How important is the orthodontist?

[nqrse]

Exactly how important is the orthodontist when getting jaw surgery?

I once spoke with a guy who had surgery with Gunson just to have his orthodontist mess up afterwards. I would sink into despair if this happened to me. I'm having surgery with Gunson as well, and I don't want to put in so much time, money, and energy going to Gunson and making sure everything is perfect, just to have the orthodontist make my efforts go to waste. I'm afraid that I'll spend $70K+ to go to the best of the best, but the orthodontist will prevent the outcome from being any better than if I had spent less and gone to a cheaper surgeon. I'm in Canada, and I can't find anyone who has worked with Gunson anywhere in a 200km radius of me. The orthodontists here all work with local surgeons who don't do ccw or know of Gunson's philosophy. This is my face on the line, and I want to ensure everything is as perfect as possible.

Gunson told me that he knows some good orthodontists in the San Francisco Bay Area. I have two options: I can either get braces now from a random orthodontist in my small town in Canada and have the surgery done by next fall, or I can wait a year until I move to the Bay Area for university and get an orthodontist whom Gunson trusts, which will postpone my surgery another year. I'm suffering quite a lot due to my deformed jaw, and I want to get surgery asap. Is the difference between the works of orthodontists significant enough for me to prolong my suffering?

[Dogmatix]

You need to differ between whats skeletal and dental. An orthodontist can't mess upp what the surgeon has done, the bones gets fractured and repositioned, this cant be changed by anyone. But it's of course important to have a skilled orthodontist to do a good preparation and understand the face structure and angles.

[PloskoPlus]

I've consulted with a big name surgeon for a revision. When I asked him about an orthodontist, he said "go back to the same guy, he did a great job". I think it's important to have an orthodontist who does many many surgical cases per year, which was the case with mine. AFAIK, your ortho will get a very detailed treatment plan from Gunson. It will be a matter of execution then, not making up movements.

[some1afterall]

I consulted with an Orthodontist who works with Gunson AND the surgeon who f*#%d up my first surgery. This particular ortho said he takes a more assertive role in advocating for his patients when working with the surgeon who did my first DJS. I’ve heard other stories where the Orthodontist knows the surgeon is f^%*king up, but goes along with the plan to try to cover up the surgical flaws by overstressing the tooth position orthodontically.

I don’t know the truth. I’d say Orthodontists that work frequently with big surgeons that bring them lots of $$$ will have some bias.

[CCW]

It's common to get your ortho work done by a local guy and then travel to Gunson for surgery. Just make sure they understand what the deal is and are willing to follow Gunson's instructions to a T. They won't f**k up if they do what Gunson says.

[GJ]

I consulted with an Orthodontist who works with Gunson AND the surgeon who f*#%d up my first surgery. This particular ortho said he takes a more assertive role in advocating for his patients when working with the surgeon who did my first DJS. I’ve heard other stories where the Orthodontist knows the surgeon is f^%*king up, but goes along with the plan to try to cover up the surgical flaws by overstressing the tooth position orthodontically.

I don’t know the truth. I’d say Orthodontists that work frequently with big surgeons that bring them lots of $$$ will have some bias.

This is all the truth.

The ortho is very important. Ideally you want one who does a lot of surgical cases, has no close affiliation (referral system, works in the same building, etc) with the surgeon, yet is on good terms with the surgeon and communicates frequently. Good orthos are really hard to find. It is the worst medical profession I've ever come across.

[nqrse]

You need to differ between whats skeletal and dental. An orthodontist can't mess upp what the surgeon has done, the bones gets fractured and repositioned, this cant be changed by anyone. But it's of course important to have a skilled orthodontist to do a good preparation and understand the face structure and angles.

My concern isn't so much the orthodontist messing up afterwards, but the orthodontist doing a subpar job before surgery. It's inevitable that the positioning of the jaw during surgery will be affected by the position of teeth. I'm sure Gunson won't let me go into surgery with anything that won't work, but if there's even the slightest difference in outcome between going to a local orthodontist and going to one who Gunson recommends, I want to take that into account.

[kavan]

My concern isn't so much the orthodontist messing up afterwards, but the orthodontist doing a subpar job before surgery. It's inevitable that the positioning of the jaw during surgery will be affected by the position of teeth. I'm sure Gunson won't let me go into surgery with anything that won't work, but if there's even the slightest difference in outcome between going to a local orthodontist and going to one who Gunson recommends, I want to take that into account.

Well, you did say in your opening post your concern was the ortho screwing up afterwards. Nonetheless, I agree that what's done BEFORE the surgery is imperative to matching up with the goal of the Gunson plan.

