bimax with or without implant?

[Sequelae]

My main concern is asymmetry. I have posted here before, I've now consulted with two surgeons, Dr. Ramieri and Dr. Pagnoni. Ramieri suggested an implant alongside jaw surgery. While Pagnoni suggested just jaw surgery. He said that an implant at the same time as jaw surgery often doesn't work very well and comes with a higher infection risk. Ramieri has a technique involving an implant acting as a plate, which he calls Implate. I'm not sure to what degree this technique can offset the potential issues with a simultaneous osteotomy and implant.

Which approach do you think is best for me? Unfortunately, if I forgo the implant at this stage, I don't think that I would be able to afford to have an implant later down the line as having an implant and jaw surgery at the same time surgery is obviously cheaper. I'd really appreciate any advice.


https://imgur.com/a/ObjhrZz

[GJ]

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[Sequelae]

Does it work now? If not I will try another method, I would be very grateful for any help

[GJ]

I think that's probably true that an implant at the same time would increase infection risk (extra openings), but I would think with proper post-care routine it can be minimized. You'd have to keep it clean in there, which can be difficult after surgery, so a lot would be on you to do that. I'd personally take the risk and do both at the same time and have the mindset I'd keep it clean at all costs. They give heavy duty RX mouthwash etc to help with this as well, and if they don't, you should ask for it and anything else that can help keep it clean.

Your curve of spee on the left side seems drastically different than the right. This is probably your body compromising for different ramus sizes/asymmetry. It should probably be addressed via ortho prior to surgery? Has anyone recommended that?

[Sequelae]

I really appreciate your reply. I think I will go with Ramieri then for the implant, this is what I was learning towards. No, nobody mentioned to me about curve of spee.

[GJ]

I really appreciate your reply. I think I will go with Ramieri then for the implant, this is what I was learning towards. No, nobody mentioned to me about curve of spee.

Good luck.

Note: don't blame me if it doesn't go as planned. It's just the risk I'd personally take, knowing it probably does increase infection probabilities, etc. My view is cutting twice, anesthesia twice, and creating more scar tissue also has risks.

I don't know these surgeons reputations, either. I'd probably go with the better surgeon for my primary surgery if one of the two has a much better reputation.