Advice on upcoming surgery and surgeon

[LeFort 3000]

You're making sense. Very interesting to hear your experience with it. I've associated it with addressing transverse discrepancies from the journal articles about it as far as tooth sparing techniques go. From what you say, it sounds promising for BSSO decompensation. Was your case a self pay for aesthetic reasons or an insurance case? The OP's case is an insurance case for sleep apnea and even if there were US doctors who do this, it doesn't sound like using MMDO to save a premolar would be something insurance would go for.

US doctors might do it (for adults). I don't know. Distraction osteogenesis procedures do seem to be more commonly used for children in the growing stages than they are for adults though.

my case is an insurance case, typical case of outward leaning incisors due to horrible camouflage orthodontics in the youth. so there wasnt enough space to pull them back in in preparation of bsso. surgery + distractor created about 0.8cm of nominal space in the front,  decompensation closed the gap. surgery took less than 30min (according to surgeon) and wasnt expensive at all (insurance paid for it). one negative tho, after surgery you need to wait 3-6months to let the bone heal which delays the djs (which still beats pulling healthy teeth and creating potential boneloss issues)

[kavan]

my case is an insurance case, typical case of outward leaning incisors due to horrible camouflage orthodontics in the youth. so there wasnt enough space to pull them back in in preparation of bsso. surgery + distractor created about 0.8cm of nominal space in the front,  decompensation closed the gap. surgery took less than 30min (according to surgeon) and wasnt expensive at all (insurance paid for it). one negative tho, after surgery you need to wait 3-6months to let the bone heal which delays the djs (which still beats pulling healthy teeth and creating potential boneloss issues)

There aren't a lot of studies on this and of the ones I found, they are studies of other studies and many resolve to  calling for more research to be done. They also mentioned a lot in the field have been reluctant to accept it on basis of it not being enough overall studies on it. But it does look to be useful for the right reasons (which do appear to be for severe anterior crowding) and all are not as simple as saving a pre-molar extraction for a BSSO. Also, from reading articles on this, I didn't get the impression the procedure was widely practiced in Europe, albeit it does appear it's more likely to find a surgeon in Europe who does it than in the US.

I put up a link to one journal article on the educational section:

Midline Mandible Distraction Osteogenesis

https://www.jdao-journal.org/articles/odfen/pdf/2016/03/odfen180110.pdf

If you scroll through the article and look for a photo from a ceph where it shows the IMPA (angle of inclination lower incisor has with the mandibular plane), it shows a 98 deg. IMPA being increased to a 99 deg. IMPA. The discussion here, reply #7 (SMSOMS who is a surgeon), makes clear that a goal is to get that angle closer to 90 deg. So, that's an example that the procedure might not be applicable to kicking up all the relationships/angle measures aimed for by a good number of surgeons.

So, since you got this in Europe (Germany?) and insurance paid for it, I'd say you lucked out and got something that worked well for you. But from reading those articles, I don't know if I would extrapolate that this would be the thing for everyone wanting to avoid a premolar extraction to jump into. Of course, if they do, they can read the article I linked to and research more from there. The particulars of all are beyond scope of this string, yet are well contained in the article link.

[LeFort 3000]

There aren't a lot of studies on this and of the ones I found, they are studies of other studies and many resolve to  calling for more research to be done. They also mentioned a lot in the field have been reluctant to accept it on basis of it not being enough overall studies on it. But it does look to be useful for the right reasons (which do appear to be for severe anterior crowding) and all are not as simple as saving a pre-molar extraction for a BSSO. Also, from reading articles on this, I didn't get the impression the procedure was widely practiced in Europe, albeit it does appear it's more likely to find a surgeon in Europe who does it than in the US.

I put up a link to one journal article on the educational section:

Midline Mandible Distraction Osteogenesis

https://www.jdao-journal.org/articles/odfen/pdf/2016/03/odfen180110.pdf

If you scroll through the article and look for a photo from a ceph where it shows the IMPA (angle of inclination lower incisor has with the mandibular plane), it shows a 98 deg. IMPA being increased to a 99 deg. IMPA. The discussion here, reply #7 (SMSOMS who is a surgeon), makes clear that a goal is to get that angle closer to 90 deg. So, that's an example that the procedure might not be applicable to kicking up all the relationships/angle measures aimed for by a good number of surgeons.