Wondering if you would have the option of flying in for some ortho 'check ups' along the way to double check if the local ortho is doing it right.

[Dogmatix]

My concern isn't so much the orthodontist messing up afterwards, but the orthodontist doing a subpar job before surgery. It's inevitable that the positioning of the jaw during surgery will be affected by the position of teeth. I'm sure Gunson won't let me go into surgery with anything that won't work, but if there's even the slightest difference in outcome between going to a local orthodontist and going to one who Gunson recommends, I want to take that into account.

You're going to a good surgeon, probably one of the best. But  he's still no magician and it all comes down to fracturing your jaws and putting them back together. We live in an age where these top class surgeons have advances tools to plan the surgery and surgery first has even become a concept, as the surgeon can understand what the orthodontist can achieve. I would say that you would need a pretty bad orthodontist to f**k up to the point that Gunson can't handle it with same result. The orthodontist just need to work in the right direction.

[nqrse]

Well, you did say in your opening post your concern was the ortho screwing up afterwards. Nonetheless, I agree that what's done BEFORE the surgery is imperative to matching up with the goal of the Gunson plan.

Wondering if you would have the option of flying in for some ortho 'check ups' along the way to double check if the local ortho is doing it right.

No, I mentioned the guy because I'm concerned about getting a bad ortho, not because I'm specifically scared of getting an ortho who screws up after the surgery. The guy in my opening post was an example of someone whose ortho messed up, and his just happened to mess up after rather than before. Either is bad obviously, but screwing up before surgery would be way worse. Honestly though, the ones messing up afterwards are probably the same ones doing a subpar job before, so it's just an all-around bad job. A bad ortho is a bad ortho - they won't be excellent before then suddenly turn bad after.

And it's not just messing up that I'm concerned about. I'm also worried that my ortho will do a passable job, just enough to go through with surgery, so the outcome turns out tolerable but not as good as it could have been. I could easily go with a local surgeon and get surgery for free (almost) and end up with an acceptable average result, but I'm going all the way to Gunson to try for an above average result. So, I want the ortho to match that. I was considering flying back and forth for check-ups, but after trying that for the consult, I don't think I'll be able to do it while attending uni.

[nqrse]

I've consulted with a big name surgeon for a revision. When I asked him about an orthodontist, he said "go back to the same guy, he did a great job". I think it's important to have an orthodontist who does many many surgical cases per year, which was the case with mine. AFAIK, your ortho will get a very detailed treatment plan from Gunson. It will be a matter of execution then, not making up movements.

So, the ortho wouldn't have to think of a treatment plan or do much decision-making. I'm inclined to think that the physical application of braces and moving teeth around is just default knowledge amongst all orthos, and the real bulk of the work and difference lies in their ability to construct a good plan. If the plan is already constructed by Gunson, wouldn't the ortho only have very simple things left to do? Or am I wrong?
 
Also, do you think it matters if an ortho has a long history of working with a surgeon who operates quite differently than Gunson? I'm worried that since Gunson's (and many other US surgeons') methods are so different than what he's used to seeing in Canada, he won't do as good of a job as someone who's worked with Gunson or similar surgeons before. He would be new to this particular type of plan despite being experienced with many jaw surgery cases. I really feel like Canada only does the most basic of surgeries. Would this matter or am I being paranoid?

[april]

I believe A&G may follow the Roth Williams/FACE orthodontic philosophy. They link to both on their website under memberships. So perhaps see if there are any RW orthodontists in your area?

http://www.rwiso.org/for-dental-professionals-quick-links
http://www.fullfacecourse.com/


But honestly just wait til you move to the Bay Area. What's one more year when it comes to getting a great result? I wish I hadn't been so impatient when choosing orthodonitsts. I've been majorly screwed.

[PloskoPlus]

And I wish I took more time choosing my surgeon. A year is nothing.

[some1afterall]

Tots!!! I will totally wait as long as I have to and pay top $$$ to get good results second time around. Don’t short change yourself!!! You have to live the rest of your life with your face and jaw.

[SKV2]

prob p important, they work in tandem. when i first went to see gunson he was fine with sarpe since his multi segment lefort wouldnt be enough to give me the space necessary for me to retain 28 teeth (raifaini quoted this as being over 10 mm) . when i saw the ortho i was going to go with who was in a diff state, all of a sudden this changed and they wanted to pull all 4 wisdoms AND 2 bicuspids. simply no. so now im prob gonna relocate to cali and just get it done in tandem with his own ortho there that works with him.