Surgical plan - who decides?
Moderator: bbsadmin
Surgical plan - who decides?
I just got back from the orthodontist and I am getting the idea he is the one calling the shots on what type of surgery I will be having. I rather thought it was a joint effort between the OS and the ortho. He said things like, ' the OS does not like to move the maxila up because he thinks it makes you look older. That's not true and your teeth, etc...'. I trust my ortho, but I really the OS as well so I am getting a bit worried. The ortho (in his late 30's) makes the OS (early 50's)sound a bit old school, but there is a LOT to be said for experience in these matters. ARG! Why can't some little part of this process be easy? Who set up your surgical plans - the ortho or the OS?
surgical plan?
Hello again
I have no idea how this works generally, except from my experience so far - the ortho and the surgeon seem to work as a pretty closely knit team. I get the impression that it is driven by the ortho as he needs to feel that the teeth are in the right place, and then the ortho and surgeon meet to discuss it and confirm schedule. My ortho has said he will book the surgery anywhere from one to three months ahead and then adjust it by weeks/ days as the date comes closer (which will be frustrating I would think!)
Don't know if that helps, I'm going to ask who decides the progress at my next appointment, next week, I'll let you know (but it's probably different depending on the ortho/ surgeon!)
I have no idea how this works generally, except from my experience so far - the ortho and the surgeon seem to work as a pretty closely knit team. I get the impression that it is driven by the ortho as he needs to feel that the teeth are in the right place, and then the ortho and surgeon meet to discuss it and confirm schedule. My ortho has said he will book the surgery anywhere from one to three months ahead and then adjust it by weeks/ days as the date comes closer (which will be frustrating I would think!)
Don't know if that helps, I'm going to ask who decides the progress at my next appointment, next week, I'll let you know (but it's probably different depending on the ortho/ surgeon!)
Well, I guess I will find out tomorrow! After a very strange set of events, which included a very odd call from my OS's assistant, being called personaly by the OS, and having my appointment moved several times(March, April, March, April)....now he wants to see me tomorrow. I spent a good part of yesterday getting x-rays - wouldn't it figure that my ortho and OD both want copies and they both want them from different labs 
Then I had to get molds - yes the day after my most painful adjustment to date - 
ouch I hope I can get some answers, but I am realistic enough to know that things might wind up being in more of a muddle than they already are. I'll update tomorrow.
Then I had to get molds - yes the day after my most painful adjustment to date - ouch I hope I can get some answers, but I am realistic enough to know that things might wind up being in more of a muddle than they already are. I'll update tomorrow.For me my ortho and OS worked closely-same plaza of office buildings. One needs the other-you aren't ready for surgery until your teeth are ready-your jaw gets done and then the ortho steps in. I would be nervous that they can't seem to work together. Who recommended who or did you just cold call? Think about getting other opinions-I did. I can't imagine having my OS and Ortho on different pages-would make the journey that much more complicated I would think. Good luck with that!
-
Brandyleigh35
- Posts: 1018
- Joined: Mon Jan 23, 2006 4:25 pm
- Location: Alaska
- Contact:
Yep....I agree with Meryten on this one. My Ortho and OS seem to be working pretty well together but truthfully, it has been my OS calling the shots from the get go. Ortho never even suggested SARPE, then my OS said, oh, you definitley need SARPE. So he called the ortho and talked to him. Ortho said...yeah, I agree, just never mentioned it because he didn't think I would want to do it.
Other day I went in again as my teeth are now in surgical alignment, OS said lower advancement was not enough (to small of a distance to fix my sleep apnea) He recommended upper, lower, and genio. So...he called the ortho and talked with him again. My ortho told me that basically his only concern is aligning my teeth and that it is the OS decisions to decide what is in my best interest regarding the whole surgical procedure. He did say that he was also concerned that the lower advancement wouldnt' be enough, so he is glad the OS has recommended upper, and lower, but again, it is all totally the OS, and no one else making the decisons.
