Need thoughts on surgically assisted orthodontics

[needadvancement]

I just had a very interesting consult with my Ortho and he presented me a treatment option I've never heard of before. I can't find info on an American website about it, they told me it's very new even in my country.
First off some of you may remember my previous thread, my issue is with my mandible crowding and over errupted incisors causing a bimax protrusion look. If I understood it correctly, the idea is to put material into the gums that will encourage new bone growth, so that they can bring the roots of the teeth forward for more space and they can be lined up straight. The other option is of cource the classical premolar extractions to pull the teeth back into the mouth. I will avoid the latter, though this other method is much more costly of cource, but it's also done within 6 months!

heres some pics for reference:
https://imgur.com/a/dy0J9#0
https://imgur.com/a/jjB1Q?#0

So what do you think? Is this a superior option, is it maybe too good to be true etc.? Would this be optimal to improve looks? Would love to read you thoughts on this.

[needadvancement]

I tried to put it together visually(bare with me lol) as you can see they want to get forward growth on the root of the teeth. No extractions. He noticed my deep mentalabial fold and said that it will be decreased substantially too. Again, sounds very good to me.

[sean89]

Are you referring to segmental distraction? Or maybe just a corticotomy?

[terry947]

Hey needadvancement.

Im in the same scenario as you. The problem, in my eyes, is that if we don't fix the protrusion problem before surgery, we'll have chimp lips after. Extractions would make the protrusion look more "normal" but I'm not sure if this is the best option. Pulling teeth collapses the face, makes the airway more narrow, plus who knows what else it does. I've been thinking and I feel like some cases of bimax protrusion could be fixed with expansion of the jaws. In my case my upper and lower jaws are like narrow U/V's and it kind of looks like yours is as well. I photoshopped a pic of your dental arches, sides expanded with the fronts brought back and it looks normal to me. I'm not an ortho or dentist but It just makes sense to me.

If your only choice is extraction or that bone thing, then Id go for the second one. But who's to say that the bone just wont reabsorb and it'll look the same after 5 years. As far as I know Bimax protrusion is causes by tongue thrusting, therefore the pressure of the tongue has pushed the teeth forward causing this.

Heres the pic: http://i.imgur.com/804dCjK.jpg

It might make the lips looks more normal. I doubt the maxilla will have any change since the molars wont be moving just the front teeth.

Let me know what you guys think! Also whats at bone procedure called?

[needadvancement]

Hey needadvancement.

Im in the same scenario as you. The problem, in my eyes, is that if we don't fix the protrusion problem before surgery, we'll have chimp lips after. Extractions would make the protrusion look more "normal" but I'm not sure if this is the best option. Pulling teeth collapses the face, makes the airway more narrow, plus who knows what else it does. I've been thinking and I feel like some cases of bimax protrusion could be fixed with expansion of the jaws. In my case my upper and lower jaws are like narrow U/V's and it kind of looks like yours is as well. I photoshopped a pic of your dental arches, sides expanded with the fronts brought back and it looks normal to me. I'm not an ortho or dentist but It just makes sense to me.

If your only choice is extraction or that bone thing, then Id go for the second one. But who's to say that the bone just wont reabsorb and it'll look the same after 5 years. As far as I know Bimax protrusion is causes by tongue thrusting, therefore the pressure of the tongue has pushed the teeth forward causing this.

Heres the pic: http://i.imgur.com/804dCjK.jpg

It might make the lips looks more normal. I doubt the maxilla will have any change since the molars wont be moving just the front teeth.

Let me know what you guys think! Also whats at bone procedure called?

Hey terry, thanks for your input. Nice photoshop, I wish my teeth were like that. I think that you are right in a sense about a broader palate helping, but I am not sure about that because I've seen people with bimax protrusion who did have a broad palate, it was just the position of the incisors and canines tipping the lips and subnasial tissue forward, and the lack of bone above and below the teeth on the root areas. My best bet is comprehensive jaw surgery for my recessed jaw and occlusal plane, but since I won't do that he did say that this is a great 'camouflage' treatment. Fix the protrusion and deepening of the mentolabial fold with this, and a SG in the future and I'm done since I don't have health problems due to my bite.

Anyway what I really should have asked him if this can be done to the molars to some extent too(the guy was in a hurry too yesterday and I forgot some questions) so that I can get more jaw width that will support more tissue around the lips. He did say that I will have a bigger smile with more teeth visible afterwards so I'm not sure on this.

I also asked about the safety and risks and he was all positive, I hope there won't be relapse or anything. I think retainer maintenance should prevent that.

[needadvancement]

Are you referring to segmental distraction? Or maybe just a corticotomy?

It is hard to say, I think it might be Distraction osteogenesis but I'm reading through some of this and they don't mention the input of plastic materials. I honestly don't understand it that well yet untill my next appointment, but the emphasis was put on the use of plastic pieces being inserted into the gums, and that this is not an invase procedure since it's about 10-15 minutes and is done with local anaesthetic.

[sean89]

It is hard to say, I think it might be Distraction osteogenesis but I'm reading through some of this and they don't mention the input of plastic materials. I honestly don't understand it that well yet untill my next appointment, but the emphasis was put on the use of plastic pieces being inserted into the gums, and that this is not an invase procedure since it's about 10-15 minutes and is done with local anaesthetic.

After your appointment, please tell us what your ortho said because my case and yours are very similar.

[needadvancement]

Hey Sean, will do. I found it on none other than Wikipedia btw, I'm currently researching it.

http://en.wikipedia.org/wiki/Accelerated_orthodontic_treatment

From the testimonials I've seen so far I can already tell that this is more invasive than they'd like to tell you. It's like the usual swelling, pain and eating liquids for a while like Jaw surgeries.

[terry947]

Hey needadvancement, When I say push the teeth back, I mean torquing it so that the root just pushed forward while the actual tooth gets pushed back. When this happens the body has to build bone so that the tooth just doesn't fall out. Atleast I think it does.

Please let us know what your ortho says because I have the exact same problem as you. I have a little bit of bimax protrusion with makes my upper jaw look almost normal, but its not, if that makes sense.

[terry947]

Is it called wilckodontics?

http://www.armitageoralsurgery.com/surgically_accelearated_osteogenic_orthodontics.htm

http://www.wilckodontics.com/Consumers/AboutTheProcedure.html

[needadvancement]

@ Terry, it sounds like the same procedure. The website of my orthodontist calls it PAOO, Periodontally Accelerated Osteogenic Orthodontics.

Thanks for the links btw, this patient's results are interesting:
http://www.fastortho.com/Consumers/PatientExamples/MZ.html

His more maxilla broadened quite a bit. I hope they can do the same for my premolars, they're bothering my tongue when I rest it on my palate since it's so narrow.

When I say push the teeth back, I mean torquing it so that the root just pushed forward while the actual tooth gets pushed back.

This is what was described to me, yes. I just really hope it fixes the look on the outside of my mouth/face. I need my lower lip brought forward and the mentolabial fold filled out a bit, and have both lips protrude less by straightening the incisors and canines.

[needadvancement]

Btw can somebody draw what my airways are supposed to be on this profile ceph of me?
http://i.imgur.com/5UiaMpp.jpg

I saw another thread where somebody's surgeon drew it on and I can't figure out what the size of my airways is supposed to be..