jaw surgery or genioplasty? w/pics

[isco92]

A genio is definitely not the way forward for you.  The lower jaw is recessed but the chin is not....a genio is going to look ridiculous

Actually, your lower jaw looks like mine does, post implant (I have a chin implant).  And I've been propose at least 8mm of advancement, and I'm female with a small face.  So for you it think it would be more like 10mm if your bite allows it which is the upper limit of what you can advance the jaw with a BSSO

The occlusion may not concern you now but believe me, it will start to concern you when you get to your late 20s and get gum recession because your lower teeth have been pushed so far forward to mask the overbite, and you have no upper lip because your upper teeth have been pulled in.

Orthos do not want to admit that they can't "fix" every bite.

strange the surgeon and the orthodontic didnt make a point
about a genio would look ridiculous. Your point
makes perfectly sense, thanks.

so are you saying my occlusion will be better in my
late 20s if I do BSSO?

[PloskoPlus]

BSSO is a tough surgery.  But genio is not trivial either.  Genio can also disturb the nerve and give you a numb chin, lip.  But you are young, so you shouldn't have problems recovering.  Fix things fundamentally.  BSSO.

[dantheman]

strange the surgeon and the orthodontic didnt make a point
about a genio would look ridiculous. Your point
makes perfectly sense, thanks.

so are you saying my occlusion will be better in my
late 20s if I do BSSO?

It's not so much occlusion that you worry about. It's the fact that if you torque your teeth like crazy to make top and bottom come together, you can run into issues. My lower front teeth were made to tilt 45 degrees forward to meet my upper teeth. I am 30 and starting to see gingival recession. Nobody wants early gum disease. My bite is perfect, but due to pushing orthdontic correction to the extreme. If you move the entire lower jaw forward, your lower teeth won't need to be proclined to meet the upper.

[Tiny]

It's the fact that if you torque your teeth like crazy to make top and bottom come together, you can run into issues. My lower front teeth were made to tilt 45 degrees forward to meet my upper teeth. I am 30 and starting to see gingival recession.

I've got the same issue.  Top teeth pulled in so much I've no support for the upper lip.  Bottom teeth pushed out so much that they're right at the front of the bone/gum and I've got gum recession.  And I still have an overjet and deep bite.  My profile is extremely similar to yours (look on my thread in 'overbites')

FYI, I would say on this board that we are quite conservative as a group about telling people to go for surgery

[isco92]

I am convinced. I was thinking about getting multiple opinions from surgeons and everything, but it seems
very clear too me, that it is only one option here and that is getting a BSSO and push my jaw forward.

As far as I understand It will not only fix my structural problems, and improve my facial profile. But it will also avoid me getting problems with my bite in my 30s, because ortho`s dont want too admit they cant fix my severe recessed jaw with orthodontic treatment. It all makes sense imo.
I booked an appointment on friday with an orthodontic too undo the treatment I did when I was a child. Thank you everyone this is priceless
information. I am feeling secure and confident that this is the way too go, even if its a long road.
This has been bothering me for a couple of years. At this point Ill do whatever it takes

here is a more fuller description of the previous treatment I did when I was 12 yrs old:
"On examination you have what is called as a class 2 malocclusion which describes the
lower jaw set backwards a little compared with the upper jaw. The orthodontic treatment
carried out for you has compensated for this jaw arrangement by moving the teeth with
fixed orthodontic appliances. The lower teeth have been moved forward and the upper
teeth moved back a little so that they meet together. Extraction of upper premolars has
been carried out to create space to achieve these movements. Bonded retainers are
in position behind your upper and lower front teeth to retain the teeth in their current
position."

 

[PloskoPlus]

Extractions... Oh boy.

[Tiny]

Typical orthodontic treatment for bad overbite due to skeletal issues

They should have left the premolars, put you in braces at 17, and then you could had the surgery at 18 between school and college.

Most of us here had to undo the orthodontic work we had done as teens.  I had four full size molars removed.  My dentist always complained about how small my mouth was

Will be interested to see your Xray when you get it

[isco92]

I should have, but I did not, surgery wasn`t in my head at the time, Im 22 now.
So how does this complicate things? and what's the difference?

X-rays from last week

[Tiny]

I should have, but I did not, surgery wasn`t in my head at the time, Im 22 now.
So how does this complicate things? and what's the difference?

It means that it's not so easy to do the surgery now, because you don't have nearly so much overjet as you had before  Now you've had the teeth removed, it is more difficult to create the space required to move the jaw forward enough  to balance the profile - your natural skeletal overjet has been removed.

Typically that seems to translate surgically into doing upper (le fort) with CCW to get more space, and/or shaving between the lower teeth a little to allow them to be pulled back.  However, your occlusional plane is not actually that steep so I don't know, how much CCW can be done.

