jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: isco92 on June 12, 2014, 11:04:41 AM
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Hello.
I went too see a surgeon and a consultant in orthodontics
He/they gave me the two options they though was the best:
1. To consider orthodontic treatment in conjunction with jaw surgery. (train track braces for a year)
2. To accept the positions of the teeth and jaws as they are and to consider a
surgical operation to the chin only called a genioplasy to augment your chin and improve facial profile.
They recommended option 2, because option 1 would be complicated.
I got told I had a class 2 malocclusion. I had braces when I was 12 years old, too compensate for that.
Im thinking that jaw surgery might be needed because my jaw is set back compared to the rest, and a genioplasty wont fix that would it?
Which option do you think is the best?
all feedback is very helpful, thanks :)
(http://imagizer.imageshack.us/v2/280x200q90/843/p58mv.jpg) (https://imageshack.com/i/nfp58mvj)
(http://imagizer.imageshack.us/v2/280x200q90/822/sor8.jpg) (https://imageshack.com/i/musor8j)
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If you don't have any problems with your bite then a genioplasty or chin wing might indeed be the best option for you. It's hard to say without knowing what your bite and airway is like though.
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orthodontics description: "Your teeth bite well together overall. There is very mild crowding of your incisors. Your occlusion
is very satisfactory"
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orthodontics description: "Your teeth bite well together overall. There is very mild crowding of your incisors. Your occlusion
is very satisfactory"
From an orthodontist, that really doesn't mean s**t, IMHO
My occlusion was "satisfactory" after 4 years of braces. How is it now? Pretty crap
I think you should do a BSSO. You look young, I think it's easier to do it when you're younger
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From an orthodontist, that really doesn't mean s**t, IMHO
My occlusion was "satisfactory" after 4 years of braces. How is it now? Pretty crap
I think you should do a BSSO. You look young, I think it's easier to do it when you're younger
The occulusion doesnt concern me. And if it gets crap I can always fix it in later stages anyway. As this is the case do you still think BSSO
still is the way to go for me?
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IMO, BSSO is the way to go. Get MULTIPLE opinions. Orthos AND surgeons.
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IMO, BSSO is the way to go. Get MULTIPLE opinions. Orthos AND surgeons.
What if I do a genioplasty first, and see what happens if its not the result I wanted, I can possibly go with a BSSO?
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Your lower jaw looks severely recessed. With a genio you would probably end up with ridiculous long chin and a deep sublabial fold.
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Your lower jaw looks severely recessed. With a genio you would probably end up with ridiculous long chin and a deep sublabial fold.
I agree
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What if I do a genioplasty first, and see what happens if its not the result I wanted, I can possibly go with a BSSO?
It's usually BSSO first, and a little genio later if needed. Structural problems should be fixed, not camouflaged.
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A genio is definitely not the way forward for you. The lower jaw is recessed but the chin is not....a genio is going to look ridiculous
Actually, your lower jaw looks like mine does, post implant (I have a chin implant). And I've been propose at least 8mm of advancement, and I'm female with a small face. So for you it think it would be more like 10mm if your bite allows it which is the upper limit of what you can advance the jaw with a BSSO
The occlusion may not concern you now but believe me, it will start to concern you when you get to your late 20s and get gum recession because your lower teeth have been pushed so far forward to mask the overbite, and you have no upper lip because your upper teeth have been pulled in.
Orthos do not want to admit that they can't "fix" every bite.
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IMO orthos are less likely to deny reality with an underbite. All 4 orthos I saw said surgery immediately.
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IMO orthos are less likely to deny reality with an underbite. All 4 orthos I saw said surgery immediately.
Yeah, this is definitely true. Wonder why? Because underbites are less common?
I saw 4 orthos and 2 dentists. 3 orthos and both dentists said surgery. The 4th ortho was stupid and proposed extrusion, which isn't stable in an adult patient
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Yeah, this is definitely true. Wonder why? Because underbites are less common?
I saw 4 orthos and 2 dentists. 3 orthos and both dentists said surgery. The 4th ortho was stupid and proposed extrusion, which isn't stable in an adult patient
Because class iii looks deformed and is impossible to mask. Class ii - jut the lower jaw forward. (Though I still can't believe what they did to that young Swedish guy. Extracted 4 lower teeth to make the lower arch fit under the upper. And his nose was pointing down. His midface was clearly flat. He was a nice guy, but looked angry/mean because of that. His ortho should have had his f**king arms extracted.)
