Author Topic: Intro: previously orthodontic work to "fix" a class II overbite  (Read 9096 times)

Alue

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Hi, I found this forum from the other forums.  I noticed some people here have had similar cases to mine.  

When I was younger I had orthodontic work done to 'fix' a class II jaw. I had bicuspids extracted on both top and bottom and wore cervical headgear to "correct" my recessed mandible.  I feel that, through the whole process my jaw and my mouth were made too small for my face, in addition to the esthetic impact, I have a hard time breathing through my nose, my jaw pops to one side when I open wide, there is some asymmetry, I get pain in my TMJ joint if I chew too much, and it just feels like my mouth is too small for my tongue. I have seen 3 orthodontists for a free consolation regarding my jaw/previous orthodontic work, but none of them could recommend jaw surgery because I have an 'adequate' occlusion.

Orthodontist one (the one who did the original orthodontic work years ago) said he couldn't see anything wrong with my jaw and he said extractions and head gear have no impact on a person's profile whatsoever. He told me if I wasn't happy about the way my profile looked I could get a chin implant. The thing is, my maxilla is recessed enough that if I were to get more pominence on my chin it would look goofy giving me an even more dished in profile.

Orthodontist two was a bit more helpful explaining the developmental phases of the jaw, and different orthodontic techniques, but ultimately he too could not recommend jaw surgery or any orthodontic work to fix this problem, he told me if I was unhappy about my profile I could consider a rhinoplasty. The thing is, although I know I have a big nose, I never saw it as a negative thing, in my opinion it is my jaw (both maxilla and mandible) that are too small for my face and that is why it looks so disproportionate.

Orthodontist three had similar opinions to the first two.  He told me that all the literature he has read indicates that extractions have little to no effect on a person's profile.  

I finally saw a plastic surgeon that used to work as a maxillofacial surgeon and he understood what I was talking about.  He told me that in addition to a recessed maxilla and mandible I have some mid-face deficiency,  which makes sense.  Looking at the before and after pictures of my orthodontic treatment makes me sick to my stomach, I went from having a class II recessed mandible but otherwise normal face to having bimaxillary recession, dark bags under my eyes (at age 16) and deep laugh lines.  The lower part of my face also got much more narrow from the front view and I cannot display many teeth when I smile.  The recessed jaw makes my already large (roman) nose look even more huge.  At 16 years old (after I had finished orthodontic work) my face just looked hollow and old (while the recessed jaw makes me look young).  

I don't know, every orthodintist I have seen tells me that extractions and headgear have little impact on a persons profile and jaw growth, but I have a hard time believing that, especially when I look at my before and after pictures and family members.  I have also been told that my jaws are not that recessed, but my nose appears to be too large for my face.  Is jaw surgery overkill in my case?  Every professional I have spoken to seems to think so.   Can extractions and headgear (during adolescence) alter jaw growth, or is it merely genetics?  
« Last Edit: March 22, 2013, 02:56:58 AM by Alue »

treevernal

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #1 on: March 13, 2013, 09:37:33 PM »
It's like I was reading about myself when I read your post.  As you probably have noticed, many orthodontists focus solely on the occlusion often at the expense of not only aesthetics, but also airway and tmj health.  I would consult with some top maxfax surgeons without a referral from your orthodontist and get their opinions.  You are sooooo making the right choice by not getting a rhinoplasty or implants; the source of the problem is your jaws.  I just had surgery back in January and I am so happy I did it; I wish I could have done it sooner on life but it is what it is.  Good luck to you.

Alue

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #2 on: March 13, 2013, 09:47:05 PM »
There are a number of oral surgeons in my area and a lot of orthodontists, but most of the oral surgeons require a referral from an orthodontist to even schedule you for a consultation, and the orthodontists (at least the ones I have talked to) seem to be of the same train of thought and are very hesitant to even comment on another orthodontists work.  

It was strange the orthodontist that retained my dental records was very hesitant to release them (initially they wouldn't, but then when I went in person they released partial records) and when I spoke with said orthodontist they had scribe sitting next to us taking notes of the conversation.  I don't know if it was something in my records or my persistence that made the orthodontist so paranoid, but I just wanted to understand what was done, what effect it had, and what my options are now.

The plastic surgeon I saw had dental degree and used to work as a oral and maxillofacial surgeon (but no longer does).  I was told that orthodontists are hesitant to send a referral to oral surgeons if the case is not likely to be covered by insurance, and the surgeons require referrals from orthodontists mainly so they don't have to spend so much time with insurance companies.  Had I waited till I was 18 for orthodontic treatment it likely would have been covered by my insurance.  

I'm just in the stages of exploring my options, but that has proven to be very difficult.  
« Last Edit: March 22, 2013, 05:33:51 PM by Alue »

Alue

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #3 on: March 14, 2013, 05:15:30 PM »
treevernal did you have bi-max advancement? 

