jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: ODog on May 11, 2019, 10:34:14 AM
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Hey guys,
My upper jaw surgery was to bring the jaw forward, down, and widen it to fit over my lower arch, so I had a 3 piece lefort done. In terms of my progress, I just got a new top wire put in to begin the segmental step down of the front 4 teeth to close the remaining anterior open bite.
My current, preop, and 6 months preop smile: https://imgur.com/a/xIhKQCN (https://imgur.com/a/xIhKQCN)
Just to give background on why my 6 months preop bite is worse than my preop: It was how my ORIGINAL surgeon wanted my bite Decompensated (maximally exposing the open bite, and I guess it looks like the cross bite is worse than my preop?) When I chose another surgeon, he wanted me in braces and started working with my orthodontist so I switched to that from Invisalign and as time went on I noticed my open bite closing which confused me. I thought the goal was to maximally decompensate to maximize the movements? When I asked my Ortho about this he just said “It won’t affect the surgery or anything.”
So anyway, my question is, does it look like my upper jaw could be have been made a bit wider?
I guess this is surely a “good enough” result, so I guess I’m wondering if IDEALLY my surgeon could have expanded the upper jaw some more so as to not rely so heavily on post-surgery orthodontics to align the bite.
When I look at other before-afters the upper teeth seem to noticeably vertically and transversely overlap the lower teeth, which is what I was expecting with my bite.
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yeah definitely, your upper jaw needs to be wider. what does your ortho say? you should sue.
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I think my ortho knows it. He just doesn’t want to say it directly. So when I said “is this the maximum the arch could have been expanded, he said “Well make your smile wider with braces.”
When we were discussing my open bite, I asked him if the upper jaw was good, and he said “I think he did a really good job with your profile.” Which is his way of insinuating something with my upper jaw was not done right.
Do you really think suing is really an option? Tbh my crossbite was actually THE most solid indication for the surgery, that along with making my upper jaw longer. I feel like both of those were not focused on as much as improving my profile.
EDIT: I’m starting to think my upper jaw wasn’t expanded at ALL and only looks wider because it was brought forward.
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Not only does it look like a crossbite, but it also looks edge to edge. There's a good chance you're going to grind down or crack your front teeth now due to that positioning. You're life will be ruined with that bite, and you're likely looking at a lot of $ in dental restoration as the teeth break down from it. It looks like classic traumatic bite. I agree cases like this are sue-worthy. You should not be responsible for the decreased quality of life and dental fees you'll incur.
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Not only does it look like a crossbite, but it also looks edge to edge. There's a good chance you're going to grind down or crack your front teeth now due to that positioning. You're life will be ruined with that bite, and you're likely looking at a lot of $ in dental restoration as the teeth break down from it. It looks like classic traumatic bite. I agree cases like this are sue-worthy. You should not be responsible for the decreased quality of life and dental fees you'll incur.
I had many injuries cracking my front teeth as a child biting into things. I also grind my teeth A LOT. . So this is extremely concerning to read given all I went though with this operation. I thought the crossbite was the number 1 concern about my jaws and that it was an obvious thing to fix. In fact the only functional concerns that I had regarding speech and grinding were probably exclusively due to the narrow upper jaw, and this was not fixed.
GJ, are you saying braces cannot fix the edge to edge bite? I don’t really have money for a lawyer but I guess my next step is to consult another surgeon and get confirmation that my crossbite wasn’t fixed. If that’s the case I’ll meet with a lawyer and see what my options are.
Should I carry on with the orthodontics or put things on hold?
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You should get an opinion from another ortho and you should sue. Your case was not handled according to what the goal should have been. You definitely have a case I would say.
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You need a revision. I very much doubt that braces can fix this. An edge to edge bite is the worst possible bite.
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You should get an opinion from another ortho and you should sue. Your case was not handled according to what the goal should have been. You definitely have a case I would say.
Thanks Lazlo. I am going to look into this asap.
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I had many injuries cracking my front teeth as a child biting into things. I also grind my teeth A LOT. . So this is extremely concerning to read given all I went though with this operation. I thought the crossbite was the number 1 concern about my jaws and that it was an obvious thing to fix. In fact the only functional concerns that I had regarding speech and grinding were probably exclusively due to the narrow upper jaw, and this was not fixed.
GJ, are you saying braces cannot fix the edge to edge bite? I don’t really have money for a lawyer but I guess my next step is to consult another surgeon and get confirmation that my crossbite wasn’t fixed. If that’s the case I’ll meet with a lawyer and see what my options are.
Should I carry on with the orthodontics or put things on hold?
You don't need money to sue in malpractice cases. If the lawyer thinks you have a case, they take it, and then they take a % of your winnings in court.
Again, who is to blame for your quality of life decreasing and the dental bills you're likely to incur from that bite?
A solid bite is the #1 goal of surgery. You'd have to have another doctor explain why that didn't happen here and why your surgery falls outside the standard of care. That's the hard part. But I'd get your records, see what went wrong, then call around. That's what I would do. It's your life and your decision. I'm very concerned about that bite. To me, that falls outside the standard of care. If your surgeon is willing to do revision for free, that's a possibility instead of a lawsuit.
Who was your surgeon?
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You don't need money to sue in malpractice cases. If the lawyer thinks you have a case, they take it, and then they take a % of your winnings in court.
Again, who is to blame for your quality of life decreasing and the dental bills you're likely to incur from that bite?
A solid bite is the #1 goal of surgery. You'd have to have another doctor explain why that didn't happen here and why your surgery falls outside the standard of care. That's the hard part. But I'd get your records, see what went wrong, then call around. That's what I would do. It's your life and your decision. I'm very concerned about that bite. To me, that falls outside the standard of care. If your surgeon is willing to do revision for free, that's a possibility instead of a lawsuit.
Who was your surgeon?
Ok thanks for explaining. I’ve emailed my Ortho and waiting on his response. I will look to consult other doctors this week and get my surgical movements faxed to me. I am concerned about the bite too, believe me, that’s why I made the thread. This is not acceptable to me.
I PM’d you the name of my surgeon. I feel uncomfortable with the idea of getting a revision with him at this point.
How long should I wait before seriously consider the idea of going under the knife again? Should this happen ASAP? Will my lower jaw have to be repositioned? Because I already have major lower lip numbness from the bsso.
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You need a revision. I very much doubt that braces can fix this. An edge to edge bite is the worst possible bite.
Thanks Plosko. Why is it the “worst bite” to have?
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Thanks Plosko. Why is it the “worst bite” to have?
Don't you feel it?
Your teeth are very likely to crack with that bite.
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Don't you feel it?
Your teeth are very likely to crack with that bite.
Teeth are probably still numb.
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Surgeons typically have a get-out clause of relapse. "It was all great when we finished surgery, but the patient relapsed, and we have no control over that."
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Surgeons typically have a get-out clause of relapse. "It was all great when we finished surgery, but the patient relapsed, and we have no control over that."
I did take X-rays 2 weeks after surgery. But I’m not sure if that shows anything. I think I took in office photos at 3 or 4 weeks but again I couldn’t open my mouth wide so I doubt it could serve as visual proof.
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Surgeons typically have a get-out clause of relapse. "It was all great when we finished surgery, but the patient relapsed, and we have no control over that."
Well I saw him this past Friday and he didn’t mention anything about relapse or any problem with the bite. I don’t think it’s reasonable to use relapse as a defence at this point unless he can prove it.
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Be vocal and voice your concerns (politely of course) with your surgeon. He might be the type that wants to sweep under the rug any post op problems and just ignore those patients. Bring notes to your next appointment so you don't forget to bring up all your concerns.
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Be vocal and voice your concerns (politely of course) with your surgeon. He might be the type that wants to sweep under the rug any post op problems and just ignore those patients. Bring notes to your next appointment so you don't forget to bring up all your concerns.
He’ll just say that orthodontics will fix it.
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Record your appointments on your phone. It has little legal value, but it helps to keep the surgeon honest.
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Record your appointments on your phone. It has little legal value, but it helps to keep the surgeon honest.
I’ll do that. Thanks.
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He’ll just say that orthodontics will fix it.
Dental widening isn't stable in adults, though.
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Record your appointments on your phone. It has little legal value, but it helps to keep the surgeon honest.
That's illegal some places unless you get consent.
Check your local laws first.
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I honestly can’t believe I need to go through another surgery omg. I really shouldn’t have to pay a dime for this.
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Did you check your bite straight after surgery and what it looked like shortly after waking up? The goal with the surgery should be to leave the operating room with no cross bite and perfect occlusion. Perfect is an utopia, but that's the anticipation. Not to leave malclusion to be fixed with orthodontics. That's kind of why you go to a surgeon.
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Did you check your bite straight after surgery and what it looked like shortly after waking up? The goal with the surgery should be to leave the operating room with no cross bite and perfect occlusion. Perfect is an utopia, but that's the anticipation. Not to leave malclusion to be fixed with orthodontics. That's kind of why you go to a surgeon.
Nah I couldn’t see my bite until my splint came off 2 weeks after. It didn’t relapse it looks the same as it did week 2.
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Did you check your bite straight after surgery and what it looked like shortly after waking up? The goal with the surgery should be to leave the operating room with no cross bite and perfect occlusion. Perfect is an utopia, but that's the anticipation. Not to leave malclusion to be fixed with orthodontics. That's kind of why you go to a surgeon.
This is not really about perfect occlusion this is about failing to provide good enough occlusion given the circumstances. At the very least one would expect the upper jawbone to be wider than the lower after surgery, even if the overlap isn’t perfect. I am still in crossbite, it’s a head scratcher.
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I guess the positive side is the revision would be very straightforward and the recovery won’t be as intense as tri-max??
I am seriously considering litigation, especially if I don’t get a free revision.
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This is not really about perfect occlusion this is about failing to provide good enough occlusion given the circumstances. At the very least one would expect the upper jawbone to be wider than the lower after surgery, even if the overlap isn’t perfect. I am still in crossbite, it’s a head scratcher.
I agree, I was just trying to figure out what had gone wrong. I don't understand why a surgeon would act like this and not be honest about the problem. This is the reason why people freak out about jaw surgery. In a case like yours when everyone in here agree it's a cross bite, why would a surgeon say something else. The worst part is not the outcome, but the fight and struggle if everyone act like it doesn't exist. I've been in this situation many times and it's ridicilous sitting in front of an orthodontist, pointing at something obvious and don't get anything more from the conversation than you would've got from discussing it with your dog. I agree with you, the revision should be no problem. Just agree on the problem and a plan.
