Surgery or TADs to fix my open bite?

[balor124]

I'm a 33yo male and I just visited an oral surgeon for an opinion. He said he could do a Le Fort Osteotomy on my upper jaw to close my open bite and something to my lower jaw to cure my sleep apnea. As an alternative, I would continue to use a CPAP and he could do TADs to close my open bite and there's a 10% chance they might not be able to close it all the way. The thought of fixing my bite without going through the full jaw surgery is appealing. I can't really relax my jaw with my bite and am starting to get some muscular orofacial pain (I think) but no other signs of TMJ problems yet (clicking, popping, locking, etc). I'm hoping that fixing my bite will at least mitigate some of the nocturnal clenching and pain resulting from it.

[sirwired]

My ortho provided me with two treatment plans for my significant transverse bite issues.:
A) Braces, a single lower extraction, a TAD and a TPA.
B) Braces and surgery.

While A was certainly cheaper and less involved, in his words: "Your root problem is jaw asymmetry; all else being equal I prefer to correct jaw asymmetry problems by moving the jaw." I went with B.

If your insurance will cover the surgery, that's the option I would choose if I were in your shoes. And not needing to use an CPAP for the rest of your life would be a nice bonus.

Before deciding I'd definitely talk to an orthodontist; while an oral surgeon certainly needs to know a thing or two about orthodontics, an actual ortho will know better the limitations of what can be done non-surgically. Since you've already seen the oral surgeon, you can even ask him for a referral to an ortho he regularly works with; an oral surgeon is certainly in a decent position to observe ortho treatment outcomes.

[vvirag]

Hi! First of all, I'm not a professional. I've just read lots of stuff in the last month about orthodontics, because I'm just starting my own treatment. I have a really narrow upper jaw, crowded teeth, overbite, etc. But my ortho don't believes in (or at least tries to avoid) invasive solutions (when it's possible of course). So I'll get an A.L.F. to expand my upper jaw. Have you considered this option? I don't know enough about your case, but maybe it's worth to take a look. (For example here: http://www.drfarid.com/alf.html)

[balor124]

Hmm yeah that's what has me worried. It's such a big procedure and hearing what other people have to say about it on the jaw surgery forum freaks me out. Would my age be a problem? Plus I'll need a whole new set of teeth since I've ground all mine down and there's no guarantee that it'll stop my bruxism at this point. I'm clenching about once every 3-4min while I sleep and I don't know how to stop it. I'm pretty sure my joints are ok but who knows how long it'll stay that way as long as this continues. I asked my oral surgeon about trying some drugs reported to address bruxism but he said he'd rather just do the surgery due to the side effects of long term use. I don't know what to make of that statement but perhaps I'm making too much of this surgery?

I've got a slight class 3 malocclusion in that my teeth fully overlap. I may have a slight asymmetry as well as only my back left molars seem to really touch but the xrays showed that my joints aren't even either so perhaps the shape is fine but just tilted and that can be addressed with therapy? An ENT looked in my throat and said he wouldn't believe I have sleep apnea from looking in there. My dentist and oral surgeon said I have a very wide palate. I don't know what that means.

I've heard a few times that simply removing my wisdom teeth may be enough to close my bite at least. I'm considering going down that route first. I'm a bit old for it but I'm in good shape, exercise regularly, and eat an extremely nutritious (Paleo) diet so hopefully it won't be an issue even with poor quality sleep?

[ajs604]

Hi, I also have a severe open bite and am currently undergoing treatment with TAD's. My advice would be to source several opinions from orthdontists before making a firm decision. I went to several before one offered me an non-surgical options. Surgery was not an option for me as I have watched the vides ect and decided it was barbaric. Saying that surgery will yield more succesful results but is much more invasive. I chose the conservative method of treatment as suited me better and I am not after perfection. Good luck with your decision.

[balor124]

Really tough call here. I don't care about the money and I don't care about any temporary discomfort. What matters is what are the long term implications. I've had muscle cut before and yes it was painful but really not a big deal in the end. I don't want to end up as one of those horror stories, where the jaw doesn't really heal or ends up worse than before. My brother says that getting the surgery done sets me up for a life of surgeries, with screws coming lose, etc and infections could cause me to permanently lose the function of my jaw.

