jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Mephala’s Razor on November 01, 2019, 06:01:33 PM
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Here is a video showing pictures of the surgery which look quite promising to me and like something that I could benefit from. The only problem is that the people in the video are younger teenagers whereas I am an adult. I know that generally the facial bones become less malleable with age, so I’m not sure if this would still be an effective aesthetic procedure at a later age. Thoughts on this?
(I don’t know how to imbed a video on here :()
https://youtu.be/7_AKD4SlfXA
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It won't as in highly unlikely it would since it's meant for use in GROWING STAGE. You can do a search on here as to others asking same/similar hopeful question,
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There was some clinic that advertised that they used it and claimed it worked in adults as well. When I researched it a bit and tried to understand what they actually do, it turned out they used it in combination with surgery. So they make a fracture, install the device and then it can work. Like these SARPE devices you see where they split the palate and turn a screw until it's enough. So if you want to use it as an adult it's still surgery. I think it's an interesting thought though, like braces for the jaws and you can direct and adjust while it heals.
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There was some clinic that advertised that they used it and claimed it worked in adults as well. When I researched it a bit and tried to understand what they actually do, it turned out they used it in combination with surgery. So they make a fracture, install the device and then it can work. Like these SARPE devices you see where they split the palate and turn a screw until it's enough. So if you want to use it as an adult it's still surgery. I think it's an interesting thought though, like braces for the jaws and you can direct and adjust while it heals.
BINGO! Those who market the IMDO never make clear to adults, past the growth stage, that for all intents and purposes the procedure ALONE is unlikely to work for them. Adult CURIOSITY and HOPE that it could is kind of 'bait' to make consult with doc/s who do it. Actual consult being OPPORTUNE time for them to suggest additional surgery in ADDITION.
I'd say better to know ahead of time whether or not one wants to waste time going to a consult to be told and sold additional surgery during the consult inquiry about IMDO 'only' for adults.
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Distraction is the new frontier and will one day make jaw surgery look barbaric. I'd have revision if they perfected it. The accuracy was not precise enough last I researched it, and I haven't seen or heard anything to say otherwise.
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Distraction is the new frontier and will one day make jaw surgery look barbaric. I'd have revision if they perfected it. The accuracy was not precise enough last I researched it, and I haven't seen or heard anything to say otherwise.
But don't they do similar adjustments with the elastics after surgery and try to pull it while they can?
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But don't they do similar adjustments with the elastics after surgery and try to pull it while they can?
I don’t think post-surgical elastics are for adjustment purposes. They’re to maintain the bite and prevent movement during the early healing phase.
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I don’t think post-surgical elastics are for adjustment purposes. They’re to maintain the bite and prevent movement during the early healing phase.
No, of course not with the purpose of moving. The jaws are put in the exact position they should be in and elastics to stabilise. But preventing movement also imply that they can move, and if they drift a bit and it's caught early enough, I meant that some strong elastics maybe can correct it. I don't know, it was more a question.
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No, of course not with the purpose of moving. The jaws are put in the exact position they should be in and elastics to stabilise. But preventing movement also imply that they can move, and if they drift a bit and it's caught early enough, I meant that some strong elastics maybe can correct it. I don't know, it was more a question.
Not totally sure if TADs (temporary anchorage devices) are also called 'elastics' or not. But the TADs use elastics. They are there to anchor things in place and they can also adjust as in move selected teeth if not in place even after a surgery. So, yes, preventing movement can also imply they can move teeth.
Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed. Ref=http://www.blankenaudentist.com/blog/post/anchors-make-all-the-difference-in-successful-orthodontic-treatment.html
eta: 'Adjustments' are in reverence to moving the teeth. Not really to the jaws.
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Hello everybody,
My name is Sergio González-Otero. I am a maxilofacial surgeon in Madrid, Spain. I have been reading these forums from time to time, but I have increased the frequency of my connections lately as I have found that these forums are useful for me to learn what short of questions and concerns people have so I can address them during my consultations. I have even contacted some users in private to answer some doubts, disclosing from the very beginning who I was. I am not a good marketer though, maybe too honest. I agree with a lot of patients experiences here regarding orthognathic surgery and the overwhelming marketing process they experience. I do not agree with some of the advices done by experienced users here, although I thing a lot of the times they are correct from a theoretical point of view.
This is my first post. I do not like public exposure but I feel I need to participate in this thread as I read some mistakes, that were also repeated in previous posts talking about IMDO.
First of all, I would like to disclose that through my learning process about the IMDO protocol and my close relation with Paul Coceancig I have become friends with him. Paul has never asked me for money and has given me a lot of surgical and diagnostic tips. He has also given me some marketing advices, for instance advised me to register IMDO term as a trademark for Spain, so I did it. He also asked me to teach IMDO following his way, and to share with him my experiences so he could improve the protocol. I must proudly say that as a result of my opinions he has been able to modify it a bit so IMDO is easier for less experienced surgeons.
I have seen him consulting and in the operating theatre and,in my humble opinion, he has a deep understanding of the airway and the aesthetic issues in orthognathic surgery. The only thing he has asked me to do in return is to try to follow his protocol precisely, to keep it updated, and not use "IMDO" term if it is not his protocol what I am doing. No money was asked in return, no "franchise" has been made as stated in other threads. I am in contact with other surgeons of the group and their experience is similar. It can be inferred from his YouTube videos he is very good at marketing and explaining his point of view about facial skeletal surgery and custom implants. Some prospective patients might not like it, but everybody is free to choose their surgeon and ask for second opinions, aren't they?
Disclosures done, I wanted to say the following:
It is also obvious, from his YouTube videos (the IMDO playlist today has more than 21 videos) and in a free PDF article you can download from Paul's Linkedin profile (and more information available online, it’s stated in my own website, although it's is only in Spanish) that IMDO is a surgical procedure, even for teenagers. Yes, it is jaw surgery. Yes, we operate from age 12. It is mandibular distraction, it is even in the name of the procedure, Intermolar Mandibular Distraction Osteogenesis. Nobody is saying this is not surgery, nobody is hiding anything. It is quite clear, I suppose. Maybe it is not specified in every video... I don't know... but it is not hidden information.
In my humble opinion, IMDO is THE way to increase the size of a small mandible. It works (and has almost the same limitations) in adults the same way it works in teeenagers, although the procedure is much easier, better tolerated and risks are lower within younger patients. And benefits are more if done at earlier ages, not only from a social point of view but also from a health point of view, as correcting earlier a skeletal class II (better said, mandibular hypoplasia) implies also an earlier correction of the airway, posture and TMJ disfunction risk related to this problem. We do not advise to do IMDO in patients over 40-45. A lot of times genioplasty is done along with IMDO. Sometimes IMDO is combined with surgical procedures in the upped jaw: the older the patient is, the more probability of requiring these done. In younger patients these procedures are not usually necessary, as we can expand the upper jaw without surgery, specially now with MARPE. Personally I advice to use MSE (Dr. Moon expander) even in kids, I am quite happy with its outcomes.
In my opinion, IMDO is better than BSSO for young adults with small mandibles wanting to get a better result, lower the risk of numbness/paraesthesia of the lower lip, chin and teeth, widen the mandible, have a perfect mandibular contour (no risk of palpable or even visible notches), avoid dental extractions because of having not enough bone for having all the teeth erupted and I never occlusion , widen the UPPER jaw more than with BSSO, but of course, also willing to accept its postops (plural, as we must remove the distractors, that is another procedure), other risks, maybe other procedures and, of course, its costs.
By the way, while searching "IMDO" in these forums I have found a previous message saying that Paul Coceancig wrote in these forums under a fake account. I have spoken with him about it and he swears he has never done that and in fact he is hurt about those apparently false accusations.
Kind regards.
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Sergio, Thank you for posting your experience. I appreciate your participation in this, as IMDO is a bit of an enigma to me.
I would like to start by saying i've personally had a negative experience interacting with Dr. Coceancig on one of the facebook maxillofacial surgery boards. At the time I was considering having him IMDO me and that experience had him knocked off my list.
MARPE - Microimplant assisted rapid palate expansion, developed by Dr. Won Moon at UCLA has shown excellent results in maxillary expansion and subsequent airway expansion. Is that what is used in conjunction with IMDO to balance the midface? Is there no Maxillary or Midface Distraction technique?
In an interview with Arnett and Gunson, Dr. Dipak Chudasama asked: Do you believe skeletal distraction can replace some orthognathic surgeries?
Dr Gunson Responded: Distraction osteogenesis, in our opinion, will not substitute for conventional orthognathic surgery. Well-done orthognathic surgery with rigid fixation produces occlusal, facial, and airway results that are the gold standard. Distraction osteogenesis does not, and will not, treat the bite in three planes of space with the same quality and precision as conventional, well-done orthognathic surgery. When thinking of distraction, we must realize its limitations. Establishment of precise vectors for distraction is exceedingly difficult. Moving a complex object such as the mandible to within 1mm of accuracy is a veritable impossibility with distraction. There are also severe limits on achieving final occlusion compared with traditional orthognathic surgery. What are the valid clinical reasons to avoid the Le Fort I and sagittal osteotomies in favor of distraction? Previously held beliefs that distraction was kinder to nerve and joint tissues have been proved false. We must be careful not to lower our standards for the sake of using new technology. Distraction does have clinical relevance when trying to correct large deformities in skeletally immature patients. Treacher-Collins patients often require early intervention to improve airway patency, and distraction can provide this. Severe hemifacial microsomia patients might also require distraction to increase the skeletal mass and structure in the condyle and ramus areas so that future orthognathic surgery can be successful.
Based on your post, Id imagines you'd hold a somewhat contrary point of view, so I would like to hear your take on this statement.
Thanks.
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Well, you certainly do sound like an apologist for him. As the mod of this board, I'll say he participated under the name 'ortho expert' or something to that effect. Account out of his part of Australia with constant links to 'Profilo' videos. A poster called 'ortho expert' posting links to Profilo and posting from his part of Australia was sufficient enough. Unlike you, he didn't disclose his affiliation to himself or to Profilo. But good if you learned a lesson not to present as he did and disclosing which IMDO maxfax you are.
His IMDO videos are full of subterfuge, not making it quite clear that IMDO is best aimed during GROWTH STAGE. Hopes of it working as an isolated procedure is what brings in the consults about it. Fat chance adult consults about it will resolve in option for IMDO 'only' as can be offered to kids, adolescents, teens in growing stages in the absence of additional surgeries to go with it .
