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The "implate" ramieri mentions in your case is not an implant in a classical sense as in putting an actual foreign body on top of the mandible but rather a technique that pushes the bone out and for this he needs custom plates. How the technique exactly works is unknown to me but we did discuss some theories before in this forum.

Ramieri also does "normal" implants, but prefers his "implate" technique I think.

It offsets the risks of implants more or less completely because it's not an actual implant. Of course, plates and screws can also become infected but this is a general risk of surgery.

 

So, it has been several years since I posted on here. I ended up going for custom implants with Dr Yaremchuck in Boston. That turned out to be one of the biggest mistakes I ever made. The implants were not very aesthetically pleasing, given I needed jaw advancement. But even worse than that, he did the custom orbital rim and malar implant, and they didn't fit together well, which left it deep trough under my eye. I went for a correction of this in late 2021, and I could go into detail as to how he botched it, but botch it he did. Right now I have a hole in my face, because he switched horses in the middle of the stream and did an unauthorized procedure during the surgery that infected the previous implants he had placed, and the wound won't heal. I've spent the last several years trying to figure out how to undo that without removing the implants and going through more surgeries. I'm at a loss. The implants are going to have to come out.  I probably should have had them out a couple years ago. But I wanted it to be the last resort.

Anyway, now I'm a candidate for jaw surgery, and that's something also I should have done years ago. But no surgeon is going to do the jaw surgery until the infection is fixed with the implants. So I'd like to find a surgeon who has some pretty deep qualifications, can address both issues hopefully. I'd like to if possible coordinate the removal of the implants with the jaw surgery, so I don't have to go under the knife twice, and so I don't have to remove just one side of my implants that are infected and leave my face hollow one one side for months until they replace implants.

Who are some outstanding jaw surgeons who may also have experience with implants? In particular, I'm thinking I might want to replace the implants and do a high cut LeFort I. This is what Dr. Schendel recommended for me before he retired.. I have mid-face hypoplasia, which is the reason I placed the implants in the first place.

So I'm looking for surgeons who 1. Are qualified to do a high cut LeFort I, 2. Have experience with implants, 3. Aren't afraid of bigger movements if needed, and 4. Have a good eye to aesthetics.

I have Aetna for my insurance. A lot of doctors accept that, but I don't know where to begin. I suspect some of the best surgeons may not be the ones that get the most hype or do the most advertising. I suspect with my symptoms it may need to be a craniofacial surgeon, who can do the high cut, but a maxillofacial surgeon is fine as long as they can feel comfortable performing that procedure.

Anyone have any advice or no any surgeons who I might look at? Thank you.

I really appreciate your reply. I think I will go with Ramieri then for the implant, this is what I was learning towards. No, nobody mentioned to me about curve of spee.

Does it work now? If not I will try another method, I would be very grateful for any help

My main concern is asymmetry. I have posted here before, I've now consulted with two surgeons, Dr. Ramieri and Dr. Pagnoni. Ramieri suggested an implant alongside jaw surgery. While Pagnoni suggested just jaw surgery. He said that an implant at the same time as jaw surgery often doesn't work very well and comes with a higher infection risk. Ramieri has a technique involving an implant acting as a plate, which he calls Implate. I'm not sure to what degree this technique can offset the potential issues with a simultaneous osteotomy and implant.

Which approach do you think is best for me? Unfortunately, if I forgo the implant at this stage, I don't think that I would be able to afford to have an implant later down the line as having an implant and jaw surgery at the same time surgery is obviously cheaper. I'd really appreciate any advice.


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