jawsurgeryforums.com
General Category => General Chat => Topic started by: bluejay on July 19, 2013, 01:24:56 PM
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I know it is small sample group, but I'm curious.
When I was about 10 yrs old I had a severe overbite. The roof of my mouth was actually sore from biting it. The orthodontist wished my parents had brought me in sooner, but felt it wasn't too late act. I was given a functional twin block appliance.
from wiki: "Fixed Twin Block Appliance: The Twin Block appliance is a removable appliance, and its high comfort level allows you to wear it 24 hours a day. This appliance actually is made up of two separate appliances that work together as one. The upper plate includes an optional expansion screw to widen your upper arch, if needed, as well as pads to cover your molars. The lower plate includes pads to cover your lower bicuspids. These two appliances interlock at an angle, and they move your lower jaw forward and lock it into the ideal position when you bite together. This new position, while temporary, will eventually become the permanent corrected position."
Unfortunately, at about age 20 my jaw began to recess. It was also discovered that at some point I had active Degenerative Joint Syndrome. I eventually decided on splint therapy. My jaw recessed, and my bite opened up. My orthodontist in college informed me that he had used the appliance on 100s of patients, including his daughter. Many of these cases, particularly females, had their jaws recess between age 17-20 and required surgery.
Anyone else use this or another appliance, experience regression and/or still require surgery?
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You mention hitting the roof of the mouth - was this with the lower incisors? Do you have a deep overbite?
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I did when I was 10. I had the appliance which "fixed" the problem, then began to recess 7-10 yrs later. Splint therapy brought me back to my natural (over)bite, then my bite ended up flying open. By that I mean about 100 microns a week.
I had corrective surgery, so I no longer have an over bite. My teeth would line up perfectly, bite function normally, if my open bite hadn't relapsed.
It was 18 years ago, but yes, I believe it was with the lower incisors.
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So you had a deep (overbite), when then turned into an open bite? Interesting. It's open at the front?
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Yes, it is anterior. It was quite a shock. My jaw had settled. It hadn't moved in weeks and we were beginning to talk about moving forward with planning the surgery. Then all of the sudden my bite just began to open quite dramatically, and certainly changed the entire course of the surgery.
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Hmmm...interesting.
If you relapsed after 7-10 years I would think it was the Osteoarthritis that caused it, no?
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Well, the orthodontist I saw in MI during college said he had done about 1500 cases using the twin block. Most of those patients ended up recessing and needing surgery, particularly females. There are tons of studies assessing the best time use the twin block and follow up results a couple of years later. I have yet to see any studies of the long term effects, stability, or whether the patients still required surgery. So, did the DJD cause the start of the recession, or did the twin block cause the DJD which resulted in the recession? I also have no idea if DJD had anything to do with the recession or if it was just a side effect of all the strain my jaw was under. Bottom line, I don't think the twin block solved the problem.
My lower teeth also went crooked within a year or so after braces. I was wearing my retainer most of the time. The orthodontist offered a spring retainer followed up with a permanent one. I turned it down, partially because I thought it was my fault and I didn't want to cost my parents any more money. I asked my current dentist, Dr. Mac, if my jaw would have recessed if I had gone through with this treatment plan. He informed me that my jaw likely would not have recessed.
He went on to tell me that my jaw still would not have been in a natural position, putting a lot of strain on the muscles. He asked me, "what happens if you just keep stretching an elastic waist band?" Eventually the band would lose its elasticity. Essentially, I would have been walking down the street one day, minding my business, and my jaw would have just dropped right open. Later, I met a co-worker who had friend that had that happen. The teeth will move if the upper and lower jaw are not in proper alignment.
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I used to bite the roof of my mouth, ortho put me in headgear to prevent my maxilla from growing while my mandible "caught up". I wound up with a normal bight but a very recessed jaw.
I'm not sure about recessing further after orthodontics has completed. Did you have bicuspids extracted?
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I'm having trouble picturing a normal bite with a recessed jaw. What is recessed?
I never had any extractions, thankfully.
My lower jaw recessed because what the orthodontist attempted did not actually work. Essentially, my lower jaw was trained to posture forward. The idea was to encourage growth during puberty, but I don't know that it actually works. It certainly didn't in my case and several others.
I generally feel that the idea you can affect growth with an appliance, in any way, without some form of surgery, is incorrect. I feel it creates more problems further down the road.
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I'm having trouble picturing a normal bite with a recessed jaw. What is recessed?
I never had any extractions, thankfully.