You say IMDO is better for 'young adults', less risks than BSSO. Well ya, less risk than needing to get a BSSO in later life for jaw retrusion when the GROWTH STAGE has passed. So, what's a 'young adult' and why not use the term 'during GROWTH STAGE' instead? Term 'young adult' avoids using terms like 'teen' where it's just clearer they are in growth stage.
You admit, younger people as those in the GROWTH STAGE will get more out of this and those past that can have it with OTHER surgeries. But consider, this board's main population is OVER 18, past the growth stage and for the most part curiosity about IMDO is with hope they can have this as SOLE procedure. So, I tell them it's highly unlikely someone in their 20's or so will be offered the IMDO INSTEAD of a BSSO and the consult they go on hoping they can get that only (as a kid could) will resolve to being suggested OTHER surgeries.
So, tell me, how likely is it that say a 20 year old or someone passed the growth stage wanting say, a 5-7 mm advancement will be offered by you and your associates IMDO only? OK, you could say, it depends. So straight out, what percentage of ADULTS, those PAST the growth stage are given IMDO only?
Now again the board is aimed at at least over 18. But better if they are over 20. They are not candidates for the max benefits IMDO yields to those in the growth stage. So, my question as the mod (and the one who critiques your associate) is: 'Shouldn't these ADULTS past the GROWTH STAGE be told IMDO as sole procedure to advance jaw is unlikely to be the 'fix' for them as it would be for a kid?' Well I don't see the IMDO promoters telling them straight out. Telling them straight out would cut down the consults about them when those consults could lead to telling them they need other surgeries either instead or with and all because the HOPE of IMDO ONLY is used as kind of a marketing carrot.
Now IF this were a board where PARENTS of CHILDREN were the main population, then IMDO as sole procedure in early growth stages INSTEAD of EXTRACTIONS to push in their faces to get 'bite right' would be fine. They certainly would not be told to have their kids get extractions and their faces pushed backwards instead of IMDO. But again this a board of population too late to have IMDO only. I just don't think that the lure of imdo 'only' --and they do think it's a possibility when they read marketing material that doesn't tell them straight out it's mostly beneficial for those in growth stages, ie children, adolescents and teens--should be used for consults where the consults are going to suggest other surgeries.
Then we've had posters on here saying they consulted with an Australian doctor and they relay he scared them by telling them they 'needed' this or that and if they didn't have the procedures suggested there could be health consequences. Although they avoided naming the doctor, I guessed it right who it was.
Then the TRADEMARK procedure doesn't sit right with me. I have more respect for doctors who share technique in medical venue than those who TRADEMARK it. This is something OTHER doctors COULD do but if they use the term; 'IMDO', he's got a TM on it. So, unlike a 'BSSO' or a 'Lefort' or most other procedures in maxfax that are NOT trademarked, this guy has a trademark on his. A trademark is to BRAND. So inquiries and discussions about 'imdo' resolve to giving exposure to his brand. Posters don't realize this is a TRADEMARK thing because it sounds like a generic procedure. He's certainly entitled to trademark his procedure and pose what ever contingencies he wants to others who agree to his terms in exchange for calling what they do; 'IMDO'. But JFS doesn't want to be positioned to be a defacto 'brand buzzer' when the term 'imdo' is used. Imagine if someone trademarked the term; 'BSSO'. Thankfully, 'BSSO' is not trademarked. Each time the term is used, it's effectively a 'buzz' for his brand and given the history of his introduction and participation here why should JSF be defacto brand reps for him .
That said, in your opinion, what would be a good GENERIC term for a procedure that does the same thing that a variety of doctors could do WITHOUT using the trademark name?
To bad you never participated on any of the threads that were very informative. Just on this guy's.
Hello everybody,
My name is Sergio González-Otero. I am a maxilofacial surgeon in Madrid, Spain. I have been reading these forums from time to time, but I have increased the frequency of my connections lately as I have found that these forums are useful for me to learn what short of questions and concerns people have so I can address them during my consultations. I have even contacted some users in private to answer some doubts, disclosing from the very beginning who I was. I am not a good marketer though, maybe too honest. I agree with a lot of patients experiences here regarding orthognathic surgery and the overwhelming marketing process they experience. I do not agree with some of the advices done by experienced users here, although I thing a lot of the times they are correct from a theoretical point of view.
This is my first post. I do not like public exposure but I feel I need to participate in this thread as I read some mistakes, that were also repeated in previous posts talking about IMDO.
First of all, I would like to disclose that through my learning process about the IMDO protocol and my close relation with Paul Coceancig I have become friends with him. Paul has never asked me for money and has given me a lot of surgical and diagnostic tips. He has also given me some marketing advices, for instance advised me to register IMDO term as a trademark for Spain, so I did it. He also asked me to teach IMDO following his way, and to share with him my experiences so he could improve the protocol. I must proudly say that as a result of my opinions he has been able to modify it a bit so IMDO is easier for less experienced surgeons.
I have seen him consulting and in the operating theatre and,in my humble opinion, he has a deep understanding of the airway and the aesthetic issues in orthognathic surgery. The only thing he has asked me to do in return is to try to follow his protocol precisely, to keep it updated, and not use "IMDO" term if it is not his protocol what I am doing. No money was asked in return, no "franchise" has been made as stated in other threads. I am in contact with other surgeons of the group and their experience is similar. It can be inferred from his YouTube videos he is very good at marketing and explaining his point of view about facial skeletal surgery and custom implants. Some prospective patients might not like it, but everybody is free to choose their surgeon and ask for second opinions, aren't they?
Disclosures done, I wanted to say the following:
It is also obvious, from his YouTube videos (the IMDO playlist today has more than 21 videos) and in a free PDF article you can download from Paul's Linkedin profile (and more information available online, it’s stated in my own website, although it's is only in Spanish) that IMDO is a surgical procedure, even for teenagers. Yes, it is jaw surgery. Yes, we operate from age 12. It is mandibular distraction, it is even in the name of the procedure, Intermolar Mandibular Distraction Osteogenesis. Nobody is saying this is not surgery, nobody is hiding anything. It is quite clear, I suppose. Maybe it is not specified in every video... I don't know... but it is not hidden information.
In my humble opinion, IMDO is THE way to increase the size of a small mandible. It works (and has almost the same limitations) in adults the same way it works in teeenagers, although the procedure is much easier, better tolerated and risks are lower within younger patients. And benefits are more if done at earlier ages, not only from a social point of view but also from a health point of view, as correcting earlier a skeletal class II (better said, mandibular hypoplasia) implies also an earlier correction of the airway, posture and TMJ disfunction risk related to this problem. We do not advise to do IMDO in patients over 40-45. A lot of times genioplasty is done along with IMDO. Sometimes IMDO is combined with surgical procedures in the upped jaw: the older the patient is, the more probability of requiring these done. In younger patients these procedures are not usually necessary, as we can expand the upper jaw without surgery, specially now with MARPE. Personally I advice to use MSE (Dr. Moon expander) even in kids, I am quite happy with its outcomes.
In my opinion, IMDO is better than BSSO for young adults with small mandibles wanting to get a better result, lower the risk of numbness/paraesthesia of the lower lip, chin and teeth, widen the mandible, have a perfect mandibular contour (no risk of palpable or even visible notches), avoid dental extractions because of having not enough bone for having all the teeth erupted and I never occlusion , widen the UPPER jaw more than with BSSO, but of course, also willing to accept its postops (plural, as we must remove the distractors, that is another procedure), other risks, maybe other procedures and, of course, its costs.
By the way, while searching "IMDO" in these forums I have found a previous message saying that Paul Coceancig wrote in these forums under a fake account. I have spoken with him about it and he swears he has never done that and in fact he is hurt about those apparently false accusations.
Kind regards.
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Distraction does have clinical relevance when trying to correct large deformities in skeletally immature patients. Treacher-Collins patients often require early intervention to improve airway patency, and distraction can provide this. Severe hemifacial microsomia patients might also require distraction to increase the skeletal mass and structure in the condyle and ramus areas so that future orthognathic surgery can be successful.
Based on your post, Id imagines you'd hold a somewhat contrary point of view, so I would like to hear your take on this statement.
Thanks.
That's the 'straight out' of it; in skeletally immature patients, ie those still in the GROWTH STAGE. Something to do for those too young to have a maxfax surgery (best done AFTER the growth stage). If these IMDO guys disagreed with the straight out of it, they would tell you straight out that IMDO can be done instead of bimax (or full orthognathic surgery) in FULL GROWN ADULTS. But they just drop implications of hope where the hopeful end up getting suggested the full orthgnathic surgery when lured by possibility of IMDO only.
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Not totally sure if TADs (temporary anchorage devices) are also called 'elastics' or not. But the TADs use elastics. They are there to anchor things in place and they can also adjust as in move selected teeth if not in place even after a surgery. So, yes, preventing movement can also imply they can move teeth.
Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed. Ref=http://www.blankenaudentist.com/blog/post/anchors-make-all-the-difference-in-successful-orthodontic-treatment.html
eta: 'Adjustments' are in reverence to moving the teeth. Not really to the jaws.
My question was regarding movement of the jaws. If there is some elasticity in the fractured spots that can be pulled before it's settling.
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Hello everybody,
My name is Sergio González-Otero. I am a maxilofacial surgeon in Madrid, Spain. I have been reading these forums from time to time, but I have increased the frequency of my connections lately as I have found that these forums are useful for me to learn what short of questions and concerns people have so I can address them during my consultations. I have even contacted some users in private to answer some doubts, disclosing from the very beginning who I was. I am not a good marketer though, maybe too honest. I agree with a lot of patients experiences here regarding orthognathic surgery and the overwhelming marketing process they experience. I do not agree with some of the advices done by experienced users here, although I thing a lot of the times they are correct from a theoretical point of view.
This is my first post. I do not like public exposure but I feel I need to participate in this thread as I read some mistakes, that were also repeated in previous posts talking about IMDO.
First of all, I would like to disclose that through my learning process about the IMDO protocol and my close relation with Paul Coceancig I have become friends with him. Paul has never asked me for money and has given me a lot of surgical and diagnostic tips. He has also given me some marketing advices, for instance advised me to register IMDO term as a trademark for Spain, so I did it. He also asked me to teach IMDO following his way, and to share with him my experiences so he could improve the protocol. I must proudly say that as a result of my opinions he has been able to modify it a bit so IMDO is easier for less experienced surgeons.