I honestly don't understand why some people work in this field, don't they want to do good?
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I honestly don't understand why some people work in this field, don't they want to do good?
They want a nice house.
Why do you think revision should be easy, though?
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Why do you think revision should be easy, though?
Maybe I use easy in the wrong word. I think every surgery should be easy, in a context that it's mostly about defining and agreeing that you see the same problem, and then have a good discussion about what can be done and achieved. Surgeons aren't magicians, they're mechanics that can advice what is possible and then execute it. Very straight forward and easy. Problem is that surgeons and orthodontist often want to portray them self as magicians and that they perform stuff that can't be explained. Thus leaving someone with a crossbite without explaining why and denying it.
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They want a nice house.
It's very sad that the medical field attract such people. I don't deny skillfull people making money on what they're good at, but not on the expense of patients health.
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They want a nice house.
Why do you think revision should be easy, though?
I had a a lot of problems on both jaws that were worked on in the first surgery, including completely recontouring my chin. Aesthetic problems were fixed including tooth show, posterior gum show, asymmetry, lower jaw projection, chin contour/ projection, maxilla was advanced just enough to not cause any monkey lip, etc. So there was a lot that went into the first surgery.
This revision wouldn’t entail aesthetic concerns which can be subjective and hard to get right; it’s a pretty straightforward, mechanical maxilla expansion and that’s all I need, so he can focus all his energy on getting this right.
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Maybe I use easy in the wrong word. I think every surgery should be easy, in a context that it's mostly about defining and agreeing that you see the same problem, and then have a good discussion about what can be done and achieved. Surgeons aren't magicians, they're mechanics that can advice what is possible and then execute it. Very straight forward and easy. Problem is that surgeons and orthodontist often want to portray them self as magicians and that they perform stuff that can't be explained. Thus leaving someone with a crossbite without explaining why and denying it.
Very good analysis.
They also diagnose every little minor thing about your bite or jaws during the initial consult, noting a mm cant or slight midline deviation in your file, to get you in braces or convince you of the need for surgery or whatever, and then afterward when the treatment is done they become far less scrutinizing simply because they don’t want to an unhappy patient on their hands, which is highly offensive that they would skew the truth after they’ve already been paid. It’s unacceptable and I’m not just going to put up with it.
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So I fully expect him to offer a revision. In fact it shouldn’t matter to him because the government is going to pay for it anyway. If anything the hesitancy about revising should come from me, not him.
What is the actual status? The thread started with asking if there is a problem, and have turned into flaming the surgeon. Have he denied you a revision and have you had a specific discussion about this? I'm fully on your side that it's bulls**t that you as a patient even have to raise such question and that they should see it and tell you. But I don't think we shall hang and sue him before he at least have been given a chance to respond to your concern.
If the surgery is paid by the government and it's done under national health care, I think he could face rather serious consequences if he doesn't do right. You're monitored in an other way than in a private practise.
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What is the actual status? The thread started with asking if there is a problem, and have turned into flaming the surgeon. Have he denied you a revision and have you had a specific discussion about this? I'm fully on your side that it's bulls**t that you as a patient even have to raise such question and that they should see it and tell you. But I don't think we shall hang and sue him before he at least have been given a chance to respond to your concern.
If the surgery is paid by the government and it's done under national health care, I think he could face rather serious consequences if he doesn't do right. You're monitored in an other way than in a private practise.
No I haven’t talked to him about it, I see him next week. To be fair though Dogmatix, I shouldn’t even need a revision. We’re talking about chances of nerve damage being increased. I’m sure you would feel the same way after your surgery if your bite is not class 1.
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No I haven’t talked to him about it, I see him next week. To be fair though Dogmatix, I shouldn’t even need a revision. We’re talking about chances of nerve damage being increased. I’m sure you would feel the same way after your surgery if your bite is not class 1.
Fully understandable, it's enough stress and risk to go through surgery once.
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Fully understandable, it's enough stress and risk to go through surgery once.
Yeah you’ll understand when you go through the recovery. You’re right though I’m jumping the gun by venting over whether my revision will be free or not when I haven’t even spoken to him about it. I guess I’m just frustrated I even have to consider this.
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They also diagnose every little minor thing about your bite or jaws during the initial consult, noting a mm cant or slight midline deviation in your file, to get you in braces or convince you of the need for surgery or whatever
So true, like all handymen. Have you ever had a plumber or painter who didn't start their work by giving critic on the current installation? I'm now in braces with my orthodontist for free. He was so keen about telling me about how big deviation I had and it made me feel safe, because if he saw all of this he would surely fix it. He recommended invisalign even though I questioned if some plastic trays really had the capability of fixing this. Guess what, they couldn't and he even did things we hadn't agreed on. So here we are after many discussions.
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Yeah you’ll understand when you go through the recovery. You’re right though I’m jumping the gun by venting over whether my revision will be free or not when I haven’t even spoken to him about it. I guess I’m just frustrated I even have to consider this.
That's all I'm saying. If you're gonna shot him before trying to speak to him you might as well not visit him at all. The situation is what it is and best scenario from here is that you agree on the problem and figure out a solution.
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So I just read a post by someone who hasn’t posted here in a while who had the same issue with my surgeon where his crossbite wasn’t fixed. He said the surgeon wanted to handle it orthodontically, which led to relapse, and then he was left with all the same problems except with about 50 % improvement. He then went to another surgeon for revision who offered SARPE with 1 cm of upper jaw widening. He never made it clear whether a segmental lefort was TRIED in the first surgery to correct the crossbite or if it was disregarded entirely. In my case there was widening of the jaw, just not enough to fix the crossbite.
So I’m starting to think my surgeon just may not feel very comfortable performing this type of procedure.
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Just want to give an update.
I met with my surgeon today, and he told me there is no cross-bite, and that my teeth are not edge to edge. He did say my teeth are anatomically flat and that may be why my upper teeth don’t overlap the lower. (I don’t understand this).
In terms of the vertical height of my upper jaw, some may have commented that my gum show has been reduced from the surgery, but he says my upper lip is still healing and distorting the tooth show. He says when my upper lip is functional again the lip line will be just above the tooth-gum line when smiling, so any additional downgrafting would give a gummy smile.
I’m satisfied with his answer regarding the vertical height, but I’m still not sure about the transverse width. I did ask him if revision is a possibility, and he didn’t say no, he basically said well anything is possible but implied there would be no reason for it. He did firmly say there is no transverse deficiency and to trust him.
So I’ll have to take his word for now. I am consulting with another surgeon in a couple months to get a second opinion. He said I’d have to wait a year anyway for the nerves and everything to heal if I wanted a revision, so I’ll see how the orthodontics shifts things into place and reassess in due time.
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Just want to give an update.
I met with my surgeon today, and he told me there is no cross-bite, and that my teeth are not edge to edge. He did say my teeth are anatomically flat and that may be why my upper teeth don’t overlap the lower. (I don’t understand this).
In terms of the vertical height of my upper jaw, some may have commented that my gum show has been reduced from the surgery, but he says my upper lip is still healing and distorting the tooth show. He says when my upper lip is functional again the lip line will be just above the tooth-gum line when smiling, so any additional downgrafting would give a gummy smile.
I’m satisfied with his answer regarding the vertical height, but I’m still not sure about the transverse width. I did ask him if revision is a possibility, and he didn’t say no, he basically said well anything is possible but implied there would be no reason for it. He did firmly say there is no transverse deficiency and to trust him.
So I’ll have to take his word for now. I am consulting with another surgeon in a couple months to get a second opinion. He said I’d have to wait a year anyway for the nerves and everything to heal if I wanted a revision, so I’ll see how the orthodontics shifts things into place and reassess in due time.
You can always get an opinion from another orthodontist as well. They are typically more accessible than a high-tier surgeon and quite literally specialize in occlusion.
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That's not what the photos you posted showed.
We'd need to see more photos, the best detail possible, and at various angles.
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"Wait 12 months" - is a standard stalling tactic. 12 months is when his obligation to you runs out. (What a coincidence!) People have revisions within months after surgery.
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Guys I’ll upload photos of my bite taken at my ortho today.
How can I push for a revision when he doesn’t even think there’s a cross bite?
If I get confirmation that it’s still a crossbite and another surgery is needed, I am going to ask him to pay for it (advice from a lawyer I spoke to). This would actually be in be best interests of both parties. $5000 is a drop in the bucket to him, I don’t imagine he’d fight me on it. I just need to tell him that I’ve consulted other orthos and surgeons and they agree with me and that I’d like to pursue my revision elsewhere with a refund of the portion I paid since my bite was simply not fixed (still presumably at this point).
When’s the best time to get a revision, should I get it ASAP or wait?
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"Wait 12 months" - is a standard stalling tactic. 12 months is when his obligation to you runs out. (What a coincidence!) People have revisions within months after surgery.
Correct. A lot of times they just tell you it's okay to make sure the statute of limitations passes. It's possible it is okay, but the photos didn't show that. I'd go get second opinions from people completely unrelated to this guy. Maybe different city, etc. Don't tell them who did the surgery. Just say you're concerned and want an objective opinion.
Agree 5k is nothing for him, but by issuing a refund he might under law be admitting culpability. And he might not want that on his record or reputation. For that reason he might fight it.
If you get a bunch of opinions, they all say something is wrong, etc, get that in writing and show him. See what he says and then go from there.
This isn't legal advice, etc etc -- just my opinion and what I'd do.
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Guys I’ll upload photos of my bite taken at my ortho today.
How can I push for a revision when he doesn’t even think there’s a cross bite?
If I get confirmation that it’s still a crossbite and another surgery is needed, I am going to ask him to pay for it (advice from a lawyer I spoke to). This would actually be in be best interests of both parties. $5000 is a drop in the bucket to him, I don’t imagine he’d fight me on it. I just need to tell him that I’ve consulted other orthos and surgeons and they agree with me and that I’d like to pursue my revision elsewhere with a refund of the portion I paid since my bite was simply not fixed (still presumably at this point).
When’s the best time to get a revision, should I get it ASAP or wait?
I'm not sure I follow. Is it your orthodontist you'll hold accountable, and are you going to do the revision at a new surgeon where you want him to pay for it?
I believe the normal procedure would be that the surgeon who messed up also should offer a free revision. Having them pay another surgeon sounds hard, at most a refund.
I heard one patient who had a bsso revision within a month after first surgery I think. But bsso is probably a bit easier.
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What GJ said times 100.
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I'm not sure I follow. Is it your orthodontist you'll hold accountable, and are you going to do the revision at a new surgeon where you want him to pay for it?
