SURGEONS WHO DO BI-MAX WITHOUT ORTHODONTICS?

[Lazlo]

Wanna know which surgeons do this and what are the advantages/disadvantages? I've heard there are stability issues and potential for relapse without orthodontics in place and I've also heard larger advancements are not possible? Especially interested in those surgeons who do CCW? THANKS!

[Dogmatix]

Wanna know which surgeons do this and what are the advantages/disadvantages? I've heard there are stability issues and potential for relapse without orthodontics in place and I've also heard larger advancements are not possible? Especially interested in those surgeons who do CCW? THANKS!

'No orthodontic' in itself does not exclude any displacements. If the teeth already are in the position required for a displacement it can be done regardless. But when bigger displacements are needed, it's probably more often related to bigger bite deviations as well. Some kind of anchorage may need to be placed to stabilize the bite after surgery even if no orthodontic work is done. Don't know if they maybe put TAD's, or bond some brackets or hooks on the teeth for surgery to have something to bind the elastics to. I've only heard a few that have done surgery without braces, but I'm pretty sure they have some anchorage placed. Having the jaws banded after surgery have nothing to do with orthodontic work, it's required to keep the jaws stable and heal in the right position.

Andvantage? Well, you don't need to go through the discomfort of braces.

Disadvantage? You can't adjust the teeth in a way that may be required for best result and you may need more invasive surgery to move stuff surgically that could've been handled with orthodontics. I consulted for SurgeryFirst and the plan for this would involve a 3 piece lefort, that was not needed if I had the bite decompensated orthodontically before instead. My surgeon also stated something after a while of discussing "The way you look at and evaluate your face, I'm completely confident I don't want to do surgery first in your case". So for best predictability, the teeth and bite should be in it's final position, then the surgeron don't need to assume, guess and try to perform magic. If you don't intend braces at all it would already be in final position though. No braces at all also involves that the bite and oclussion can't be perfected after. Even for the best surgeon it's hard to get perfect oclussion on every single tooth after surgery and orthodontic adjustment is normally done for this.

[Lefortitude]

I've asked this on here before and it basically comes down to accuracy, and quality of the result.  Alot of Surgery first docs get pretty good results, but if you want excellence, most require ortho.

[april]

Idk, it's called 'Surgery First' not 'Surgery Only'...  so you might still need some ortho fine-tuning afterward

Although that said, you have been through this before so maybe your teeth will be in good enough positions

*fingers crossed for you*

[Lazlo]

Yeah so obviously if you have crowding or whatever you need ortho, surgery won't fix that.

I guess I'm talking about (in my case) a revision where the teeth are already in line and the ortho work is done (obviously I don't want to go into decompensation which is f**king horrible). I would like to see if I can just have a revision surgery done (mostly to just make my lower jaw more prominent so an overall advancement is what I want. And I want to see if there are docs who can do this.

[Lefortitude]

whys decomp so horrible?

[Post bimax]

Yeah so obviously if you have crowding or whatever you need ortho, surgery won't fix that.

I guess I'm talking about (in my case) a revision where the teeth are already in line and the ortho work is done (obviously I don't want to go into decompensation which is f**king horrible). I would like to see if I can just have a revision surgery done (mostly to just make my lower jaw more prominent so an overall advancement is what I want. And I want to see if there are docs who can do this.

The best surgeon who is willing to do surgery first method is probably Alfaro in Spain.

[kavan]

Not sure but I don't think US maxfax docs do the surgery first method. More likely to have it in Europe.

Ortho, STILL comes into play. But they do it afterwards and the ortho needs to be in communication with the doctor.

They say it takes the braces (or what ever other teeth moving devices they elect to use) to move the teeth into place in less time when the 'wounds are fresh' (after surgery) than it does to before the surgery.

You need to consult with a doctor who does the surgery first method because they need to make a determination IF you are a candidate. Not everyone is a candidate for it.

The only example I know of bi-max without ortho (at all) is in some sleep apnea cases where both jaws are moved equally via 'linear advancement' and the person already has their bite right. Linear advancement is NO ROTATIONS at maxilla. Just cut and advancement over what ever angle of inclination it already has with a 'horizontal' reference plane.

[Dogmatix]

Not sure but I don't think US maxfax docs do the surgery first method. More likely to have it in Europe.

Ortho, STILL comes into play. But they do it afterwards and the ortho needs to be in communication with the doctor.

