Class 3 - Surgery before orthodontic treatment

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#1 Post by **pricklypear** » Thu Nov 12, 2009 4:43 pm

I posted this a couple of months back but didn't really get the replies...so here we go.

My orthodontist is recommending that I do the surgery before the orthodontic treatment for my class 3/underbite case. He said I would be braced for about a month before the surgery takes place (keeping in mind that the expected treatment time for orthodontics in my case is 2 years). He has mentioned that this is a new approach in oral surgeries.

I'm wondering if anyone knows about this way of treatment. What are the risks/benefits of doing the surgery before orthodontics is complete?

My concern is that this approach is totally opposite of how treatments are typically done. There is obviously a reason why in most cases orthodontic treatment is done before the surgery and the benefit of doing the surgery before orthodontics must be balanced by risks as well (maybe a increased risk of jaws relapsing back to their original position - I don't know.).

Although I'm open to the idea of doing the surgery first, I do not wish to do it at the increased risk of something going wrong, especially since this approach is 'new'. I've consulted with several other orthodontists before and none have recommended this approach nor was I able to find anyone (on this forum and others) who has had this experience. Any insight would be appreciated.

#2 Post by **OzzysMom** » Thu Nov 12, 2009 6:04 pm

Have you consulted with any surgeons yet? I would recommend a consult with one(or more) before making any decisions.

#3 Post by **soleil4716** » Thu Nov 12, 2009 10:41 pm

Better to go with a proven approach than a new one. I do not know how this could be done in my case. My jaw was advanced 6-8mm and that could not be done without 17 months of orthodontic treatment because my lower teeth were slated forward.

#4 Post by **Teeth of Cthulhu** » Fri Nov 13, 2009 4:17 am

Works just as well as the braces first approach if done correctly. It's the standard in South Korea where class III bites are much more common than in the west. Take a gander: http://asfoa.org/pro/index1.asp

#5 Post by **Noam** » Fri Nov 13, 2009 7:11 am

Wow, ~5 months for Surgery+Orthodonic treatment...

But from the before/after pics it seems that they are doing shortcuts. They keep the upper teeth projected forward, they don't straighten it.

Take a look at this for example:

Mon Nov 23, 2009 12:52 am

Not sure what you mean - the after depicts a perfect bite. There is no excess overjet.

#7 Post by **Jewles** » Mon Nov 23, 2009 2:40 am

Are you sure the before and after isnt backwards?
The before looks far better! a defined jaw line, the chin isnt receded and the teeth are sitting straight rather than jutting forwards at an angle.

#8 Post by **crazybeautiful** » Mon Nov 23, 2009 6:16 am

Teeth of Cthulhu wrote:Not sure what you mean - the after depicts a perfect bite. There is no excess overjet.

The upper teeth are tipped forwards at an angle. That's not a normal bite.

While the underbite is corrected, the teeth do not meet how they should do.

#9 Post by **crazybeautiful** » Mon Nov 23, 2009 6:18 am

crazybeautiful wrote:
Teeth of Cthulhu wrote:Not sure what you mean - the after depicts a perfect bite. There is no excess overjet.
The upper teeth are tipped forwards at an angle. That's not a normal bite.

While the underbite is corrected, the teeth do not meet how they should do.

forgot to add: this method seems to be like move the jaw then play catch-up with the teeth, and make them meet. I always thought the alignment of teeth was a better dictator as to how the jaws should meet up, not the other way around

#10 Post by **OzzysMom** » Mon Nov 23, 2009 12:31 pm

They look backwards to me as well. I don't like the after pics at all. If that was my final result, I would not be happy.

#11 Post by **projo198** » Mon Nov 23, 2009 1:21 pm

Hmm... I'm no doctor but it doesn't sound like the best approach to me. Much easier to get move teeth around to accomodate the surgery than to move a jaw around to accomodate the teeth..

My surgeon took molds almost every time I went in and practiced on them until he was happy with how the surgery would go. To be honest I got tired of him saying "not yet", but I went back to my ortho last week and it's nearly perfect. 2 more visits and I'm done with braces.

But like I said, not a doctor. You might query a bit more and see if anyone else had done it this way.

#12 Post by **fromjersey** » Sat Nov 28, 2009 10:53 am

I'm wondering if we are looking at final results in the "after". Mandible does look recessed now. Maybe in a few months lower jaw will look more normal.
In the "before", teeth were definitely not a good bite. In the "after" I see a slight overbite but so much better than the "before" photo.
I don't think photos were switched mainly because of the comments that with most Asians there is a prognathism problem, not retrusion of mandible.
Helen

#13 Post by **boatsink** » Thu Dec 24, 2009 9:06 pm

Jewles wrote:Are you sure the before and after isnt backwards?
The before looks far better! a defined jaw line, the chin isnt receded and the teeth are sitting straight rather than jutting forwards at an angle.

Agreed 100%. If that was the final result, I would definitely cry and go back under the knife. Botox to tighten up the chin perhaps?

#14 Post by **sgguy** » Mon Dec 28, 2009 11:07 pm

My ortho did mention either do braces for a longer time than do surgery or do braces for a shorter time first, do the surgery then braces wil continue for longer time..

I did braces for a longer time before op, and i feel as this was a traditional way, it might provide better stability.

#15 Post by **drrick** » Tue Dec 29, 2009 7:53 am

crazybeautiful wrote:
crazybeautiful wrote:
Teeth of Cthulhu wrote: I always thought the alignment of teeth was a better dictator as to how the jaws should meet up, not the other way around

Actually it is the other way around. In an ideal world the jaws would line up and then the teeth are matched to the ideal jaw alignment.

That is why in many sx cases everything will look worse before the sx. (more underbite, etc. as they line the teeth over the jaw)