I believe the normal procedure would be that the surgeon who messed up also should offer a free revision. Having them pay another surgeon sounds hard, at most a refund.
I heard one patient who had a bsso revision within a month after first surgery I think. But bsso is probably a bit easier.
No my orthodontist wouldn’t be held accountable at all. The cost of the patient portion of the surgery here in Canada is only $5000, so that would be the amount he would refund. This would allow me to get a surgery elsewhere with a surgeon I feel comfortable with. How can I trust him to do a revision if he literally thinks there’s nothing to revise? It doesn’t seem like a smart move for either party. Obviously if the least he offers is a revision I’ll take it though.
I know it sounds less likely that’d he’d offer a refund but actually, he may find it more of a nuisance and annoyance to do an operation that he doesn’t think needs to be done, than he would refunding 5 grand.
However, maybe he’s right, I think professional ortho photos of just my bite at multiple angles will help you guys diagnose it better. I’ll post these tmrw hopefully.
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What GJ said times 100.
For me the upper jaw healing was a breeze compared to my BSSO and genio. I’d be very comfortable getting another upper jaw surgery since my sensation is back but I’m still recovering feeling in my lower lip.
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Correct. A lot of times they just tell you it's okay to make sure the statute of limitations passes. It's possible it is okay, but the photos didn't show that. I'd go get second opinions from people completely unrelated to this guy. Maybe different city, etc. Don't tell them who did the surgery. Just say you're concerned and want an objective opinion.
Agree 5k is nothing for him, but by issuing a refund he might under law be admitting culpability. And he might not want that on his record or reputation. For that reason he might fight it.
If you get a bunch of opinions, they all say something is wrong, etc, get that in writing and show him. See what he says and then go from there.
This isn't legal advice, etc etc -- just my opinion and what I'd do.
Very true. But he doesn’t have a choice if his peers believe the bite was not corrected. It’s either revise or refund. I’m not totally opposed to getting revised by him it’s just I need to hear that he understands the problem. If he can do that, then sure I’ll concede to a revision.
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Very true. But he doesn’t have a choice if his peers believe the bite was not corrected. It’s either revise or refund. I’m not totally opposed to getting revised by him it’s just I need to hear that he understands the problem. If he can do that, then sure I’ll concede to a revision.
I don't think it's really about understanding the problem, it's more about wanting to correct it, and of course knowing what the limits are. As I said earlier, I had similar problems with my orthodontist who were brushing things off like it's nothing, I should just wait and see etc. It was first when I had got a second opinion and arranged everything and basically said it's up to him to either help me, or we're done and I'll abandon the treatment, that things that had been impossible before suddenly became possible. I didn't bring in money in my discussion, in my case I think my orthodontist didn't want a patient who've abandoned him on his record in his position. Especially not someone who is not just unhappy, but actually knows that things in the process have not been correct and is going around spreading it. I was so frustrated and confused because everything that was said on this board made perfectly sense, and then stepping into the office at someone who've spent 25 years doing this and do publications says something completely else.
The problem with a surgeon is that you don't have the leverage of cancelling a treatment, the treatment is automatically ended when you wake up. But you could maybe do the same approach with your orthodontist and say that you don't accept if he doesn't help you pushing this and will go somewhere else. A surgeon can brush of a patient more easy than the treating orthodontist. Don't let them finish before you say it's done.
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I don't think it's really about understanding the problem, it's more about wanting to correct it, and of course knowing what the limits are. As I said earlier, I had similar problems with my orthodontist who were brushing things off like it's nothing, I should just wait and see etc. It was first when I had got a second opinion and arranged everything and basically said it's up to him to either help me, or we're done and I'll abandon the treatment, that things that had been impossible before suddenly became possible. I didn't bring in money in my discussion, in my case I think my orthodontist didn't want a patient who've abandoned him on his record in his position. Especially not someone who is not just unhappy, but actually knows that things in the process have not been correct and is going around spreading it. I was so frustrated and confused because everything that was said on this board made perfectly sense, and then stepping into the office at someone who've spent 25 years doing this and do publications says something completely else.
The problem with a surgeon is that you don't have the leverage of cancelling a treatment, the treatment is automatically ended when you wake up. But you could maybe do the same approach with your orthodontist and say that you don't accept if he doesn't help you pushing this and will go somewhere else. A surgeon can brush of a patient more easy than the treating orthodontist. Don't let them finish before you say it's done.
I believe I signed a contract with my orthodontist so I believe I’m financially obligated to finish paying for the treatment. Are you saying I should ask him to support my assertions and if not to drop out of treatment? I can’t afford another orthodontist so I’m not sure that’s an option.
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My bite Pre-op: https://imgur.com/a/oNMmC1R (https://imgur.com/a/oNMmC1R)
2.5 weeks post-op: https://imgur.com/a/63E3U1K (https://imgur.com/a/63E3U1K)
Before-after comparison: https://imgur.com/a/e7cWuJD. (https://imgur.com/a/e7cWuJD.) I don’t see any difference in my arch width.
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My bite Pre-op: https://imgur.com/a/oNMmC1R (https://imgur.com/a/oNMmC1R)
2.5 weeks post-op: https://imgur.com/a/63E3U1K (https://imgur.com/a/63E3U1K)
To me, the left side of the photo seems to be in better occlusion than the right side. It's hard to tell though, need more angles to be certain.
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My bite Pre-op: https://imgur.com/a/oNMmC1R (https://imgur.com/a/oNMmC1R)
2.5 weeks post-op: https://imgur.com/a/63E3U1K (https://imgur.com/a/63E3U1K)
Before-after comparison: https://imgur.com/a/e7cWuJD. (https://imgur.com/a/e7cWuJD.) I don’t see any difference in my arch width.
Also, didn't you have anterior open bite? The incisor overlap looks exactly the same.
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Also, didn't you have anterior open bite? The incisor overlap looks exactly the same.
I did as you’ve seen in a previous photo. As explained that open bite closed when I switched surgeons and went from Invisalign to braces. The open bite was decompensated initially as seen here: https://imgur.com/a/7gxn3gx (https://imgur.com/a/7gxn3gx)
When I asked my ortho why my open bite was reduced as I switched from Invisalign to braces to prepare for surgery with my new surgeon, this was his response:
“When you made the switch to (your new surgeon) he requested braces on the upper - so when you have braces vs. Invisalign it is a little different but ultimately does not affect anything as once again, the teeth were in segments, and the segments can be moved wherever they need.”
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I did as you’ve seen in a previous photo. As explained that open bite closed when I switched surgeons and went from Invisalign to braces. The open bite was decompensated initially as seen here: https://imgur.com/a/7gxn3gx (https://imgur.com/a/7gxn3gx)
When I asked my ortho why my open bite was reduced as I switched from Invisalign to braces to prepare for surgery with my new surgeon, this was his response:
“When you made the switch to (your new surgeon) he requested braces on the upper - so when you have braces vs. Invisalign it is a little different but ultimately does not affect anything as once again, the teeth were in segments, and the segments can be moved wherever they need.”
Okay, I forgot about that pic. The link doesn't work anymore. That seems to be a BS explanation considering many surgeons DO decompensate, even in the case of a segmented LF1. But yes, the bite is virtually unchanged from that view except MAYBE slightly better occlusion on the left side of the pic. Your case is beyond my understanding to comment further though. I don't understand what what your surgeon thinks was corrected.
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Okay, I forgot about that pic. The link doesn't work anymore. That seems to be a BS explanation considering many surgeons DO decompensate, even in the case of a segmented LF1. But yes, the bite is virtually unchanged from that view except MAYBE slightly better occlusion on the left side of the pic. Your case is beyond my understanding to comment further though. I don't understand what what your surgeon thinks was corrected.
Here’s photos from yesterday. I have (blue) spacers under 2 of my top teeth on either side so that I’m occluding properly, so it’s hard to assess my bite here:
https://imgur.com/a/Bau8Hfb (https://imgur.com/a/Bau8Hfb)
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Okay, I forgot about that pic. The link doesn't work anymore. That seems to be a BS explanation considering many surgeons DO decompensate, even in the case of a segmented LF1. But yes, the bite is virtually unchanged from that view except MAYBE slightly better occlusion on the left side of the pic. Your case is beyond my understanding to comment further though. I don't understand what what your surgeon thinks was corrected.
I guess the main point of the surgery was the bi-max advancement to improve breathing but I didn’t think that precluded a bite correction. Honestly man I don’t get it either. What makes this so damn aggravating is the lack of straight answers from the professionals I’m working with.
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Okay, I forgot about that pic. The link doesn't work anymore. That seems to be a BS explanation considering many surgeons DO decompensate, even in the case of a segmented LF1. But yes, the bite is virtually unchanged from that view except MAYBE slightly better occlusion on the left side of the pic. Your case is beyond my understanding to comment further though. I don't understand what what your surgeon thinks was corrected.
His explanation is absolutely bulls**t because my original surgeon was also doing a segmental lefort 1. I’m assuming he wanted to do more posterior impaction to close the decompensated AOB and my actual surgeon wasn’t comfortable with posterior impaction (he didn’t do posterior impaction other than the 1 mm from the saw cut) and wanted to just bring down the front.
So does that mean I’m still posteriorly long compared to the front (Skeletal AOB) and my surgeon camouflaged this skeletal discrepancy but reversing the original decompensation? I don’t know that’s why I need to see a US surgeon. I have a consult with Wolford in July.
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I believe I signed a contract with my orthodontist so I believe I’m financially obligated to finish paying for the treatment. Are you saying I should ask him to support my assertions and if not to drop out of treatment? I can’t afford another orthodontist so I’m not sure that’s an option.
Having your orthodontist speaking for you would be the best. During the treatment you shouldn't actually have to be involved in discussions like these. They should send you back and forth until they can deliver a good end result, and if the surgeon have delivered something to the orthodontist that he can't work with, he should be the one sending it back. That is the ethical approach from them.
BUT, in the case your orthodontist and surgeon are not handling it properly, that's when it gets tricky.
I believe your side view of the bite us same in your first before and after comparison?
The side view that you posted with the blue stuff, I'm not sure how bad it really is. If you bite, your lower incisors are behind the upper, and not edge to edge as I think it has looked like before? Basically, when you bite, your upper incisors and canines should overlap your lower, and not edge to edge or beyond. If there is only a slight problem, it can probably be adjusted orthodontically. E.g on your left side you have some space to pull the lower incisors and canines back.
Looking at your width, I agree. Do they say they have widened your upper arch? Can you see on the x-rays that the maxilla have been splitted, or inside your mouth?