My lower jaw recessed because what the orthodontist attempted did not actually work. Essentially, my lower jaw was trained to posture forward. The idea was to encourage growth during puberty, but I don't know that it actually works. It certainly didn't in my case and several others.
I generally feel that the idea you can affect growth with an appliance, in any way, without some form of surgery, is incorrect. I feel it creates more problems further down the road.
Sounds like bad nuwz for me >:( im getting non surgical expansion right now at 18.
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I generally feel that the idea you can affect growth with an appliance, in any way, without some form of surgery, is incorrect. I feel it creates more problems further down the road.
not a feeling, fact. confirmed by multiple studies and experiments. many orthodontists like to pretend they have same capabilities as surgeons. and the whole gimmicky appliances that obviously are never subject to rigorous testing remain unchallenged in spite of the overwhelming problems created by them.
i think someone mentioned a paper written in 1960 that explained how terrible headgear is for facial growth. yet i know orthodontists STILL use it 2013.
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not a feeling, fact. confirmed by multiple studies and experiments. many orthodontists like to pretend they have same capabilities as surgeons. and the whole gimmicky appliances that obviously are never subject to rigorous testing remain unchallenged in spite of the overwhelming problems created by them.
i think someone mentioned a paper written in 1960 that explained how terrible headgear is for facial growth. yet i know orthodontists STILL use it 2013.
Do you have any links to the studies? what problems do these appliances create?
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Do you have any links to the studies? what problems do these appliances create?
the study on headgear is on the forum somewhere. for the other appliances im not entirely sure, but considering how reckless the orthodontic community has been generally every kind of appliance that orthos say can inhibits abnormal growth or jaw deformities should be held with great suspicion.
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You can absolutely modify growth if you put enough force on it. I posted some specific links to studies a while back, it's just the abstracts. Primitive cultures even modified cranial growth by a process called head binding https://en.wikipedia.org/wiki/Artificial_cranial_deformation. There is also Chines foot binding https://en.wikipedia.org/wiki/Foot_binding. Point being, if you put enough force anywhere on the body for long periods of time, you can modify growth patterns. It just depends on how much force is used and for how much time.
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sad. really really sad. because the damage isnt seen till adulthood orthos continue to get away with these kinds of treatment plans.
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i have seen some great transformations (kids -> teenager) with braces only
(http://bowbeerortho.com/yahoo_site_admin/assets/images/soldbi.335135217_std.jpg)
(http://bowbeerortho.com/yahoo_site_admin/assets/images/rhdbi.24271750_std.jpg)
(http://bowbeerortho.com/yahoo_site_admin/assets/images/ale_l.110113221_std.jpg)
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:-\Lucky kids .... They got a good ortho
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:-\Lucky kids .... They got a good ortho
Or they were cherry picked good results, poor results get swept under the rug.
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Or they were cherry picked good results, poor results get swept under the rug.
for sure
however that guy doesn't to seem to hesitate when it comes to surgery
http://bowbeerortho.com/before__after/surgical_cases (http://bowbeerortho.com/before__after/surgical_cases)
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the problem with looking at kids is we assume there's an alternative universe where they end up looking deformed because they didn't get the right ortho, didn't get extractions, didn't get surgery at a young age when we have no idea how they would've turned out otherwise. that's where all this early surgical intervention nonsense started up
and to me all those kids look like there problem was mostly with the dentition and not the skeleton
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for sure
however that guy doesn't to seem to hesitate when it comes to surgery
http://bowbeerortho.com/before__after/surgical_cases (http://bowbeerortho.com/before__after/surgical_cases)
again, not seeing before/afters that blow away adults. I've seen plenty of adults with just as nice of results
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that's where all this early surgical intervention nonsense started up
not non-sense
ask sharptoys to send you the paper that he sent me
the problem is early surgical intervention comes in making the right diagnosis = is my son/daughter going to end up with a cute/endearing overbite or underbite that is easily fixable or is it going to be one of those cases where the entire face becomes distorted? <- I would imagine that only a few select surgeons can safely make that decision
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i have yet to see one case where a truly deformed adult becomes highly attractive, but i have seen plenty of truly night and day cases with young people. the ortho examples above seem dental exclusive as you suggested.
then again we have seen some kids who get surgery and end up meh later or require more surgeries. really depends on the individual.
the problem is early surgical intervention comes in making the right diagnosis = is my son/daughter going to end up with a cute/endearing overbite or underbite that is easily fixable or is it going to be one of those cases where the entire face becomes distorted? <- I would imagine that only a few select surgeons can safely make decision
orthos seem more comfortable in employing unsophisticated and proven to be harmful appliances in their treatment plan. i bet if more resources were poured into diagnosing growth disorders early in life rather than slapping on braces at the first sign of bite problems we would all be better off....except for orthos who would be making far less $$$$.