I have seen him consulting and in the operating theatre and,in my humble opinion, he has a deep understanding of the airway and the aesthetic issues in orthognathic surgery. The only thing he has asked me to do in return is to try to follow his protocol precisely, to keep it updated, and not use "IMDO" term if it is not his protocol what I am doing. No money was asked in return, no "franchise" has been made as stated in other threads. I am in contact with other surgeons of the group and their experience is similar. It can be inferred from his YouTube videos he is very good at marketing and explaining his point of view about facial skeletal surgery and custom implants. Some prospective patients might not like it, but everybody is free to choose their surgeon and ask for second opinions, aren't they?
Disclosures done, I wanted to say the following:
It is also obvious, from his YouTube videos (the IMDO playlist today has more than 21 videos) and in a free PDF article you can download from Paul's Linkedin profile (and more information available online, it’s stated in my own website, although it's is only in Spanish) that IMDO is a surgical procedure, even for teenagers. Yes, it is jaw surgery. Yes, we operate from age 12. It is mandibular distraction, it is even in the name of the procedure, Intermolar Mandibular Distraction Osteogenesis. Nobody is saying this is not surgery, nobody is hiding anything. It is quite clear, I suppose. Maybe it is not specified in every video... I don't know... but it is not hidden information.
In my humble opinion, IMDO is THE way to increase the size of a small mandible. It works (and has almost the same limitations) in adults the same way it works in teeenagers, although the procedure is much easier, better tolerated and risks are lower within younger patients. And benefits are more if done at earlier ages, not only from a social point of view but also from a health point of view, as correcting earlier a skeletal class II (better said, mandibular hypoplasia) implies also an earlier correction of the airway, posture and TMJ disfunction risk related to this problem. We do not advise to do IMDO in patients over 40-45. A lot of times genioplasty is done along with IMDO. Sometimes IMDO is combined with surgical procedures in the upped jaw: the older the patient is, the more probability of requiring these done. In younger patients these procedures are not usually necessary, as we can expand the upper jaw without surgery, specially now with MARPE. Personally I advice to use MSE (Dr. Moon expander) even in kids, I am quite happy with its outcomes.
In my opinion, IMDO is better than BSSO for young adults with small mandibles wanting to get a better result, lower the risk of numbness/paraesthesia of the lower lip, chin and teeth, widen the mandible, have a perfect mandibular contour (no risk of palpable or even visible notches), avoid dental extractions because of having not enough bone for having all the teeth erupted and I never occlusion , widen the UPPER jaw more than with BSSO, but of course, also willing to accept its postops (plural, as we must remove the distractors, that is another procedure), other risks, maybe other procedures and, of course, its costs.
By the way, while searching "IMDO" in these forums I have found a previous message saying that Paul Coceancig wrote in these forums under a fake account. I have spoken with him about it and he swears he has never done that and in fact he is hurt about those apparently false accusations.
Kind regards.
Well, fact is that there is a lot of people confused about IMDO. First time I read about it, it seemed like a non surgical procedure and it was not obvious to find this information, even though it's of course obvious for the one doing the surgery. It's also not obvious what the actual surgery is and how it differs from the fracture you do with BSSO. Can you tell us the technical difference in the cut you make for the IMDO™️? Because if you want to separate a bone you need to fracture it, and how can we understand the difference in this fracture compared to BSSO and why it's better?
I also agree with Kavan on the nonsense of trade marking a procedure, making it harder to do research on and hindering it to be evaluated by other surgeons.
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My question was regarding movement of the jaws. If there is some elasticity in the fractured spots that can be pulled before it's settling.
Yes, I saw on your other post your question was regarding movement of the jaws. But also that people were referring to the use of 'elastics' to prevent movement of the jaws. So since one of your posts referred to moving something, my post referred to the same devices that used elastics (TADs) in reference to moving the TEETH. That is to say they can use those things for fine tuning the bite past surgery; adjustments with reference to moving the teeth.
Now with reference to 'elastics' NOT moving the jaws, I think these 'elastics' people are referring to are the TADs. Since they are ANCHORAGE devices, they are used to anchor down the bite (assuming the bite comes out right post surgery) so the jaws stay in place. So, they don't move jaws nor are they aimed at moving the jaws.
To the best of my knowledge, the TADs used to anchor down a right bite post surgery so the jaws DON'T move can also be used to move selected teeth to fine tune the bite. They ANCHOR down teeth not wanted to be moved so selected teeth can be moved.
The whole point of my entry depends on whether what people are calling 'elastics' are the TADs. If so, then they are used to ANCHOR the jaw in place by anchoring the bite so the jaws and/or they can be used to make fine tune adjustments to certain teeth without moving the other ones.
So, if they are referring to TADs and to TADs when the post surgery bite is right, they are used to ANCHOR down the bite so the jaws DON'T move. But to the best of my knowledge not used to move the jaws.
I also had CONFUSION via reference to 'elastics's and just wanted to clarify that if they are talking about the TADs, the MOVEMENT they refer to is either movement of selective teeth to fine tune/adjust OR to PREVENT movement of jaws post surgery. They are not aimed at moving the jaws. With reference to TADs, the only movement they would refer to is movement of selected teeth so the others stay in place.
So the DEVICES aimed at non movement also have capacity to move SOMETHING. But the 'something' the devices are aimed at moving (if that's needed post surgery) is selected TEETH. Not the jaws. With reference to 'movement' of the jaws, the devices are aimed at NON MOVEMENT of them.
All I wanted to add here was what devices WITH ELASTICS are called; TADs which can be aimed at anchoring down so the jaws stay in place or aimed at moving selected teeth into place while anchoring the other teeth so the other teeth don't move.
I can't actually answer the question about 'elasticity' of the 'fractured spot' with any reference to devices aimed 'pulling' the jaws 'before things settle'.
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Well, fact is that there is a lot of people confused about IMDO. First time I read about it, it seemed like a non surgical procedure and it was not obvious to find this information, even though it's of course obvious for the one doing the surgery. It's also not obvious what the actual surgery is and how it differs from the fracture you do with BSSO. Can you tell us the technical difference in the cut you make for the IMDO™️? Because if you want to separate a bone you need to fracture it, and how can we understand the difference in this fracture compared to BSSO and why it's better?
I also agree with Kavan on the nonsense of trade marking a procedure, making it harder to do research on and hindering it to be evaluated by other surgeons.
CORRECT. The act of TRADEMARKING a term where within the TMed term is; 'Distraction Osteogenisis', (DO), IMO resolves to act of APPROPRIATING a term for procedures already in the public/scientific venue into one's trademark. This, in turn, results in posters equating or confusing DO with the TRADEMARK term; 'IMDO'. Because they see the TRADEMARK term that includes the term; 'DO', ask about that and then post LINKS to the practice of the OWNER of that TM. So, the act of TMing something with the term 'DO' in it often resolves to discussion about the TM term. That, in turn, positions JSF to provide a type of involuntary advertising exposure to the owners and practitioners associated with this TM each time a poster inquires about 'DO' with the PREFIX of 'IM' attached to it. Hence to acknowledge the TM term; 'IMDO' positions us to be defacto promoters of it if we DON'T critique how it's used and then confused in the act of marketing.
Straight out: A TM term is a financially motivated term for the purpose of branding. JSF would prefer that discussion of DO resolve to sources where the term 'DO' is NOT part of a TM term. For that reason:
I am offering links to some articles on DO because JSF often get inquiries about a TRADE MARK procedure that has within it 'DO'. JSF and mods thereof feel that posters in pursuit of information about DO (as it applies to moving the mandible) are better served by referring them to NON financially motivated academic sources that openly contribute to the scientific information to this venue than to those who appropriate the the term 'DO' into a TRADEMARK procedure for business branding.
"Distraction Osteogenesis of the Ascending
Ramus for Mandibular Hypoplasia
Using Extraoral or Intraoral Devices:
A Report of 8 Cases
Pilar Rubio-Bueno, MD, PhD,* Alicia Padro´n, MD,†
Esther Villa, MD,‡ and Francisco J. Dı´az-Gonza´lez, MD, PhD§"
https://s3-eu-west-1.amazonaws.com/hsd-sites/maaxilo/publicaciones/rubio_bueno_2000_mandibular_distraction_osteogenesis.pdf
-----
Intraoral mandibular distraction osteogenesis: special attention to
treatment planning
Pilar Rubio-Bueno,1 Esther Villa,2 Alberto Carren˜o,2 Luis Naval,1 Jesu´ s Sastre,1 Rafael Manzanares,3
Francisco J Dı´az-Gonza´lez1
1
Department of Oral and Maxillofacial Surgery (Head: FJ Dı´az-Gonza´lez, MD, PhD); 2
Department of
Orthodontics (Head: FJ Dı´az-Gonza´lez, MD, PhD); 3
Department of Radiology (Head: D. Tagarro, MD,
PhD) Hospital Universitario de la Princesa, Madrid, Spain
http://www.sld.cu/galerias/pdf/sitios/cirugiamaxilo/do_planificacion_del_tratamiento.pdf
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Hi, I will try to write a single message. After reading some messages I felt like I was not qualified to participate in this forum (put it politely).
I will try to follow an order and I will start from a message posted previously to my first one. I hope I don't make any mistakes as I am editing the message separately.
But don't they do similar adjustments with the elastics after surgery and try to pull it while they can?
Those adjustments are done sometimes. This is normally called "floating bone" technique or concept. Widely used in other techniques of mandibular and maxillary distraction. And even after conventional orthognathic surgery, after a 3 piece Le Fort, the central part (the premaxilla) can be managed that way by the orthodontist. This requires not to place a final split (or remove it early, after a few days) and choose other method of transverse stabilisation.
Sergio, Thank you for posting your experience. I appreciate your participation in this, as IMDO is a bit of an enigma to me.
Thank you for your words. I will try to help. IMDO can be a little bit difficult to be understood, even for experienced surgeons. It is always difficult to think outside the box.
I would like to start by saying i've personally had a negative experience interacting with Dr. Coceancig on one of the facebook maxillofacial surgery boards. At the time I was considering having him IMDO me and that experience had him knocked off my list.
