hello I'm new and a little slow

[honeycomb2325]

Hello! I'm new here. I found this forum after doing some research about jaw surgery. I am a 23 year old female living in the US and over the past few years I have noticed that something was "off" with my face. One day about 5 or so years ago I was riding in the car and I looked at my face in the mirror and noticed that whenever I closed my mouth my chin would wrinkle and my mouth would get this kind of snout-like appearance. After I noticed this I started realizing that, well, I never really closed my mouth. I was a mouth breather and I had no idea!  However, I didn't think much of it and figured I would train myself to breathe through my nose. Ultimately, this was a mistake, because as soon as I became used to keeping my mouth closed I developed jaw pain and started clenching in my sleep. I'd wake up every morning with horrible jaw pain and I'd grind my teeth at night, which horrified my boyfriend, bc it's a ghastly sound if you've ever heard it. Either way, I had no idea what was going on and was completely clueless that it was somehow all related to my jaw.
Then, a couple of years ago I went to an oral surgeon to see if my wisdom teeth had to be removed- basically I assumed this must be the source of my jaw pain. The oral surgeon diagnosed me with a slight open bite, but said since my wisdom teeth were not impacted, there was no need to remove them; however, I should have my bite checked by an orthodontist. There was a disconnect here. I heard slight open bite and figured it had nothing to do with my pain or facial disharmony. The reason I came to this conclusion was because I thought if I truly needed braces, surely in my youth I would have heard something from my dentist or parents! In fact, I always heard the opposite, that my teeth were very straight and how I must have had braces, etc. I never knew that teeth could still be straight and need braces.

At this time, I became a little obsessed with my jaw pain. It was driving me insane! If it wasn't my wisdom teeth, then what was it? One night I began to think about why I hated having my picture taken. I never had issues looking at myself in the mirror, but somehow what I saw in the mirror never seemed to transpose correctly in photographs. I was about to resign to the thought that maybe I was just not photogenic and should leave it at that, but instead I began to look at pictures and see if I could pinpoint exactly what I didn't like. I didn't like that my face always appeared too long and flat in pictures, especially from the profile. I also noticed that my smile was too gummy. After this I decided to google "long profile" (to see if maybe I just needed a haircut!) which led to "long face syndrome" and ultimately back to open bite". For f's sake, I realized I had had the answer for years and just never made the connection that this was the cause of everything.
Soon after this realization I scheduled an appointment with an orthodontist. I was excited to begin my journey with braces and fix my bite. Once again, I ASSumed since this was a slight open bite, I'd probably just need braces. I definitely wasn't a candidate for surgery- not me! Well, after my exam and x-rays the orthodontist gave me two solutions, one being that they would remove four bicuspids and give me regular metal braces and only fix my bite, but my face would remain unchanged, or two I could undergo corrective jaw surgery, which would fix my face and bite, and then have invisalign to correct some asymmetries with my teeth.
Right now I'm not sure what to do. Being 23 and out of high school, I don't think the first option is the most appropriate one for me, but then again I've never had surgery, so I don't know what fresh hell I'd be enduring if I decided to go with the second option. I mean, of course in a perfect world I'd like to correct the asymmetries in my face, but I am ok with learning to love what I have. In fact, I'm not sure if I could handle no longer being able to recognize myself after surgery, or worse, just not liking what I see. I'm realizing that I may have trivialized how important this decision is and I want to make sure I'm educated enough before I go through with it. I've watched several videos and looked through blogs detailing open bite surgeries and their extensive recoveries. I must say that everybody always looks better in their after photos and it is truly impressive what a difference the surgery makes regarding pain and TMJ. However, with all the blogs and videos I see, most are cases where the bites are somewhat severe, but I have yet to see someone who went through surgery for an open bite that was moderately less severe. In my case, I can still close my mouth but if I press my tongue up against my closed teeth you can see it sneak through a little bit. Aside, from the jaw pain and facial disharmony/long face, my open bite is not too apparent. In fact, many people have told me they don't notice anything at all...

SO, the reason I'm writing here is because I'm wondering if there is anybody else out there who has had an open bite that wasn't too severe and what they did  to correct it. Any information would greatly help!
Thank you!!

[DrBirbe]

Hi there! I didn?t know there was such a great and usefull forum for jaw surgery patients! Congratulations for the idea and bringing it to everybody.
First of all, let me introduce myself. I am Dr Birbe MD, DDS, PhD, Oral and Maxillofacial Surgeon diplomate of the American Board of Oral and Maxillofacial Surgery. I mantain a practice dedicated to jaw surgery, and I think I can answer some of the questions and doubts you have.
Open bites are mainly a vertical problem. This vertical problem might be due to a dental problem or a skeletal problem. Dental open bites are conveniently and stably treated with orthodontics only, and this might be the treatment of choice, if the patient doesn?t have any facial aesthetic requirement. Skeletal openbites are caused by a malposition of the jaws. The two main reasons are posterior vertical maxillary excess and short mandibular ramus. This type of open bite need a surgical treatment, combined with orthodontics. Otherwise, if they are treated with ortho only, there are good chances of having a relapse.
Now. There are some skeletal open bites, that might be treated with, let?s say, skeletal orthodontics by using TAD?s ( Temporary Anchoring Devices). This needs the placement of screws or miniplates under local anesthetics at the office ( very simple procedure) and are used to intrude the posterior teeth, so that the open bite can ble closed. There are a nummer of studies already published and the results are stable. Obviously, this would be a good opetion for patients with light to moderate skeletal open bites , that do no want major facial changes.
Having said that, let me point out that skeletal open bites, as you mentioned, frequently have well aligned and level teeth, which makes them ideal candidates for a "surgery first" approach, where we basically place braces the week before surgery, do the surgery, and start ortho treatment 2 weeks after surgery. Whay we do that? Because we such teeth relationship we can obtain a good postop oclusion, and secon we benefit from the RAP ( Regional Acceleratory Phenomenon) and teeth move easily and with less resistance to orthodontics forces. Which basically means that we can be done in 8 +/- 2 months. This is a major change and very convenient for every one. We solve the open bite from the begining and we convert the skeletal problem in a minor ortho problem, easily treated.
To finish, in my experience, TMJ problems realted to open bite tend to have good prognosis afte open bite treatment.
Regarding the stability of the treatment, I can point out some nice long term follow uo studies if some one is interested.
I hope I helped you to have an idea of the problem .

