braces + lower jaw surgery or braces only?

[ticktickatick]

You don't necessarily have to decide right this moment. Most orthodontists charge you a set price whether you have braces for 6 months or 4 years. My one year of braces pre-op cost the same amount as the teenager sitting next to me who's gonna be in them for years.

Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.

One oral surgeon I talked to (I believe it was Dr. Posnick) said that the risk of permanent numbness is closer to about 1% for how old you are. So at 40 you'd have about a 40% chance of at least a small area permanent numbness. He may have been overstating things, but I wouldn't underestimate how risky this surgery is at your age. It's also crazy expensive and not covered by most insurances. Law of diminishing returns says that age 40 this surgery is only worth it if your bite is crazy bad and you are really really depressed about how you look.

You seem pretty well-adjusted and happy with how you look, so I would at least give braces some time before you make a decision.

[PloskoPlus]

FWIW, the ortho managed to bring my midlines into alignment with braces only.  Apparently this obviated the need for operating on the lower jaw.

[Mark32]

Thanks Mark! Yes, I'm pretty nervous about surgery. While I knew my chin was wonky, I thought braces would improve it along with my bite. So I was rather taken back when the orthodontist suggested surgery. It really surprised me. Oh well, it is what it is, you know? : )

i find the prospect really daunting but the advice and info here can be reassuring. how supportive are your friends/other half of you doing the surgery thing?

from your last pic it looks like your underbite is bit more pronounced than in the earlier ones. but is that just a result of lining up your mid lines? when your jaws relax back into their usual positions does the underbite decrease?

You don't necessarily have to decide right this moment. Most orthodontists charge you a set price whether you have braces for 6 months or 4 years. My one year of braces pre-op cost the same amount as the teenager sitting next to me who's gonna be in them for years.

Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.

that's really interesting. when i last went to get something done about my teeth i was given the option of either orthodontics or surgery, i never realised i could have went for the latter and then changed my mind six months later. that would have been far more flexible. 

the only thing i don't understand is doesn't the orthodontics sort of go in two different directions depending on whether you're just getting braces or going down the surgical route. doesn't the ortho camouflage a jaw discrepency one way but perhaps make it more apparent if your getting surgery. in my case if you put my lower incisors, canines and first premolars at the correct inclination my class 3 situation would get worse. but wouldn't the ortho be moving these teeth in the other direction (and maybe tipping my upper incisors forward) if i was only having braces?

[PloskoPlus]

Yes, orthodontical preparation for jaw surgery is called decompensation.

[Mark32]

is there an initial period during the orthodontic treatment where the teeth are sort of just loosened up a bit (can't think of anything else) where the treatment plan wouldn't vary between a patient going for surgery and one not?

also, is it usual for dental compensation that's already occurred as you grew to go far back into the mouth? i mean, certainly the incisors might be affected but would molars have changed their inclinations due to a jaw misalignment?

just from looking at pics many people who don't appear to have had braces have crowded/crooked lower incisors. I've read this comes from the lower jaw growing a bit longer than the upper with the result being that the lower incisors are left with no space and so are 'uprighted' into a smaller arc.

[Gregor Samsa]

The goal of decompensation is to get the teeth in such a position that the jaws can be moved enough to correct the skeletal discrepancy while still giving you a good bite. That's not always possible though like in my case. I am post-surgery and my teeth are now aligned exactly as they're supposed to be, yet I still have a skeletal underbite of around 1 cm. I'm not really sure how that can happen.

[Modigliani]

You are a most special snowflake 

[Ginger]

Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.

Thanks. This would be the route I would go if I could. The need for lower extractions with the 'braces only' option is the one thing stopping it. Extractions would need to be done now.

And thanks for the nerve damage info. I didn't realize the risk went up so much with age. It's a risk for some serious consideration.

[PloskoPlus]

Thanks. This would be the route I would go I could. The need for lower extractions with the 'braces only' option is the one thing stopping it. Extractions would need to be done now.

And thanks for the nerve damage info. I didn't realize the risk went up so much with age. It's a risk for some serious consideration.

Don't pay the ortho upfront if possible. Extra motivation for them. I've been told people don't notice the numbness after a while. 

[Modigliani]

I'm your age Ginger and I didn't have any numbness at all, everything else went wrong but not that 

[Ginger]

i find the prospect really daunting but the advice and info here can be reassuring. how supportive are your friends/other half of you doing the surgery thing?

from your last pic it looks like your underbite is bit more pronounced than in the earlier ones. but is that just a result of lining up your mid lines? when your jaws relax back into their usual positions does the underbite decrease?

Mark, good questions. Yes, the more noticeable underbite is from lining up my midlines, which brings my chin center. It shows how much asymmetry is really going on. When my jaws are in normal position, it's more of an edge to edge bite/ very slight underbite.

As for support, I haven't told many people yet. My sister is very supportive. She used this orthodontist and loves him. Her teeth were much more crooked than mine and they're beautiful now. She was pretty symmetric to begin with though.

My husband... he thinks I look fine and that my crookedness is part of my charm. lol. Mostly I think he's nervous about surgery because of possible complications, and would rather have me skip it. However, he also aware that my bite has caused serious issues like worsening TMJ and even nerve damage. If I do have surgery, he'll be supportive.

I haven't told hardly any friends about surgery... when I mention even braces, they act surprised. Most told me they think my teeth are pretty straight. My closest friend guessed I had braces when I was younger. It kind of goes to show you how much people really notice... probably less than we think.

[Ginger]

It looks like upper jaw might be an option as well.

I think you're right. Looking through some of my other pics, I probably need at least an at least an impaction to go along with lower jaw surgery. My normal smile isn't gummy, probably because of lip size, but things can get gummy if I smile big or laugh.

Wow, you really do have an underbite. It was not that noticeable in the prior set of photos.

I cannot stress enough the need to get multiple opinions from different surgeons. I've had many consults, and I received three grossly different plans. Seriously, you wouldn't think they were made for the same person.

Getting multiple opinions has its downside, though. How far down the rabbit hole are you ready to go?

It really is a rabbit hole, isn't it?

[Ginger]

Well, my profile pics above are pretty crappy. Bad angles and I have a some weight masking my lower jaw. New profile pics below, along with angled views. These better show how long my lower jaw is, especially on the left side.  (Can you tell I'm not a big fan of my left side?) Right side is bit shorter than the left but still has a bit of an underbite.

[Ginger]

I'm your age Ginger and I didn't have any numbness at all, everything else went wrong but not that 

That's good news about the numbness, but damn, I'm sorry to hear things didn't go well.

[Mark32]

Ginger, I think you look really good as well - you have very good skin. I suppose if you go for surgery and end up with something close to a perfect smile/jaw shape you really will have a very attractive face. but then your in the happy place of being attractive to begin with.

it's good to hear that your sister and husband are supportive. as surgery must be an intensely emotional ordeal having your nearest and dearest fully behind you is probably really important, don't you think?