I understand perfectly, and I am sure you did the right thing. It is important that both patient and surgeon are on the same wavelength.
MARPE - Microimplant assisted rapid palate expansion, developed by Dr. Won Moon at UCLA has shown excellent results in maxillary expansion and subsequent airway expansion. Is that what is used in conjunction with IMDO to balance the midface? Is there no Maxillary or Midface Distraction technique?
I think the device developed by the UCLA team led my Won Moon is the MSE. Maybe MARPE concept precedes Moon work? Anyway, it is not an important thing, it's just a detail.
MSE type-2 is the one I prefer to use in the few cases I am doing. Other surgeons use other expanders or do a SARPE in adult patients.
To answer your question please see the following short video: https://youtu.be/pTiL4g8PEv0?t=2 (https://youtu.be/pTiL4g8PEv0?t=2) Maxillary expansion is part of the protocol. In fact, with MSE (and I am sure other devices) it is a transverse non-surgical midfacial distraction.
But I suppose you also want to ask about the forward movement of the upper jaw. Yes, we need overjet. If there is no overjet that should be addressed (before or simultaneously). It means proclining the upper teeth or accepting to have a Le Fort I done.
In an interview with Arnett and Gunson, Dr. Dipak Chudasama asked: Do you believe skeletal distraction can replace some orthognathic surgeries?
Dr Gunson Responded: Distraction osteogenesis, in our opinion, will not substitute for conventional orthognathic surgery. Well-done orthognathic surgery with rigid fixation produces occlusal, facial, and airway results that are the gold standard. Distraction osteogenesis does not, and will not, treat the bite in three planes of space with the same quality and precision as conventional, well-done orthognathic surgery. When thinking of distraction, we must realize its limitations. Establishment of precise vectors for distraction is exceedingly difficult. Moving a complex object such as the mandible to within 1mm of accuracy is a veritable impossibility with distraction. There are also severe limits on achieving final occlusion compared with traditional orthognathic surgery. What are the valid clinical reasons to avoid the Le Fort I and sagittal osteotomies in favor of distraction? Previously held beliefs that distraction was kinder to nerve and joint tissues have been proved false. We must be careful not to lower our standards for the sake of using new technology. Distraction does have clinical relevance when trying to correct large deformities in skeletally immature patients. Treacher-Collins patients often require early intervention to improve airway patency, and distraction can provide this. Severe hemifacial microsomia patients might also require distraction to increase the skeletal mass and structure in the condyle and ramus areas so that future orthognathic surgery can be successful.
Based on your post, Id imagines you'd hold a somewhat contrary point of view, so I would like to hear your take on this statement.
Thanks.
I agree with Dr. Gunson almost completely. Distraction osteogenesis has its limitations, even if done as an inter molar osteotomy (trademarked or not), as a ramus distraction or as any other distraction technique. But so do BSSO, MMA and CCW have limitations and risks. All of them are tools in the surgeon's armamentarium.
For instance, the larger the osteotomy gap of the BSSO, the higher the risk of relapse (and the larger the relapse). Not only due to the instability of the osteosynthesis but also because of the risk of condylar resorption. Several authors recommend to consider the use of distraction if the planned gap is larger than 7 mm because of the long term relapse after BSSO in those advancements. Soft tissues (skin, muscles) adapt better with distraction.
What I do not agree with him is on the assumed statement that BSSO has to be accepted as the gold standard for every patient.
No, of course not with the purpose of moving. The jaws are put in the exact position they should be in and elastics to stabilise. But preventing movement also imply that they can move, and if they drift a bit and it's caught early enough, I meant that some strong elastics maybe can correct it. I don't know, it was more a question.
Precisely.
His IMDO videos are full of subterfuge, not making it quite clear that IMDO is best aimed during GROWTH STAGE. Hopes of it working as an isolated procedure is what brings in the consults about it. Fat chance adult consults about it will resolve in option for IMDO 'only' as can be offered to kids, adolescents, teens in growing stages in the absence of additional surgeries to go with it .
Hello kavan.
Well, maybe to me it is was not that way due to my background. I never felt that way while watching those videos.
I have personally seen Paul removing distractors from a 28 year old female. And another friend of ours recently did an IMDO on a 40 year old female as a sole procedure, successfully. IMDO is a type of surgery-first procedure. Orthodontics has to continue afterwards. But that's planned from the very beginning. And sometimes more procedures are planned, specially in adult patients.
His IMDO videos are full of subterfuge, not making it quite clear that IMDO is best aimed during GROWTH STAGE.
Please see the first seconds of this one, from the same playlist: https://www.youtube.com/watch?v=chU4ImyeZl8&list=PLjC4hIwmyQfjXgckxslgVI9BPkh6wcv-a&index=12 (https://www.youtube.com/watch?v=chU4ImyeZl8&list=PLjC4hIwmyQfjXgckxslgVI9BPkh6wcv-a&index=12)
You say IMDO is better for 'young adults', less risks than BSSO. Well ya, less risk than needing to get a BSSO in later life for jaw retrusion when the GROWTH STAGE has passed. So, what's a 'young adult' and why not use the term 'during GROWTH STAGE' instead? Term 'young adult' avoids using terms like 'teen' where it's just clearer they are in growth stage.
Young adults would be anybody under 35, but willing to accept the other inconveniences, risks and costs.
You admit, younger people as those in the GROWTH STAGE will get more out of this and those past that can have it with OTHER surgeries. But consider, this board's main population is OVER 18, past the growth stage and for the most part curiosity about IMDO is with hope they can have this as SOLE procedure. So, I tell them it's highly unlikely someone in their 20's or so will be offered the IMDO INSTEAD of a BSSO and the consult they go on hoping they can get that only (as a kid could) will resolve to being suggested OTHER surgeries.
That's what I am trying to clarify here.
So, tell me, how likely is it that say a 20 year old or someone passed the growth stage wanting say, a 5-7 mm advancement will be offered by you and your associates IMDO only? OK, you could say, it depends. So straight out, what percentage of ADULTS, those PAST the growth stage are given IMDO only?
There is a need to address the maxilla. And we need the overjet. Given a good candidate, this procedure could be offered as a sole procedure.
Now again the board is aimed at at least over 18. But better if they are over 20.
Sorry, I did not know that this forum was for discussing adult surgery only. maybe you could change the domain name? ;D just kidding ;)
They are not candidates for the max benefits IMDO yields to those in the growth stage. So, my question as the mod (and the one who critiques your associate) is: 'Shouldn't these ADULTS past the GROWTH STAGE be told IMDO as sole procedure to advance jaw is unlikely to be the 'fix' for them as it would be for a kid?' Well I don't see the IMDO promoters telling them straight out. Telling them straight out would cut down the consults about them when those consults could lead to telling them they need other surgeries either instead or with and all because the HOPE of IMDO ONLY is used as kind of a marketing carrot.
I think you have made your point clear. But to the best of my understanding nobody has said these things. As I told you, the IMDO playlist on YouTube is quite clear what the perfect candidate would be. And it also even explains the surgical technique!
Then the TRADEMARK procedure doesn't sit right with me. I have more respect for doctors who share technique in medical venue than those who TRADEMARK it. This is something OTHER doctors COULD do but if they use the term; 'IMDO', he's got a TM on it. So, unlike a 'BSSO' or a 'Lefort' or most other procedures in maxfax that are NOT trademarked, this guy has a trademark on his. A trademark is to BRAND. So inquiries and discussions about 'imdo' resolve to giving exposure to his brand. Posters don't realize this is a TRADEMARK thing because it sounds like a generic procedure. He's certainly entitled to trademark his procedure and pose what ever contingencies he wants to others who agree to his terms in exchange for calling what they do; 'IMDO'. But JFS doesn't want to be positioned to be a defacto 'brand buzzer' when the term 'imdo' is used. Imagine if someone trademarked the term; 'BSSO'. Thankfully, 'BSSO' is not trademarked. Each time the term is used, it's effectively a 'buzz' for his brand and given the history of his introduction and participation here why should JSF be defacto brand reps for him .
That said, in your opinion, what would be a good GENERIC term for a procedure that does the same thing that a variety of doctors could do WITHOUT using the trademark name?
Trademarks are not patents, as you know (besides, surgical techniques cannot be patented). There are other surgeons there doing this procedure. What we want is to protect an image. Everybody knows what a Big Mac is no matter the country, right? We also do not want manufacturers to use the four IMDO letters as a brand without our permission to sell things.
To bad you never participated on any of the threads that were very informative. Just on this guy's.
Well I had more important things to do, no offense intended. And I think patients need places to communicate, kind of support groups away from surgeons and all the aggressive marketing being done all around. I was not sure if participating on this thread but I felt I had to do it as detected some wrong assumptions that could be clarified. Dr. Google is not always right!
Well, fact is that there is a lot of people confused about IMDO. First time I read about it, it seemed like a non surgical procedure and it was not obvious to find this information, even though it's of course obvious for the one doing the surgery. It's also not obvious what the actual surgery is and how it differs from the fracture you do with BSSO. Can you tell us the technical difference in the cut you make for the IMDO™️? Because if you want to separate a bone you need to fracture it, and how can we understand the difference in this fracture compared to BSSO and why it's better?
Please have a look a two minutes of this video, starting at that precise point: https://youtu.be/YgWnUDQRlTs?t=1370 I hope it helps. And watch any BSSO video, I think you will see the difference. I will gladly answer you doubts after you watch it.
I also agree with Kavan on the nonsense of trade marking a procedure, making it harder to do research on and hindering it to be evaluated by other surgeons.
I think statements like kavan's about trademarking are based on wrong premises on trademarks and patents. I am not a lawyer, though, I am just a surgeon.
It does not hinder any one to research or publish, nor it prevents anyone to try to do the procedure. It's only a way to say who we are. Call it a badge for a study club or treehouse friends club if you like, where we agree to follow the same protocol, share experiences, back each other and learn together for the good of our patients.
I hope everything is clearer now. Anyway, I've got the feeling that my words won't matter much ;D
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Great to see a surgeon participating in discussions. I would like to see that more often, but I would understand surgeons don't want to post here under there actual name. On the other hand, it would be great if surgeons would share their knowledge openly, online. Many surgeons could learn from eachother, i have the feeling there isn't much communication between surgeons.
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Thank you Sergio for addressing our questions and sharing your experience. Its extremely valuable to us and to the body of information available to the public regarding these procedures to have a clinician step in and clarify or explain certain concepts. I see it as a great service to the public.