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yea i agree but i have yet to see one case where a truly deformed adult becomes highly attractive, but i have seen plenty of truly night and day cases with young people. the ortho examples above seem dental exclusive as you suggested.
then again we have seen some kids who get surgery and end up meh later or require more surgeries. really depends on the individual.
that's what I'm saying. those people who become highly attractive, I bet if they had waited to get surgery, they would've been one of those adults who we'd classify as having "a great starting point, but just the jaws are throwing everything off" much like this girl pekay once posted:
(http://i.imgur.com/dJ3UMBu.jpg)
In my opinion it comes down to the uncontrollable features, not at what point in your life you get surgery
not non-sense
ask sharptoys to send you the paper that he sent me
the problem is early surgical intervention comes in making the right diagnosis = is my son/daughter going to end up with a cute/endearing overbite or underbite that is easily fixable or is it going to be one of those cases where the entire face becomes distorted? <- I would imagine that only a few select surgeons can safely make that decision
I sourced the article from Wolford that describes how downwards & backwards growth continues in spite of surgical intervention, feel free to post your source because I have yet to see one that backs the growth can be redirected theory you keep proposing
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here's the abstract and article again Pekay:
"Vertical maxillary hyperplasia
Maxillary vertical hyperplasia or maxillary vertical excess is defined as excess in the vertical growth of the maxilla which may or may not result in an anterior open bite.13 This deformity can be corrected during the growth period with fairly predictable results. The vertical growth of the maxilla will continue after surgery in the same proportion as before the surgery,14 but the postoperative occlusal outcome will probably be preserved. The facial growth vector will continue downwards and backwards. Le Fort I osteotomy is not recommended as it may compromise the anteroposterior growth of the maxilla.3"
http://www.scielo.br/scielo.php?pid=S2176-94512012000100019&script=sci_arttext (http://www.scielo.br/scielo.php?pid=S2176-94512012000100019&script=sci_arttext)
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Euphoria: I actually have the link myself, check PM
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I'll go ahead and post the abstract, but first, let us be clear. I'm in no way suggesting surgery during growth isn't effective, won't work. What Ive seen time and again on here is the notion that, specifically in long face syndrome cases it seems, bones of the upper face that were grown downward and backward will suddenly stop and start growing forward like they're ideally supposed to. This is the supposed advantage, of early intervention correct?
Management of the growing patient with mandibular dentofacial deformities presents a unique and challengingproblem for orthodontists and surgeons.The surgical procedures required for correction of the deformity mayaffect postsurgical growth and dentofacial development.Further, facial growth may continue postoperativelyand negate the benefits of surgery performed, resulting in treatment outcomes that are less than ideal.Fromindividual patient characteristics, the type of deformity, and the indications for early surgical intervention, it ispossible to effectively treat many cases during growth.A thorough understanding of facial growth patterns isessential, and each case needs to be evaluated individually.Surgery is often undertaken with the expectationthat additional treatment, including more surgery, may be required after the completion of growth.The materialpresented here is based on the available research and the senior author?s clinical experience of more than 25years in the correction of mandibular deformities in the growing patient.Advantages and disadvantages ofspecific surgical techniques for correction of common mandibular deformities and pertinent age and surgicalconsiderations are discussed.The material should be viewed as a general outline that provides broadguidelines for management of these patients.The management of maxillary deformities will be discussed inPart 2 of this article.(Am J Orthod Dentofacial Orthop 2001;119:95-101)
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There is one before/after, can't find it now but I think it's Arnett/Gunson - the girl with the red hair, about 18, overbite/underdeveloped mandible She looked amazing post-surgery, huge improvement
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There is one before/after, can't find it now but I think it's Arnett/Gunson - the girl with the red hair, about 18, overbite/underdeveloped mandible She looked amazing post-surgery, huge improvement
her?