They say it takes the braces (or what ever other teeth moving devices they elect to use) to move the teeth into place in less time when the 'wounds are fresh' (after surgery) than it does to before the surgery.

You need to consult with a doctor who does the surgery first method because they need to make a determination IF you are a candidate. Not everyone is a candidate for it.

The only example I know of bi-max without ortho (at all) is in some sleep apnea cases where both jaws are moved equally via 'linear advancement' and the person already has their bite right. Linear advancement is NO ROTATIONS at maxilla. Just cut and advancement over what ever angle of inclination it already has with a 'horizontal' reference plane.

I have one contact who did ccw rotation without braces before or after. "Surgery only" is a concept and not same as "surgery first" that imply orthodontics after.
https://www.institutomaxilofacial.com/wp-content/uploads/2016/05/On-a-definition-of-the-appropriate.pdf

[Lazlo]

yeah i would prefer "surgery only"

[Lazlo]

what exactly is decompensation anyway? My understanding is that the ortho tries to make a greater overjet (if you're for example, class II) so that the surgeon can then move the the lower jaw a greater distance overall when matching both the jaws.

The problem with this is that it takes forever (usually 9 months) and ALSO, your facial aesthetics are severely undermined during this period as you look much worse than normal! Then you're supposed to wear the braces for at least 6 months afterward, and of course none of this goes as planned and so you're in braces for actually more like 2 years altogether!!!

Am I right? Is this what decompensation means? If not, what is it?

[PloskoPlus]

Decompensation is only necessary when your bite is compensated naturally or with braces - eg. upper teeth excessively declined to meet the lower teeth because of an overbite.  If you already have a class I bite without compensation, there is no need to decompensate.  However, it is still necessary to have fixation to fine tune the bite after surgery.  So, an inactive wire probably 1 month before surgery and an active wire 4 months after surgery to fine tune the bite, because that's how long it takes for the osteotomy to heal and the teeth are unstable during this period.  You need some sort of fixation.  A retainer might do the job, but no surgery is perfect and some sort of fine tuning is required.  The best surgeon says his accuracy is ±1 mm.  This is huge in orthodontic terms.  And he insists on braces.  Arch bars are another options, but they offer retention only (no fine tuning) and will shred your gums.

[Dogmatix]

what exactly is decompensation anyway? My understanding is that the ortho tries to make a greater overjet (if you're for example, class II) so that the surgeon can then move the the lower jaw a greater distance overall when matching both the jaws.

The problem with this is that it takes forever (usually 9 months) and ALSO, your facial aesthetics are severely undermined during this period as you look much worse than normal! Then you're supposed to wear the braces for at least 6 months afterward, and of course none of this goes as planned and so you're in braces for actually more like 2 years altogether!!!

Am I right? Is this what decompensation means? If not, what is it?

http://jawsurgeryforums.com/index.php/topic,7835.msg71284.html#msg71284
I'll refer to my previous answear, I'm not sure if you're asking twice because the first answear was not what you wanted to hear or if it was unclear. There's not really much more to say about decompensation, you set the teeth in the position to get a good bite after surgery and to allow the displacement needed for a good result.

Honestly, if you've had surgery once and are thinking about revision for aesthetic reasons only. Don't try to cheat it by going for a more simple solution and risk not getting the result you want again. It may be that you actually don't need braces or much adjustments, but don't try to force this solution on a surgeon. Braces suck, but so do revisions.
If it's mostly about making the lower jaw more prominent and you have a good bite, airways etc, have you considered a genio or an implant instead of bimax?

[kavan]

Lazlo,

You've been a member of JSF since 2012. In all that time, there's never been info about what decompensation is?

Dogmatix addressed your question in another thread.

My short 'answer'--with no explanation as to what it is-- is what it RESOLVES TO.

It resolves to the very HIGH probability of needing to be in ortho devices for whatever time so the teeth will 'mesh' correctly with whatever JAW displacements are done in surgery and whether or not you're in the devices before or after sugery or both or whether or not your bite is good or bad prior to the surgery.

If you need an answer as to how long you will need to be in them, before or after surgery or what ever small chance there is that you can have surgery with absolutely NO ortho at all, CONSULTATIONS will help you get a better idea of it.

[april]

Here's a link about decompensation - got to section "3. Presurgical orthodontics"

https://www.intechopen.com/books/a-textbook-of-advanced-oral-and-maxillofacial-surgery-volume-2/orthodontic-preparation-for-orthognathic-surgery