I enjoyed reading your thoughts on the topic and would encourage you to continue to contribute in any way you feel appropriate.
There's an interesting dynamic nowadays between clinical practitioners and the public due to the access to information phenomena presented by the internet (places like this board as well). I can understand why they are generally hesitant to post. On the public side, we have such a vast and ever-evolving body of knowledge available to us, that no clinician could ever possibly keep up with all the latest research and papers coming out of universities around the world. On the clinician's side, they have the practical EXPERIENCE and APPLIED KNOWLEDGE which no amount of research and reading papers online could ever give. It creates a disparity between "the research shows..." and "In my clinical experience...".
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Sergio,
Is IMDO purely linear? Can it be used to achieve CCW rotation?
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Sergio, I just want to say thank you for taking time and sharing your insights here.
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Great to see a surgeon participating in discussions. I would like to see that more often.
There are several who read here. In the past several posted.
Sergio, is there any major, active research taking place to advance distraction so it's as accurate as traditional surgery? If so, who is doing it? If not, why aren't huge research grants/funds being allocated to this? Patients would want distraction over traditional surgery. Do you think it ever becomes the gold standard, and if so, how long out is that?
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There are several who read here. In the past several posted.
Sergio, is there any major, active research taking place to advance distraction so it's as accurate as traditional surgery? If so, who is doing it? If not, why aren't huge research grants/funds being allocated to this? Patients would want distraction over traditional surgery. Do you think it ever becomes the gold standard, and if so, how long out is that?
One surgeon I talked to told me he did quite a lot with my surgeon (of all people) about 20 years ago. He said you basically end up with multiple surgeries instead of one and it can get complicated for non-linear movements. So they reserve it for syndromal cases where movements must be huge.
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One surgeon I talked to told me he did quite a lot with my surgeon (of all people) about 20 years ago. He said you basically end up with multiple surgeries instead of one and it can get complicated for non-linear movements. So they reserve it for syndromal cases where movements must be huge.
Yeah.
I'd like to know when that will all change and they figure out how to move in all planes with accuracy. This should be getting the majority of research money.
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Great to see a surgeon participating in discussions. I would like to see that more often, but I would understand surgeons don't want to post here under there actual name.
I think anybody giving medical advice should use their real name.
On the other hand, it would be great if surgeons would share their knowledge openly, online. Many surgeons could learn from eachother, i have the feeling there isn't much communication between surgeons.
I think you are probably right. Multiple reasons for that. Congresses and symposia are mainly places to show off, especially in some subspecialties where money (the future of your practice, employees, and your family) can be at stake. It is difficult to choose to really train your competitors. Besides, competitors maybe do not want to be trained, accept the protocol or they might not be skilled surgeons! Every surgeon thinks that they are better and when we learn something new we always try to adapt it to our own previous beliefs and conceptions of the problem. And materials and instruments are a problem, too. We think we can do the same technique with the sutures or instruments we already have (unless it becomes pretty obvious that it can't be done... I mean nobody is going to do laser surgery with no laser... but might try to use another machine like a Bovie). And we don't like to be told what to do. We are always the best, always right, everybody else is wrong. This does not happen only in surgery, though... Orthodontics is even worse.
Thank you Sergio for addressing our questions and sharing your experience. Its extremely valuable to us and to the body of information available to the public regarding these procedures to have a clinician step in and clarify or explain certain concepts. I see it as a great service to the public.
I enjoyed reading your thoughts on the topic and would encourage you to continue to contribute in any way you feel appropriate.
Thank you, I will re-read these words when I need to read them.
There's an interesting dynamic nowadays between clinical practitioners and the public due to the access to information phenomena presented by the internet (places like this board as well). I can understand why they are generally hesitant to post. On the public side, we have such a vast and ever-evolving body of knowledge available to us, that no clinician could ever possibly keep up with all the latest research and papers coming out of universities around the world. On the clinician's side, they have the practical EXPERIENCE and APPLIED KNOWLEDGE which no amount of research and reading papers online could ever give. It creates a disparity between "the research shows..." and "In my clinical experience...".
Research in surgery is very very difficult, this is not like testing a vaccine or a new drug. No control groups, no randomisation. And it is more difficult in orthognathic surgery. A lot of possible biases, orthodontists also involved.... There are way to many factors that also affect the extrapolation of the results.
Is IMDO purely linear? Can it be used to achieve CCW rotation?
No if you mean a pure CCW in a patient with a good class I presurgical bite where the tip of the upper incisors act as the pivot point and no anterior impaction is done. IMDO is limited by the overjet.
But it can be used in the context of a CCW rotation with a Le Fort I that advances the maxilla and does a CCW by means of anterior impaction and a posterior descent, and with a curved osteotomy a posterior graft is not necessary and it's even worse to use it. But maxillary/midfacial expansion has to be done too in IMDO, remember. preop maybe? or a 2-piece Le Fort. I would probably try to go for the preop with a MARPE but its success rate diminishes with the age and becomes unpredictable in adults (over 25). But it's always possible to try, if it doesn't work then a 2-piece Le Fort along with the CCW... with CAD-CAM plates, otherwise it's too unstable.
Sergio, I just want to say thank you for taking time and sharing your insights here.
You are welcome.
Sergio, is there any major, active research taking place to advance distraction so it's as accurate as traditional surgery? If so, who is doing it? If not, why aren't huge research grants/funds being allocated to this? Patients would want distraction over traditional surgery. Do you think it ever becomes the gold standard, and if so, how long out is that?
Doing research is very difficult, very biased and a lot of times very dishonest. How many prospective patients are told that the risk of having some type of nerve damage in the mandible is 5 %? or 10 %? Those figures are the most heard in preop consultations, and they are based on actual research... and, to be honest.... what is the real outcome? And what does damage mean? total numbness? paraesthesia? hypoaesthesia? measured how? by the surgeon? self-reported? does everybody complain the same way?... oh, come on...
Personally, I do not like researching, I am a surgeon, not a researcher. Although the clinical data of previous IMDO patients is there, so I suppose retrospective research could be done, theoretically, but research would lead to conclusions with difficult interpretation. And with nowadays regulations about the access of clinical data, research is more and more difficult, even retrospective research. I do not have enough experience to provide a big sample though, but I am very happy with the results on my patients, although my IMDO patients until now are teenagers I wouldn't mind operating a young adult after what I am seeing. But it is very difficult for an adult to understand the advantages of IMDO over BSSO in large mandibular advancements, even more difficult than it is for parents to let a surgeon operate on their kid while there are orthodontists claiming that they can grow the mandible of a grown kid (mandibles do not grow much after age 12) without surgery, which is not true. They end up doing camouflage, messing with the TMJs and all to obtain an unstable and very suboptimal result.
By the way, I forgot to say that would probably describe the effects of IMDO surgery as a mandibular enlargement, not only advancement, and the full IMDO protocol as maxillomandibular enlargement. The reason for this is that the active phase of the IMDO protocol enlarges the body of the mandible and it widens it, skeletally. It means that the upper arch must be expanded more than with a BSSO (any mandibular advancement produces a relative/false expansion, that is why upper expansion has to be done along with any mandibular advancement, even non surgical ones. And, in my opinion, it is much better if we do an upper skeletal expansion instead of a dental expansion. And even much better with MSE or other MARPE devices, because that type of expansion is a midfacial expansion compared to the maxillary expansion produced by SARPE, DOME or 2- 3 piece Le Fort.
One surgeon I talked to told me he did quite a lot with my surgeon (of all people) about 20 years ago. He said you basically end up with multiple surgeries instead of one and it can get complicated for non-linear movements. So they reserve it for syndromal cases where movements must be huge.
That was my understanding about distraction, too. I had no previous experience with mandibular distraction when I started with IMDO though 2.5 years ago, so I can't compare. But when I read the papers / books on distraction and I see photos and videos or other distraction patients I think I understand why so many things can go south... and actually do.
Yeah.
I'd like to know when that will all change and they figure out how to move in all planes with accuracy.
There are too many factors that precludes a 100 % accuracy in any technique, and specially distraction. The reason why IMDO works really well on teens is because postop orthodontics are easier, callus molding is easier so the surgical inaccuracy is compensated by other factors.
Mandibular enlargement is done slowly (distraction is 1 mm per day) while condyles rest in the fossae in their comfiest position, this happens in teens and adults (I do not have to place the condyle during the operation). Small midline corrections can be done... occlusal interferences happen at the end of the distraction period... then orthodontics play an important role. And yes, calluses take more time to heal in adults. Adults do not heal as fast as teenagers and the social / work life of an adult makes IMDO an uncomfortable treatment. But some adults accept these drawbacks and risks in exchange for the advantages.
By the way there are several recent research papers there on how accurate conventional orthognathic surgery is even with computer planned software, comparing the outcomes with the planned surgery (for instance, https://www.ncbi.nlm.nih.gov/pubmed/29275075 (https://www.ncbi.nlm.nih.gov/pubmed/29275075) or https://www.ncbi.nlm.nih.gov/pubmed/31034793 (https://www.ncbi.nlm.nih.gov/pubmed/31034793) ) You might want to dig a little bit into it.
Let me add this, no disrespect intended... but I have got the feeling that many people in this forum think of orthognathic surgery as operating casts or 3D models. Many active users here believe 3D planning is almost a synonym of getting good results and, believe me, it is not. Computer software is coded by humans, based on information given by other humans, and then another human will do the operation in... another human! We do not operate x-rays or rendered images. Clinical planning is way more important than software planning.
The next step in the ladder or accuracy in orhognathic surgery is the use of CAD-CAM plates and guides. That is not computer planning, that is actual computer personalised surgery, where the planning, if done correctly, can be transferred with the highest degree of accuracy possible. But, again, we need to plan the intervention, design the plates (not every surgeons would like to use the same basic type of design and follow the same principles when designing them, or use the same grade of titanium) and then perform it... human on human. And this type of approach is veeery expensive. Interventions take longer, incisions and detachments are larger... And large advancements or large CCWs will be always be a challenge even with this approach. Soft tissues and TMJs do not like these large movements. So IMDO can always be useful in some patients, as soft tissues adapt better to slow movements (they stretch slowly following the underlying bone)
This should be getting the majority of research money.