In your case, I'd actually consider reopening the extraction spaces and getting implants.  You need quite a lot of advancement but because your chin bone already is protruding, you can't use a genio to get any of it - it needs to come from the BSSO.  If you re-created the skeletal overjet that you started with, you wouldn't even need to do a le fort - just a big advancement (~10+mm) via BSSO

The only other option is to remove the premolars on the lower arch and recreate the overjet that way.  IMO it's much better to add teeth than to remove them.  Supports the face

Go find and shoot your childhood orthodontist.  Surgery at 18 could have saved you from extractions and years of braces.  It sucks.  It's the same for a lot of us here - skeletal issue that was "fixed" by orthodontics as a teen, at a time when we didn't know about this surgery 

[isco92]

Typically that seems to translate surgically into doing upper (le fort) with CCW to get more space, and/or shaving between the lower teeth a little to allow them to be pulled back.  However, your occlusional plane is not actually that steep so I don't know, how much CCW can be done.

In your case, I'd actually consider reopening the extraction spaces and getting implants.  You need quite a lot of advancement but because your chin bone already is protruding, you can't use a genio to get any of it - it needs to come from the BSSO.  If you re-created the skeletal overjet that you started with, you wouldn't even need to do a le fort - just a big advancement (~10+mm) via BSSO

The only other option is to remove the premolars on the lower arch and recreate the overjet that way.  IMO it's much better to add teeth than to remove them.  Supports the face

Do you mean getting teeth implants?
I`ll do whatever it takes too re-create the overjet, you mean this is fully possible?  Several years with braces sounds very rough though.

[PloskoPlus]

Just remember time flies whether you're having fun or not.  And the older you are the quicker it goes. Take comfort in the fact that some of us are doing this in their late 30s. Good luck.

[Tiny]

what timeframe do you think option 2&3 is?

Minimum 12 months of braces, maybe a little more. If you want to speed it up you can get wilkodontics.  It's not cheap but it works

[isco92]

Hi everyone

updates on this situation

I went to see the orthodontics last week. Apperently I got a TMJ disfunction. And might have too wear
a splint to learn too eat and chew properly. Now I use the muscles in the lower jaw to chew.
got shown this link:

https://www.youtube.com/watch?v=IRI_eKiJ2So#t=127

They would not recommend me remove the lower busquids and pull the arch back.
which leaves me with reopening the extraction spaces. This will take about 2 years.

got a letter today which showed me the costs and what method and such, Ill post it under:



the tumbnail is not working properly press the link under for full frame
https://imageshack.com/i/p298ad71j

convert this to US the pricetag will be around $20,000. Sounds quite expensive.
Any inputs on method? are these damon braces very noticeble? Id prefer invincible onces obviously

[isco92]

one more thing.

My orthodontist say that because they extracted my upper premolars
the lower jaw didnt have enough space to grow/slide out out. Now when they re-open the spaces he said the jaw may slide out but he wasn't sure about that because its been such a long time (10 years)
Any inputs on this matter? maybe I dont need surgery 

found this on a google search this guy seems too have gotten good results
http://claimingpower.com/reverse-extraction-orthodontics-is-it-possible-for-adults-progress-report/

[LoveofScotch]

Take this with like a truck full of salt; I looked into reopening my extraction spaces and still can't decide what to do.

It may indeed be the best thing ever for a lot of people both from an aesthetic perspective AND a functional perspective, but it is also potentially ripe with problems. I'm under the impression that moving teeth that much, to reopen the extraction spaces, is tremendously hard on both our teeth and gums (root resorption, gum recession, etc.). Another thing to consider is the life of the implants. They essentially come in two separate parts: the root (implant), and the crown (visible part of the tooth). For the implant (root) two materials are available: titanium (common), and ceramic (newer and less common). (If I go this route, I will pick ceramic. I personally believe it to be superior, but that's certainly debatable.) So you'll have two separate parts to maintain for the rest of your life! Most people seem to do really well with implants, but keep in mind they can fail at any time (become loose, fall out, etc.), and they don't last forever, either. I was told between 8 and 25 years is the life of an implant if everything goes perfectly. Also, crowns don't last forever (I was told 8 years is standard). Another thing to keep in mind, and someone at the office should have told you this, is that you can go through this entire process and still end up needing surgery. I looked into working with Dr. Hang, and the one thing I really appreciated about him is that he acknowledged right off the bat that many of his patients still end up needing surgery to create an optimal result. I didn't read the entire thread; I'm not sure of your specific circumstances, so I don't know if that applies to you.

I think if all goes right this could be the most amazing treatment ever, but I just personally see the potential for SOOOO much to go wrong. It's a tough call.

The $20,000 you were quoted sounds a little high, but maybe that includes the splints to stabilize your joints, too. If it includes that splints/appliances/whatever that price is probably about right.