Am I still in crossbite?

[Dogmatix]

They want a nice house.

It's very sad that the medical field attract such people. I don't deny skillfull people making money on what they're good at, but not on the expense of patients health.

[ODog]

They want a nice house.

Why do you think revision should be easy, though?

I had a a lot of problems on both jaws that were worked on in the first surgery, including completely recontouring my chin. Aesthetic problems were fixed including tooth show, posterior gum show, asymmetry, lower jaw projection, chin contour/ projection, maxilla was advanced just enough to not cause any monkey lip, etc. So there was a lot that went into the first surgery.

This revision wouldn’t entail aesthetic concerns which can be subjective and hard to get right; it’s a pretty straightforward, mechanical maxilla expansion and that’s all I need, so he can focus all his energy on getting this right.

[ODog]

Maybe I use easy in the wrong word. I think every surgery should be easy, in a context that it's mostly about defining and agreeing that you see the same problem, and then have a good discussion about what can be done and achieved. Surgeons aren't magicians, they're mechanics that can advice what is possible and then execute it. Very straight forward and easy. Problem is that surgeons and orthodontist often want to portray them self as magicians and that they perform stuff that can't be explained. Thus leaving someone with a crossbite without explaining why and denying it.

Very good analysis.

They also diagnose every little minor thing about your bite or jaws during the initial consult, noting a mm cant or slight midline deviation in your file, to get you in braces or convince you of the need for surgery or whatever, and then afterward when the treatment is done they become far less scrutinizing simply because they don’t want to an unhappy patient on their hands, which is highly offensive that they would skew the truth after they’ve already been paid. It’s unacceptable and I’m not just going to put up with it.

[Dogmatix]

So I fully expect him to offer a revision. In fact it shouldn’t matter to him because the government is going to pay for it anyway. If anything the hesitancy about revising should come from me, not him.

What is the actual status? The thread started with asking if there is a problem, and have turned into flaming the surgeon. Have he denied you a revision and have you had a specific discussion about this? I'm fully on your side that it's bulls**t that you as a patient even have to raise such question and that they should see it and tell you. But I don't think we shall hang and sue him before he at least have been given a chance to respond to your concern.

If the surgery is paid by the government and it's done under national health care, I think he could face rather serious consequences if he doesn't do right. You're monitored in an other way than in a private practise.

[ODog]

What is the actual status? The thread started with asking if there is a problem, and have turned into flaming the surgeon. Have he denied you a revision and have you had a specific discussion about this? I'm fully on your side that it's bulls**t that you as a patient even have to raise such question and that they should see it and tell you. But I don't think we shall hang and sue him before he at least have been given a chance to respond to your concern.

If the surgery is paid by the government and it's done under national health care, I think he could face rather serious consequences if he doesn't do right. You're monitored in an other way than in a private practise.

No I haven’t talked to him about it, I see him next week. To be fair though Dogmatix, I shouldn’t even need a revision. We’re talking about chances of nerve damage being increased. I’m sure you would feel the same way after your surgery if your bite is not class 1.

[Dogmatix]

No I haven’t talked to him about it, I see him next week. To be fair though Dogmatix, I shouldn’t even need a revision. We’re talking about chances of nerve damage being increased. I’m sure you would feel the same way after your surgery if your bite is not class 1.

Fully understandable, it's enough stress and risk to go through surgery once.

[ODog]

Fully understandable, it's enough stress and risk to go through surgery once.

Yeah you’ll understand when you go through the recovery. You’re right though I’m jumping the gun by venting over whether my revision will be free or not when I haven’t even spoken to him about it. I guess I’m just frustrated I even have to consider this.

[Dogmatix]

They also diagnose every little minor thing about your bite or jaws during the initial consult, noting a mm cant or slight midline deviation in your file, to get you in braces or convince you of the need for surgery or whatever

So true, like all handymen. Have you ever had a plumber or painter who didn't start their work by giving critic on the current installation? I'm now in braces with my orthodontist for free. He was so keen about telling me about how big deviation I had and it made me feel safe, because if he saw all of this he would surely fix it. He recommended invisalign even though I questioned if some plastic trays really had the capability of fixing this. Guess what, they couldn't and he even did things we hadn't agreed on. So here we are after many discussions.

