Got back from my second consultation with Dr. Birbe last week.
I met with his orthodontist first, and then I spoke with him afterwards.
The ortho said he believes that he can correct my bite without surgery, but he wasn't very forthcoming with how he would actually achieve that.
His explanation didn't make sense to me. I have a lower incisor midline shift to the left of approx 2mm. He said he would move the bottom left teeth forward to the right 1mm and the top teeth left and back 1mm. Logically this seems like it would result in my upper midline being off by 1mm, and the same for the lower. He also suggested filing my incisors down on either side to create space so that they could be pulled back. The fact that I used to have a perfect bite suggests to me that there is no need to shave my teeth down; I really didn't like this suggestion.
His English wasn't as a good as Dr. Birbe's. They both said that surgery MAY (not certain) reduce the time in braces due to jaw movements. However their blanket statement was essentially 18 months in braces either way. My teeth are already very straight so they didn't explain to me very well when I asked how they calculated the length of time needed in braces. A year and a half seems long to me given that I have no crowding, but perhaps this is standard.
The orthodontist did an oral exam only, no impressions or models or anything like that, although I did show him models I had done from 2012, the same ones where my previous surgeon suggested that orthodontic correction was impossible without surgery.
Dr. Birbe said I need to determine my prioritites; cosmetic improvement vs functional improvement. The former requiring surgery and the latter braces only.
I was quoted for braces only (regular and invisalign) and then braces and BIMAX + Genio. The orthodontics only was honestly a lot more than I expected for Spain, in fact I know people in Ireland and the UK who get orthodontic work done for the same price and even up to 30% less; and the average salary is double there.
The requote for bimax was more than the original quote I got the first day. Their front desk staff never emailed me after the first day like they said they would, so now the second quote they did email is more + the orthodontics cost; which the front desk staff told me was included the first time.
So overall I would be paying about 30% more than I originally thought. Not to mention the fact that 18 months of orthodontics in Spain, with 18 monthly check-ins would be an additional 4 or 5 thousand EURO in flights alone.
I will email and enquire whether I can do orthodontics at home if he can work with someone abroad if I decide to go ahead.
I think I will consult with another couple of surgeons in the mean time.
He does do posterior downgrafting as someone asked.
He doesn't use custom built plates, but rather customises them himself.
I saw a few before and afters that looked okay, he was kind of scrolling through them though. A lot of the images were from lectures he has given. I waited almost an hour after my appointment date to actually see them which kind of annoyed me considering I was awake at 4am to fly to Spain. I explained that to him when I felt he might be in a rush and he seemed to understand this and became more relaxed and accommodating to answering my questions, and explained how grateful he was that people have travelled internationally to consult with him.
He said nose upturning isn't a foregone conclusion and that steps can be taken intraoperatively to mitigate this if needed.
Average surgical time is a couple of hours or less.
I explained how I had read that advancement can actually cause FURTHER asymmetry, but he didn't agree and claimed that the whole point of surgery to improve asymmetry wouldn't increase it as that would be counterproductive to the whole point of surgery.
I still like Dr. Birbe although I'm not 100% on the orthodontist. He seemed surprised that I knew much of the terminology and was aware of my own anatomy at first - he is probably used to telling patients quickly and without any inquisition. The quote was also more the second time around.
Any questions feel free to ask.