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His explanation is absolutely bulls**t because my original surgeon was also doing a segmental lefort 1. I’m assuming he wanted to do more posterior impaction to close the decompensated AOB and my actual surgeon wasn’t comfortable with posterior impaction (he didn’t do posterior impaction other than the 1 mm from the saw cut) and wanted to just bring down the front.
So does that mean I’m still posteriorly long compared to the front (Skeletal AOB) and my surgeon camouflaged this skeletal discrepancy but reversing the original decompensation? I don’t know that’s why I need to see a US surgeon. I have a consult with Wolford in July.
I really think you should save money and get a second orthodontist option first. Your aesthetic result is so good that something potentially fixed in orthodonture should be handled there.
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Having your orthodontist speaking for you would be the best. During the treatment you shouldn't actually have to be involved in discussions like these. They should send you back and forth until they can deliver a good end result, and if the surgeon have delivered something to the orthodontist that he can't work with, he should be the one sending it back. That is the ethical approach from them.
BUT, in the case your orthodontist and surgeon are not handling it properly, that's when it gets tricky.
I believe your side view of the bite us same in your first before and after comparison?
The side view that you posted with the blue stuff, I'm not sure how bad it really is. If you bite, your lower incisors are behind the upper, and not edge to edge as I think it has looked like before? Basically, when you bite, your upper incisors and canines should overlap your lower, and not edge to edge or beyond. If there is only a slight problem, it can probably be adjusted orthodontically. E.g on your left side you have some space to pull the lower incisors and canines back.
Looking at your width, I agree. Do they say they have widened your upper arch? Can you see on the x-rays that the maxilla have been splitted, or inside your mouth?
My palate certainly looks wider: https://imgur.com/a/lHKJmU8 (https://imgur.com/a/lHKJmU8)
I don’t know maybe he widened by 5 mm and this is the furthest you can go with a segmental and that’s why I was left in cross bite. Maybe I need SARPE to get more expansion. Or perhaps he only widened like 2 mm but the actual palate change does look like it was more than that. Hmm.
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I really think you should save money and get a second orthodontist option first. Your aesthetic result is so good that something potentially fixed in orthodonture should be handled there.
That is true. Honestly my ortho is very very good, he’s going to fix the bite to the best that can be reasonably fixed. My open bite will be closed he said, and my smile will be wider than it is currently. I don’t really think another ortho would change anything.
I think his response to my situation is simply to avoid conflict and to make the best out of the situation but his technical skills cannot be doubted. HE knows that it’s a crossbite, his reaction told me so, it’s just he’s reluctant to say it to me directly. So I’m confident he is doing what needs to be fixed. Some people just don’t really feel comfortable commenting poorly on another professional’s work, especially a highly esteemed one. That’s why I’m seeing another ortho and surgeon... however my ortho is 5 star in my area and is not cheap, and has undergone jaw surgery himself. He knows his stuff. Actually he even went to a conference held by William Arnett a couple years ago.
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https://imgur.com/a/Q34sJJp (https://imgur.com/a/Q34sJJp)
Looking at my smile, is my open bite on the left side caused by a upper jaw cant that went uncorrected? I don’t know if my smile is just crooked from the healing, but I did get diagnosed with a maxillary cant at my previous surgeon, however the one that did the surgery did not write this on my file and only commented on midline deviation.
I think if my upper jaw was in 3 segments, the slight cant could also have been corrected and I wouldn’t have that posterior open bite. But do you have to change the position of the lower jaw when fixing a an upper jaw cant, not sure if I’m oversimplifying it.
Also can anyone answer if a maxillary cant to one side can give asymmetry to the mouth where one side drops lower the other. Could that be a tell that the upper jaw isn’t levelled, or could it be purely soft-tissue? Because I do have that.
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Late to the party here but TBH, I gave up on the FIRST post on this thread because I thought the presentation was poorly organized, confusing and just lacked all the salient info.
Wording like: 'My 6 months pre-op worse than my pre-op.' along with absence of info as to how far along POST OP you actually were and no mention of what the PO brace period was planned to be. Since, then I see you removed your photos from the entry post. But I recall looking at the photo presentation and it looked like the photos were out of order where people may have been looking at a pre-op cross bite and not the post op. Also recall a post where you had to ask if people were sure they were looking at the right photo. But I don't see that entry anymore in this string either. So, it very well could be that some of the early responses you got here could have been reactions to mixed up photos.
Some other points of confused presentation:
1: Not mentioning just how post-op you were. Had to search for that independent of any mention of such in your entry.) You're about 2 months post op right. How post op were the early photos you showed in your entry post were you called it your 'result'? How sure are you that people were not mixing up a post op with a pre-op when they gave initial responses?
2: Casting your ortho and surgeon in a bad light so soon because you're told you need to stay in braces longer as if that's a cop out for their not expanding your maxilla enough. What's so unusual of a in braces post op period taking some time to even things out? It took 6 months for the member 'post bimax' with AOB before he got his braces off.
3: Presenting the cross bite as your '#1 concern' and main indication for the surgery. Oh no...could not possibly be that such things like recessed maxilla, the anterior open bite with posterior excess gum show and the speech problems you said you had some time back were the main concerns for the surgery. Now after what would have been the the main issues for having this surgery (which you did mention in prior posts), now suddenly the cross bite was your primary concern. Really?
4: Thinking you didn't have posterior impaction. You posted a photo elsewhere where you had a LOT of excess posterior gum show in the before and little to none in the after. Removal of all that excess posterior gum show is highly unlikely without posterior impaction. Although there are some situations where intrusion of the back teeth can help close the open bite, those cases are when someone does NOT have a lot of posterior gum show. Who knows. Maybe the surgeon didn't want to tell you that you had posterior impaction if he thought that would or that too much information could result in your getting it mixed up and alarm you in some way. Surgeons are LESS apt to leave out out information when they feel the patient has a good understandings of how things work from the get go. But if they feel a patient could get easily confused by tech details and would need excess time for explanations of them, they are MORE apt to leave them out. If you really want to know what kind of surgery you got, get your op. report.
Some pointers for you:
Next time you have a surgery, establish what the estimated POST OP period is meant to be before you start jumping the gun, alarming yourself it was done wrong and you need a revision or need to sue and drawing others into the alarm system. Consider making clear how post op you are. Consider using time lines for your pre-ops. If you have 2 pre-ops, put a time line on both of them instead of saying, 'Heres my 6 month pre-op' and just calling the other one just your 'pre-op sans timeline of it. Put as many photos as you can on one imger link and use the text function to note the timeline of each photo for easy comparison with minimal confusion.
As to the question of whether or not you 'need a revision' or are 'still in cross bite', I didn't engage early on due to the confusing presentation and also because given that post op braces can take 6 months or so for some bites to fit into place, I felt it was too early to be even asking it.
I think you should just chill out because based on your most recent pics, it looks like your bite is coming along fine and just MAYBE the doctor was correct when he told you at your last visit you had no cross bite.
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But I recall looking at the photo presentation and it looked like the photos were out of order where people may have been looking at a pre-op cross bite and not the post op. Also recall a post where you had to ask if people were sure they were looking at the right photo. But I don't see that entry anymore in this string either. So, it very well could be that some of the early responses you got here could have been reactions to mixed up photos.
I thought this could be the case as well but I had descriptions under each picture and had commented in the post clarifying which of the pictures was the post-op. I also emailed Gj making sure he was looking at the correct picture. I don't think there was a mix-up.
Some other points of confused presentation:
1: Not mentioning just how post-op you were. Had to search for that independent of any mention of such in your entry.) You're about 2 months post op right. How post op were the early photos you showed in your entry post were you called it your 'result'? How sure are you that people were not mixing up a post op with a pre-op when they gave initial responses?
The posters who commented knew how far along post-op I was.
2: Casting your ortho and surgeon in a bad light so soon because you're told you need to stay in braces longer as if that's a cop out for their not expanding your maxilla enough. What's so unusual of a in braces post op period taking some time to even things out? It took 6 months for the member 'post bimax' with AOB before he got his braces off.
Fair enough in regards to the first part, but I definitely didn't say staying in braces LONGER was a cop-out for not expanding my maxilla enough. How long I'm in braces is irrelevant, I don't care. What I meant was, I didn't want an outcome where 70% of the bite problem was fixed skeletally with surgery, and 30% was compensated for with orthodontics, because I wanted my bones in the best possible position. That's what I meant when I said I don't know why my surgeon is "over-relying on orthodontics to fix the discrepancies." I'm sure all my bite issues could have been fixed somewhat without surgery at all. But you go for surgery to not have to rely on camouflage ortho, and that's what I felt was happening at the time WRT my cross-bite.
3: Presenting the cross bite as your '#1 concern' and main indication for the surgery. Oh no...could not possibly be that such things like recessed maxilla, the anterior open bite with posterior excess gum show and the speech problems you said you had some time back were the main concerns for the surgery. Now after what would have been the the main issues for having this surgery (which you did mention in prior posts), now suddenly the cross bite was your primary concern. Really?
I said it was my number 1 technical indication. Did I say it was my number one concern? I don't think I did. If I DID, I meant it was the number 1 thing a surgeon would point out in my consults. The most obvious thing. Yes, I had many other concerns as well.
4: Thinking you didn't have posterior impaction. You posted a photo elsewhere where you had a LOT of excess posterior gum show in the before and little to none in the after. Removal of all that excess posterior gum show is highly unlikely without posterior impaction. Although there are some situations where intrusion of the back teeth can help close the open bite, those cases are when someone does NOT have a lot of posterior gum show. Who knows. Maybe the surgeon didn't want to tell you that you had posterior impaction if he thought that would or that too much information could result in your getting it mixed up and alarm you in some way. Surgeons are LESS apt to leave out out information when they feel the patient has a good understandings of how things work from the get go. But if they feel a patient could get easily confused by tech details and would need excess time for explanations of them, they are MORE apt to leave them out. If you really want to know what kind of surgery you got, get your op. report.
Yes! Which is confusing. My posterior gum show is gone. I had a lot before. Also my mandible plane seems less steep. But I asked him a couple times before surgery about posterior impaction. I think at that point he thought I meant anterior impaction. Whatever maybe he was distracted.
But AFTER surgery he showed me his hand-written surgical report (Yes, very old school), which shows 1 mm vertical reduction at the back. He said the back was shortened but only by a mm and that was from the saw cut and so he disregarded that as counting as a "posterior impaction." Looking at my gum show pre-op wouldn't you agree that I'd have needed more than 1 mm?
