Thinking of going for DJS

[GJ]

and any idea why the "surgery first approach" is so much more common in europe in comparison to the usa?

My guess would be the court system - harder to bring a malpractice claim in Europe.

I'm not positive, though. It's possible they genuinely think it's a good idea, I guess.

[trandom]

My guess would be the court system - harder to bring a malpractice claim in Europe.

I'm not positive, though. It's possible they genuinely think it's a good idea, I guess.

I'm doing my surgery with Alfaro, it's hard for me to believe that he'll do something that the success rate for will be so low like you mentioned.

Maybe it's a matter of skill that most don't have.

[GJ]

I'm doing my surgery with Alfaro, it's hard for me to believe that he'll do something that the success rate for will be so low like you mentioned.

Maybe it's a matter of skill that most don't have.

You can believe what you want. This is what you're about to deal with, though. So reality and belief are not in alignment with you.

So, what's the downside of not having braces with jaw surgery?

Braces is needed to fine tune the position of the teeth, which is an integral part of an aesthetic and pleasing smile, as well as good biting efficiency. Without braces, we cannot achieve the optimal aesthetics and function. In addition, it also increases the degree of positional change that often occur after corrective jaw surgery as the bite will not be as stable and that can cause deviation to the jaw position before healing is complete.

The lone exception is VME cases, which sometimes do not need braces. To my understanding, that's not you.

Either way, good luck. I hope you're a rare case where it works.

[trandom]

You can believe what you want. This is what you're about to deal with, though. So reality and belief are not in alignment with you.

The lone exception is VME cases, which sometimes do not need braces. To my understanding, that's not you.

Either way, good luck. I hope you're a rare case where it works.

Thank you, I will update you about the final plan after the 3D scans and all this week, let's see if anything changes from what he said in the video call to where he has his tests done.

[lookism]

My guess would be the court system - harder to bring a malpractice claim in Europe.

I'm not positive, though. It's possible they genuinely think it's a good idea, I guess.

maybe the usa is just a bit behind:


Introduction: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking.

Methods: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally.

Results: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible.

Conclusions: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.


https://pubmed.ncbi.nlm.nih.gov/27021449/

[GJ]

maybe the usa is just a bit behind:

Yeah, I'm sure that's it.

[kavan]

so basically all surgeries that are done for the purpose of sleep apnea (most people have an ok bite) will destroy the bite. because braces are not common in that regard?

and any idea why the "surgery first approach" is so much more common in europe in comparison to the usa?

Are you are asking this question to GJ based on anything the OP (trandom) conveyed to you or GJ?

If so, trandom has reached the point where he is beyond help by the mods here. Posters reach the point where they are beyond help when they become over confident that that their thinking process is grounded on the right premise when the premise it's grounded on is actually faulty.

Note how GJ is having a hard time getting through to him about the need for braces. That's what happens when you get sucked into someones erroneous thinking process and let's face it, some people on this board would need a brain transplant to overcome the confusion they generate for themselves. From my perspective it's a futile endeavor if I see that type of pattern going on and being used to contend things based on belief systems that have nothing to do with how things work.

Trandom's premise here is that he actually BELIEVES he can take the visual proposal of one doctor and CHANGE it to apply to what A DIFFERENT doctor TOLD him. https://imgur.com/a/2lnbao7

"Right: 1st proposed plan
Left: I edited the photo in photoshop so that the bite stays the same, it's basically a simulation of how the plan is going to look if the bite is not being altered."

So, with that, he's basically PREDICTING that his photoshop change of what the PRIOR doctor did (correct his bite) reflects his outcome from ANOTHER doctor who told him he could do a surgery without changing his bite and without braces. Too hard to unbelieve that FOR someone. But his belief that his morph somehow predicted his outcome with an entirely different doctor (who told him he could do a surgery with no braces) was a faulty premise. Although the other doctor might be able to do a surgery that does not change his bite or require braces, the faulty premise is the expectation that altering one doctor's morph/plan is how the other doctor is going to make him look just because the other doctor told him he could do without braces. Like he's contending that in the total absence of a plan from the other doctor, running with it and butting horns with GJ where 'suddenly' after a period not to long ago of knowing little to nothing, he now knows enough to be countering GJ.

