Your thoughts on surgery results

[Mighty_Mouth]

Hello everyone!  I am new to the forum, but not new to jaw surgery.  I've had two surgeries.  My first was in May 2012.  I had a Lefort I (2-piece), an IVRO, and a genio.  I had a severe open bite, overjet, asymmetry, and degeneration of both condyles.  I've had braces since December 2010.  I had to wear a MAGO splint before braces (I had it for nine months) and then a deprogrammer splint which I wore from Jan 2012 until my surgery in May.  My orthodontist took care of the splint adjustments.

After my surgery, I was wired shut (not just banded, because with the IVRO, I did not have rigid fixation in my mandible) for six weeks.  I had to wear the surgical splint for five weeks more after my wires were cut.  When the splint was out, I went to my ortho the same day who gave me an elastic to correct the midlines (they were over 3 mm off).  I knew right away something was wrong (things were just so not straight and my bite was still open). 

I had to have a 2nd surgery in October (upper only).  My bite closed (almost), but my bite is edge to edge and I have no overbite (no overlap of top teeth over the bottom) and my midlines are still off by 2mm.  Also, I am unhappy with my profile.  I had a fairly deep mental-labial groove before surgery, but with the genio, it seems worse to me.  I am hoping some of this can be fixed with orthodontics, as I really can't think of going through this again.

I'm hesitant to post pics just yet.  I'd be grateful for any thoughts on your experiences with orthodontics and how much they are able to fix post-surgery.  My surgeon is pleased with the bite and the sense I get from him is that I have the best result I could have given how bad my jaw was before.

Thank you!

[Sharptoys]

I had to have a 2nd surgery in October (upper only).  My bite closed (almost), but my bite is edge to edge and I have no overbite (no overlap of top teeth over the bottom) and my midlines are still off by 2mm.  Also, I am unhappy with my profile.  I had a fairly deep mental-labial groove before surgery, but with the genio, it seems worse to me.  I am hoping some of this can be fixed with orthodontics, as I really can't think of going through this again.

At this point, I would find a lack of overbite to be troublesome. Your orthodontist may be able to use elastics or TADs to extrude or intrude teeth to compensate dentally, but such treatment may or may not be stable, and does not correct the underlying skeletal problem, which may worsen if the degeneration of your condyles continues. In open bite cases, surgeons generally try to create as much of an overbite as acceptable, and some go to the point of over-correction, assuming a slight relapse will occur.

I'm hesitant to post pics just yet.  I'd be grateful for any thoughts on your experiences with orthodontics and how much they are able to fix post-surgery.  My surgeon is pleased with the bite and the sense I get from him is that I have the best result I could have given how bad my jaw was before.

Feel free to post as much information as possible. It really is difficult to get a handle of cases without a full set of pictures and/or xrays.

[Mighty_Mouth]

Thanks, Sharptoys.  These photos are absolutely huge.  Sorry about that; I don't know how to make them smaller...

Here is my pre-surgery profile:


Here is my pre-surgery bite:

and


Post-first-surgery

and


Post-second surgery:

and

[Mighty_Mouth]

I should mention that the incredibly bad first surgery result was not surgeon error necessarily.  The titanium plates holding my top jaw in place actually broke for the force of my muscles and bone re-growth once I was freed from the splint.  So the bite shifted almost immediately after the splint coming out.

[Mighty_Mouth]

I think the difference for me regarding my profile is that pre-surgery, I could hide the labial mental fold by posturing, but now there is nothing I can do to hide it.  The first picture shows me in a relaxed position, which I never had in public.  Of course, I suppose that it is better that part of the underlying problem has been addressed, but I think I had hoped it would be even less pronounced.

Thank you for your input!  It puts things in perspective.

[Mighty_Mouth]

Another question for you all...

My surgeon explained that the reason I have zero overbite is because my teeth are too short and I'll need to have restorative work (bonding) to make them longer.  This seems like BS to me, but I am no expert.  I don't think my teeth are short.  I had a nice smile before all of this began.  It seems that both my lower and upper incisors are protruding and that maybe should have been taken care of pre-op with orthodontics (I've had no extractions, btw) so that my jaws could have been brought forward more.

He's telling me that he gave me the best result I could have had given my jaw and my teeth, but I am not so sure.  I wasn't looking for perfection, but I still can't bite into a sandwich because my incisors don't touch properly.  I was hoping for at least that much.

Do you guys think something is wrong here, or is my result ok, knowing that I still have several months left in braces?