I doubt that he didn't want to tell me for fear of "worrying me" because by that point I understood what it was for, what it does, and how it would it benefit my face. I relayed that my orthodontist and I feel that my face is shorter which was a GOOD thing and I thanked him for that, and then inquired whether this achieved with posterior impaction. He replied with the above ^ "well yeah but only by 1 mm" and said if anything my face was LONGER because of the anterior drop-down of 3 mm. Lol so if anything his denial of impaction would have alarmed me more than conceding to it.
Some pointers for you:
Next time you have a surgery, establish what the estimated POST OP period is meant to be before you start jumping the gun, alarming yourself it was done wrong and you need a revision or need to sue and drawing others into the alarm system. Consider making clear how post op you are. Consider using time lines for your pre-ops. If you have 2 pre-ops, put a time line on both of them instead of saying, 'Heres my 6 month pre-op' and just calling the other one just your 'pre-op sans timeline of it. Put as many photos as you can on one imger link and use the text function to note the timeline of each photo for easy comparison with minimal confusion.
As I said I did write descriptors under each picture, by simply "Pre-op" I meant immediately before surgery as in 1-2 weeks before as in I was already ready orthodontically for 2 months before my surgery date and so it was irrelevant to add an exact timeline. My point was that this was my final bite that had me ready for surgery.
As to the question of whether or not you 'need a revision' or are 'still in cross bite', I didn't engage early on due to the confusing presentation and also because given that post op braces can take 6 months or so for some bites to fit into place, I felt it was too early to be even asking it.
I think you should just chill out because based on your most recent pics, it looks like your bite is coming along fine and just MAYBE the doctor was correct when he told you at your last visit you had no cross bite.
Fair enough. This is great news if I don't need a revision. I know it seems like I was overreacting but I did have many well-respected members here telling me to sue. I didn't open the thread claiming lawsuit.
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I thought this could be the case as well but I had descriptions under each picture and had commented in the post clarifying which of the pictures was the post-op. I also emailed Gj making sure he was looking at the correct picture. I don't think there was a mix-up.
What I found confusing was the 'this is my 6 month post op' vs 'this is my post op' where the latter had no time frame to it. If you still have the imgur link of the photo presentation (it's not there anymore), I can better clarify what I thought could have been better organized.
The posters who commented knew how far along post-op I was.
Perhaps so. But it was not mentioned in your opening entry.
Fair enough in regards to the first part, but I definitely didn't say staying in braces LONGER was a cop-out for not expanding my maxilla enough. How long I'm in braces is irrelevant, I don't care. What I meant was, I didn't want an outcome where 70% of the bite problem was fixed skeletally with surgery, and 30% was compensated for with orthodontics, because I wanted my bones in the best possible position. That's what I meant when I said I don't know why my surgeon is "over-relying on orthodontics to fix the discrepancies." I'm sure all my bite issues could have been fixed somewhat without surgery at all. But you go for surgery to not have to rely on camouflage ortho, and that's what I felt was happening at the time WRT my cross-bite.
To me, it came off that someone was covering up for not doing it right and instead depending on braces to do all the work that 'should have' been done during the surgery and that was in a circumstance where you were just too early post op. Surgery alone does not always get the bite right directly after surgery and post op brace adjustments are common.
I said it was my number 1 technical indication. Did I say it was my number one concern? I don't think I did. If I DID, I meant it was the number 1 thing a surgeon would point out in my consults. The most obvious thing. Yes, I had many other concerns as well.
To me, it came off as your stressing the crossbite correction was the number 1 indication for having the surgery or a primary concern whereas in your prior posts, the other corrections were prioritized such as AOB, speech, recessed maxilla, mandible, chin ect.
Yes! Which is confusing. My posterior gum show is gone. I had a lot before. Also my mandible plane seems less steep. But I asked him a couple times before surgery about posterior impaction. I think at that point he thought I meant anterior impaction. Whatever maybe he was distracted.
I can pretty much guess what he did: Posterior impaction to the 2 side maxilla segments beyond the lateral incisors (or maybe canines), a little downgraft of upper front teeth (segment being from lateral incisor to lateral incisor-or maybe canines-) so all would be kind of 'leveled out' and ready for advancement. As for the front central incisors, they could be pulling them down with the braces (extrusion) as they probably had to be pulled down more than the 'level out' of the posterior impaction with blended with the whole anterior downgraft.
But AFTER surgery he showed me his hand-written surgical report (Yes, very old school), which shows 1 mm vertical reduction at the back. He said the back was shortened but only by a mm and that was from the saw cut and so he disregarded that as counting as a "posterior impaction." Looking at my gum show pre-op wouldn't you agree that I'd have needed more than 1 mm?
Again, the only way to have leveled out the smile so there was not all that posterior gum show would be posterior impactions of the of the 2 segments lateral to the lateral incisors (or canines) and to bring front segment down a bit and quite possibly pull down the front central incisors with the braces. So the impaction would have been more than 1mm. If one segment was longer than the other, maybe the 1mm refers to 1mm more than the other side.
I doubt that he didn't want to tell me for fear of "worrying me" because by that point I understood what it was for, what it does, and how it would it benefit my face. I relayed that my orthodontist and I feel that my face is shorter which was a GOOD thing and I thanked him for that, and then inquired whether this achieved with posterior impaction. He replied with the above ^ "well yeah but only by 1 mm" and said if anything my face was LONGER because of the anterior drop-down of 3 mm. Lol so if anything his denial of impaction would have alarmed me more than conceding to it.
Well, the anterior part of the face can look longer with an anterior drop down and can also look longer when the posterior part is impacted. But if the whole face (whole gestalt) looks shorter, that would be from the mandible being able to swing up in CCW direction subsequent to removal of posterior excess pushing it down. Can also be from a CCW effect of type of genio aimed at that.
As I said I did write descriptors under each picture, by simply "Pre-op" I meant immediately before surgery as in 1-2 weeks before as in I was already ready orthodontically for 2 months before my surgery date and so it was irrelevant to add an exact timeline. My point was that this was my final bite that had me ready for surgery.
Well, hard for me to tell what was meant and easier when the time frame is given.
Fair enough. This is great news if I don't need a revision. I know it seems like I was overreacting but I did have many well-respected members here telling me to sue. I didn't open the thread claiming lawsuit.
I think they were just tapping into your very EARLY alarm and quite frankly, I was surprised that advice was given SO EARLY post op during the 'brace stay on' period. There is little to be alarmed about at this stage of the game. Your recent post op palate looks normal and not narrow and you should allow maybe 6 months or so for all the teeth to 'mesh'. Recent photos show improvement from the early post op. Best of luck. You will do alright.
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Kavan,
Regarding the posterior impaction, I consulted with a new ortho today who assessed my bite. He said if my upper jaw was brought down at the front, there would be no shaving at the back (impaction) because the leveling would be created by the “tilting” down of the upper jaw, with the back being pushed up. This would eliminate the excess gum posteriorly. I think this is more in line with what my surgeon actually did. Does this seem right to you?
You did see my before-after profile however and it does seem like I got some CCW-r effect. Would this have been possible with the method stated above, I.e. without impaction?
In regards to my bite, the new Ortho said it’s too early to say anything and to wait 6 months. He doesn’t think there will be any crossbite issues after ortho treatment.
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Kavan,
Regarding the posterior impaction, I consulted with a new ortho today who assessed my bite. He said if my upper jaw was brought down at the front, there would be no shaving at the back (impaction) because the leveling would be created by the “tilting” down of the upper jaw, with the back being pushed up. This would eliminate the excess gum posteriorly. I think this is more in line with what my surgeon actually did. Does this seem right to you?
You did see my before-after profile however and it does seem like I got some CCW-r effect. Would this have been possible with the method stated above, I.e. without impaction?
In regards to my bite, the new Ortho said it’s too early to say anything and to wait 6 months. He doesn’t think there will be any crossbite issues after ortho treatment.
I don't think so because the posterior excess which resulted in excess posterior gum show was gone. Also, a lot of posterior excess where a person can't close their bite can give kind of creates a 'gullet' look to back of jaw where there is no demarcation from it to connecting neck area. That's gone too. However, I could be wrong. In my PM to you, I explained 'upward swings' and downward swings in terms of the right and left side of a clock. So CW on right side of clock is downward swing but on left side of clock CW is upward swing. It's the very noticible 'upward swing' I see to back of jaw that makes me think you got posterior impaction. Again, I could be wrong but gave my explanation of why I thought that was so. But on some level, I 'knew' you would get an upward swing effect from the surgery which I see in the photos sent. Anyway, all pans out to no reason for ALARM and plenty reason to be very happy with the great aesthetic outcome.
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I don't think so because the posterior excess which resulted in excess posterior gum show was gone. Also, a lot of posterior excess where a person can't close their bite can give kind of creates a 'gullet' look to back of jaw where there is no demarcation from it to connecting neck area. That's gone too. However, I could be wrong. In my PM to you, I explained 'upward swings' and downward swings in terms of the right and left side of a clock. So CW on right side of clock is downward swing but on left side of clock CW is upward swing. It's the very noticible 'upward swing' I see to back of jaw that makes me think you got posterior impaction. Again, I could be wrong but gave my explanation of why I thought that was so. But on some level, I 'knew' you would get an upward swing effect from the surgery which I see in the photos sent. Anyway, all pans out to no reason for ALARM and plenty reason to be very happy with the great aesthetic outcome.
Yeah I certainly agree with all you’ve said ^. There’s no way I didn’t get impacted considering all these changes. But I guess it’s possible something else was done.
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Yeah I certainly agree with all you’ve said ^. There’s no way I didn’t get impacted considering all these changes. But I guess it’s possible something else was done.
i know they can 'intrude' the back teeth--shove them back into the bone--and that can help relieve some posterior excess associated with AOB. Who knows, maybe there is some mechanical device to shove the gums and bone up higher that could give the effect of posterior impaction.
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i know they can 'intrude' the back teeth--shove them back into the bone--and that can help relieve some posterior excess associated with AOB. Who knows, maybe there is some mechanical device to shove the gums and bone up higher that could give the effect of posterior impaction.
My ortho actually suggested this to close my AOB but said the chance of relapse is somewhat high and that JS would be a more comprehensive solution.
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My ortho actually suggested this to close my AOB but said the chance of relapse is somewhat high and that JS would be a more comprehensive solution.
Molestrip managed to fix his (pretty bad) AOB orthodontically.
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Molestrip managed to fix his (pretty bad) AOB orthodontically.