Let me tease you a little bit (I know you did not mean this) don't you think there are more important fields of medicine to spend research money on? ;)
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I've really enjoyed reading your posts Sergio! Thanks for sharing with us.
I know someone who had IMDO in their 30's.
But it can be used in the context of a CCW rotation with a Le Fort I that advances the maxilla and does a CCW by means of anterior impaction and a posterior descent, and with a curved osteotomy a posterior graft is not necessary and it's even worse to use it
Just to clarify. Are you saying that the back of the maxilla can be brought down without needing a graft? If so, is there a limit to the amount of inferior positioning that can be done without grafts?
What do you mean by a curved osteotomy? Is that like an osteotomy where some form of bone contact between the gaps is maintained?
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Thank you for the informative posts Sergio - I think most of us on this forum are very grateful for your input.
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Let me tease you a little bit (I know you did not mean this) don't you think there are more important fields of medicine to spend research money on? ;)
Oh, I meant research money allocated to jaw surgery. I'm not sure if any money even is allocated to it, but if it is, distraction would be a great place to put it.
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Oh, I meant research money allocated to jaw surgery. I'm not sure if any money even is allocated to it, but if it is, distraction would be a great place to put it.
Lots of jaw surgeons that publish in OMS journals are also faculty at public universities, so in that sense OMS research is publicly funded.
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Sergio, thanx for your responses to me and to others.
As to patents vs. trademarks, I know the difference. In general, a patent can be challenged if someone else has patent on it or if it's something already in common use where the patent is not a novel use for it. A trademark can be challenged if it's not distinctive enough and confusingly similar to something else.
Salient difference concerning DO and DO with a prefix that renders it a TM is that one can find a variety of non financially motivated articles/information about Distraction Osteogenesis; when, how and why it's used whereas when a procedure is TMed there is not that extent of academic openness/sharing. But when they look for the DO with the TM prefix, since it's not openly shared or subject to peer review, hard to evaluate what makes it preferable to other types of DO aimed at doing similar or for patients who are considering DO to look outside of this TMed procedure. Also, use of 'DO' just confuses a lot of patients because hard to differentiate the DO aspect of it from DO in general.
TM's can be put on procedures, modalities etc that have been shared in medical venues and where the TMer has gleaned knowledge from. For example, knowledge about DO and use of certainly existed prior to 2014, the year the TM was taken out.
I've seen situations in PS venue where info of new or innovative techniques are shared and there are those who incorporate them into their practice and give credit to the innovator and then those who go on to TM 'ways' they learned by others who openly shared with motivation to advance field in general. Sure, it gives patients the impression the TMer came up with a new and 'revolutionary' modality and all the better for the doctor who does that when patients get impression that is so and removed from looking further into the resources the 'ways' or methods arose from in the first place.
Now, I'm not a lawyer either. Just someone who in the past did 'grunt' or 'gopher' work in venue of TMs, patents and IP. Best TMs are those with fanciful names that are distinctive. There's nothing distinctive about use of 'DO' (distraction osteogenesis), nor prefix 'inter-molar' to it. It closely resembles common descriptive terms in standard use. You know it's not too far from regestering as a TM 'Mandibular BSSO' or 'Maxillary Lefort 1' or even; 'Suction Vacuum cleaner'.
I'm surprised he had no TM challenges on grounds of lack of distinction of what's out there already.
Hmm...on closer inspection, it looks like his TM lapsed , was not accepted in 2016 and presently not registered.
https://search.ipaustralia.gov.au/trademarks/search/view/1645894?q=IMDO
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There's nothing distinctive about use of 'DO' (distraction osteogenesis), nor prefix 'inter-molar' to it. It closely resembles common descriptive terms in standard use. You know it's not too far from regestering as a TM 'Mandibular BSSO' or 'Maxillary Lefort 1' or even; 'Suction Vacuum cleaner'.
Not commenting of the validity of trademarks or whatever, but I think the distinctive part is that the IMDO distractors are designed so that the cut/distraction is between the molars (i.e Inter Molar). I think that's actually what makes it different to other mandibular DO designs.
Also it seems IMDO also widens the mandible? I'm not sure if regular DO does that. Do you know?
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Not commenting of the validity of trademarks or whatever, but I think the distinctive part is that the IMDO distractors are designed so that the cut/distraction is between the molars (i.e Inter Molar). I think that's actually what makes it different to other mandibular DO designs.
Also it seems IMDO also widens the mandible? I'm not sure if regular DO does that. Do you know?
Well, I was commenting on the validity of the TM. Now he does have a patent (since 2012) on a distraction device to be used between the molars.
" By placing an osteotomy cut between the first and second molars of the lower jaw, such jaw distraction surgery pre-emptively creates spaces by distracting the lower jaw forward, thus allowing for the creation of an orthodontic space for later orthodontic alignment of crowded lower dental arches"
So, yes. In terms of other distraction devices (that are actually patented), there has to be some difference from the 'prior art' to avoid a patent challenge. However, as to other distraction devices used for lower jaw expansion that are not patented, it could be possible for them to be adapted for use between the molars, of course by docs conversant in DO of the mandible.
Distraction vectors can be in different directions as is situation in general DO.
Would you happen to know if his device is shown on his website?
Here's a site from a Children's hospital that performs all kinds of DO.
https://www.seattlechildrens.org/clinics/craniofacial/services/distraction/
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Here is link to mandibular advancement by distraction. (Sorry if it's a lot of junk in the link but it worked when I tested it.)
https://www2.aofoundation.org/wps/portal/!ut/p/a1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAx8jYEKIvEocDQnTr8BDuBoQEi_l35Uek5-EtipkY55ScYW6fpRRalpqUWpRXqlRUDhjJKSgmIrVQNVg_Lycr30_Pz0nFS95PxcVQNsWjLyi0v0I1BV6hfkhkZU-aSGAwDYYmkN/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwME0z/?approach=&bone=CMF&classification=95a-HFM%2C%20Pruzansky%20IIa&contentUrl=srg%2F95a%2F05-RedFix%2FHFM%2FP185-DOMandAdv%2F01_Introduction.enl.jsp&implantstype=Mandibular%20advancement%20by%20distraction%20osteogenesis&method=Orthognathic%20and%20rotational%20osteotomies&redfix_url=1340371913125&segment=Congenital&showPage=redfix&soloState=lb&step=1&subStep=showLast&treatment=
#4 in the series shows the distraction device and where cut is made, beyond the back teeth close to where a BSSO cut is made. Illustration also shows a BIG overjet and the distraction device they are using brings out the lower jaw when there's that extent of overjet. I guess the main difference of making the cut between the teeth is since a space is made there, they can push the lower teeth back if they need to without having remove a tooth to make space. But there might be other cases where they might not otherwise need to to push the teeth back and the space created between the teeth would necessitate that because cut was made between the teeth and not in back of them. Basically, they would have to push them back even if they would not otherwise need to if they had used the device that had the cut behind both molars. So, his method and device he has for it looks advantageous for cases that would need the lower teeth pushed back (and a space there) where extraction would not have to be done to make space. But not for cases that wouldn't need the teeth pushed back.
Interesting article by some Indian doctors on development and evolution of distraction devices. They make their own for the case at hand and don't buy proprietary ones.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591036/
...and another
Mandibular Distraction Osteogenesis (MDO) to treat upper airway obstruction.
https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/222755
So, I guess my question is; When people come here asking about IMDO do they NOT want MDO or DO in general to the mandible. Are they wanting to avoid the cut behind the molars to have DO to expand the jaw or are they specifically wanting the cut to be between the molars or is it just that they think IMDO is the only DO out there?
Well, I was commenting on the validity of the TM. Now he does have a patent (since 2012) on a distraction device to be used between the molars.
" By placing an osteotomy cut between the first and second molars of the lower jaw, such jaw distraction surgery pre-emptively creates spaces by distracting the lower jaw forward, thus allowing for the creation of an orthodontic space for later orthodontic alignment of crowded lower dental arches"
So, yes. In terms of other distraction devices (that are actually patented), there has to be some difference from the 'prior art' to avoid a patent challenge. However, as to other distraction devices used for lower jaw expansion that are not patented, it could be possible for them to be adapted for use between the molars, of course by docs conversant in DO of the mandible.
Distraction vectors can be in different directions as is situation in general DO.
Would you happen to know if his device is shown on his website?
Here's a site from a Children's hospital that performs all kinds of DO.
https://www.seattlechildrens.org/clinics/craniofacial/services/distraction/
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Thank you for the informative posts Sergio - I think most of us on this forum are very grateful for your input.
Thank you for you words
Not commenting of the validity of trademarks or whatever, but I think the distinctive part is that the IMDO distractors are designed so that the cut/distraction is between the molars (i.e Inter Molar). I think that's actually what makes it different to other mandibular DO designs.
Also it seems IMDO also widens the mandible? I'm not sure if regular DO does that. Do you know?
I read way too many unnecessary thoughts on branding and trademarking. Call it a quality seal. It is not only the devices used, there are more factors involved, as in any surgical procedure there is a learning curve, it is not a secret. Believe it or not, all the information to understand the differences between IMDO protocol and other techniques (BSSO and mandibular distraction protocols, and also a Herbst appliance, as I recall) is in that playlist https://www.youtube.com/playlist?list=PLjC4hIwmyQfjXgckxslgVI9BPkh6wcv-a (https://www.youtube.com/playlist?list=PLjC4hIwmyQfjXgckxslgVI9BPkh6wcv-a). You can also see the early postop of some patients. But the protocol has evolved since the first video several years ago.
Adults are being treated nowadays with IMDO. It started with teens and it is still mainly done in teens. But it is useful for some adults as it provides unique advantages, but it also other disadvantages and risks. When you decide to cross a street you also accept risks and take precautionary measures like using a pedestrian cross. Every patient is different, a proper diagnosis has to be made and explained. Treatment options explained and, in the end, the decision must be made by the patient, a difficult decision, I agree.
Until now my IMDO patients have not stayed more than a few hours in the hospital (it was a day surgery procedure). No nerve damage at all (100 % normal sensation from the day after, except one girl that had some tingling for a few weeks on one side). Very nice widening of the mandible (proportional to the amount of distraction, of course). Perfect contour (no "lumpy" jawline like sometimes happens with large mandibular advances with BSSO). Paul's IMDO patients normally spend one night but they fly from distant places so an early discharge is normally not possible. And if he also does an upper jaw surgery simultaneously, they normally spend more time in the hospital.