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A genio is definitely not the way forward for you. The lower jaw is recessed but the chin is not....a genio is going to look ridiculous
Actually, your lower jaw looks like mine does, post implant (I have a chin implant). And I've been propose at least 8mm of advancement, and I'm female with a small face. So for you it think it would be more like 10mm if your bite allows it which is the upper limit of what you can advance the jaw with a BSSO
The occlusion may not concern you now but believe me, it will start to concern you when you get to your late 20s and get gum recession because your lower teeth have been pushed so far forward to mask the overbite, and you have no upper lip because your upper teeth have been pulled in.
Orthos do not want to admit that they can't "fix" every bite.
You know what I don't get? In every medical field, a doctor has to get consent from a patient for any procedure explaining the indication, the benefits, risks, and alternatives to treatment. I don't remember the ortho ever saying that I may have issues with early gum recession if we procline my lower incisors. Which is exactly what has happened. The only silver lining is that he didn't pull in my upper teeth :-[
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A genio is definitely not the way forward for you. The lower jaw is recessed but the chin is not....a genio is going to look ridiculous
Actually, your lower jaw looks like mine does, post implant (I have a chin implant). And I've been propose at least 8mm of advancement, and I'm female with a small face. So for you it think it would be more like 10mm if your bite allows it which is the upper limit of what you can advance the jaw with a BSSO
The occlusion may not concern you now but believe me, it will start to concern you when you get to your late 20s and get gum recession because your lower teeth have been pushed so far forward to mask the overbite, and you have no upper lip because your upper teeth have been pulled in.
Orthos do not want to admit that they can't "fix" every bite.
strange the surgeon and the orthodontic didnt make a point
about a genio would look ridiculous. Your point
makes perfectly sense, thanks.
so are you saying my occlusion will be better in my
late 20s if I do BSSO?
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BSSO is a tough surgery. But genio is not trivial either. Genio can also disturb the nerve and give you a numb chin, lip. But you are young, so you shouldn't have problems recovering. Fix things fundamentally. BSSO.
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strange the surgeon and the orthodontic didnt make a point
about a genio would look ridiculous. Your point
makes perfectly sense, thanks.
so are you saying my occlusion will be better in my
late 20s if I do BSSO?
It's not so much occlusion that you worry about. It's the fact that if you torque your teeth like crazy to make top and bottom come together, you can run into issues. My lower front teeth were made to tilt 45 degrees forward to meet my upper teeth. I am 30 and starting to see gingival recession. Nobody wants early gum disease. My bite is perfect, but due to pushing orthdontic correction to the extreme. If you move the entire lower jaw forward, your lower teeth won't need to be proclined to meet the upper.
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It's the fact that if you torque your teeth like crazy to make top and bottom come together, you can run into issues. My lower front teeth were made to tilt 45 degrees forward to meet my upper teeth. I am 30 and starting to see gingival recession.
I've got the same issue. Top teeth pulled in so much I've no support for the upper lip. Bottom teeth pushed out so much that they're right at the front of the bone/gum and I've got gum recession. And I still have an overjet and deep bite. My profile is extremely similar to yours (look on my thread in 'overbites')
FYI, I would say on this board that we are quite conservative as a group about telling people to go for surgery
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I am convinced. I was thinking about getting multiple opinions from surgeons and everything, but it seems
very clear too me, that it is only one option here and that is getting a BSSO and push my jaw forward.
As far as I understand It will not only fix my structural problems, and improve my facial profile. But it will also avoid me getting problems with my bite in my 30s, because ortho`s dont want too admit they cant fix my severe recessed jaw with orthodontic treatment. It all makes sense imo.
I booked an appointment on friday with an orthodontic too undo the treatment I did when I was a child. Thank you everyone this is priceless
information. I am feeling secure and confident that this is the way too go, even if its a long road.
This has been bothering me for a couple of years. At this point Ill do whatever it takes :)
here is a more fuller description of the previous treatment I did when I was 12 yrs old:
"On examination you have what is called as a class 2 malocclusion which describes the
lower jaw set backwards a little compared with the upper jaw. The orthodontic treatment
carried out for you has compensated for this jaw arrangement by moving the teeth with
fixed orthodontic appliances. The lower teeth have been moved forward and the upper
teeth moved back a little so that they meet together. Extraction of upper premolars has
been carried out to create space to achieve these movements. Bonded retainers are
in position behind your upper and lower front teeth to retain the teeth in their current
position."
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Extractions... Oh boy.
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Typical orthodontic treatment for bad overbite due to skeletal issues
They should have left the premolars, put you in braces at 17, and then you could had the surgery at 18 between school and college.
Most of us here had to undo the orthodontic work we had done as teens. I had four full size molars removed. My dentist always complained about how small my mouth was
Will be interested to see your Xray when you get it
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I should have, but I did not, surgery wasn`t in my head at the time, Im 22 now.