So....that has been my experience. My os has been doing jaw surgery for 30 years. In fact I work with a girl who had upper, lower, and genio done by him 15 years ago. So.....I feel very safe, and definitley trust his opinon regarding the surgery aspect of it. In the same breath I trust my ortho with the teeth alignment part. He has done an amazing job thus far so I guess they are a good team.
That whole ordeal must just be miserable. I do agree with you though, I would probably err on the side of older, means more experience! LOL...
Other day I went in again as my teeth are now in surgical alignment, OS said lower advancement was not enough (to small of a distance to fix my sleep apnea) He recommended upper, lower, and genio. So...he called the ortho and talked with him again. My ortho told me that basically his only concern is aligning my teeth and that it is the OS decisions to decide what is in my best interest regarding the whole surgical procedure. He did say that he was also concerned that the lower advancement wouldnt' be enough, so he is glad the OS has recommended upper, and lower, but again, it is all totally the OS, and no one else making the decisons.
So....that has been my experience. My os has been doing jaw surgery for 30 years. In fact I work with a girl who had upper, lower, and genio done by him 15 years ago. So.....I feel very safe, and definitley trust his opinon regarding the surgery aspect of it. In the same breath I trust my ortho with the teeth alignment part. He has done an amazing job thus far so I guess they are a good team.
That whole ordeal must just be miserable. I do agree with you though, I would probably err on the side of older, means more experience! LOL...
Thank you all so much for taking the time to share your experiences. I posted yesterday about my OS appointment. The OS is really pissed off with the ortho - he tried to not look it, but I could see that he was really worried. My teeth have not been alighned properly and much work will have to be redone. After a good nights sleep and reading all of your relpies, I think I am going to follow the OS's advice. I have yet to talk with the ortho and hear his side of things, but as far as surgery goes, I would be a fool to ignore what my OS recommends. Depending on how this plays out I may change orothodontists.
I guess what is really bothering me most of all is that I really tried to do this thing right. I saw 3 or 4 dentists and got ortho recomendations from each one. I saw 4 othos (one of which really wasn't an option though as he is in the USA), I talked to scads of people who used this ortho (including medical professionals) and like his work. I feel like I have blown this somehow. My next step is to hear what the ortho has to say. I am also considering calling my dentist to get his take on this, but I don't want to put him in a difficult situation with his peers.
I guess what is really bothering me most of all is that I really tried to do this thing right. I saw 3 or 4 dentists and got ortho recomendations from each one. I saw 4 othos (one of which really wasn't an option though as he is in the USA), I talked to scads of people who used this ortho (including medical professionals) and like his work. I feel like I have blown this somehow. My next step is to hear what the ortho has to say. I am also considering calling my dentist to get his take on this, but I don't want to put him in a difficult situation with his peers.
-
Brandyleigh35
- Posts: 1018
- Joined: Mon Jan 23, 2006 4:25 pm
- Location: Alaska
- Contact:
Yes getting together with all three would be ideal, or even if you could meet with one and then conference call in the other so that all three of you could communicate, and hear each other at the same time.
How frustrating! I do think you need to not beat yourself up about this. It sounds like you did everything correctly. I mean how can you factor in personality or differences in style when you're setting up all this stuff. Sometimes I think it is a power thing...get a couple of really big ego's in the same room and the guys get into a pissing match about who knows more etc. It is so stupid, but I have seen it happen in many different situations. I think it is going to come down to you taking the lead in this one, or like you said maybe finding a new ortho. Especially if the OS is saying that he (your ortho) is screwing things up! I mean god knows, we don't want to deal with all this oral drama longer then we have to, if he is making things worse or dragging it out longer due to his lack of expertise then I think you would be completely entitled to switch doctors. I mean who really needs that kind of headache anyway?????