I had AOB and orthodontics as a teen which was fixed and subsequently relapsed (pretty sure my jaw was done growing) so I’m guessing that’s why the ortho suggested JS instead of trying again.
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No I haven’t talked to him about it, I see him next week. To be fair though Dogmatix, I shouldn’t even need a revision. We’re talking about chances of nerve damage being increased. I’m sure you would feel the same way after your surgery if your bite is not class 1.
I have to tell you, its the worst bite. I had class one to start with and now my finished bite looks like this. I dont know if i could a handle a revision, so i am looking at things such as the DNA appliance and the ALF to see if i can get any room. My teeth are chipping away. I dont even know where to start. Sadly, lawyers and lawsuits dont fix bites—that would take years. I am an attorney, and i cant practice because my teeth smack together 24/7.
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Is that your front top and bottom teeth clacking together? I don’t have that, it just appears that my teeth are contacting prematurely on the sides. That looks awful. How did it happen?
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Is that your front top and bottom teeth clacking together? I don’t have that, it just appears that my teeth are contacting prematurely on the sides. That looks awful. How did it happen?
She had a complication mid-surgery which required a change in plan, leaving her in a bad situation. I wonder if it would have been better to stick to the original plan, or if a different practitioner would have done it differently to yield a more favorable outcome.
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In case anyone's interested, I did indeed have a crossbite after the surgery. I know it sounds crazy but you start to second guess yourself when nobody is telling you the truth. My surgeon told me there is no transverse deficiency there, and my ortho was very indirect/ cryptic, so I really didn't know for sure, especially with regards to how much ortho could improve the bite. Even a second orthodontist I consulted told me to wait 6 months to let things settle. No hard, clear answers.
Now recently, according to my orthodontist, finally he just came out with it and said I was in a crossbite on the left side after surgery but now (at 5 months) with elastics, I'm more edge-to-edge. I think my right side is ok; maybe not perfect but its certainly not a crossbite and teeth are meshing nicely on that side. The upper arch is certainly wider than the lower on that side.
Still unsure what to do about the left side that's now edge to edge. Is it even healthy to forcibly tilt the teeth outward into proper position? Could this cause gum recession down the road? Relapse? If the orthodontics doesn't improve things further, am I going to grind my teeth down eventually? I was already a grinder before. Having my teeth mesh adequately has alleviated that somewhat but it's probably still / will be an issue.
I type out this whole post but the truth is, I already know the answer. The techs who adjust my wires always ask when my surgeon consult so I can get a second opinion on the bite. They already know things won't be fixed perfectly with orthdontics.
I guess I still don't know what to do. Is it worth going through another surgery to move one side of my jaw outward 2 mm? The fact that I still have to worry about my crossbite after all this just seems really stupid, to be quite f**king honest.
On top of that, I've been informed by another post here that my surgeon is retiring (no longer accepting new patients).
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On a positive note, now that all of my swelling is gone, it looks like I was advanced the right amount. After the surgery I was wondering if I should have asked for more advancement, but now the the swelling above my upper lip has dissipated (paranasal), I see that I came ever so close to straddling that line into chimp-lip territory. Further advancement would have done absolutely nothing aesthetically and probably would have make me look worse.
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In case anyone's interested, I did indeed have a crossbite after the surgery. I know it sounds crazy but you start to second guess yourself when nobody is telling you the truth. My surgeon told me there is no transverse deficiency there, and my ortho was very indirect/ cryptic, so I really didn't know for sure, especially with regards to how much ortho could improve the bite. Even a second orthodontist I consulted told me to wait 6 months to let things settle. No hard, clear answers.
Now recently, according to my orthodontist, finally he just came out with it and said I was in a crossbite on the left side after surgery but now (at 5 months) with elastics, I'm more edge-to-edge. I think my right side is ok; maybe not perfect but its certainly not a crossbite and teeth are meshing nicely on that side. The upper arch is certainly wider than the lower on that side.
Still unsure what to do about the left side that's now edge to edge. Is it even healthy to forcibly tilt the teeth outward into proper position? Could this cause gum recession down the road? Relapse? If the orthodontics doesn't improve things further, am I going to grind my teeth down eventually? I was already a grinder before. Having my teeth mesh adequately has alleviated that somewhat but it's probably still / will be an issue.
I type out this whole post but the truth is, I already know the answer. The techs who adjust my wires always ask when my surgeon consult so I can get a second opinion on the bite. They already know things won't be fixed perfectly with orthdontics.
I guess I still don't know what to do. Is it worth going through another surgery to move one side of my jaw outward 2 mm? The fact that I still have to worry about my crossbite after all this just seems really stupid, to be quite f**king honest.
On top of that, I've been informed by another post here that my surgeon is retiring (no longer accepting new patients).
It's a tough call and hard decision. The entire purpose of surgery is to create a good bite, and when you go through the entire process and don't get this, then this objective is not met. As I understand you had orthodontic preparation prior to surgery, in that case the surgery should be considered the last part of the treatment and near as perfect occlusion after. In case of surgery first or early, the surgeon may have to make assumptions of post operative orthodontic work, but not when proper preparation has been made.
Let us know what you decide to do. Have they offered you a revision?
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Is it even healthy to forcibly tilt the teeth outward into proper position? Could this cause gum recession down the road? Relapse? If the orthodontics doesn't improve things further, am I going to grind my teeth down eventually? I was already a grinder before. Having my teeth mesh adequately has alleviated that somewhat but it's probably still / will be an issue.
No. Yes. Yes. Possibly. Dental widening isn't stable in adults and it should've been done surgically. There's not much your ortho can do now.
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No. Yes. Yes. Possibly. Dental widening isn't stable in adults and it should've been done surgically. There's not much your ortho can do now.
Sorry I didn’t see this reply. Thank you for the straight answers. Jesus I am being heavily manipulated then. I am going to ask for a revision. I have no choice.
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This is my bite now at almost 6 months post-op. Orthodontist said I’m edge to edge on one side now (cross-bite before), the other side is good.
What do you guys think? Worth a revision?
https://imgur.com/a/RXYaC5e (https://imgur.com/a/RXYaC5e)
You’ll notice my right canine is shorter and flatter than the left. I noticed that before surgery; I didn’t have that wear and tear even two years ago when I started braces. So my grinding is obviously excessive enough to wear down teeth - and in a short amount of time to boot. So it’s not ideal for me to live with a cross bite
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This is my bite now at almost 6 months post-op. Orthodontist said I’m edge to edge on one side now (cross-bite before), the other side is good.
What do you guys think? Worth a revision?
https://imgur.com/a/RXYaC5e (https://imgur.com/a/RXYaC5e)
You’ll notice my right canine is shorter and flatter than the left. I noticed that before surgery; I didn’t have that wear and tear even two years ago when I started braces. So my grinding is obviously excessive enough to wear down teeth - and in a short amount of time to boot. So it’s not ideal for me to live with a cross bite
I don't think I can contribute anything more than you already know about your bite or situation. These pictures look far better than the ones you've showed earlier. To my untrained eye, I don't see any clear crossbite or edge to edge on the canins as it was before, but if you say it's there, maybe it's better shown on professional pictures or at another angle. Are they offering you a revision, or would you have to struggle for it? It's bad how surgery left you with a crossbite that take 6+ months to work away, it should only be minor adjustments post op. But now you've gone through it and if they can fix it, it must be nice to get away without more surgery, but I also understand that you didn't got into this for almost a good bite. You say that you've grinded on your canine, but can it be that they've fixed it so it doesn't happen any more now?
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I don't think I can contribute anything more than you already know about your bite or situation. These pictures look far better than the ones you've showed earlier. To my untrained eye, I don't see any clear crossbite or edge to edge on the canins as it was before, but if you say it's there, maybe it's better shown on professional pictures or at another angle. Are they offering you a revision, or would you have to struggle for it? It's bad how surgery left you with a crossbite that take 6+ months to work away, it should only be minor adjustments post op. But now you've gone through it and if they can fix it, it must be nice to get away without more surgery, but I also understand that you didn't got into this for almost a good bite. You say that you've grinded on your canine, but can it be that they've fixed it so it doesn't happen any more now?
Yeah my bite looks fine now but like you said this was supposed to be achieved with bone movement not tooth movement, so it’s not going to be stable. Crossbite fixed with ortho is never stable long term, as CCW said.
So question is should I get the surgery now to avoid future relapse. Maybe I can just get the surgery again when I’m older. The benefit of doing it now is they’ll do the revision for free if I pushed for it.
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Is that your front top and bottom teeth clacking together? I don’t have that, it just appears that my teeth are contacting prematurely on the sides. That looks awful. How did it happen?
Yes i am edge to edge, the top teeth are veneers and they have been modified so i dont bang in the front but they hit at canines now, its miserable
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Yeah my bite looks fine now but like you said this was supposed to be achieved with bone movement not tooth movement, so it’s not going to be stable. Crossbite fixed with ortho is never stable long term, as CCW said.
So question is should I get the surgery now to avoid future relapse. Maybe I can just get the surgery again when I’m older. The benefit of doing it now is they’ll do the revision for free if I pushed for it.
There will never be a better time to have surgery, than now. So saving it for later sounds like a bad option. Either now, or never.
I'm actually having similar movements done. Angling the canines out to allow the mandible to come forward without getting a crossbite. Gunson also included this in the preop adjustments for me on his consultation. So it can't be totally unreliable. So I don't think you should get totally caught up in the instability horror stories, even if there's of course reasons people say it. Actually all teeth in both upper and lower jaw are unstable alone. Class II patients often have div II bite because nothing stops them from tilting inward etc. The stability comes from good occlusion and interaction between the lower and upper jaw while biting etc. I don't know, but if they get the bite to fit, it might be stabilizing it self?
I guess neither your surgeon or orthodontist is pushing or entertaining the thought of a revision? If they were you would probably already had it done. This is the problem with this field, you have 2 professionals who are supposed to look after you, but still you need to get advice here, and I'm certainly not the best one to know what to do. The only thing I feel strongly about is if you're gonna do it, don't wait.
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There will never be a better time to have surgery, than now.
Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.
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Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.
"Tomorrow you gonna wish you had started yesterday"
This is true for so much, not least myself and this orthognatic work. I want nothing else than getting out of this and never have to think about it again. Putting myself in a situation where I can't feel done and close this book would not be an option. Getting out in a situation I don't believe in to wait for some robots or what ever would be my last option. Fixing it later would probably mean to get in braces again and start it all up at a higher age where you tolerate surgery even less.
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Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.
