tads as an alternative to impaction

[Optimistic]

Hi there!
Flaring of the nose after a maxillary impaction is a well known indirect effect of the maxilla movement. In my experience, I have good control of it with 3 surgical manoeuvers: piriform rim remodeling, caudal septum triming and good nasal alar elevators muscles repositioning. If there is concern also about thenaso labial angle, we should do some triming of the anterior nasal spine.
Hope I helped to clarify some doubts.

Hey doc,

Do you find TAD's are able to improve lip cant at all? Examples in studies seem to show this, though I don't understand why.

[DrBirbe]

Yes. Canting can be improved -to a certain limit- with unilateral tads. Ortho will take longer but good results can be obtained.

[falcao]

My bite is still off. My orthodontist has been closing it with elastics and from very open it has come to a point where I have an "edge to edge" bite now. However, the stupid elastics worked by pulling my upper teeth down, causing a less than desirable profile 4 months after the surgery, with a longer than planned lower third and sharp jaw angles. This is because my lower jaw is not where it was planned to be, and the bite has closed using opposite forces of those that should have been used.

I hope that the window opportunity for TADs has not been closed altogether, as I think they are a very viable alternative to a revision surgery (and I fear I'm heading in that direction). If I have to do another surgery and go through hell once again, I will blame my orthodontist even more so than my primary surgeon (who may or may be not responsible for this situation) for not using his f**king brain. I've been seeing some extremely impressive results from TADs, and I think in my situations they would have worked wonders. I hope it's not too late for me, I'm going to have this conversation with a maxillofacial surgeon next week.

I'm edge to edge now, but if the molar intrusion creates enough space for the lower jaw to come up softening the jaw angle and for the chin to come a bit forward, I'm happy to try it, even if I end up with a deeper bite in the end.

I feel this should have been done immediately when the open bite appeared. I would have had the opportunity for about 5mm of intrusion. Now it's much less.
f**king orthodontist fixating on bites with their narrow tunnel vision and not seeing the big picture.

These are a couple of incredible TADs result that shows an alternative to maxillary impaction  - no surgery! The evidence is out there.



[attachment deleted by admin]

[attachment deleted by admin]

[Optimistic]

From what I've seen TAD's can be amazing. I'm going to get them to fix my slight maxillary cant, and based on all the studies I've read so far it should prove to be the most logical option considering how minor mine is.

I still would love to know why TAD's appear to have an impact on soft tissue like they do. Even in those before and afters you can see changes. Yet conventional wisdom amongst orthodontists and surgeons still seems to state that soft tissue follows bone, TAD's only move the teeth and won't change the maxilla, therefore your appearance won't be altered.

Then again I question how much people really know about TAD's. My ortho felt that if I ever wanted to address my cant I would need upper jaw surgery.  As soon as I brought up TAD's he had nothing bad to say about them except that their long-term stability has not been proven and there could be a risk of relapse. So why wouldn't he have at least suggested them?

Moreover, we're talking about TAD's not hacking a jaw up. So I've got no problem if I need TAD's again in a decade to touch it up again.

[falcao]

TADs do change the way you look even as much as a surgery in some cases (as the photos above - I can also show you many more). This is because they enact dento-skeletal changes, they do not simply move teeth. There are many, many different forms of them, but watch the video I posted originally about how the lower jaw changes its position significantly. This process completely changes your jaw angle, facial height and the final position of your chin. And this is only one type that does molar intrusion. From what I've seen, many TADs have the ability to enact this type of dento-skeletal changes.
Many orthos are still in the dark ages though when it comes to TADs. Maxillofacial surgeons are catching up more quickly - in many instances they propose themselves TADs as an alternative to surgery.
I managed to find someone close to me who specializes in these dento-skeletal changes TADs can make in adults as a means to improve functionality and appearance. I'm excited about the appointment and only hope it's not too late for me after my orthodontist has failed miserably to come up with an adequate plan to treat my post-surgery concerns.
If only it was that easy to fire your orthodontist, I swear half of them would be out of work within a year.

[geijutsu]

My bite is still off. My orthodontist has been closing it with elastics and from very open it has come to a point where I have an "edge to edge" bite now. However, the stupid elastics worked by pulling my upper teeth down, causing a less than desirable profile 4 months after the surgery, with a longer than planned lower third and sharp jaw angles. This is because my lower jaw is not where it was planned to be, and the bite has closed using opposite forces of those that should have been used.

I hope that the window opportunity for TADs has not been closed altogether, as I think they are a very viable alternative to a revision surgery (and I fear I'm heading in that direction). If I have to do another surgery and go through hell once again, I will blame my orthodontist even more so than my primary surgeon (who may or may be not responsible for this situation) for not using his f**king brain. I've been seeing some extremely impressive results from TADs, and I think in my situations they would have worked wonders. I hope it's not too late for me, I'm going to have this conversation with a maxillofacial surgeon next week.

I'm edge to edge now, but if the molar intrusion creates enough space for the lower jaw to come up softening the jaw angle and for the chin to come a bit forward, I'm happy to try it, even if I end up with a deeper bite in the end.