How frustrating! I do think you need to not beat yourself up about this. It sounds like you did everything correctly. I mean how can you factor in personality or differences in style when you're setting up all this stuff. Sometimes I think it is a power thing...get a couple of really big ego's in the same room and the guys get into a pissing match about who knows more etc. It is so stupid, but I have seen it happen in many different situations. I think it is going to come down to you taking the lead in this one, or like you said maybe finding a new ortho. Especially if the OS is saying that he (your ortho) is screwing things up! I mean god knows, we don't want to deal with all this oral drama longer then we have to, if he is making things worse or dragging it out longer due to his lack of expertise then I think you would be completely entitled to switch doctors. I mean who really needs that kind of headache anyway?????
Arrgh! I feel for you, Delag.
I guess I'm one of the lucky ones. My ortho actually recommended and spoke very highly of my OS. They've liaised closely throughout the interconnected BSSO and orthadontic processes.
I sure hope these guys will get on the same page for you. Let us know what happens.
I guess I'm one of the lucky ones. My ortho actually recommended and spoke very highly of my OS. They've liaised closely throughout the interconnected BSSO and orthadontic processes.
I sure hope these guys will get on the same page for you. Let us know what happens.
Braced March 2005 (lower); November 2005 (upper); all ceramic. Goal = correcting overbite.
Lower jaw surgery was successfully performed December 18, 2006.
Lower jaw surgery was successfully performed December 18, 2006.
Ok, so I called the ortho and asked him to call the OS. He said they had already spoken and that the the OS was wrong. He (the OS) didn't understand that I have only been braced for 5 months, and that he doesnt' understand why my teeth need to be moved this way. In addition, he said that the OS told him I don't want the Lefort anymore. WTF? - according to my ortho these guys have reviewed my case twice this month.....maybe they are talking over tequila shooters or something, becuase it sounds like they havent' spoken at all.
I wrote them both a letter stating what I want out of this whole thing and what I understand both of them to be saying. I pasted some of it below. I don't know if it will help, but it made me feel better
.
.......My primary concern is achieving a functional bite which will preserve my crown work, avoid future problems with my teeth, TMJ, and gingival tissue.
I now understand that SARPE is not considered surgery by those in the medical community. I considered both the SARPE and the Lefort osteotomy as surgical proceedures – hence a source of confusion in our communication.
I believe Dr. M’s position is that the segmented Lefort is the best option as it will protect my TMJ from further deterioration, and will reduce my gummy smile. My understanding of Dr. A’s position is that the Lefort is excessive, a satisfactory outcome will be obtained with the SARPE, and the reduction of the maxilla is not indicated.
I realize that which surgery I need has yet to be determined. Given the choice, I would prefer the least invasive option, SARPE. However I realize that a segmented Lefort may be called for in my case in order for the best outcome to be achieved. In this event, I am willing to undergo the Lefort expansion........
I have decided I am not going to worry about it for the time being - I'm going on vacation with my kids in two weeks!!! There will be time enough to fret when I get back.
I wrote them both a letter stating what I want out of this whole thing and what I understand both of them to be saying. I pasted some of it below. I don't know if it will help, but it made me feel better
.
.......My primary concern is achieving a functional bite which will preserve my crown work, avoid future problems with my teeth, TMJ, and gingival tissue.
I now understand that SARPE is not considered surgery by those in the medical community. I considered both the SARPE and the Lefort osteotomy as surgical proceedures – hence a source of confusion in our communication.
I believe Dr. M’s position is that the segmented Lefort is the best option as it will protect my TMJ from further deterioration, and will reduce my gummy smile. My understanding of Dr. A’s position is that the Lefort is excessive, a satisfactory outcome will be obtained with the SARPE, and the reduction of the maxilla is not indicated.
I realize that which surgery I need has yet to be determined. Given the choice, I would prefer the least invasive option, SARPE. However I realize that a segmented Lefort may be called for in my case in order for the best outcome to be achieved. In this event, I am willing to undergo the Lefort expansion........
I have decided I am not going to worry about it for the time being - I'm going on vacation with my kids in two weeks!!! There will be time enough to fret when I get back.