[Dogmatix]

Yeah you’ll understand when you go through the recovery. You’re right though I’m jumping the gun by venting over whether my revision will be free or not when I haven’t even spoken to him about it. I guess I’m just frustrated I even have to consider this.

That's all I'm saying. If you're gonna shot him before trying to speak to him you might as well not visit him at all. The situation is what it is and best scenario from here is that you agree on the problem and figure out a solution.

[ODog]

So I just read a post by someone who hasn’t posted here in a while who had the same issue with my surgeon where his crossbite wasn’t fixed. He said the surgeon wanted to handle it orthodontically, which led to relapse, and then he was left with all the same problems except with about 50 % improvement. He then went to another surgeon for revision who offered SARPE with 1 cm of upper jaw widening. He never made it clear whether a segmental lefort was TRIED in the first surgery to correct the crossbite or if it was disregarded entirely. In my case there was widening of the jaw, just not enough to fix the crossbite.

So I’m starting to think my surgeon just may not feel very comfortable performing this type of procedure.

[ODog]

Just want to give an update.

I met with my surgeon today, and he told me there is no cross-bite, and that my teeth are not edge to edge. He did say my teeth are anatomically flat and that may be why my upper teeth don’t overlap the lower. (I don’t understand this).

In terms of the vertical height of my upper jaw, some may have commented that my gum show has been reduced from the surgery, but he says my upper lip is still healing and distorting the tooth show. He says when my upper lip is functional again the lip line will be just above the tooth-gum line when smiling, so any additional downgrafting would give a gummy smile.

I’m satisfied with his answer regarding the vertical height, but I’m still not sure about the transverse width. I did ask him if revision is a possibility, and he didn’t say no, he basically said well anything is possible but implied there would be no reason for it. He did firmly say there is no transverse deficiency and to trust him.

So I’ll have to take his word for now. I am consulting with another surgeon in a couple months to get a second opinion. He said I’d have to wait a year anyway for the nerves and everything to heal if I wanted a revision, so I’ll see how the orthodontics shifts things into place and reassess in due time.

[Post bimax]

Just want to give an update.

I met with my surgeon today, and he told me there is no cross-bite, and that my teeth are not edge to edge. He did say my teeth are anatomically flat and that may be why my upper teeth don’t overlap the lower. (I don’t understand this).

In terms of the vertical height of my upper jaw, some may have commented that my gum show has been reduced from the surgery, but he says my upper lip is still healing and distorting the tooth show. He says when my upper lip is functional again the lip line will be just above the tooth-gum line when smiling, so any additional downgrafting would give a gummy smile.

I’m satisfied with his answer regarding the vertical height, but I’m still not sure about the transverse width. I did ask him if revision is a possibility, and he didn’t say no, he basically said well anything is possible but implied there would be no reason for it. He did firmly say there is no transverse deficiency and to trust him.

So I’ll have to take his word for now. I am consulting with another surgeon in a couple months to get a second opinion. He said I’d have to wait a year anyway for the nerves and everything to heal if I wanted a revision, so I’ll see how the orthodontics shifts things into place and reassess in due time.

You can always get an opinion from another orthodontist as well.  They are typically more accessible than a high-tier surgeon and quite literally specialize in occlusion. 

[GJ]

That's not what the photos you posted showed.
We'd need to see more photos, the  best detail possible, and at various angles.

[PloskoPlus]

"Wait 12 months" - is a standard stalling tactic. 12 months is when his obligation to you runs out. (What a coincidence!) People have revisions within months after surgery.

[ODog]

Guys I’ll upload photos of my bite taken at my ortho today.

How can I push for a revision when he doesn’t even think there’s a cross bite?

If I get confirmation that it’s still a crossbite and another surgery is needed, I am going to ask him to pay for it (advice from a lawyer I spoke to). This would actually be in be best interests of both parties. $5000 is a drop in the bucket to him, I don’t imagine he’d fight me on it. I just need to tell him that I’ve consulted other orthos and surgeons and they agree with me and that I’d like to pursue my revision elsewhere with a refund of the portion I paid since my bite was simply not fixed (still presumably at this point).

When’s the best time to get a revision, should I get it ASAP or wait?