So, I guess my question is; When people come here asking about IMDO do they NOT want MDO or DO in general to the mandible. Are they wanting to avoid the cut behind the molars to have DO to expand the jaw or are they specifically wanting the cut to be between the molars or is it just that they think IMDO is the only DO out there?
I suppose they are just curious about it and they want to know more about it. That is why everybody uses Dr. Google, right? And they are lucky to find forums like this one so they can get their questions answered. By the way, I think the cut behind the molars or in the ramus is responsible for the bad reputation of those other distraction protocols.
I hope that my participation here has contributed to clarify some aspects of IMDO.
Regards,
Sergio
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Well, fact is that there is a lot of people confused about IMDO. First time I read about it, it seemed like a non surgical procedure and it was not obvious to find this information, even though it's of course obvious for the one doing the surgery. It's also not obvious what the actual surgery is and how it differs from the fracture you do with BSSO. Can you tell us the technical difference in the cut you make for the IMDO™️? Because if you want to separate a bone you need to fracture it, and how can we understand the difference in this fracture compared to BSSO and why it's better?
I also agree with Kavan on the nonsense of trade marking a procedure, making it harder to do research on and hindering it to be evaluated by other surgeons.
Thank you so much for all of these informative posts. I was wondering whether you have had any success in older patients expanding and advancing the maxilla through distraction osteogenesis with or without the use of stem cells or other growth factors to help the replacement bone grow stronger?
As to the trademark issue, i am an an attorney with a marketing background but my IP experience is limited to the sports and music industry. I dont believe though that a procedure can be trademarked. However the marketing name for the procedure could be trademarked and nobody could use the marketing name. However IMDO, even if you successfully obtain a trademark, which is going to be a challenge because its so generic, if you are marketing to patients its should have something memorable that people will search for (maybe something added after IMDO) or it will NOT have a lot of marketing traction until you spend a long time marketing and branding. You could patent a medical procedure but if a doctor uses the same procedure on a patient he or she does so under an exception and is not liable for infringement. I am sure that you have the guidance of excellent IP counsel and a marketing strategist to bring your ideas to into motion.
Thanks again for all of your posts.
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I read way too many unnecessary thoughts on branding and trademarking. Call it a quality seal.
Keep in mind that prior you suggested (to Dogmatix) I was not conversant in matters of trademarks and patents.
I think statements like kavan's about trademarking are based on wrong premises on trademarks and patents.
To that regard, I made clear what some premises were. Such things that the TM was not distinctive and confusingly similar to terms in common usage and even gave a link to TM search of Australian Gov to show the TM was listed as not accepted/lapsed. I also found the patent.
Other things:
IMDO targeted to Adults:
Inquiries coming to JSF (about IMDO) have been from adults who use the term and cite videos with children as patients where there is some mention/suggestion in text it also works on adults but not enough clarity to resolve confusion about adult candidacy. To that regard, I did search OUTSIDE of the material he was putting out to directly appeal to patients. What I look for as to material doctors put out is WHAT do they tell their PEERS about their procedures and not what they convey/imply in thier marketing material aimed at patients. This is so, when there is confusion based on promotional marketing materials aimed at patients.
In the process of looking for published papers either by or about Coceancig's method/device I found mention of it's use limited to use on children/adolescents. One paper out of New Zealand said it worked well for children. Another from Coceancig himself with title; "Introducing the IMDO protocol into practical private orthognathic practice for first line management of adolescent class ii malocclusion." In the article he states: "The IMDO protocol is a surgery first management strategy for orthognathic problems found during mid to late ADOLESCENCE." Another journal article mentioned 4 patients in a study but no reference to age. Newspaper article referenced it to treating children and TEENS. Also the first sentence of the PATENT on it reads: "Mandibular retrognathia in adolescents is an abnormal posterior positioning of the mandible relative to the facial skeleton and soft tissues."
Due diligence:
Due diligence was done by me to find material --yes outside of his YT marketing links and website--applicable to an 'IMDO ONLY' fix for adults. None was found by me. This was not to claim it can't be done on adults. Just that material found OUTSIDE of that directly targeted to patients didn't suggest it. However, further searches on MDO in general, had mention of adults being treatable in addition to Sergio saying possible.
As to due diligence, I suggest patients interested in ANY type of MDO (Mandibular Distraction Osteogenesis) do their research on MDO (ample papers out there. I've already left links to some.) so they know what it involves in GENERAL and not assume just because the TM brand is mentioned here more or material of such is targeted to the patient venue and not peer venue it 'therefore must be superior'. However, no skin off my teeth if you do.
For those wanting more details about Coceancig's device, I'm providing the link to the PATENT on it.
https://patents.google.com/patent/US9113958
The patent has citations of other patents having to do with DO and other devices/distractors and also citations of academic articles on DO which provide a rich source of research material for those so technically inclined to explore further.
TIP! If you click on another patent listed in the citations it will bring you to even more patents and mentions of different devices. For example, I clicked on; 'Device for widening the jaw', from Coceancig's citations and found a patent by Triaca for widening the jaw. So, if you kept doing that, you'd find distraction options for a lot of facial things. The patent itself is a rich source of information for those so inclined to research further on many possibilities for distraction.
Enclosed is an illustration of the device taken from the patent.
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Thank you so much for all of these informative posts. I was wondering whether you have had any success in older patients expanding and advancing the maxilla through distraction osteogenesis with or without the use of stem cells or other growth factors to help the replacement bone grow stronger?
Thank you for your words.
I have never used distraction for advancing the upper jaw, only for expansion. And I know nothing about the use of growth factors in distraction osteogenesis, although I might worth looking into it, so I will. Thanks for the hint.
Keep in mind that prior you suggested (to Dogmatix) I was not conversant in matters of trademarks and patents.
Well, let me politely disagree with you. But at least we can agree to disagree.
To that regard, I made clear what some premises were. Such things that the TM was not distinctive and confusingly similar to terms in common usage and even gave a link to TM search of Australian Gov to show the TM was listed as not accepted/lapsed. I also found the patent.
Good for you. Finding the patent is no a difficult thing to do, and, to start with, its drawings are shown in a couple of videos of that playlist, and Google is a good search engine.
I only brought the TM thing in the disclosures stated in my first message not no make any point, just because when I searched for IMDO messages I read some comments in other threads on licensing and franchising. TM doesn’t not impede any research or forbids other surgeons to do it, or force patients. But I think it is for the good of the patients to be able to know if their surgeon is endorsed by the rest of the surgeons doing IMDO.
In the process of looking for published papers either by or about Coceancig's method/device I found mention of it's use limited to use on children/adolescents. One paper out of New Zealand said it worked well for children. Another from Coceancig himself with title; "Introducing the IMDO protocol into practical private orthognathic practice for first line management of adolescent class ii malocclusion." In the article he states: "The IMDO protocol is a surgery first management strategy for orthognathic problems found during mid to late ADOLESCENCE." Another journal article mentioned 4 patients in a study but no reference to age. Newspaper article referenced it to treating children and TEENS. Also the first sentence of the PATENT on it reads: "Mandibular retrognathia in adolescents is an abnormal posterior positioning of the mandible relative to the facial skeleton and soft tissues."
You did not find any paper (there is no scientific article published yet, although a two or three articles wrote for the general public had been made available)
You just found the abstracts of a few talks on IMDO that were given by Paul and other friends at the ICOMS 2019 (Rio de Janeiro, a few month ago)
Paul is working on a book, but I do not know when it will be published, maybe 2020 or 2021 ?
As to due diligence, I suggest patients interested in ANY type of MDO (Mandibular Distraction Osteogenesis) do their research on MDO (ample papers out there. I've already left links to some.) so they know what it involves in GENERAL and not assume just because the TM brand is mentioned here more or material of such is targeted to the patient venue and not peer venue it 'therefore must be superior'. However, no skin off my teeth if you do.
Of course, they need to do their own research and make their own decision, and it is great that they have all that information here so they can compare. And I do provide all that information during my consultations and encourage that attitude on my patients, too.
Do you think experience, skills, training on postop management and preop planning... knowing the involved orthodontic treatment and having access to the specific set of instruments are not necessary to perform a correct IMDO and prevent complications?
Surgery sounds so easy sometimes... no offense.
You know, I also went through the same process you are experiencing now when I tried to reverse engineer the IMDO protocol.
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Keep in mind that prior you suggested (to Dogmatix) I was not conversant in matters of trademarks and patents.
Well, let me politely disagree with you. But at least we can agree to disagree.
So, you are disagreeing you made the following statement?
I think statements like kavan's about trademarking are based on wrong premises on trademarks and patents.
Neither here nor there though.
Good for you. Finding the patent is no a difficult thing to do, and, to start with, its drawings are shown in a couple of videos of that playlist, and Google is a good search engine.
Not difficult to just find. Just some effort to screen shot diagrams and explain how to use it to look for other patents of similar art and/or citations. As I noted in my post, I SPECIFICALLY looked OUTSIDE of his video links. In my past posts, it's probably quite palpable that part of the issue I have as to pursuit of information about DO is that it often resolves to links to IMDO. So, I guess we can agree that when it comes to MDO, I look OUTSIDE of videos about IMDO.
I only brought the TM thing in the disclosures stated in my first message not no make any point, just because when I searched for IMDO messages I read some comments in other threads on licensing and franchising. TM doesn’t not impede any research or forbids other surgeons to do it, or force patients. But I think it is for the good of the patients to be able to know if their surgeon is endorsed by the rest of the surgeons doing IMDO.
Undoubtedly, there was some confusion about exact terminology; 'licencing' or 'franchising'-- or something else-- that would be applicable to a collection of doctors having permissions to use the term; 'IMDO'. For example, there was a big Franchise called (TMed); 'LifeStyle Lift' and only those who were part of it could use the term. Yet the technique used to do it (purse string suture) was nothing novel and something in past common use.
I'm quite aware that there would be absolutely no preclusion for a doctor to do MDO where the cut was between the molars. For example they could say: 'We do MDO and use either a cut behind OR between the molars depending on the specific case.' But I'm a loss (or just not clear on) what kind of endorsement a doctor, already conversant in MDO, would need in the event he/she purchased the exact distractor of the patent design (assuming the product is available for purchase and no controls exist as to which doctors can purchase) and used as such an option.