So how does this complicate things? and what's the difference?
X-rays from last week
(http://imagizer.imageshack.us/v2/280x200q90/840/uajw.jpg) (https://imageshack.com/i/ncuajwj)
(http://imagizer.imageshack.us/v2/280x200q90/840/tmlm.jpg) (https://imageshack.com/i/nctmlmj)
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I should have, but I did not, surgery wasn`t in my head at the time, Im 22 now.
So how does this complicate things? and what's the difference?
It means that it's not so easy to do the surgery now, because you don't have nearly so much overjet as you had before Now you've had the teeth removed, it is more difficult to create the space required to move the jaw forward enough to balance the profile - your natural skeletal overjet has been removed.
Typically that seems to translate surgically into doing upper (le fort) with CCW to get more space, and/or shaving between the lower teeth a little to allow them to be pulled back. However, your occlusional plane is not actually that steep so I don't know, how much CCW can be done.
In your case, I'd actually consider reopening the extraction spaces and getting implants. You need quite a lot of advancement but because your chin bone already is protruding, you can't use a genio to get any of it - it needs to come from the BSSO. If you re-created the skeletal overjet that you started with, you wouldn't even need to do a le fort - just a big advancement (~10+mm) via BSSO
The only other option is to remove the premolars on the lower arch and recreate the overjet that way. IMO it's much better to add teeth than to remove them. Supports the face
Go find and shoot your childhood orthodontist. Surgery at 18 could have saved you from extractions and years of braces. It sucks. It's the same for a lot of us here - skeletal issue that was "fixed" by orthodontics as a teen, at a time when we didn't know about this surgery >:( >:( >:(
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Typically that seems to translate surgically into doing upper (le fort) with CCW to get more space, and/or shaving between the lower teeth a little to allow them to be pulled back. However, your occlusional plane is not actually that steep so I don't know, how much CCW can be done.
In your case, I'd actually consider reopening the extraction spaces and getting implants. You need quite a lot of advancement but because your chin bone already is protruding, you can't use a genio to get any of it - it needs to come from the BSSO. If you re-created the skeletal overjet that you started with, you wouldn't even need to do a le fort - just a big advancement (~10+mm) via BSSO
The only other option is to remove the premolars on the lower arch and recreate the overjet that way. IMO it's much better to add teeth than to remove them. Supports the face
Do you mean getting teeth implants?
I`ll do whatever it takes too re-create the overjet, you mean this is fully possible? Several years with braces sounds very rough though.
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Just remember time flies whether you're having fun or not. And the older you are the quicker it goes. Take comfort in the fact that some of us are doing this in their late 30s. Good luck.
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what timeframe do you think option 2&3 is?
Minimum 12 months of braces, maybe a little more. If you want to speed it up you can get wilkodontics. It's not cheap but it works
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Hi everyone
updates on this situation
I went to see the orthodontics last week. Apperently I got a TMJ disfunction. And might have too wear
a splint to learn too eat and chew properly. Now I use the muscles in the lower jaw to chew.
got shown this link:
https://www.youtube.com/watch?v=IRI_eKiJ2So#t=127
They would not recommend me remove the lower busquids and pull the arch back.
which leaves me with reopening the extraction spaces. This will take about 2 years.
got a letter today which showed me the costs and what method and such, Ill post it under:
(http://imagizer.imageshack.us/v2/280x200q90/902/98ad71.jpg) (http://imageshack.us/photo/my-images/902/98ad71.jpg/)
the tumbnail is not working properly press the link under for full frame
https://imageshack.com/i/p298ad71j
convert this to US the pricetag will be around $20,000. Sounds quite expensive.
Any inputs on method? are these damon braces very noticeble? Id prefer invincible onces obviously
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one more thing.
My orthodontist say that because they extracted my upper premolars
the lower jaw didnt have enough space to grow/slide out out. Now when they re-open the spaces he said the jaw may slide out but he wasn't sure about that because its been such a long time (10 years)
Any inputs on this matter? maybe I dont need surgery 8)
found this on a google search this guy seems too have gotten good results
http://claimingpower.com/reverse-extraction-orthodontics-is-it-possible-for-adults-progress-report/
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Take this with like a truck full of salt; I looked into reopening my extraction spaces and still can't decide what to do.