[PloskoPlus]

I am a 23 year old female living in the US and over the past few years I have noticed that something was "off" with my face.

23 is better than 35.  (No TMJ or functional issues, thank g*d.  I just realised my face was deformed.)

[DrBirbe]

Hi there!
As always in Medicine, there is no perfect solution without any risk. But in well selected and well treated cases, TAD might be an option. You mention stability and root resorption as potential complications. Root resorption is also a complication of conventional ortho, specially when roots get to close to te cortical walls...Stability, might be classifiedin 2 grups. Some open bite relapse but we still have overbite is OK for me. The problem is the group where we loose all the attained over bite. Smaill group in % but terrible for the patient that suffers it. So , if we have to make a hierarchy of stabilty, open bite treated with extractions are more stable than nonextraction. Open bite with monomaxilary surgery is more stable than bimax surgery, and open bite treated with TAD, have a stability simlar to monomaxillary surgery. Again , remember we are not only talking of total open bite relapse, but also relapses of 1-2mm, maintaining positive overbites.
Regarding the second aspect of your comment, flared incisors are very easilly treated as postop ortho, benefiting of the RAP phenomenon.
To leave a clear message, my recomendaton is :
skeletal open bites are treated with surgery. An alternative for patients that do not want surgery might be TADs, but with a previous discussions of limitations, risks, benefits.
dental open bites (frequently they have lip competence) are stabily treated with ortho only.
I copy some references regarding open bite stability with TAD?s...hope hty are helpfull.

 Open-Bite Malocclusion. Treatment And Stability Janson, G.; Valarelli, F.
Enhanced Effect of Combined Treatment With Corticotomy and Skeletal Anchorage in Open Bite Correction Original Research Article
Journal of Oral and Maxillofacial Surgery, Volume 67, Issue 3, March 2009, Pages 563-569
Mehmet Cemal Akay, Aynur Aras, Tayfun G?nbay, Sercan Akyal?ın, Banu ?zveri Koyuncue
 Show preview  |   PDF (913 K)   |   Recommended articles  |  Related reference work articles   
 
2   
Open bite: Spectrum of treatment potentials and limitations Original Research Article
Seminars in Orthodontics, Volume 19, Issue 4, December 2013, Pages 239-252
Joseph G. Ghafari, Ramzi V. Haddad
 Show preview  |   PDF (3647 K)   |   Recommended articles  |  Related reference work articles   
 
3   
Deep bite: Treatment options and challenges Original Research Article
Seminars in Orthodontics, Volume 19, Issue 4, December 2013, Pages 253-266
Joseph G. Ghafari, Anthony T. Macari, Ramzi V. Haddad
 Show preview  |   PDF (2170 K)   |   Recommended articles  |  Related reference work articles   
 
4   
Class III Correction Using Biocreative Therapy (C-Therapy) Original Research Article
Seminars in Orthodontics, Volume 17, Issue 2, June 2011, Pages 108-123
Kyu-Rhim Chung, Seong-Hun Kim, HyeRan Choo
 Show preview  |   PDF (8403 K)   |   Recommended articles  |  Related reference work articles   
 
5   
Five-year experience with orthodontic miniscrew implants: A retrospective investigation of factors influencing success rates Original Research Article
American Journal of Orthodontics and Dentofacial Orthopedics, Volume 136, Issue 2, August 2009, Pages 158.e1-158.e10
Joanna Antoszewska, Moschos A. Papadopoulos, Hyo-Sang Park, Bj?rn Ludwig
 Show preview  |   PDF (158 K)   |   Recommended articles  |  Related reference work articles   
 
6   
Survival analysis of a miniplate and tube device designed to provide skeletal anchorage Original Research Article
American Journal of Orthodontics and Dentofacial Orthopedics, Volume 144, Issue 3, September 2013, Pages 349-356
Shin-Jae Lee, Lu Lin, Seong-Hun Kim, Kyu-Rhim Chung, Richard E. Donatelli
 Show preview  |   PDF (1073 K)   |   Recommended articles  |  Related reference work articles   
 
7   
Bone anchor systems for orthodontic application: a systematic review Review Article
International Journal of Oral and Maxillofacial Surgery, Volume 41, Issue 11, November 2012, Pages 1427-1438
W.K. Tsui, H.D.P. Chua, L.K. Cheung
 Show preview  |   PDF (377 K)   |   Recommended articles  |  Related reference work articles   

[PloskoPlus]

Hi there!
As always in Medicine, there is no perfect solution without any risk...

Wow, an actual surgeon dropped by!  Would you mind doing a Q&A thread?

[DrBirbe]

I?d be glad to...don?t beat me to hard!

[honeycomb2325]

Hi Dr. Birbe
Thank you for your reply. I was looking into TAD and do you know if this type of treatment will have an effect on fixing the outer structure of my face? Or will it be like just opting for braces where the bite itself may be fixed by the facial aspect will remain unchanged?

[DrBirbe]

TAD?s allow for bigger ortho movements, but they do not substitute osteotomies. Specially if some facial imbalance needs to be corrected.