Does anyone have experience or knowledge of bi-max when a person only has 24 teeth.  I only have 24 teeth, 4 bicuspids removed and 4 wisdom teeth removed, and I'm wondering if that would create a challenge if I were to have bi-maxillary advancement.  Can bone absorption occur after surgery if there are teeth missing in the back of the jaw?  I have conflicting thoughts about re-opening extraction spaces. 


Every orthodontist I have talked to have told me that cervical headgear serves the function of holding molars in place while letting the mandible "catch up" to the maxilla, and that it should have little to no effect on maxillary growth.  I had one orthodontist tell me that cervical headgear promotes mandibular growth by "disengaging the joint".  I can really find any evidence supporting these claims.  I've found a few abstracts (I no longer have access to research articles) that suggest headgear does have more effects than what is being claimed by orthodontics. 
http://www.ncbi.nlm.nih.gov/pubmed/18004917
http://www.ncbi.nlm.nih.gov/pubmed/22322499

Sorry if I'm being overly analytical, it is in my nature. 

Alue

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #4 on: March 14, 2013, 06:41:01 PM »
Thanks for the reply.  The gums receding is what I would be worried about with any non surgical expansion/reopening extraction spaces.  

I am curious if it has an effect on long term stability as the jaw does have a tenancy to shrink with age.  I would rather not have go through the additional time and money of re-opening extraction spaces.  Extracting my bicuspids was never my choice, but I'm kicking myself for having my wisdom teeth extracted.  


treevernal

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #5 on: March 14, 2013, 08:07:25 PM »
treevernal did you have bi-max advancement? 

Does anyone have experience or knowledge of bi-max when a person only has 24 teeth.  I only have 24 teeth, 4 bicuspids removed and 4 wisdom teeth removed, and I'm wondering if that would create a challenge if I were to have bi-maxillary advancement.  Can bone absorption occur after surgery if there are teeth missing in the back of the jaw?  I have conflicting thoughts about re-opening extraction spaces. 


Every orthodontist I have talked to have told me that cervical headgear serves the function of holding molars in place while letting the mandible "catch up" to the maxilla, and that it should have little to no effect on maxillary growth.  I had one orthodontist tell me that cervical headgear promotes mandibular growth by "disengaging the joint".  I can really find any evidence supporting these claims.  I've found a few abstracts (I no longer have access to research articles) that suggest headgear does have more effects than what is being claimed by orthodontics. 
http://www.ncbi.nlm.nih.gov/pubmed/18004917
http://www.ncbi.nlm.nih.gov/pubmed/22322499

Sorry if I'm being overly analytical, it is in my nature. 

Yes I did.  As a teen I had a herbst appliance which was supposed to guide the growth of my lower jaw forward but instead (according to my surgeon) it kept my upper jaw from growing forward.  He said this was a common problem with people who had the herbst.

Alue

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #6 on: March 22, 2013, 05:31:44 PM »
I finally got in to see a maxillofacial surgeon.  He pretty much confirmed everything I had thought.  He suggested doing a high lefort 1 bi-max.  Tentatively suggested about 6mm of forward movement.   He told me from my receded profile he would expect me to have airway issues and/or sleep apnea, but looking at the ceph my airway looks fine.  He does genioplasties, but he told me in my case he thought a genioplasty would be a mistake and would give my profile giving me an artificial (dished in) look. I tend to agree.  The biggest surprise was that he told my particular insurance has a good chance of covering it.

stupidjaws

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #7 on: March 22, 2013, 07:20:11 PM »
i thinks he means a genioplasty alone. i

buzzhead

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #8 on: September 22, 2013, 06:43:36 PM »
This could be my story.  I had four bicuspids removed at age eighteen and my front teeth moved back.  I complained to my ortho the whole time about him doing this but he was adamant that this would be fine.  I never thought it was the right thing to do and now I have a concave profile, weak smile(too little teeth show)and sleep apnea.  I finally was referred to an orthodontist by my new dentist who seemed to be the first dental professional that understood or empathized with my concerns.  He referred my to an oral surgeon who tells me that I am not an uncommon case.  Bicuspid removal was in vogue in my youth and was done far too often.  I am now in braces preparing my teeth for bi max surgery that will move both jaws forward with top jaw lowered to show more teeth.  Might need genioplasty as well to reshape chin.

What is your current situation?

Lazlo

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Re: Intro: previously orthodontic work to "fix" a class II overbite
« Reply #9 on: September 22, 2013, 10:47:17 PM »
Let me tell you guys something. Orthodontists don't know s**t about aesthetics or facial aesthetics and most know very very little about maxillofacial surgery or even periodontology. You would think they know a fair bit about these things, but I know now from experience they know much less than several of the "laymen" on this board. The just don't receive any of the training and they don't care. If you're going to have surgery, start with a really good surgeon and then only have the ortho work done according to their specifications.