So, with that, we leave them to their own devices and thinking process when it just looks like it's going to be too hard to UNDO it or UNTHINK it FOR them which is what it's looking like with his interaction with GJ.

That said, GJ and I shall wait until the next doctor actually confirms that trandom's morph made from the prior doctor reflects what the next doctor can do without changing his bite and WITHOUT  braces afterwards.

Surgery first is when the surgeon does the surgery and leaves it up to the ORTHO to decide what ortho work needs to be done after that and/or for the ortho to decide if they are candidate for surgery first. It's based on the teeth moving FASTER when the braces are put on right after a surgery where as when you put them on before a surgery, the braces take longer to position the teeth to where they want them to prepare for the surgery.

[GJ]

Surgery first is when the surgeon does the surgery and leaves it up to the ORTHO to decide what ortho work needs to be done after that and/or for the ortho to decide if they are candidate for surgery first. It's based on the teeth moving FASTER when the braces are put on right after a surgery where as when you put them on before a surgery, the braces take longer to position the teeth to where they want them to prepare for the surgery.

Yeah, and that can be done if you have braces on prior to surgery, too. I'd argue it's a bit dangerous to move teeth fast, even with the increased blood flow to the area. They still have to move through bone and thus root resorption is a real risk if/when they try to do that. I think they like to do it because it's less "chair time"...orthos are obsessed with chair time.

VME patients, and to a degree Class III patients, can potentially get away with surgery first because their teeth generally fit properly in their arches (i.e. less compensation). This doesn't mean it's a great idea, but at least it makes some sense. Class 2, crowding, etc that is not the case at all. The only justification for surgery first, IMO, is if someone has sleep apnea and is at risk to die. Then you do the surgery and figure out the teeth later.

[kavan]

Yeah, and that can be done if you have braces on prior to surgery, too. I'd argue it's a bit dangerous to move teeth fast, even with the increased blood flow to the area. They still have to move through bone and thus root resorption is a real risk if/when they try to do that. I think they like to do it because it's less "chair time"...orthos are obsessed with chair time.

VME patients, and to a degree Class III patients, can potentially get away with surgery first because their teeth generally fit properly in their arches (i.e. less compensation). This doesn't mean it's a great idea, but at least it makes some sense. Class 2, crowding, etc that is not the case at all. The only justification for surgery first, IMO, is if someone has sleep apnea and is at risk to die. Then you do the surgery and figure out the teeth later.

The OP looks to have Class 2 Division 2 DEEP BITE and basically claiming that because he can have surgery first with no change in bite, he therefore won't need braces afterwards and with that he's assuming his morph changing one doctor's plan reflects the next doctor's plan. When that's behind the thinking process and you tried to make your point with him and it didn't get through, the BALL IS IN HIS COURT to go where his own 'beliefs' take him and come back and show us that the next doctor's plan is going to look like his morph prediction of it and this plan involves NO braces afterwards.

I have no issue with what you wanted to convey to him and the reasoning behind it.

[GJ]

The OP looks to have Class 2 Division 2 DEEP BITE and basically claiming that because he can have surgery first with no change in bite, he therefore won't need braces afterwards and with that he's assuming his morph changing one doctor's plan reflects the next doctor's plan. When that's behind the thinking process and you tried to make your point with him and it didn't get through, the BALL IS IN HIS COURT to go where his own 'beliefs' take him and come back and show us that the next doctor's plan is going to look like his morph prediction of it and this plan involves NO braces afterwards.

I have no issue with what you wanted to convey to him and the reasoning behind it.

Yes, agree, just wanted to clarify my thoughts on that for anyone who comes across this info in the future.