Are you suggesting that a patient pursuing MDO from a doctor conversant in MDO who offered options of 2 cuts; one between the molars and one behind them and used Coceancig's distractor for the former would need to know if the doctor had an ENDORSEMENT from Coceancig and associates?
You did not find any paper (there is no scientific article published yet, although a two or three articles wrote for the general public had been made available)
You just found the abstracts of a few talks on IMDO that were given by Paul and other friends at the ICOMS 2019 (Rio de Janeiro, a few month ago)...
LOL, this is veering into quibbling about SEMANTICS or finding some in-germane technical error where I found the abstracts of things that were not actually 'papers' and called what I found such. OK. So I didn't find 'papers'. But the SALIENT point is that I mentioned that in the process of looking for published papers what I found. Salient point being I did NOT find any material mentioning IMDO for ADULTS but ONLY mentions limited to use on CHILDREN and ADOLESCENTS. Other salient point was I did DUE DILIGENCE to LOOK for material (outside of his YT channel and website) about mention of use for ADULTS and found NO mention of such.
*Due Diligence. I'm using in context of looking for material where mention was made (to perhaps peer group) about process being used on adults and doing so BEFORE I said on here the process very much looked to be limited to children/adolescents or those in the growing stage.
So, I guess what we can AGREE on is that he does NOT have any peer reviewed papers about IMDO on ADULTS.
Of course, they need to do their own research and make their own decision, and it is great that they have all that information here so they can compare. And I do provide all that information during my consultations and encourage that attitude on my patients, too.
Do you think experience, skills, training on postop management and preop planning... knowing the involved orthodontic treatment and having access to the specific set of instruments are not necessary to perform a correct IMDO and prevent complications?
Surgery sounds so easy sometimes... no offense.
You know, I also went through the same process you are experiencing now when I tried to reverse engineer the IMDO protocol.
No offense taken.
Sergio, just to make clear, critiques of mine having to do with IMDO (in adults) were in reference to Coceancig's presentation. This would have nothing to do with how you communicate with your patients or those reading your website. I have no doubt that you would be very forthright in all your consults. When I initially checked your website, it was in process of approving your membership. I didn't seek it out for IMDO stuff, nor do I recall people bringing your name or website to the fore here on JSF. Nonetheless, you're welcome here, you seem like great guy even though I butt horns. (I am year of the goat in Chinese calendar.)
As to experience with the device (or any device with similar aim) and/or capacity to use it along with post op management and pre-op planning, preventing complications etc., of course I think those things are important and since I don't do surgery, I have no pre-conceived notions as to if this type of procedure (or any other) is easy vs. difficult other than what surgeons relay.
It's just that I would not deem by default that a doctor already conversant in MDO, who had this particular distractor adapted to making cut between molars would be incapable of using it to good effect in the absence of some kind of endorsement from Coceancig. As I said earlier, a doctor conversant in MDO could have option to have a device for cut behind molars and one suitable for cut between them (assuming the latter is not limited to only those approved by Coceancig). As to TMs, such a doctor would not even have to use the term; 'IMDO'. The operative term for what he's doing would be; 'MDO' and from there, the mention of 2 types of options for cuts; one behind molars and one between, depending on the case. One case could call for a big space between the teeth to avoid extraction if lower teeth had to be pushed back later down the line. Another case might not and instead need to avoid a big space between the teeth to have to close.
In closing, it looks like ADULTS would prefer an option of MDO (with or without prefix of 'I') over BSSO. There just needs to be more clarity on the websites YT channels--what ever--about that and also more 'papers' (peer reviewed academic articles) where adult applicability is the topic matter.
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.... older patients expanding and advancing the maxilla through distraction osteogenesis with or without the use of stem cells or other growth factors to help the replacement bone grow stronger?
In the process of looking at articles on DO for this string and also in process of another string about 'questions' having to do with a doctor in India....well, I was looking at his publications and I found something on maxilla distraction where age was mentioned as not a factor. Here is link. https://journals.sagepub.com/doi/pdf/10.5005/jp-journals-10021-1229 Ya, for cleft patients but they are way more than getting an extra 3mm. Not suggestion or referral. But just it came up from research for other thread and just in case it could be helpful. It's just a distractor device though which looks like no surgery to put it in.
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I disagree with you in the fact that your knowledge on trademarking and patents is large enough in order to reach those conclusions. And I do not think your medical and surgical knowledge and experience is large enough to reach other conclusions.
Of course, everybody can do IMDO, I suppose even you could try yourself.
I have met another Spanish surgeons that have claim to have done it in the past and abandoned doing it after two patients because all the discomfort, nerve damage and pain the caused... I was questioned about it while presenting a short conference talk on IMDO one month ago in my hometown. And they say IMDO just does not work. It turns out that their problem is that they are applying their previous conceptions of distraction for IMDO and he problem is that it does not work in their hands. And there is also a specific instrument handcrafted for IMDO. Trying without it increases the chances of having an unfavourable outcome. A fellow reputed surgeon from another EU country confessed to me while having a beer that it had happened in his one and only IMDO patient. And he is probably one of the most experienced distraction surgeons I have ever met. He had to unturn the distractors completely and remove them after a few weeks after having achieved nothing.
Sorry I did not spend time for quoting specific sentences this time
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I disagree with you in the fact that your knowledge on trademarking and patents is large enough in order to reach those conclusions. And I do not think your medical and surgical knowledge and experience is large enough to reach other conclusions.
Of course, everybody can do IMDO, I suppose even you could try yourself.
I have met another Spanish surgeons that have claim to have done it in the past and abandoned doing it after two patients because all the discomfort, nerve damage and pain the caused... I was questioned about it while presenting a short conference talk on IMDO one month ago in my hometown. And they say IMDO just does not work. It turns out that their problem is that they are applying their previous conceptions of distraction for IMDO and he problem is that it does not work in their hands. And there is also a specific instrument handcrafted for IMDO. Trying without it increases the chances of having an unfavourable outcome. A fellow reputed surgeon from another EU country confessed to me while having a beer that it had happened in his one and only IMDO patient. And he is probably one of the most experienced distraction surgeons I have ever met. He had to unturn the distractors completely and remove them after a few weeks after having achieved nothing.
Sorry I did not spend time for quoting specific sentences this time
Well, certainly just easier to disagree than provide a substantive argument to counter. But we can agree I'm not of same conclusion as you.
My conclusion was that doctors conversant in MDO would be in capacity to do Mandibular Distraction Osteogenesis with his device if the device facilitated a cut between the molars and they wanted to offer that as option in addition to behind molar cut.
You point out I made wrong conclusion that doctors skilled in the art of MDO would be in capacity to use Coceancig's distractor if they wanted to offer option of a cut between the molars.You pointed out by providing example where docs skilled in MDO had poor success with using Coceancig's device. You're basically saying that his device has little advantage over the devices they presently use for MDO. So, if it can't be used to good effect in the hands of doctors conversant in MDO, it sounds like a bust. But maybe silly of me to conclude that getting a patent with claim of being advantages to those skilled in the art isn't actually going to be useful to other doctors in the field.
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Would you happen to know if his device is shown on his website?
Late reply sorry, I see you've found detailed pics of the device. good find! Not sure if it was shown on his website. In the past I think I saw xrays and animations of it on instagram.
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Well, certainly just easier to disagree than provide a substantive argument to counter. But we can agree I'm not of same conclusion as you.
My conclusion was that doctors conversant in MDO would be in capacity to do Mandibular Distraction Osteogenesis with his device if the device facilitated a cut between the molars and they wanted to offer that as option in addition to behind molar cut.
You point out I made wrong conclusion that doctors skilled in the art of MDO would be in capacity to use Coceancig's distractor if they wanted to offer option of a cut between the molars.You pointed out by providing example where docs skilled in MDO had poor success with using Coceancig's device. You're basically saying that his device has little advantage over the devices they presently use for MDO. So, if it can't be used to good effect in the hands of doctors conversant in MDO, it sounds like a bust. But maybe silly of me to conclude that getting a patent with claim of being advantages to those skilled in the art isn't actually going to be useful to other doctors in the field.
It is a whole (I don't know if this makes sense in English): right diagnosis + right distractor design + right presurgical orthodontic treatment + following, step by step, the planned IMDO intervention using the specific instruments + right postsurgical management (including orthodontics).
This is the only way IMDO really works.
I've been trying to explain this from my very first message, sorry I was not to as explicit as in this one, as I started addressing some other questions (to start with, I was really surprised that some people can think IMDO is not a surgical treatment).
IMDO protocol provides unique features to maximise mandibular and airway enlargement while lowering risks, but the protocol has to be followed.
Hope this helps.
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Dr. Sergio, thank you very very much for your input, also great to have someone with extensive knowledge.
I'm very interested in IMDO procedure or distraction osteogenesis of the jaw in general, because I think it can lead to superior aesthetic results. In this regard my question is if you can recommend to me a Dr. from your "IMDO-network" who practices in Germany? I did alot of googling but didnt find anyone who promotes this kind of work on his website here in Germany. Im afraid Madrid wouldnt be an option for me for such an extensive procedure, so I really hope you can maybe help me and possibly other readers out on this. Thank you again sir!
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Dr. Sergio, thank you very very much for your input, also great to have someone with extensive knowledge.
I'm very interested in IMDO procedure or distraction osteogenesis of the jaw in general, because I think it can lead to superior aesthetic results. In this regard my question is if you can recommend to me a Dr. from your "IMDO-network" who practices in Germany? I did alot of googling but didnt find anyone who promotes this kind of work on his website here in Germany. Im afraid Madrid wouldnt be an option for me for such an extensive procedure, so I really hope you can maybe help me and possibly other readers out on this. Thank you again sir!
Sorry, I am not aware of any surgeon in Germany doing IMDO. Maybe you could ask directly to Paul Coceancig or consult directly to some surgeons, but I think there might not be anybody. In fact, I will be operating soon on a patient coming from Germany.
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stay far away from Paul C
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Sorry, I am not aware of any surgeon in Germany doing IMDO. Maybe you could ask directly to Paul C or consult directly to some surgeons, but I think there might not be anybody. In fact, I will be operating soon on a patient coming from Germany.
Thank you very much Dr Sergio. I will keep your name in mind in case I will find nobody closer to my area.
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stay far away from Paul C
Why's that? PM me if you don't want to publicly post