1. Age concerns and the (increasing) related recovery/damage risks
2. I’ve read that the best time for revision is within 1-2 years because of progressive ossification (I don’t know much about this)
3. Fixing his issue and getting on with his life
Waiting around for technology and techniques to progress could mean waiting a very long time
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Yeah those are valid takes, but it really depends on the case. If revision isn't 100% required might be better off waiting for more precise techniques and technology.
Age isn't a big deal at all. It's more your health. If you're 60 and a cyclist/ripped on a great diet you'll be better off and recover faster than an overweight 20 year old eating fast food. I recovered much faster than people half my age because I ate an all superfood diet during recovery and was in shape going in.
I asked Gunson about this, and he said health, not age, is the limiting factor (up to a degree...you don't want to be 80, but 50s or 60s is fine).
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There will never be a better time to have surgery, than now. So saving it for later sounds like a bad option. Either now, or never.
I'm actually having similar movements done. Angling the canines out to allow the mandible to come forward without getting a crossbite. Gunson also included this in the preop adjustments for me on his consultation. So it can't be totally unreliable. So I don't think you should get totally caught up in the instability horror stories, even if there's of course reasons people say it. Actually all teeth in both upper and lower jaw are unstable alone. Class II patients often have div II bite because nothing stops them from tilting inward etc. The stability comes from good occlusion and interaction between the lower and upper jaw while biting etc. I don't know, but if they get the bite to fit, it might be stabilizing it self?
I guess neither your surgeon or orthodontist is pushing or entertaining the thought of a revision? If they were you would probably already had it done. This is the problem with this field, you have 2 professionals who are supposed to look after you, but still you need to get advice here, and I'm certainly not the best one to know what to do. The only thing I feel strongly about is if you're gonna do it, don't wait.
Well why would my surgeon push for a revision? That wouldn’t make sense for him unless his mistake was blatant and there were a potential lawsuit at hand. No surgeon wants to remove hardware and redo a surgery again for free.
My ortho is of course supporting in my decision RE revision, I’m consulting with Caminitti in 2 weeks, and Antonyshyn shortly as well but no consult date booked.
Once I hear these opinions, I’ll decide how to approach my surgeon about it.
I completely 100% agree about getting the surgery done and over with so it’s not hanging over your head. You can see from the pics though that it meshes good, my smile is fine now, so I was just saying since there’s no blatant pressing need for revision (like a weird smile or w.e or chewing issues) other than for the potential of relapse, I COULD put it off for now and see what happens. But I of course would always choose to take care of things in the now.
Oh and no my surgeon said you have to wait 1 year for revision. Was that a lie ?
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Why?
The surgery is primitive. You have think it will get much more exact and cheaper in the future as technology improves. E.g. distraction, when it can move accurately in all planes and be performed by precise robots, will destroy current techniques.
This is true but he’s right. Better to do it now. My surgery will be extremely easy now. He did a lot in my surgery. This one would entail ONE thing to correct.
Surgeons are human. I should have asked to be the first patient scheduled that day. He made some comments/ jokes about how being the last patient isn’t ideal or something. And with the surgery, he brought both jaws forward, making sure it wasn’t too much or too little. He did great there. He did a genio with bone shaving to re-contour my deep labialmental fold. Great job there. He had to tilt my upper jaw CW enough to give more tooth show but not so much as to give gum show. He did that perfectly. I guess when it came to widening the upper jaw, that took a backseat.
It’s only common sense that the less a surgeon has to do, the more they can make sure that that aspect is perfect. Maybe the above is nothing to an American surgeon but I think it’s actually considered a LOT of work in one surgery in Canada.
Typically jaw surgeries here are absolute bare minimum. I just found out that my initial surgeon was JUST going to do posterior impaction and nothing else, to fix the bite and gum show. No concern for aesthetics, my dished in lip area, my chin fold, poor submental area, etc. None of that would’ve been even considered.
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"Tomorrow you gonna wish you had started yesterday"
This is true for so much, not least myself and this orthognatic work. I want nothing else than getting out of this and never have to think about it again. Putting myself in a situation where I can't feel done and close this book would not be an option. Getting out in a situation I don't believe in to wait for some robots or what ever would be my last option. Fixing it later would probably mean to get in braces again and start it all up at a higher age where you tolerate surgery even less.
Amen. Also you waste your youth having jaw and bite problems. Holding out for a hypothetical ideal future surgery is insane. You will waste your life.
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Well why would my surgeon push for a revision? That wouldn’t make sense for him unless his mistake was blatant and there were a potential lawsuit at hand. No surgeon wants to remove hardware and redo a surgery again for free.
My ortho is of course supporting in my decision RE revision, I’m consulting with Caminitti in 2 weeks, and Antonyshyn shortly as well but no consult date booked.
If the surgeon is serious he should be honest about the situation and tell you that you need a revision if he thinks you do. Why? Because his entire profession and his position is a joke else and it would make no sense for him to practise at all. If you're ready to help patients with a bad situation before surgery, you should insist on helping your patients if they have a bad situation after surgery.
I know this is not always true and how it works, but this is what I have to believe to not lose faith in humanity.
If you mean that your orthodontist is supporting you in a way where he tells you it's in your best interest to have a revision, then I'd say it's a no brainer.
I don't think you have to wait 1 year for revision. Different surgeons may have different safety margins and it may depend on what you're redoing though. I've heard patients having the bsso adjusted pretty soon after surgery. I'm not sure what your revision would require, is it a full lefort fracture and then splitting the palate, or can they manage without lefort to distract it? If it's a full mobilization of the maxilla and a 3 piece lefort, it's actually a pretty big surgery. It seems like a small issue to fix, but it might involve breaking it all up.
But again, it might be that stability is fine with the orthodontic work. Try to have a good discussion with your orthodontist and understand the situation.
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One thing I don't understand is why these issues cant be easily addressed after surgery. What's the reason you're not allowed to chew etc after surgery? Because of stability issues and that things might move around. So why not use this instability and use
an activatorator or something to work small forces where you want to adjust. After surgery you've created all these cuts that allow it to move in the directions you want. With SARPE this is actually what you sometimes do, install a device where you turn a wheel to expand until satisfied. Would be very neat if this was standard for all movements. Fine tuning the bsso advancement, palate width etc daily the weeks after surgery and make sure the occlusion gets right, just as the orthodontist work with the braces.
Edit: Maybe this is also something that has happened to some extent, having the crossbite pulled with braces during healing.
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And with the surgery, he brought both jaws forward, making sure it wasn’t too much or too little. He did great there. He did a genio with bone shaving to re-contour my deep labialmental fold. Great job there. He had to tilt my upper jaw CW enough to give more tooth show but not so much as to give gum show. He did that perfectly. I guess when it came to widening the upper jaw, that took a backseat
Have you posted a before & after ceph? I'd love to see the changes from those movements.
Typically jaw surgeries here are absolute bare minimum. I just found out that my initial surgeon was JUST going to do posterior impaction and nothing else, to fix the bite and gum show. No concern for aesthetics, my dished in lip area, my chin fold, poor submental area, etc. None of that would’ve been even considered.
Yeah, it's a completely different level of standards. It's the same in my country. the bar is set way too low. It becomes just like a bullet-dodging exercise. Glad you dodged that one.
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If the surgeon is serious he should be honest about the situation and tell you that you need a revision if he thinks you do. Why? Because his entire profession and his position is a joke else and it would make no sense for him to practise at all. If you're ready to help patients with a bad situation before surgery, you should insist on helping your patients if they have a bad situation after surgery.
I know this is not always true and how it works, but this is what I have to believe to not lose faith in humanity.
If you mean that your orthodontist is supporting you in a way where he tells you it's in your best interest to have a revision, then I'd say it's a no brainer.
I don't think you have to wait 1 year for revision. Different surgeons may have different safety margins and it may depend on what you're redoing though. I've heard patients having the bsso adjusted pretty soon after surgery. I'm not sure what your revision would require, is it a full lefort fracture and then splitting the palate, or can they manage without lefort to distract it? If it's a full mobilization of the maxilla and a 3 piece lefort, it's actually a pretty big surgery. It seems like a small issue to fix, but it might involve breaking it all up.
But again, it might be that stability is fine with the orthodontic work. Try to have a good discussion with your orthodontist and understand the situation.
I feel like I’ve said this over and over, but my orthodontist and surgeon, as are probably all orthodontists and surgeons, are very vague regarding my bite. My orthodontist said it was a crossbite after surgery and is edge to edge now. My surgeon said “there is no transverse deficiency” at the last meeting. Now that my bite has improved even further with more time in orthodontics, how can I expect him to admit NOW that the bite is bad. It was worse a few months ago and he never admitted anything.
My ortho, on the other hand, finally told me straight up, but then he will say “well work on it.” They are not going to elaborate on that. They are trained to be positive, to manage patient expectations, to keep patients happy, and to work with the result given to them by the surgeons.
Why would he say “You need a revision now”. Professionals do not talk bad of other professionals’ work. Basically it is completely up to me to read between the lines and to decide if a revision is worth it. I do not expect anything else of my orthodontist. I understand now how the game works. You will only be given hints.
Also, just because my bite isn’t perfect doesn’t mean I NEED a revision. The question is more, how much do I personally WANT a revision. So my ortho has absolutely nothing to gain by convincing me I need a revision. In his mind, he probably sees this as encouraging perfectionist tendencies in his patients which can bring him headaches and lead to an unhappy patient who starts making a stirr and uses his name as the so called witness or expert testimony.
NEEDING a revision is a very subjective thing, nobody needs anything.
I’m trying to clarify because you keep thinking my ortho or surgeon is supposed to be not only 100% honest with me, but also 100% a perfectionist. Only in that case would they ever tell me I need a revision. But in their view, the bite is probably something more along the lines of “good enough.”
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Have you posted a before & after ceph? I'd love to see the changes from those movements.
Yeah, it's a completely different level of standards. It's the same in my country. the bar is set way too low. It becomes just like a bullet-dodging exercise. Glad you dodged that one.
I’ll PM you b/a’s
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I feel like I’ve said this over and over, but my orthodontist and surgeon, as are probably all orthodontists and surgeons, are very vague regarding my bite. My orthodontist said it was a crossbite after surgery and is edge to edge now. My surgeon said “there is no transverse deficiency” at the last meeting. Now that my bite has improved even further with more time in orthodontics, how can I expect him to admit NOW that the bite is bad. It was worse a few months ago and he never admitted anything.
