Extraction Reversal After BSSO

[jawsurgery029184]

I had jaw surgery (upper and lower but no genioplasty) and was told that the best course of action would be to remove two lower premolars to maximize the advancement for the BSSO. After the extractions, a lot of my friends told me I looked much, much older due to the blunter/more concave chin. I thought so as well but was told that the BSSO would eventually make it look normal again. However, after surgery I realized that I still have the old lady mouth look, which is incredibly obvious when I smile. My tongue still feels constricted and I really regret the extractions.

I scheduled consultations with a few renowned surgeons when I was looking for a possible revision surgery due to other issues I had with my surgery outcome. I was told by all surgeons that my lower teeth were not tipped forward enough to warrant extractions and that a genioplasty will not make the old-lady look improve, nor will it help with tongue space, because it was due to the extractions.

I am wondering if it is even possible to reopen lower premolar extraction spaces and get implants after a BSSO? Because I don't know how that would logistically work without having surgery to move the lower jaw back first. Has anyone had this done or heard of someone who has this done?
(I would ask the surgeons but they told me they would like for me to wait until the 1 year mark to schedule another appointment and reevaluate my concerns after swelling is fully down.) Thank you

[GJ]

It's definitely possible to reopen extraction spaces, but as you note, how will that mesh with the jaws' current position? It's impossible for us to say based on a text-based post, and even photos might not help. It really comes down to math. Can you open 6.5-7mm of space with the jaw in the current position? Maybe. You'd know the answer more than we would. So just go have a look and see if there is any space.

I believe they also make mini implants that are ~4mm, so you might want to research those. You might have to do strange movements using TADs or even headgear to reopen that space, if it is possible.

Your best bet might be seeing several restorative dentists.

What happens when a tooth is extracted is the bone resorbs. Bite force is what creates new bone. When the tooth is gone and no force exerted on the area, the body gets a signal bone is no longer needed there.

[Dutcherhatcher]

It's definitely possible to reopen extraction spaces, but as you note, how will that mesh with the jaws' current position? It's impossible for us to say based on a text-based post, and even photos might not help. It really comes down to math. Can you open 6.5-7mm of space with the jaw in the current position? Maybe. You'd know the answer more than we would. So just go have a look and see if there is any space.

I believe they also make mini implants that are ~4mm, so you might want to research those. You might have to do strange movements using TADs or even headgear to reopen that space, if it is possible.

Your best bet might be seeing several restorative dentists.

What happens when a tooth is extracted is the bone resorbs. Bite force is what creates new bone. When the tooth is gone and no force exerted on the area, the body gets a signal bone is no longer needed there.

I thought bone loss due to extraction take years?

Anyway GJi don’t know if you remember but i consulted you years ago when I had molars extracted by an incompetent local surgeon. I ended up going with a top surgeon and orthodontist and had a successful DJS. Now that they are going to put an implant where the molar was but it’s 1/2 it’s size since some mm were used to create an artificial overjet. Do you think some bone loss is guaranteed despite the implant because of the distance closed?

[GJ]

I thought bone loss due to extraction take years?

No way. Few months if no bite force.

Anyway GJi don’t know if you remember but i consulted you years ago when I had molars extracted by an incompetent local surgeon. I ended up going with a top surgeon and orthodontist and had a successful DJS. Now that they are going to put an implant where the molar was but it’s 1/2 it’s size since some mm were used to create an artificial overjet. Do you think some bone loss is guaranteed despite the implant because of the distance closed?

Why would you get bone loss from inserting an implant? If anything you should gain bone. For one, they can graft bone with the implant, but secondly the bite force should create more bone if there's enough to get the implant in.

[Dutcherhatcher]

No way. Few months if no bite force.

Why would you get bone loss from inserting an implant? If anything you should gain bone. For one, they can graft bone with the implant, but secondly the bite force should create more bone if there's enough to get the implant in.

Sorry, I meant if the implant is 1/2 the size of the original teeth, should I get the same bone back or will it be 1/2 of the size

[GJ]

Sorry, I meant if the implant is 1/2 the size of the original teeth, should I get the same bone back or will it be 1/2 of the size

Ah, that's a good question. Wherever there is bite force it should come back. If the implant is going in an open space where it's the only area with no bite force, in theory, that's the only area that should have bone loss, and it should come back.

My guess is if there's not enough bone they will graft some to the implant. That becomes iffy if the body accepts the foreign material. Do you have enough bone right now to put the implant in? If so, you should be okay.