jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: jaw on October 28, 2016, 12:01:23 PM
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I've been speaking with Dr. Gunsons staff. After all the paperwork they said I can be seen for a consultation but the earliest day would be in May.
The only issue with this is my current treatment with braces (I have had them on for 6 months already) will potentially be off in 6 months and my overbite "fixed".
I saw a surgeon in my area and he said I could benefit from jaw surgery both functionally and aesthetically. But I really wanted to see Gunson.
Any advice? Would Gunson still take me in if I had an "ideal" bite or no real functional issues? Should I just go ahead and make the appointment?
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If you want to get jaw surgery at some point, then you should not be trying to have your orthodontist correct your overbite through orthodontic compensation. Instead, your orthodontist should attempt to position your teeth in the ideal alignment for each jaw, independent of the overall occlusion. For a class 2 case, this typically involves resolving mandibular crowding, uprighting and retracting the lower incisors, and slightly flaring the upper incisors. Since you have 6 months before your consultation, your orthodontist can likely complete all or most of this decompensation. Make sure to tell him that you are committed to jaw surgery.
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I was just listening to what my current ortho was saying in terms of treatment. I've been considering jaw surgery but before making a full commitment I wanted to see Gunson. I guess that is my issue. I need to make sure this is something I want before talking to my orthodontist again?
Ultimately according to him the only reason to do it for me would be for aesthetic reasons bc the functional again would be minimal. He didn't recommend it.
I think you've seen my pics. And you mentioned I should talk to Gunson as well and also mentioned it seems like I could benefit from jaw surgery
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I was just listening to what my current ortho was saying in terms of treatment. I've been considering jaw surgery but before making a full commitment I wanted to see Gunson. I guess that is my issue. I need to make sure this is something I want before talking to my orthodontist again?
Ultimately according to him the only reason to do it for me would be for aesthetic reasons bc the functional again would be minimal. He didn't recommend it.
I think you've seen my pics. And you mentioned I should talk to Gunson as well and also mentioned it seems like I could benefit from jaw surgery
It sounds like your orthodontist is being lazy and doesn't want to deal with a surgical case. I think you should call Gunson's office and ask if there's an orthodontist in your area who he likes to work with.
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Maybe take the braces off for 6 months while you wait. It'll be better for the health of your teeth to do that.
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I am not sure I agree with the automatic assumption that your ortho must be lazy and not want to deal with a surgical case as somebody stated above. What were your original measurements? Maybe you were borderline of being a surgery case vs. being able to be fixed with ortho. Regardless, I always encourage people to fix what they can with ortho if there is any shot of being able to do that. Use surgery as a last resort worst case scenario thing.
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I don't think he's lazy. My case was just 'easy to fix with braces' and I was admittedly too scared to ask about jaw surgery at the time and he went ahead with treatment saying 'I don't recommend jaw surgery for anything so small'
I don't remember my original overbite. I think it was 8mm and my teeth had some crowding + misalignment. I just went ahead with his recommendation thinking if anything was wrong he would've referred me to a surgeon.
But I am heavily self-conscious of my appearance and my recessed jaw. I do want surgery at least I think. I'm constantly pushing my lower jaw forward and it looks much better.
Now that I've asked about it he referred me to local surgeons but said I didn't need it from a functional standpoint.
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I don't think he's lazy. My case was just 'easy to fix with braces' and I was admittedly too scared to ask about jaw surgery at the time and he went ahead with treatment saying 'I don't recommend jaw surgery for anything so small'
I don't remember my original overbite. I think it was 8mm and my teeth had some crowding + misalignment. I just went ahead with his recommendation thinking if anything was wrong he would've referred me to a surgeon.
But I am heavily self-conscious of my appearance and my recessed jaw. I do want surgery at least I think. I'm constantly pushing my lower jaw forward and it looks much better.
Now that I've asked about it he referred me to local surgeons but said I didn't need it from a functional standpoint.
Your orthodontist is focused mostly on your bite. He's probably not considering your facial balance, airway, and posture to the extent that you'd want him to. When I look at your pictures, I see a very strong case for jaw surgery from a functional and cosmetic perspective. And since you're interested in the cosmetic improvement that only jaw surgery can provide, I see no reason to continue with orthodontic camouflage.
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Your orthodontist is focused mostly on your bite. He's probably not considering your facial balance, airway, and posture to the extent that you'd want him to. When I look at your pictures, I see a very strong case for jaw surgery from a functional and cosmetic perspective. And since you're interested in the cosmetic improvement that only jaw surgery can provide, I see no reason to continue with orthodontic camouflage.
What do I tell my orthodontist? Won't he need direction from the surgeon as to what they need him to do for my teeth?
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What do I tell my orthodontist? Won't he need direction from the surgeon as to what they need him to do for my teeth?
Just tell him that you really want to get jaw surgery for cosmetic and functional reasons. It's your face, so it's your choice.
You could consider meeting with a local surgeon to get an idea of what sort of pre-surgical orthodontic work you might need. Most surgeons will recommend a typical protocol for class 2 cases (retract lower teeth, normalize incisor inclinations, maximize dental overbite). Some will opt for lower bicuspid extractions, which I would not recommend doing until you consult with Gunson. Also, now would be a good time to get your wisdom teeth removed if you haven't already done so.
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Just tell him that you really want to get jaw surgery for cosmetic and functional reasons. It's your face, so it's your choice.
You could consider meeting with a local surgeon to get an idea of what sort of pre-surgical orthodontic work you might need. Most surgeons will recommend a typical protocol for class 2 cases (retract lower teeth, normalize incisor inclinations, maximize dental overbite). Some will opt for lower bicuspid extractions, which I would not recommend doing until you consult with Gunson. Also, now would be a good time to get your wisdom teeth removed if you haven't already done so.