I feel this should have been done immediately when the open bite appeared. I would have had the opportunity for about 5mm of intrusion. Now it's much less.
f**king orthodontist fixating on bites with their narrow tunnel vision and not seeing the big picture.

These are a couple of incredible TADs result that shows an alternative to maxillary impaction  - no surgery! The evidence is out there.

Those results are astounding, specially  because they're not even surgical!

[falcao]

Those results are astounding, specially  because they're not even surgical!

Yeah, I know. I can show you cases where the maxilla was advanced, cases where the maxilla was impacted (or equivalent), cases where the mandible was rotated clock-wise, counterclockwise etc. TADs are probably not a solution for 90% of the cases considering a surgery, but for those 10% that they may (or may not) be they are an easy way out and can produce a f**king amazing result. Just start downloading studies off Google scholar and you'll see. And the interesting thing - they come up with new ones all the time. 

Too bad some orthodontists are lazy, old school bastards who refuse to learn anything new because they make a s**tload of money anyhow. Why bother. 

[geijutsu]

lol, I agree. It's amazing how some of the orthos are behind the cutting edge research. I guess it only takes very passionate and maybe even daring ones to go out of their way to learn these new techniques to offer better services. I'd imagine the only way for that to change is if the public in mass becomes more educated and demanding thus raising competition level forcing some of the lazy ones to start stepping up their game.

[Optimistic]

TADs do change the way you look even as much as a surgery in some cases (as the photos above - I can also show you many more). This is because they enact dento-skeletal changes, they do not simply move teeth. There are many, many different forms of them, but watch the video I posted originally about how the lower jaw changes its position significantly. This process completely changes your jaw angle, facial height and the final position of your chin. And this is only one type that does molar intrusion. From what I've seen, many TADs have the ability to enact this type of dento-skeletal changes.
Many orthos are still in the dark ages though when it comes to TADs. Maxillofacial surgeons are catching up more quickly - in many instances they propose themselves TADs as an alternative to surgery.
I managed to find someone close to me who specializes in these dento-skeletal changes TADs can make in adults as a means to improve functionality and appearance. I'm excited about the appointment and only hope it's not too late for me after my orthodontist has failed miserably to come up with an adequate plan to treat my post-surgery concerns.
If only it was that easy to fire your orthodontist, I swear half of them would be out of work within a year.

Do you have any studies explaining these dento-skeletal changes? I can only find ones referring to the teeth being moved. Unless you mean the teeth get moved, and this makes the jaw to move into a different position (like auto-rotation), thus changing the appearance without actually altering the bone.

[falcao]

The studies are there if you search for a particular issue.

Also, watch all youtube videos on the subject. e.g. this video to see how TADs can do what braces never can. Notice the movement of the anterior maxilla here. An absolutely amazing movement. And as I said, each year they are designing more and more different types that can do all sorts of things on both jaws. Rotation is also a big part of how they work. 

Use of mini-screws in orthodontics

[falcao]

Still researching TADs in a desperate attempt to avoid a revision surgery. My bite is still totally off and the "camouflage" orthodontics is not going in the right direction.

This guy's chin came well forward and got a nice curve to it (from being completely flat) and his face was shortened as well with TADs, as his bite was closed and his mandible rotated counterclockwise. Do you think this result approximates impaction or would impaction be generally speaking much more significant? I have before and after pictures of this case if you're interested.

[attachment deleted by admin]

[falcao]

This is one of the most powerful cases of TADs being used as an alternative to surgical impaction that I have come across. For all those of you out there with open bites, pay attention and demand answers from your surgeons if TADs could be an alternative to impaction in your case. I can think of 100 advantages of not having to have an impaction and still accomplishing a wonderful result.



[attachment deleted by admin]

[falcao]

By the way, let me explain that the girl above had a BSSO setback and a genioplasty. However, her original surgical plan called for an impaction as a must. Her surgeon fortunately was wise and hard-working enough and proposed TADs for her. The result you see above involved no upper jaw surgery whatsoever.

[Tiny]

Do TADS work for extrusion of teeth as well as intrusion?  I've always been advised that extrusion in an adult patient is not stable which is why I need surgery to close my posterior open bite.  My maxilla is the too short posterior, rather than being too long in the anterior like most people with gummy smile

Weakjawbrah - botox can work on gummy smile, by partially freezing the muscles and not allowing the lip to come up so high when smiling.  There's no reason why you can't get it on one side only.

[Optimistic]

Do TADS work for extrusion of teeth as well as intrusion?  I've always been advised that extrusion in an adult patient is not stable which is why I need surgery to close my posterior open bite.  My maxilla is the too short posterior, rather than being too long in the anterior like most people with gummy smile

Weakjawbrah - botox can work on gummy smile, by partially freezing the muscles and not allowing the lip to come up so high when smiling.  There's no reason why you can't get it on one side only.

Thanks, but I don't actually have a gummy smile. My problem is that one side of the lip sits about couple of mm's lower than the other, which lines with roughly with the degree of maxillary cant I have.

I'm currently unaware of any ways to solve this, though have heard TADs sometimes improve lip posture. My cant is likely too minor for upper jaw surgery.

Do you know if there's a way to lip one side of the lip slightly?