My ortho, on the other hand, finally told me straight up, but then he will say “well work on it.” They are not going to elaborate on that. They are trained to be positive, to manage patient expectations, to keep patients happy, and to work with the result given to them by the surgeons.
Why would he say “You need a revision now”. Professionals do not talk bad of other professionals’ work. Basically it is completely up to me to read between the lines and to decide if a revision is worth it. I do not expect anything else of my orthodontist. I understand now how the game works. You will only be given hints.
Also, just because my bite isn’t perfect doesn’t mean I NEED a revision. The question is more, how much do I personally WANT a revision. So my ortho has absolutely nothing to gain by convincing me I need a revision. In his mind, he probably sees this as encouraging perfectionist tendencies in his patients which can bring him headaches and lead to an unhappy patient who starts making a stirr and uses his name as the so called witness or expert testimony.
NEEDING a revision is a very subjective thing, nobody needs anything.
I’m trying to clarify because you keep thinking my ortho or surgeon is supposed to be not only 100% honest with me, but also 100% a perfectionist. Only in that case would they ever tell me I need a revision. But in their view, the bite is probably something more along the lines of “good enough.”
I totally hear you. Sure I've told you how I spent 2 years with invisalign, compensating against my will, being promised on numerous occasions that we will discuss my questions on next appointment, lying to me, giving deceiving answers. I was even told he was decompensating my bite when he did exactly the oposite.
I just don't want to believe this is as common and it scares the s**t out of me hearing I'm not unique.
I would actually want to work in this field, because it's really not hard to be nice and honest to your patients and it makes such difference. Some doctors seem to think they do you a favour by not giving you full insight, but it's just opposite when you understand they avoid the question and you have no idea what their actual opinion is.
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I feel like I’ve said this over and over, but my orthodontist and surgeon, as are probably all orthodontists and surgeons, are very vague regarding my bite. My orthodontist said it was a crossbite after surgery and is edge to edge now. My surgeon said “there is no transverse deficiency” at the last meeting. Now that my bite has improved even further with more time in orthodontics, how can I expect him to admit NOW that the bite is bad. It was worse a few months ago and he never admitted anything.
My ortho, on the other hand, finally told me straight up, but then he will say “well work on it.” They are not going to elaborate on that. They are trained to be positive, to manage patient expectations, to keep patients happy, and to work with the result given to them by the surgeons.
Why would he say “You need a revision now”. Professionals do not talk bad of other professionals’ work. Basically it is completely up to me to read between the lines and to decide if a revision is worth it. I do not expect anything else of my orthodontist. I understand now how the game works. You will only be given hints.
Also, just because my bite isn’t perfect doesn’t mean I NEED a revision. The question is more, how much do I personally WANT a revision. So my ortho has absolutely nothing to gain by convincing me I need a revision. In his mind, he probably sees this as encouraging perfectionist tendencies in his patients which can bring him headaches and lead to an unhappy patient who starts making a stirr and uses his name as the so called witness or expert testimony.
NEEDING a revision is a very subjective thing, nobody needs anything.
I’m trying to clarify because you keep thinking my ortho or surgeon is supposed to be not only 100% honest with me, but also 100% a perfectionist. Only in that case would they ever tell me I need a revision. But in their view, the bite is probably something more along the lines of “good enough.”
Very realistic and yes, that's how it probably works.
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I totally hear you. Sure I've told you how I spent 2 years with invisalign, compensating against my will, being promised on numerous occasions that we will discuss my questions on next appointment, lying to me, giving deceiving answers. I was even told he was decompensating my bite when he did exactly the oposite.
I just don't want to believe this is as common and it scares the s**t out of me hearing I'm not unique.
I would actually want to work in this field, because it's really not hard to be nice and honest to your patients and it makes such difference. Some doctors seem to think they do you a favour by not giving you full insight, but it's just opposite when you understand they avoid the question and you have no idea what their actual opinion is.
It’s not uncommon. Some people, when they get a hold of a kind of power, say through specialization in one subject, will have a need to control the information they’ve learned because it is their sole source of power, identity, purpose, etc. They are the expert in this field, not you. It makes them uncomfortable giving you too much info. You will know these types if they talk in a condescending way you, using very elementary terms, and then if you use technical terms to join them in the conversation on a more in depth level, they will be shocked by it rather than excited by it.
The type of person who you would want to be in this field, who genuinely is honest with their patients about everything, gets excited when a patient uses a technical word or shares a more in depth idea with them, because they can then teach what they know and have more impact - and that’s what these types are, teachers, not gatekeeers of specialized information, which is how your previous ortho sounds.
I’m not even really judging btw, it’s just how people are. Better to just recognize what you’re dealing with rather than get angered by it.
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Very realistic and yes, that's how it probably works.
I bet orthodontists and even surgeons are trained, or maybe they probably learn through experience, to use language carefully. If my ortho advises me to get a revision because my bite is not perfect, and then I suffer nerve damage in my upper lip, and I later find out my bite was “good enough” and there was no revision that NEEDED to be done, he would be screwed and potentially liable to lawsuit.
So instead of saying directly “you have a transverse deficiency,” they might say “I know YOU have concerns about the transverse.” That way they can never be accused of leading the patient, only responding to the patient.
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I bet orthodontists and even surgeons are trained, or maybe they probably learn through experience, to use language carefully. If my ortho advises me to get a revision because my bite is not perfect, and then I suffer nerve damage in my upper lip, and I later find out my bite was “good enough” and there was no revision that NEEDED to be done, he would be screwed and potentially liable to lawsuit.
So instead of saying directly “you have a transverse deficiency,” they might say “I know YOU have concerns about the transverse.” That way they can never be accused of leading the patient, only responding to the patient.
True. That goes more or less for any kind of business, but even more for this kind of stuff with high risks.
Though in the end, it doesn't really matter. Either someone has the skill or he doesn't. And you just don't know beforehand if someone has it or not. And even if someone has the skills, it doesn't exclude the fact that even the best can make a mistake, or that his aestethic view doesn't correspond with that of the client. In a sense, beauty is subjective. A surgeon might be satisfied with a result, while a client is not. Fact is, some surgeons are better than others. I would say, based on experience: 90 percent are s**t, only 10 percent are good, but every one of them think they are the best.
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True. That goes more or less for any kind of business, but even more for this kind of stuff with high risks.
Though in the end, it doesn't really matter. Either someone has the skill or he doesn't. And you just don't know beforehand if someone has it or not. And even if someone has the skills, it doesn't exclude the fact that even the best can make a mistake, or that his aestethic view doesn't correspond with that of the client. In a sense, beauty is subjective. A surgeon might be satisfied with a result, while a client is not. Fact is, some surgeons are better than others. I would say, based on experience: 90 percent are s**t, only 10 percent are good, but every one of them think they are the best.
Haha exactly. In summary, s**t is complicated, and surgery is imperfect. I do agree that beauty is subjective ONLY when a person is far enough away from the aesthetic ideal but they may have a unique look that isn’t typical, but that isn’t bad either. In that case, you have to work more on subjectivity WRT what would look good for that particular patient and toss out objective standards.
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Is that your front top and bottom teeth clacking together? I don’t have that, it just appears that my teeth are contacting prematurely on the sides. That looks awful. How did it happen?
I had surgery with Dr. Gunson in Santa Barbra and my lower jaw is too far forward.
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I consulted with Caminitti finally, he said it’s a minimal edge to edge bite on one side and he personally would be satisfied with this bite. He said he grades occlusion out of 5, and said he would give me a 5/5. When I pressed him on that he said okay fine 4.9/5.
He wouldn’t do a revision under any circumstances and advised me to stay away from anyone who he says they can improve my bite further. Although, again, he did say it was a bit edge on edge and a slight open bite on one side. But the bite itself occludes and meshes fine.
So it is what it is. I don’t think anyone would do a revision on me. I’m consulting one other surgeon.
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I consulted with Caminitti finally, he said it’s a minimal edge to edge bite on one side and he personally would be satisfied with this bite. He said he grades occlusion out of 5, and said he would give me a 5/5. When I pressed him on that he said okay fine 4.9/5.
He wouldn’t do a revision under any circumstances and advised me to stay away from anyone who he says they can improve my bite further. Although, again, he did say it was a bit edge on edge and a slight open bite on one side. But the bite itself occludes and meshes fine.
So it is what it is. I don’t think anyone would do a revision on me. I’m consulting one other surgeon.
I think what he's conveying is that a bite does not have to be perfect Class 1 to be 'ok' or functional. One of Wolford's proteges once told me that Class 1 does not necessarily convey perfect occlusion because there is class 1 malocclusion. Also, that Class 2 and Class 3 occlusion does not necessarily mean 'malocclusion' because there can be Class 2 and Class 3 occlusion where the occlusion is good.
Basically, a deviation from 'perfect' occlusion does not automatically default to an assessment of malocclusion. So, it sounds like the doctor is validating that you don't have perfect occlusion but the occlusion you have would not be considered malocclusion.
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I think what he's conveying is that a bite does not have to be perfect Class 1 to be 'ok' or functional. One of Wolford's proteges once told me that Class 1 does not necessarily convey perfect occlusion because there is class 1 malocclusion. Also, that Class 2 and Class 3 occlusion does not necessarily mean 'malocclusion' because there can be Class 2 and Class 3 occlusion where the occlusion is good.
Basically, a deviation from 'perfect' occlusion does not automatically default to an assessment of malocclusion. So, it sounds like the doctor is validating that you don't have perfect occlusion but the occlusion you have would not be considered malocclusion.
Yeah, exactly. It doesn’t mean the bite shouldn’t have been made better with the surgery since well, I’m going through this whole thing so may as well make the bite as perfect as possible. But it does mean the mild discrepancies don’t really have any functional significance, I guess.
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I consulted with Caminitti finally, he said it’s a minimal edge to edge bite on one side and he personally would be satisfied with this bite. He said he grades occlusion out of 5, and said he would give me a 5/5. When I pressed him on that he said okay fine 4.9/5.
He wouldn’t do a revision under any circumstances and advised me to stay away from anyone who he says they can improve my bite further. Although, again, he did say it was a bit edge on edge and a slight open bite on one side. But the bite itself occludes and meshes fine.
So it is what it is. I don’t think anyone would do a revision on me. I’m consulting one other surgeon.
Did he say anything regarding the stiffness, speech etc?
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Did he say anything regarding the stiffness, speech etc?
Said it’s nerve damage and that removing screws/ plates won’t do anything. He actually described the speech issue exactly as I had in a post here, trouble with m,b,p’s like in Bell’s palsy. Has to do with not feeling your lower lip, knowing it’s position, etc.