So, since you got this in Europe (Germany?) and insurance paid for it, I'd say you lucked out and got something that worked well for you. But from reading those articles, I don't know if I would extrapolate that this would be the thing for everyone wanting to avoid a premolar extraction to jump into. Of course, if they do, they can read the article I linked to and research more from there. The particulars of all are beyond scope of this string, yet are well contained in the article link.

I did get this in a large german university hospital. they do this procedure thousands of times a year, so this isnt some experimental procedure they did for my special case. hell the surgeon who did my surgery probably wasnt even 35.
if it can be used for cases of massive overcrowding, why shouldnt it be used for correction of excess forward incisor tilting? what is the goal of tooth extraction or this procedure? creating space. with this procedure you can create as much space as you want bluntly said, so why would the procedure be a limiting factor here in reaching a very well desired 90° IMPA in comparison to tooth extraction? that doesnt make sense to me. The IMPA of atleast 90° should be reached by all means, in my understanding of most optimal aesthetic jaw surgery surgery results, so if this can only be achieved by teeth extractions - im all for it. but in my understanding, this isnt a matter of how you create the space, but just how aggressively you decompensate the incisors, which probably depends on how serious the ortho and/or patient value the matter of aesthetics

[kavan]

I did get this in a large german university hospital. they do this procedure thousands of times a year, so this isnt some experimental procedure they did for my special case. hell the surgeon who did my surgery probably wasnt even 35.
if it can be used for cases of massive overcrowding, why shouldnt it be used for correction of excess forward incisor tilting? what is the goal of tooth extraction or this procedure? creating space. with this procedure you can create as much space as you want bluntly said, so why would the procedure be a limiting factor here in reaching a very well desired 90° IMPA in comparison to tooth extraction? that doesnt make sense to me. The IMPA of atleast 90° should be reached by all means, in my understanding of most optimal aesthetic jaw surgery surgery results, so if this can only be achieved by teeth extractions - im all for it. but in my understanding, this isnt a matter of how you create the space, but just how aggressively you decompensate the incisors, which probably depends on how serious the ortho and/or patient value the matter of aesthetics

Well, let's leave it as this thread is in the FUNCTIONAL surgery section where the OP is in the US and is an insurance case and since your first question was; 'Why don't American surgeons use the MMDO technique?', you have good reason to know the OP is not going to have that whether or not I know exactly why it's not used in the US.

[Breakingbad]

There aren't a lot of studies on this and of the ones I found, they are studies of other studies and many resolve to  calling for more research to be done. They also mentioned a lot in the field have been reluctant to accept it on basis of it not being enough overall studies on it. But it does look to be useful for the right reasons (which do appear to be for severe anterior crowding) and all are not as simple as saving a pre-molar extraction for a BSSO. Also, from reading articles on this, I didn't get the impression the procedure was widely practiced in Europe, albeit it does appear it's more likely to find a surgeon in Europe who does it than in the US.

I put up a link to one journal article on the educational section:

Midline Mandible Distraction Osteogenesis

https://www.jdao-journal.org/articles/odfen/pdf/2016/03/odfen180110.pdf

If you scroll through the article and look for a photo from a ceph where it shows the IMPA (angle of inclination lower incisor has with the mandibular plane), it shows a 98 deg. IMPA being increased to a 99 deg. IMPA. The discussion here, reply #7 (SMSOMS who is a surgeon), makes clear that a goal is to get that angle closer to 90 deg. So, that's an example that the procedure might not be applicable to kicking up all the relationships/angle measures aimed for by a good number of surgeons.

So, since you got this in Europe (Germany?) and insurance paid for it, I'd say you lucked out and got something that worked well for you. But from reading those articles, I don't know if I would extrapolate that this would be the thing for everyone wanting to avoid a premolar extraction to jump into. Of course, if they do, they can read the article I linked to and research more from there. The particulars of all are beyond scope of this string, yet are well contained in the article link.