Alright. Thanks so much!
I have had my wisdom teeth out; but is it possible to hold off on the extractions? My orthodontist said I should expect extractions if I went this route, I guess is it possible to wait on those like you said?
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Alright. Thanks so much!
I have had my wisdom teeth out; but is it possible to hold off on the extractions? My orthodontist said I should expect extractions if I went this route, I guess is it possible to wait on those like you said?
Gunson won't want you to get teeth extracted.
I think your orthodontist is pretty clueless. It seems he's thinking that you would get only lower jaw surgery and that he'd need to create a huge overbite with extractions. A good surgeon will perform bimax with counterclockwise rotation, which will allow him to lengthen the lower jaw without a large overbite.
Does your orthodontist do a lot of surgery cases? I've found during my various consultations that some orthodontists have virtually no experience with surgical cases and never recommend surgery to patients or accept patients who want surgery.
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What if extractions are needed to upright lower incisors AND there's a need for counterclockwise rotation? Is it never the case that they're both indicated?
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What if extractions are needed to upright lower incisors AND there's a need for counterclockwise rotation? Is it never the case that they're both indicated?
I think it depends on the surgeon. Arnett/Gunson will probably just leave the incisors slightly flared and perform more rotation. I've never seen them recommend extractions as part of a pre-surgical orthodontic plan. Surgeons who rely on linear advancements are the ones who more likely to recommend extractions.
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I see, thanks for replying. Isn't there a specific amount of rotation that's needed to flatten the occlusal plane though? I had first premolar extractions as per my first surgeon and will be going with Gunson who will perform CCW with posterior downgrafting. From what I understood he'll do a chin repositioning to bring back the chin to where it should be.
I've seen a picture of a patient who had a surgery first approach with CCW and no decompemsation and she didn't look fully corrected.
I really hope Gunson will make it work even with the extractions I've had.. I'm so stressed from thinking about this.
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I see, thanks for replying. Isn't there a specific amount of rotation that's needed to flatten the occlusal plane though? I had first premolar extractions as per my first surgeon and will be going with Gunson who will perform CCW with posterior downgrafting. From what I understood he'll do a chin repositioning to bring back the chin to where it should be.
I've seen a picture of a patient who had a surgery first approach with CCW and no decompemsation and she didn't look fully corrected.
I really hope Gunson will make it work even with the extractions I've had.. I'm so stressed from thinking about this.
I think you'll be fine. Actually, I think you might have a better result because of your extractions, since you'll have a larger mandibular advancement. I don't think you should get your chin reduced during surgery though. I rarely see class 2 cases end up with an overly prominent lower jaw or chin, and you'll also increase the risk of permanent nerve damage if you have surgery on your lower jaw and chin at the same time.
Do you have pictures of the patient you're describing? Who was the surgeon?
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Awesome, that's so great to hear.
It was an article on surgery first with a case study, probably by a Korean doctor.. I've been trying to find it. I'll post it here when I do.
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Surgeons who rely on linear advancements are the ones who more likely to recommend extractions.
What is the other way of doing jaw surgery besides linear advancements?
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I think it depends on the surgeon. Arnett/Gunson will probably just leave the incisors slightly flared and perform more rotation. I've never seen them recommend extractions as part of a pre-surgical orthodontic plan. Surgeons who rely on linear advancements are the ones who more likely to recommend extractions.
Per the ArnettGunson website, extractions are recommended when indicated. They wouldn't want the ortho to leave incisors flared. Interproximal reduction can be used in lieu of that depending on the amount of space needed.
OP - Gunson has a good rep but is hardly the only qualified and aesthetically-conscious surgeon around. Consult with a couple other good surgeons. Also, you should probably either pause the orthodontics until you make a decision or start decompensation - any camouflage work done will have to be undone. And ask your ortho if he's done surgical cases before. If not and if you decide to go that route, you might want to take a monetary loss and find one who has.
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for f**k's sake just take the braces off for 6 months like GJ said.
And get an ortho Gunson likes to work with.
And just commit to jaw surgery. It's not that big a deal so stop being a p*ssy. I had a couple weeks of bad pain and my lip is a bit numb now and sensation is slowly coming back. maybe 20 percent back now. And growing steadily.
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Hey jaw, I'm kind of in the same position as you. I'm about 7 months into orthodontic treatment to correct from what I understand is a mild class ii, crowding, and open bite case. Before putting my braces on, I was told I could choose to have 4 molars extracted (2 top and 2 bottom) any time during treatment if I feel that my teeth are going to be too forward or flared out. I have yet to do extractions, and I'm also now considering jaw surgery to fix my receded chin and jaw. Do you think the extractions helped you with your case? and what have you decided to do about continuing treatment and about surgery?
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Hey jaw, I'm kind of in the same position as you. I'm about 7 months into orthodontic treatment to correct from what I understand is a mild class ii, crowding, and open bite case. Before putting my braces on, I was told I could choose to have 4 molars extracted (2 top and 2 bottom) any time during treatment if I feel that my teeth are going to be too forward or flared out. I have yet to do extractions, and I'm also now considering jaw surgery to fix my receded chin and jaw. Do you think the extractions helped you with your case? and what have you decided to do about continuing treatment and about surgery?
I told my ortho i wanted surgery and he changed my treatment plan. He keeps suggesting extractions - but I told him not until I get word from Gunson
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I told my ortho i wanted surgery and he changed my treatment plan. He keeps suggesting extractions - but I told him not until I get word from Gunson
Oh I misread that you already had extractions. That's great, though this wait to consult with Gunson is pretty crazy. I plan on doing the same, and until then I'm gonna be saving.