(http://www.arnettgunson.com/sites/default/files/uploads/bite-fig4.jpg)
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sorry, what do you want me to say? i don't have much stake in that early intervention theory as I was told that my upper face developed properly, I would be extremely happy if I could have surgery now with a "top guy" but unfortunately due to logistics related problems I'm forced to either settle with a guy that is doing mandibular set-backs in 30mins (wtf?) or walking away completely
witnessed two cases myself 1) mom's best friend her 17 year old daughter (class 2, gummy smile) had surgery at that elite craniofacial surgery center in Campinas and has now relapsed (she is 22-23? and her gummy smile sorta came back) 2) Class III girl over at the .br forum had surgery for her underbite when she was 19 and has relapsed completely (under-bite came back)
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@ Pekay, yes this girl. Amazing result IMO
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sorry, what do you want me to say? i don't have much stake in that early intervention theory as I was told that my upper face developed properly, I would be extremely happy if I could have surgery now with a "top guy" but unfortunately due to logistics related problems I'm forced to either settle with a guy that is doing mandibular set-backs in 30mins (wtf?) or walking away completely
witnessed two cases myself 1) mom's best friend her 17 year old daughter (class 2, gummy smile) had surgery at that elite craniofacial surgery in Campinas and has now relapsed (she is 22-23? and her gummy smile sorta came back) 2) Class III girl over at the .br forum had surgery for her underbite when she was 19 and has relapsed completely (under-bite came back)
yeah I deleted the post cause it was bound to only start another argument
underbite patients really should be waiting till almost mid-20's to get treated because their mandibular growth occurs over a much longer time than your average adult
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Some of the problem lies in the fact that the facial skeleton isn't fully set until some where between 22-25 yrs of age.
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underbite patients really should be waiting till almost mid-20's to get treated because their mandibular growth occurs over a much longer time than your average adult
not doubting you (i believe you 100%) but where did you read that? do you remember?
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not doubting you (i believe you 100%) but where did you read that? do you remember?
I've read it a couple times, but don't have a source on me at the moment
I was also told in person by a surgeon that it was applicable to the normal prognathic patient, but not me cause my problem is the maxilla. Something something about their growth spurts going well past adolescence and into their early 20's, especially in the mandible, so they relapse and have to get a redo or live with it
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I've read it a couple times, but don't have a source on me at the moment
I was also told in person by a surgeon that it was applicable to the normal prognathic patient, but not me cause my problem is the maxilla. Something something about their growth spurts going well past adolescence and into their early 20's, especially in the mandible, so they relapse and have to get a redo or live with it
ah okay, this girl had her surgery done when she was 17 but it was entirely because of psychological issues. i wonder if she is going to relapse? in my own ignorant opinion that left hand x-ray thingy is sort of bulls**t
http://jawsurgeryforums.com/index.php/topic,418.0.html (http://jawsurgeryforums.com/index.php/topic,418.0.html)
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ah okay, this girl had her surgery done when she was 17 but it was entirely because of psychological issues. i wonder if she is going to relapse? in my own ignorant opinion that left hand x-ray thingy is sort of bulls**t
http://jawsurgeryforums.com/index.php/topic,418.0.html (http://jawsurgeryforums.com/index.php/topic,418.0.html)
couldn't say but wow is that a hell of an underbite! she looks great, but I'd hate to undergo a bsso twice
here's a quick source I did from a 5 minute Google search:
"Another distinct feature of Class III development is
the tendency to display a later, longer, and larger peak of
growth than Class I controls. In a large cross-sectional
study, Reyes et al.22 demonstrated that Class III patients
had a mandibular growth peak approximately 1 year later
than Class I subjects. In males, the peak occurred at 13-14
and females at ages 11-12. Additionally, the amount of
supplementary growth during the pubertal peak was larger in
Class III subjects and lasted longer than that of Class I
subjects. "
"In a similar cross-sectional investigation, using only
Class III subjects and a cervical vertebrae maturation
21 index, Baccetti et al.25 concluded that the average duration
of the growth spurt in the Class III subject was eighteen
months. The authors stated that this duration is
approximately six months longer than that of Class I
individuals. The authors also found changes in mandibular
length (measured as Co-Gn) continued into the late
maturation stages (i.e., after the peak of growth) and were
two times greater in Class III females and three times
greater in Class III males than in Class I subjects."
"Another longitudinal investigation examined 103 Class
III subjects from ages 4 to 20 with no control group. A
series of longitudinal films of each subject varied from 2
to 20 films. Cephalometric analysis yielded results similar
to those found in previous cross-sectional studies. The
average increments of change of the antero-posterior
cephalometric measurements indicated a worsening of the
skeletal relationship with the mandible becoming more
prognathic and the maxilla remaining retrognathic in
position. Additionally, a considerable amount of mandibular
growth occurs following the adolescent growth spurt.4"
http://www.slu.edu/Documents/cade/thesis/Wolfe_Thesis.pdf (http://www.slu.edu/Documents/cade/thesis/Wolfe_Thesis.pdf)