Why do american top surgeons REQUIRE braces while European ones don't?

[Lefortitude]

I noticed ALL american top surgeons AFAIK require pre surgical orthodontics, while the requirements for pre surgical orthodontics is not so stringent among European top surgeons.

Whats the deal? What are the cons of the european style surgery first?

[Post bimax]

For Posnick, he wanted my orthodontist to make any necessary adjustments as quickly as possible post-op so that everything would 'set' properly.

Other surgeons like Gunson seem to use braces to achieve the best possible aesthetic result by decompensating the teeth even further prior to surgery, allowing more movement of the jaws to meet optimal occlusion.

Not really sure about why it's different though

[kavan]

Some class 3 cases can do surgery first. But ya, not in US.

[GJ]

In short: degree of accuracy.

Standard of care is higher in the U.S., so higher chance of lawsuits. This gives motivation to get the highest accuracy (in theory).

[PloskoPlus]

In short: degree of accuracy.

Standard of care is higher in the U.S., so higher chance of lawsuits. This gives motivation to get the highest accuracy (in theory).

Seeing all those misaligned midlines on Alfaro's website at least supports the accuracy theory.

[GJ]

Yeah.
Also, I asked some US surgeons this question, and "accuracy" was the answer.

[kavan]

Thing is that there are some cases--usually SOME class 3--that CAN have it where the braces are said to take less time (or easier to move) afterwards than if they use them before. However WHICH cases that can have it are limited. Like it really isn't a choice that a patient can have--even with the surgery first doctors--just because they want it but are not a candidate. Not sure of all the tech details of the selection process. But would imagine case would need to be straight forward enough where they think accuracy can be achieved post surgery.

I've perused some articles about this and it seems to be limited to some class 3 types. But not a thing like the US where someone who could be candidate for surgery first in say Europe or Korea is PRECLUDED from that option in US.

On another point, I have NO clue WHY, in the US, someone FIRST has to go to an ortho to get a referral to a maxfax and not directly to a maxfax. I mean there are a lot of cases where people DO go to an ortho first and it's the ortho who messes up their face just to get the 'bite right'.

[Post bimax]

Thing is that there are some cases--usually SOME class 3--that CAN have it where the braces are said to take less time (or easier to move) afterwards than if they use them before. However WHICH cases that can have it are limited. Like it really isn't a choice that a patient can have--even with the surgery first doctors--just because they want it but are not a candidate. Not sure of all the tech details of the selection process. But would imagine case would need to be straight forward enough where they think accuracy can be achieved post surgery.

I've perused some articles about this and it seems to be limited to some class 3 types. But not a thing like the US where someone who could be candidate for surgery first in say Europe or Korea is PRECLUDED from that option in US.

On another point, I have NO clue WHY, in the US, someone FIRST has to go to an ortho to get a referral to a maxfax and not directly to a maxfax. I mean there are a lot of cases where people DO go to an ortho first and it's the ortho who messes up their face just to get the 'bite right'.

Well it's not always true that you have to go to an ortho first for a referral.  For example I went straight to Gunson after surgery without a referral from my ortho.  I think I could have gone straight to Posnick as well, though his policy may be different since he is also a PS. 

[kavan]

Well it's not always true that you have to go to an ortho first for a referral.  For example I went straight to Gunson after surgery without a referral from my ortho.  I think I could have gone straight to Posnick as well, though his policy may be different since he is also a PS.

Well, it's different if one is consulting about REVISION surgery. Also, for a maxfax who's also a PS, the route can be direct to go in and inquire about the jaw balance surgery.

[GJ]

Well it's not always true that you have to go to an ortho first for a referral.  For example I went straight to Gunson after surgery without a referral from my ortho.  I think I could have gone straight to Posnick as well, though his policy may be different since he is also a PS.

That could be because Gunson takes zero insurance. Does Posnick?
Insurance might be the ones requiring a referral.

[Post bimax]

That could be because Gunson takes zero insurance. Does Posnick?
Insurance might be the ones requiring a referral.

Posnick does not. None of the top US guys do.

[GJ]

Posnick does not. None of the top US guys do.

Then that could be why.
Insurance tends to like referrals from someone underneath the final doctor. Probably hoping to save $ before it gets to surgery.

[Dogmatix]

Surgery last is the most accurate protocol, surgery first is the fastest protocol. I was set on surgery first from beginning and was told I would probably need some months decompensation, but surgery early would be possible. But after some discussions and me asking all my questions, the response was something like "The way you look at your face, you should definitely go for surgery last".

I won't say all cases, but many cases can be handled with surgery first or early with todays technology. You can do 3 piece lefort etc and get the bite to fit. But best outcome is always with surgery last, as that involves no guessing of what can be achieved in the postoperative orthodontics, and the surgical intervention can maybe also be handled with less invasive procedures and the surgeon don't have to make tradeoffs because the bite is not properly prepared.

As my surgeon explained it, it's really up to the orthodontist when the surgery can be done. If the ortodontist take the models and put them in the anticipated class I relation and figure it's a suficient starting point for the posoperative orthodontic treatment, then it's a go. That's really all that surgery first is.