[lookism]

Are you are asking this question to GJ based on anything the OP (trandom) conveyed to you or GJ?

more like a general question

i just wonder when surgery without braces is so dangerous then why many patients who get jaw surgery for sleep apnea related issues dont get braces at all or only after jaw surgery? wouldnt that be irresponsible
and are european surgeons really that irresponsible compared to usa surgeons for following the surgery first approach? i think thats a very harsh claim especially when literature and studies are not clear on the topic as far as i know?

[trandom]

I want to clarify a few points.

Are you are asking this question to GJ based on anything the OP (trandom) conveyed to you or GJ?

If so, trandom has reached the point where he is beyond help by the mods here. Posters reach the point where they are beyond help when they become over confident that that their thinking process is grounded on the right premise when the premise it's grounded on is actually faulty.

Note how GJ is having a hard time getting through to him about the need for braces. That's what happens when you get sucked into someones erroneous thinking process and let's face it, some people on this board would need a brain transplant to overcome the confusion they generate for themselves. From my perspective it's a futile endeavor if I see that type of pattern going on and being used to contend things based on belief systems that have nothing to do with how things work.

Trandom's premise here is that he actually BELIEVES he can take the visual proposal of one doctor and CHANGE it to apply to what A DIFFERENT doctor TOLD him. https://imgur.com/a/2lnbao7

"Right: 1st proposed plan
Left: I edited the photo in photoshop so that the bite stays the same, it's basically a simulation of how the plan is going to look if the bite is not being altered."

So, with that, he's basically PREDICTING that his photoshop change of what the PRIOR doctor did (correct his bite) reflects his outcome from ANOTHER doctor who told him he could do a surgery without changing his bite and without braces. Too hard to unbelieve that FOR someone. But his belief that his morph somehow predicted his outcome with an entirely different doctor (who told him he could do a surgery with no braces) was a faulty premise. Although the other doctor might be able to do a surgery that does not change his bite or require braces, the faulty premise is the expectation that altering one doctor's morph/plan is how the other doctor is going to make him look just because the other doctor told him he could do without braces. Like he's contending that in the total absence of a plan from the other doctor, running with it and butting horns with GJ where 'suddenly' after a period not to long ago of knowing little to nothing, he now knows enough to be countering GJ.

So, with that, we leave them to their own devices and thinking process when it just looks like it's going to be too hard to UNDO it or UNTHINK it FOR them which is what it's looking like with his interaction with GJ.

That said, GJ and I shall wait until the next doctor actually confirms that trandom's morph made from the prior doctor reflects what the next doctor can do without changing his bite and WITHOUT  braces afterwards.

Surgery first is when the surgeon does the surgery and leaves it up to the ORTHO to decide what ortho work needs to be done after that and/or for the ortho to decide if they are candidate for surgery first. It's based on the teeth moving FASTER when the braces are put on right after a surgery where as when you put them on before a surgery, the braces take longer to position the teeth to where they want them to prepare for the surgery.

Photo edit - The edit of the photo was done to represent the change between what A first told me, and then what he told me a week later, both simulations are around his plan, I did not mix between 2 doctors plans / simulations. These simulations are not a very precise representation anyways, especially for someone like me with thick soft tissue in the chin area, projection in real life would be a few mm less.
I decided pretty early in the process to go forward with A, so everything I present here is around his plan and advice.

Braces - I will clarify on what A told me regarding this subject:
1. Post-op orthodontics might, or might not be needed.
2. If it is needed, my ortho can choose whether to do it with braces or Invisalign.
3. If it's needed and he chooses to do it with braces - they will have to be put on before the treatment.


Tomorrow I meet with A, will update on progress, I will arise some of the concerns to him.

[kavan]

I want to clarify a few points.

Photo edit - The edit of the photo was done to represent the change between what A first told me, and then what he told me a week later, both simulations are around his plan, I did not mix between 2 doctors plans / simulations. These simulations are not a very precise representation anyways, especially for someone like me with thick soft tissue in the chin area, projection in real life would be a few mm less.
I decided pretty early in the process to go forward with A, so everything I present here is around his plan and advice.