[ajs604]

Hi, how bad is your open bite? Quite honestly I did not research surgery so know very little about it, so saying that my views are probably biased as I was always against surgery. Also where are you located? There are lots of people on here who have had surgery or going down that route so I am sure they can put some of your concerns at ease. What I can say is that I am happy with the method of treatment I have chosen and have made considerable improvement. Intact I had an adjustment today and my open bite is at 2-2.5 I started at 6-7mm. I would consult several independent opinions and then make your decision based on what you are comfortable with. Best of luck with your journey and I look forward to following the direction you decide to take.

[balor124]

I'm not sure how bad it is. I've seen worse. I put some pictures online but can't post the link here. It's a tinyurl/ky4pmb5 if you can figure that out.

I am located in Austin. I'm concerned that orthodontic treatment might further restrict my airway. I'm also concerned that even if the surgery goes as planned it might not fix the nocturnal clenching, relapse, or worsen TMJ symptoms. At this rate, doesn't seem like not doing surgery is going to be much better except for avoiding the discomfort so it's probably worth a shot except for the possibility that something might go horribly wrong or long term small lingering effects (like permanent nerve damage, etc).

[mmkay]

My open bite is severe and an orthodontic approach has been recommended to me, but it does involve surgery to insert miniplates.

Assuming you have an overjet, usually the upper upper molars would be intruded. This causes the mandible to slide forward. If anything this should open up your airway. Intruding the lower molars causes the mandible to slide back.

A maxillary impaction (surgical approach) by itself will in theory constrict your airway unless you also get a maxillary advancement (which may well be appropriate in your case). Then again, your lower jaw may come forward as with the orthodontic approach, which could improve airway.

In addition to occlusion and the airway thing, don't forget aesthetics. You may look better with a maxillary advancement, which you can't get with orthodontics. If you have too long a midface, an impaction may well help with that. But surgery can also reduce incisor display too much, for example, if you pick the wrong surgeon.

Based on what I have been told (and expected anyway), don't think that fixing your bite will solve noctural clenching and grinding. If it does, that's great, but expect to continue wearing an occlusal splint at night. Also, more teeth will be touching, so more teeth to grind and damage against each other (yay!).

Forgetting occlusion for a moment (which is probably ok either way), I'd be asking for each approach, among other questions:
-How far forward/back will the mandible go?
-How far forward/back will the maxilla go?
-How much up will the back of the maxilla go?
-How much up will the front of the maxilla go?
-How will my incisor display and upper lip support be affected?

[sirwired]

More teeth touching is not a bad thing; it distributes bite forces more evenly. Clenching a perfect bite is much less stressful on teeth and gums than clenching a maloccluded one.

[balor124]

I don't mind wearing a nightguard. I've been wearing one for the last 20 years. I just want the massater muscle pains to go away and, most of all, I don't want to develop problems in my joint. I'd also rather that my bite not get worse, that is the bite opening up more or more asymmetry. Hard for me to tell if that's happening. I've got a stabilization splint that contacts all teeth right now and is thicker on the front to prevent grinding. That's having the effect of pushing my mandible back and constricting the airway more I think. I'm thinking of asking for a Modified Hawley splint to be made to stop the clenching - what do you think? Once I stabilize the clenching then I can think about fixing my bite. I'm certainly not averse to orthodontic changes.

Oral surgeon said he thinks there's a 85% - 90% chance they can succeed in closing my bite that way but there isn't much data on relapse and it won't fix my apnea. Also, I'll need to remove the wisdom teeth and replace some with crowns since I won't have a bit anymore. That doesn't sound too bad, right? My only concern there is that I have surprisingly little damage right now. I've ground my teeth down but no fractures and fillings only pop out every few years. Will the replacements be as strong? In that case, perhaps I'd be better waiting until I need a crown anyway.

I have a class 3 malocclusion. It might be an overbite but hard to tell since they seem pretty straight. Remember, they don't touch in the front so there aren't forces pushing them either direction.

[mmkay]

My understanding is that your splint should reflect your 'natural' bite, and if all teeth don't make contact (e.g. NTI) then that can negatively affect your bite.

Anecdotal evidence on up to 10 year stability is that it is ok, my orthodontist made a big deal out of the fact relapse was a problem for (nocturnal) mouth breathers. Something to do with the mouth needing to be closed in order to maintain.

Removal of wisdom teeth is common with (lower) jaw surgery also.

I have some severe wear as well, but prosthodontist favours onlays (bonded onto enamel, not dentin) rather than crowns, with simply small chunks of composite resin on areas of some teeth with less loss. Different dentists have different opinions, but the orthodontist had a similar attitude - too young for crowns, which are very destructive to teeth. You are the one who has to live with your mouth for another 50 years.