My question thread

[tdawg]

Welp, back.

Main points:

-The orthodontist noticed some definite changes and shifts from since I stopped treatment (early 2009), mostly probably caused by my not wearing my tooth positioner. He noticed the recessed mandible, and a lopsided bite, with one side coming down further than the other.
-He suggested I wear my tooth positioner diligently for the next 4 months, so I guess I'm maybe still in the late stages of growth.
-I brought up a maxillofacial surgeon referral to him and he seemed to recognize it as a real possibility, but I guess he wants to wait and see how the tooth positioner goes first.
-He said that tooth positioners could bring the lower jaw forward. That didn't sound right to me, but I deferred to him as the expert. Anyone wanna confirm or deny this?
-He didn't seem to think my maxillary was too long, but my mandible is.  I though quite the opposite, considering how recessed the mandible is.
-He said I should see an ENJ I think it was called, cause I'm a mouth breather. I don't know what that is, I guess I'll have to do my own research on it.

I'm probably forgetting some things, if they come to me I'll post them.

Sounds a lot like the advice I have received from various doctors. I was also told that the bad growth was in the mandible. I think it is because in both of our cases, the mandibular ramus is actually too short. This leads to an open bite and the appearance of a recessed jaw/long face. I doubt you have significant growth left though and I dont think the tooth positioner will change anything other than the bite which would be dental compensation.

I suggest that if you are serious about this, you go to a surgeon. Its hard to get a referral from an orthodontist unless you have a severe deformity.

[tdawg]

I mean it's not as extreme as not being able to discern between my chin and my mandible or something (which I've seen in some cases), but it was retruded enough for my orthodontist to notice it as an issue.

This is about what it looks like:

That is not what I remember from your pics. However if that is an accurate representation, a genioplasty from a good surgeon might be the right way to go imo.

[x]

I'm not too keen on plastic surgery, I'd rather address the root causes. I'll just consult with the ENT doctor and the orthognathic surgeon. I don't have to have a referral, right?

[tdawg]

Some places require a referral but most of the ones around me do not. A Genioplasty isnt really plastic surgery as it is using your own bone, and is actually used as a supplement in many jaw surgery cases.

http://www.facecenterla.com/photos/genioplasty.html

Here are some good examples. I emailed the surgeon and she said these were all "just" genioplasty cases.

[x]

Some places require a referral but most of the ones around me do not. A Genioplasty isnt really plastic surgery as it is using your own bone, and is actually used as a supplement in many jaw surgery cases.

http://www.facecenterla.com/photos/genioplasty.html

Here are some good examples. I emailed the surgeon and she said these were all "just" genioplasty cases.

That's a good point, but I feel like procedures like that don't balance out the face properly the way jaw surgeries do, like the jaw is adjusted and other parts of the face follow in suit. Maybe that's a flawed way of thinking, that's just how I looked at it. I'll look into it though.

[x]

Ok so I think I was actually able to convince my parents on scheduling the consult without much trouble. I was sure they'd get hung up on the 'surgeon' part of orthognathic surgeon, but I guess they figured it was an extension of the orthodontics.

[x]

So tongue thrusting and mouth breathing, how are these two things corrected? I am still waiting on my mom to schedule the appointments for the ENT and max-fax, and this is one part of my situation I know nothing about.

[Marisama]

I've been told by my surgeon that tongue thrusting can be corrected when both jaws are moved forward, thus creating more room for the tongue in the mouth.  When proper occlusion is achieved and lip competence is satisfactory, mouth breathing should be resolved as well.  So it sounds like your issues can be fixed with orthognathic surgery.

[x]

I've been told by my surgeon that tongue thrusting can be corrected when both jaws are moved forward, thus creating more room for the tongue in the mouth.  When proper occlusion is achieved and lip competence is satisfactory, mouth breathing should be resolved as well.  So it sounds like your issues can be fixed with orthognathic surgery.

Cool, thanks. That's a lot more convenient then I thought it would be. I should mention that I already have proper lip competence (possibly over-competence), I'm not sure if that makes any difference, but I'm still a mouth breather apparently, though I think I accidentally hang my mouth open unconsciously sometimes.

[Marisama]

Well if your tongue is resting on the top of your palate with your teeth apart and lips closed, you can't mouth breath.  So when tongue thrusting is corrected, so is mouth breathing.

[x]

if your lips aren't completed sealed as mine aren't, and only part of your tongue sits on top of your palate, you can still mouth breath some of the time.

not sure if tongue thrusting is corrected by jaw surgery.

What he said about expanding both jaws makes sense to an extent, if my mouth can't fit my tongue properly it'll be pushing against my teeth constantly, and the consensus seems to be I have an underdeveloped upper jaw, and a lower jaw that doesn't extend out as far as it should. Remains to be seen if this is true or not though.

[trigeminalneuralgia]

okay i dont want to hijack this thread but im going in for 2 ortho consults   

wtf is a tooth positioner, ive never heard of those, are there any advantages?  did insurance cover it?  can you go straight from braces to retainer without a problem?

[x]

Yeah insurance covered the tooth positioner.

I went from retainer to braces/retainer (wearing the retainer when I could) to tooth positioner after I got the braces removed. I think it's mainly used for final adjustments and to indefinitely keep your teeth in place. Which is why I want to talk to a max-fax surgeon, cause I don't think a tooth positioner will be that effective for my jaw issues, except for somewhat closing the bite.



^ That's what they look like. You stick them in hot water and when it gets soft enough, you put it on your teeth and it'll mold to fit your teeth, then slowly pull them into position.

[trigeminalneuralgia]

thanks (I GAVE YOU KARMA)

i might need one of these.  im going to have to wear something to keep my teeth in place for eternity (....as i have a connective tissue disorder and the teeth have a tendency to move around more).  it looks more practical long term than a retainer

[x]

thanks (I GAVE YOU KARMA)

i might need one of these.  im going to have to wear something to keep my teeth in place for eternity (....as i have a connective tissue disorder and the teeth have a tendency to move around more).  it looks more practical long term than a retainer

It definitely is, in the final stages of your treatment you should only have to wear it at night, at least that's what I did. And it's something you won't have much trouble falling asleep with once you get used to it.