Braces - I will clarify on what A told me regarding this subject:
1. Post-op orthodontics might, or might not be needed.
2. If it is needed, my ortho can choose whether to do it with braces or Invisalign.
3. If it's needed and he chooses to do it with braces - they will have to be put on before the treatment.


Tomorrow I meet with A, will update on progress, I will arise some of the concerns to him.

Then your presentation was confusing as f**k because you failed to clarify it was Alfaro's initial proposal even when you were asked on this string (by CCW and Lefort3000) who's proposal it was. Even if it was same doctor's (Alfaro's), it's still a 'no no' to assume changes you, yourself make to it are going to reflect what he says to you.

Well OF COURSE, Alfaro actually told you or would tell you what you NOW disclose he actually told you which was not an absolute confirmation from him that you would not need braces. Clearly statements #1, #2 and #3 from him don't tell you for SURE no braces at any time would be needed. Yet you kept on doubling down on the claim you would't need them.

[kavan]

more like a general question

i just wonder when surgery without braces is so dangerous then why many patients who get jaw surgery for sleep apnea related issues dont get braces at all or only after jaw surgery? wouldnt that be irresponsible
and are european surgeons really that irresponsible compared to usa surgeons for following the surgery first approach? i think thats a very harsh claim especially when literature and studies are not clear on the topic as far as i know?

For sleep apnea surgery, when the bite is OK, it's often linear advancement where both jaws are advanced the same amount when they are not using braces to move the teeth to prepare for the surgery and/or they might put them on after the max/mand advancment (MMA). So, no pre surgery brace prepping and/or some post surgery brace refinements is associated with LINEAR ADVANCEMENT where both jaws are advanced by same amount and usually when their bite is 'OK'.

With more advanced practioners (in USA) who also treat sleep apnea and use CCW to balance face, airway and bite, there is brace preparation for that because they are focused on both FORM and FUNCTION. There could be post op ortho appliances with that too.

Surgery first puts a lot of the responsibility in the ORTHO's hands to be the ones to approve for surgery first and also do all the teeth adjustments for the bite to be right afterwards. Like the ortho is the one to make the PREDICTION that they will be able to make the bite right in accordance to how the surgeon wants to displace the jaws.

In the situation of USA doctors, let's take Gunson as example. He would want to FIRST see that the ortho put the teeth where he wanted them to be to carry out his surgical plan and if during the pre-surgery 'inspection', if he sees that the ortho has NOT done that, he can call off the surgery.

So, I guess you could say the difference is that the American surgeon wants to FIRST see IF the ortho's prediction of moving the teeth in right place pans out as true and that will take a LONG TIME in braces to wait and see, whereas the Euro surgeon places a lot of confidence in the ortho that their prediction that they will get the bite right AFTER the surgery WILL pan out later down the line and will pan out in LESS TIME than it would take for a pre surgical 'wait and see' period. (It takes less time to move teeth after a surgery.)

As to whether or not Euro doctors are 'behind' USA ones, I could be wrong one to ask that because by nature, I would be considered a 'Europhile' as in someone who considers European cultural history of advancement, especially in medicine a very salient thing to acknowledge. Consider the university of Padua in Italy where medical principles first taught in the 1200's . Then you have your early surgeons teaching at Cordoba in Spain in early 900s making a lot of medical discoveries and instruments. Just 2 examples but there are many more. Add Galen, Hippocrates Leonardo, Lois Pasteur...etc.

[kavan]

maybe the usa is just a bit behind:


Introduction: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking.

Methods: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally.

Results: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible.

Conclusions: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.


https://pubmed.ncbi.nlm.nih.gov/27021449/

Lot's of articles on surgery first. Here's one that tells you what they look at. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314839/

 They mention, many examples are for class 3 types but can be done on class 2 types, limitations as to when to use surgery first. It's not for everybody, takes a lot of coordination, a minor surgical error could compromise occlusion, prediction of final occlusion is the greatest challenge etc.