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.

[Tomasjohn]

The "implate" ramieri mentions in your case is not an implant in a classical sense as in putting an actual foreign body on top of the mandible but rather a technique that pushes the bone out and for this he needs custom plates. How the technique exactly works is unknown to me but we did discuss some theories before in this forum.

Ramieri also does "normal" implants, but prefers his "implate" technique I think.

It offsets the risks of implants more or less completely because it's not an actual implant. Of course, plates and screws can also become infected but this is a general risk of surgery.

 

[GJ]

The "implate" ramieri mentions in your case is not an implant in a classical sense as in putting an actual foreign body on top of the mandible but rather a technique that pushes the bone out and for this he needs custom plates. How the technique exactly works is unknown to me but we did discuss some theories before in this forum.

It seems like the risk of that would be lack of precision and therefore a higher risk of asymmetry? The only way I can think to do that is splitting the mandible along the length and/or width, and that is not going to be very accurate.

I'm sure on his site we'd only see the best results, but I'd be curious to see how many times it succeeds vs fails.

[Sequelae]

The "implate" ramieri mentions in your case is not an implant in a classical sense as in putting an actual foreign body on top of the mandible but rather a technique that pushes the bone out and for this he needs custom plates. How the technique exactly works is unknown to me but we did discuss some theories before in this forum.

Ramieri also does "normal" implants, but prefers his "implate" technique I think.

It offsets the risks of implants more or less completely because it's not an actual implant. Of course, plates and screws can also become infected but this is a general risk of surgery.

 

I don't think you are correct; he pretty explicitly referred to an implant. He mentioned that he normally prefered to use PEEK for implants but that this one would be titanium because it doubles as a plate, so he was definitely referring to foreign material

[Tomasjohn]

I don't think you are correct; he pretty explicitly referred to an implant. He mentioned that he normally prefered to use PEEK for implants but that this one would be titanium because it doubles as a plate, so he was definitely referring to foreign material

Yes of course foreign material, the plates are always titanium. But as far as I know it's not a jaw angle implant.

[kavan]

1: Your asymmetry at the jaw angle is pretty minor. I think I told you before that there was a good chance of addressing it with filler (which can be dissolved if you don't like it). Whether or not you didn't like the idea of filler, it's still a lower infection risk than putting an implant over a fresh bone cut.

2: Even though it seems you would rather risk having an implant placed directly over a fresh bone cut (because both can be done at same time) which increases the risk of infection, the suggestion of filler (even though you don't like the idea of it) suggests that the asymmetry at the jaw is MINOR.

3: Thomasjohns description of the 'imPLATE' was not incorrect. He was correct in the sense that it is something that pushes the bone out; separates one part from the other to push one part out (or away from an other part). It is just a matter of SEMANTICS that the material used; titanium, that doubles as a plate was also a 'foreign' material. Hence, the 'implate' thing is SEPARATING the bone. That is different from slapping an implant directly over a fresh bone cut because it (the implate) is not an OVERLAY over a fresh bone cut as would be the case if you slapped an implant over a fresh bone cut. Bones are separated all the time in maxfax surgery and the separation is held in place by plates and screws. So, what you are being offered via the 'imPLATE' is similar concept in the sense it will push part of the jaw angle in the direction to match the other side.

4: Since your jaw asymmetry is minor, your risk of infection is lower by getting the imPLATE rather than slapping an implant over a fresh cut.

[Sequelae]

1: Your asymmetry at the jaw angle is pretty minor. I think I told you before that there was a good chance of addressing it with filler (which can be dissolved if you don't like it). Whether or not you didn't like the idea of filler, it's still a lower infection risk than putting an implant over a fresh bone cut.

2: Even though it seems you would rather risk having an implant placed directly over a fresh bone cut (because both can be done at same time) which increases the risk of infection, the suggestion of filler (even though you don't like the idea of it) suggests that the asymmetry at the jaw is MINOR.

3: Thomasjohns description of the 'imPLATE' was not incorrect. He was correct in the sense that it is something that pushes the bone out; separates one part from the other to push one part out (or away from an other part). It is just a matter of SEMANTICS that the material used; titanium, that doubles as a plate was also a 'foreign' material. Hence, the 'implate' thing is SEPARATING the bone. That is different from slapping an implant directly over a fresh bone cut because it (the implate) is not an OVERLAY over a fresh bone cut as would be the case if you slapped an implant over a fresh bone cut. Bones are separated all the time in maxfax surgery and the separation is held in place by plates and screws. So, what you are being offered via the 'imPLATE' is similar concept in the sense it will push part of the jaw angle in the direction to match the other side.

4: Since your jaw asymmetry is minor, your risk of infection is lower by getting the imPLATE rather than slapping an implant over a fresh cut.

If you look at this image of his implate, it looks to be an implant, no?

[Sequelae]

The picture is a bit messed up, this video should give a better look https://youtu.be/qH5NHM_mubc?si=s44tlzIo3P84nbC_

[kavan]

If you look at this image of his implate, it looks to be an implant, no?

Your right it does. Assuming the chin plates and screws are titanium, it looks like titanium implant. I wonder if it is some kind of marketing gimmick  to call it an 'implate' instead of a titanium implant.

[Sequelae]

I think it is because the implant also holds the bone segments in the new post-osteotomy position like plates typically do.