Thank you Kavan for sharing this information. It is tremendously helpful to getting a better understanding of the issues at play here.

I did get this in a large german university hospital. they do this procedure thousands of times a year, so this isnt some experimental procedure they did for my special case. hell the surgeon who did my surgery probably wasnt even 35.
if it can be used for cases of massive overcrowding, why shouldnt it be used for correction of excess forward incisor tilting? what is the goal of tooth extraction or this procedure? creating space. with this procedure you can create as much space as you want bluntly said, so why would the procedure be a limiting factor here in reaching a very well desired 90° IMPA in comparison to tooth extraction? that doesnt make sense to me. The IMPA of atleast 90° should be reached by all means, in my understanding of most optimal aesthetic jaw surgery surgery results, so if this can only be achieved by teeth extractions - im all for it. but in my understanding, this isnt a matter of how you create the space, but just how aggressively you decompensate the incisors, which probably depends on how serious the ortho and/or patient value the matter of aesthetics

It’s interesting hearing about your experience. I also don’t understand why this wouldn’t work. It seems like it would just be a question of getting the right and left pre-molars far enough apart so that there’s clearance for the front teeth to be moved back. And space is space, right? I don’t know. Perhaps someone else could chime in.

If you’ve already closed the gap and done orthodontic treatment, could you please confirm whether you were able to reach an IMPA of 90° or close to it? Thanks.

[LeFort 3000]

Well, let's leave it as this thread is in the FUNCTIONAL surgery section where the OP is in the US and is an insurance case and since your first question was; 'Why don't American surgeons use the MMDO technique?', you have good reason to know the OP is not going to have that whether or not I know exactly why it's not used in the US.

yes, maybe you can transfer our posts into the corresponding thread in educational material? Maybe there are some people who are interested in learning more about this. Lets leave this thread to OP then.

[kavan]

yes, maybe you can transfer our posts into the corresponding thread in educational material? Maybe there are some people who are interested in learning more about this. Lets leave this thread to OP then.

 I'd like to keep that thread as a 'depository' for more academic links. But it's a good thing that we are coming to some closure here as to how much we should be going back and forth about this procedure on this thread.

Actually, I'm glad you asked your initial question. However for reasons other than the question being directly applicable to the OP's case. In particular, it was because you stated a TERM for a procedure that US doctors 'don't do'. So, with the term you provided, I did some initial research as to what this procedure actually was. Turned out it resolved to something people sometimes ask about as in 'How do I expand my mandible?', but not by a term/name that is researchable. So, in that sense, it lead to the NAME/s of the procedure people could research if they want to know more about mandibular expansion.

JSF is a US based board and mods here don't claim to be conversant in every procedure out there that aren't commonly done in the US. On my part, when a procedure comes up that seems to be an esoteric one relative to what's commonly done in the US, I look into it when it's referred to by a TERM that would kick up academic articles. That is to say, I was NOT inherently familiar with the procedure you were referring to BUT once there was a TERM to research, I was able to acquire and 'digest' information on it in a short period of time and take an educated guess at why US doctors might not have embraced the procedure, in particular as 'the way' to save a pre-molar.

 I think your initial inquiry was useful in the sense that it allowed me to TARGET the name of the procedure applicable to questions that pop up (on OTHER sections of the board) about 'expanding the mandible'and to put up a link to an article about that for others who are CURIOUS about such a procedure.

That said,  given that this particular procedure isn't directly on target to the OP's limitations (insurance in US) or  his questions I think your personal experience with the procedure would be very helpful/useful in strings where people inquire about 'expanding their mandible' .

[Wksos]

I very much would prefer to have my mandible expanded rather than more extractions, but no surgeon covered by my insurance does that. Worried about possible bone lose, but I'm hoping the overall aesthetics of the surgery will out weigh the extractions.
Right now I just have to do everything I can to get my insurance to cover the procedure. Thanks for the discussions though

[recessedmandible]

I have a similar issue to you, both jaws recessed with an overbite, will you be getting any rotation in the maxilla?