It may indeed be the best thing ever for a lot of people both from an aesthetic perspective AND a functional perspective, but it is also potentially ripe with problems. I'm under the impression that moving teeth that much, to reopen the extraction spaces, is tremendously hard on both our teeth and gums (root resorption, gum recession, etc.). Another thing to consider is the life of the implants. They essentially come in two separate parts: the root (implant), and the crown (visible part of the tooth). For the implant (root) two materials are available: titanium (common), and ceramic (newer and less common). (If I go this route, I will pick ceramic. I personally believe it to be superior, but that's certainly debatable.) So you'll have two separate parts to maintain for the rest of your life! Most people seem to do really well with implants, but keep in mind they can fail at any time (become loose, fall out, etc.), and they don't last forever, either. I was told between 8 and 25 years is the life of an implant if everything goes perfectly. Also, crowns don't last forever (I was told 8 years is standard). Another thing to keep in mind, and someone at the office should have told you this, is that you can go through this entire process and still end up needing surgery. I looked into working with Dr. Hang, and the one thing I really appreciated about him is that he acknowledged right off the bat that many of his patients still end up needing surgery to create an optimal result. I didn't read the entire thread; I'm not sure of your specific circumstances, so I don't know if that applies to you.
I think if all goes right this could be the most amazing treatment ever, but I just personally see the potential for SOOOO much to go wrong. It's a tough call.
The $20,000 you were quoted sounds a little high, but maybe that includes the splints to stabilize your joints, too. If it includes that splints/appliances/whatever that price is probably about right.
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I forgot something. Just to be clear, that price would only include the reopening of extraction spaces, braces, and potentially the splint(s) to stabilize your joints. I'm sure you know this, but that would NOT include the price of the implants or crowns.
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Another thing to keep in mind, and someone at the office should have told you this, is that you can go through this entire process and still end up needing surgery.
The $20,000 you were quoted sounds a little high, but maybe that includes the splints to stabilize your joints, too. If it includes that splints/appliances/whatever that price is probably about right.
I have to go through this process of re-open spaces in order to create enough space to do the surgery, I am prepared for that. The implans is going to recreate the initially overjet I had. Thats the whole point.
The pricetag includes crown and everything, except surgery. As for doing this
f you really really want it. And trust the orthodontics is doing a good job. I think its an easy choice. I can only speak for myself though I am sure that this will improve my life quality with atleast 30%
Why are you considering this? and how did you get the impression that so many things can go wrong?
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Alright, got it. Sorry, I misunderstood a few things.
Yes, I'm still considering this. Having my bicuspids pulled (4) made my once nonexistent jaw joints problems not so good. My thought was to try and undo that process. I got the impression that things can go really wrong because that's just how stuff like this works. I don't mean that in a bad way or in a negative way; it's just the reality of stuff like this. Hell, it's the reality of medical treatment in general. I don't think it means don't do it, I would just expect some degree of issue. You just hope that the benefit is bigger than the cost (cost/benefit, risk/reward).
It's a fact that moving teeth that much (to reopen extraction spaces or whatever) is really hard on both your teeth and gums. It's a fact that braces alone are hard on the teeth and gums of adults. It's also true that implants and crowns don't last forever, and that implants can fail. Also, sometimes implants need bone grafting done, too.
Again, I don't mean this in a bad way. Like I mentioned, this is something I'm still considering as I really believe it makes a ton of sense for the right patient. I'm just a realist, and fully expect s**t to happen, and prefer to see that s**t coming before it gets to me and I'm left surprised. That's all.
Cheers! Best of luck with whatever you choose!
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one more thing.
My orthodontist say that because they extracted my upper premolars
the lower jaw didnt have enough space to grow/slide out out. Now when they re-open the spaces he said the jaw may slide out but he wasn't sure about that because its been such a long time (10 years)
I'm curious about this. My case is a little different from yours but I'm wondering if the same thing happened (extractions + headgear) prevented my mandible from growing out as much. I can jut out my lower jaw a lot but I cannot pull it backwards much at all from where I normally bite down. Can you pull your lower jaw back further from where it normally seats in your bite?
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wow I am in the same situation but you already said yes to the surgery.. and I am still thinking so much about it... My situation is very similar to yours, only that I have an extra large awful chin implant.. that balances my face out but look so awful when I smile. (check my post)
by the way, the oral surgeons I have consulted told me that it was hard in case to recreate the space for the premolar s and use implants.. how are you doing with that???
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wow I am in the same situation but you already said yes to the surgery.. and I am still thinking so much about it... My situation is very similar to yours, only that I have an extra large awful chin implant.. that balances my face out but look so awful when I smile. (check my post)
by the way, the oral surgeons I have consulted told me that it was hard in case to recreate the space for the premolar s and use implants.. how are you doing with that???
welcome to the club, this sucks. luckily we are in 2014 and can fix it
What do you mean he said its hard go recreate the space?
If you undo previous ortho treatment and get the teeth the same position they were w/implants
the overjet will automaticly come back no? There should be enough space to do a bsso then
Im gonna get more opinions before
I go through with it, just too be sure.