipping' to the BUCCAL side. But it might not be that or if it is, teeth tipping to the buccal side might not be a bad thing if your lower teeth are presently tipped toward the lingual. You should find out from the doctor, what the ortho procedure is called and if it's something requiring a permanent retainer. You have already established from the doctor that it's NOT mandibular expansion.

I believe the surgeon is known for being a good alternative to Dr. Gunson in the Los Angeles area. That's the general impression I got from searching this forum and others. People in the LA area seem to often go to him because he's a big name, but works with insurance while Gunson doesn't. I am certain that you know of him and at least one other doctor who works out of the same practice. I hope that makes things clearer.

I think I see your point now about the lack of information. You're right that he was suggesting teeth tipping to the buccal side in the lower arch, in order to match the width of the upper arch. My understanding was that this would be done using braces, but I may have misunderstood. I do remember that he wanted 2 lower pre-molars extracted so that the lower anterior teeth could be pushed back with braces to achieve decompensation, so I assume that he meant that using the braces, the lower teeth could be tipped to the buccal side simultaneously.

I have an appointment in 2 days with the orthodontist that he said would do the MSE and all the orthodontic work, so I'll have more information soon. That orthodontist is an expert in MSE located in Southern California.

When I get more information, would you suggest that I post it here along with more specifics about my case, or in a new thread focussed on my specific case? I don’t want to derail the thread by talking too much about my specific case. For example, you just mentioned that if my lower teeth are presently tipped toward the lingual, tipping them outward could be okay, and I could reply with more information about this, and even include x-rays, but like I said, I don’t want to derail the thread. Your advice would be greatly appreciated.

[kavan]

.......

I think I see your point now about the lack of information. You're right that he was suggesting teeth tipping to the buccal side in the lower arch, in order to match the width of the upper arch. My understanding was that this would be done using braces, but I may have misunderstood. I do remember that he wanted 2 lower pre-molars extracted so that the lower anterior teeth could be pushed back with braces to achieve decompensation, so I assume that he meant that using the braces, the lower teeth could be tipped to the buccal side simultaneously.

Well, then the lack of information was from your not relaying what I guessed he may have been relaying, in particular, teeth tipping to the buccal side which is fine if they are tipped towards lingual and tipping towards buccal will match up with what's done to the maxillary arch.

I have an appointment in 2 days with the orthodontist that he said would do the MSE and all the orthodontic work, so I'll have more information soon. That orthodontist is an expert in MSE located in Southern California.

When I get more information, would you suggest that I post it here along with more specifics about my case, or in a new thread focussed on my specific case? I don’t want to derail the thread by talking too much about my specific case. For example, you just mentioned that if my lower teeth are presently tipped toward the lingual, tipping them outward could be okay, and I could reply with more information about this, and even include x-rays, but like I said, I don’t want to derail the thread. Your advice would be greatly appreciated.

You can post the info in this thread. X-rays are not required and most certainly Paul C's stuff is not needed. If you're concerned about relapse, what he told you about that possibility would be needed or if he told you a perm retainer would be needed.

[Breakingbad]

Well, then the lack of information was from your not relaying what I guessed he may have been relaying, in particular, teeth tipping to the buccal side which is fine if they are tipped towards lingual and tipping towards buccal will match up with what's done to the maxillary arch.

You can post the info in this thread. X-rays are not required and most certainly Paul C's stuff is not needed. If you're concerned about relapse, what he told you about that possibility would be needed or if he told you a perm retainer would be needed.

Sorry, I thought that “teeth tipping” and “teeth flaring” were synonymous. Apparently not.

Anyway, your assumption about my lower teeth being tipped toward the lingual side was correct. The orthodontist that specializes in MSE confirmed that in my case, tipping the lower teeth outward would be an appropriate solution, since my lower teeth are presently tipped toward the lingual side, meaning that they could be tipped outward to account for the increase in upper arch width from MSE. He stated that doing this would result in them being in an upright position over the bone, which would be healthier than the lingually tipped position that they are in currently.

[kavan]

Sorry, I thought that “teeth tipping” and “teeth flaring” were synonymous. Apparently not.

Anyway, your assumption about my lower teeth being tipped toward the lingual side was correct. The orthodontist that specializes in MSE confirmed that in my case, tipping the lower teeth outward would be an appropriate solution, since my lower teeth are presently tipped toward the lingual side, meaning that they could be tipped outward to account for the increase in upper arch width from MSE. He stated that doing this would result in them being in an upright position over the bone, which would be healthier than the lingually tipped position that they are in currently.

OK. That's a good reason and glad to hear it is what it sounded like it could be.

[Lazlo]

See the link provided in reply #13 if you want to know more about mandible expansion.

wow that cuck surgeon didn't even respond to my question.

[Salemare]

I believe the surgeon is known for being a good alternative to Dr. Gunson in the Los Angeles area. That's the general impression I got from searching this forum and others. People in the LA area seem to often go to him because he's a big name, but works with insurance while Gunson doesn't. I am certain that you know of him and at least one other doctor who works out of the same practice. I hope that makes things clearer.

I think I see your point now about the lack of information. You're right that he was suggesting teeth tipping to the buccal side in the lower arch, in order to match the width of the upper arch. My understanding was that this would be done using braces, but I may have misunderstood. I do remember that he wanted 2 lower pre-molars extracted so that the lower anterior teeth could be pushed back with braces to achieve decompensation, so I assume that he meant that using the braces, the lower teeth could be tipped to the buccal side simultaneously.

I have an appointment in 2 days with the orthodontist that he said would do the MSE and all the orthodontic work, so I'll have more information soon. That orthodontist is an expert in MSE located in Southern California.

When I get more information, would you suggest that I post it here along with more specifics about my case, or in a new thread focussed on my specific case? I don’t want to derail the thread by talking too much about my specific case. For example, you just mentioned that if my lower teeth are presently tipped toward the lingual, tipping them outward could be okay, and I could reply with more information about this, and even include x-rays, but like I said, I don’t want to derail the thread. Your advice would be greatly appreciated.

Hi Breakingbad,

When you say 2 premolars removed, do you mean one on either side or two on both sides?

[Breakingbad]

Hi Breakingbad,

When you say 2 premolars removed, do you mean one on either side or two on both sides?

I meant one on each side, so 2 lower teeth in total.