Reversing camoflague in favour of orthognathic surgery

[abro884]

Self explanatory title: I'm reopening my 2/3 closed extraction sites, proclining my upper incisors, and revisitng lower jaw surgery.

It wasn't evident just how much lip support I would loose, so I actively raised my concerns with the ortho and basically said I'd stop treatment if he refused to reopen them (and go elsewhere). He wasn't very happy with me but agreed to do it, after making me visit with the surgeon to 'Be certain". I'll need implants to replace the upper premolars but such is life.

Has anyone done this? It's so hard to anticipate the retraction results but mine were terrible....

[PierreDeFermat]

I'm guessing extractions were indicated by your oral surgeon because of excessive crowding or a severe open-bite deformity (or both), is this true?

Or did you decline orthognathic surgery and the orthodontist decided to pulled teeth as part of his treatment plan (orthodontic "camouflage")?

I think we need a little backstory

[abro884]

Ah right.

I was a half cusp class 2. The oral surgeon said we could do surgery but the orthodontist didn't like the flaring and so wanted to do retraction instead.

I found out later on that my teeth weren't actually the flared, and that the lip support they gave was needed anyway.

The upper extractions were done to retract the uppers to meet the lowers.

[PierreDeFermat]

It sounds like your orthodontist thinks your case can be treated completely with aggressive orthodontics, while your surgeon believes it should be treated by both orthognathic surgery and orthodontics.

I'm assuming you suffer from some degree of retrognathism, and your surgeon wants to advance your mandible to improve your facial aesthetics (and possibly cure some upper pharyngeal obstruction-- do you have sleep apnea?).

If you got surgery now, the surgeon only needs to bring your mandible in status with a bilateral sagittal split osteotomy (BSSO), and your orthodontist will be able to finalize your bite. The extractions may even have been to your benefit depending on the particular procedures your surgeon wants to perform.

If you fix your occlusion completely and have surgery after, then the surgeon will have to perform bimaxillary advancement to preserve your bite. As a consequence of moving the maxilla forward, you may gain additional lip support that you lost from reclining your incisors (though soft tissue changes are notoriously difficult to predict and are dependent on the structure of the individual's lips).

In my own case, I have a hypoplastic mandible and and a little bit of maxillary retrusion, but my Class 2 deep bite was corrected completely with non-extraction orthodontics (Damon system). 10 years later, I was diagnosed with severe sleep apnea and I'm having bimax with CCW rotation and a genioplasty next month. My bite is still stable.

If your bite can be fixed with braces alone it's far less invase than surgery, but then again surgery will give you the best aesthetic result (along with additional risk). The stability of each is also particular to your own individual case.

Again this is all general, only your clinicians know the specifics of your case and will be able to properly treat your specific condition. It might be worth it to see an additional oral surgeon and see what they have to say about your treatment plan and orthodontic history.

[abro884]

Yeah I think you are probably about right in that analysis.

I met with the surgeon yesterday and now that we went down the extraction route, he's sort've saying that it's a lot of effort to reverse and do surgery - but that it's my call. I need to have set back genioplasty, too.

I'm still going ahead though. It's well worth it to me.

[wolfhero]

I had orthodontic camouflage treatment which retracted/retroclined my upper teeth while flaring out my lower incisors due to class II elastic use.

I had it reversed by an excellent orthodontist after I and other people noticed that my upper profile got flatter and that I couldn't move my lower jaw forward anymore to compensate for a severe class II malocclusion.

Although I don't know how severe your malocclusion is, what I do know is that camouflage treatment can be good alternative in minor cases of malocclusions but shouldn't be done in severe cases of bite discrepancies/jaw misalignments.

Luckily my extraction spaces weren't fully closed. My spaces were opened using coil springs and upper teeth proclined using a TAD. I was in braces for 2 years for decompensation and I had a BSSO (lower jaw surgery).

It was absolutely worth it aesthetically, I look way different(for the better) from the days where my upper teeth were retracted and from now. It took about 2 years for my spaces to be opened enough for implants and for my lower jaw to be moved forward.

I suggest you find a different orthodontist who is fully supportive and on board with your decision for you to get lower jaw surgery, while also showing you the reason why you should get lower jaw surgery, with a cephalometric analysis to show you why you need the surgery.

[abro884]

Wolfhero - that's awesome to hear! I'm so glad you are happy with the results!

For what it's worth, another maxfax surgeon I saw said he totally understood why I was doing it, and that he thought I was making the right choice.

And I've done exactly whst you suggest - found a new ortho! She'll see me through to surfery and sounds like she'll be using coil springs as well. I had upper 2nd bicuspids pulled so a bit different. I was told a year before surgery for decomp - we start in the next few weeks. Her attitude was so much better! She said to me "you're allowed to change your mind".

I had to find another ortho because the guy who did the retraction dropped me, saying he wasn't comfortable with it. He led me on for 3 months saying he'd do it once I met the maxfax surgeon, then dropped me as soon as I reconfirmed for the upteenth time that yes - I wanted to do this. He was the one who pushed me out of surgery originally, acticelt discouraging me. It was a 7mm overjet which I later discovered was a borderline case. The maxfax later said "yeah that was a huge overjet". I wish the old ortho had told me the reality of my case instead of acting like the surgery wasn't warranted. His dropping me after saying he'll fix it speaks volumes.

I believe I am making the right choice now, and can't wait

[abro884]

Hi again Wolfhero

Can you elaborate on who you went to to reopen the spaces?

I think Ive found someone who will do it, but I'm still waiting for their approval.

Thanks heaps

[wolfhero]

Hi abro,

I saw your post on the other thread and you say you're from NZ. I'm not so I wouldn't be able to refer you to my orthodontist, but if you do have any more questions I'll be happy to answer them to the best of my ability.

[abro884]

Hi wolfhero

Thanks so much!

I do have a couple questions....

The new ortho said she should have me in and out of surgery within a year. I have 2 extraction spaces, one at 2 and the other at 3mm. From what position did you start?

NZ is reallllllly behind the times so the ortho who did this actually dropped me after saying he'd do it, and now I've hopefully got another ortho about to reopen. It seems like some orthos just don't get it. It's really disturbing. It was mostly the male practitioners who thought it was a stupid idea ("I don't know what the point is though it looks fine") and the women kind of got it ("well you could try filler.... but yeah, I see what you mean." One actually said "you're a woman - you're allowed to change your mind." The women were a lot more understanding of what I'm going through, although one maxillo surgeon basically said "yeah I think you're making the right choice to reverse and go with surgery". The current ortho was pretty blunt and said "yeah your teeth look really flat, and they'll probably just get flatter". I appreciated her honestly and bluntness because that's the world we live in, and it's appreciated criticism because it validates exactly what I've been saying!

I can relate to what you said about heart throb and then not. It was like night and day - I literally felt the interest dripping away over the few months of retraction. Which sounds terrible but it's like that big yellow taxi song - you don't know what you've got til it's gone. Welp, I had no idea I even wielded attention until it disappeared!

So praying this new ortho gets me sorted. I'm almost 25 and I started this whole process at 22. I really need my lip support as I get older - it's only guna get worse!!

If I was located oin London i'd just do the Dr Mew pathway and get it done, but it's a bit too far for me I'm afraid.

[wolfhero]

I don't have an exact measurement, but my extraction spaces weren't fully closed yet. Class II elastics retroclined my upper teeth, then I started power chains to close the spaces. That is when I really noticed the loss of upper lip support so I immediately had them removed and I went to a new orthodontist. Since my spaces weren't fully closed yet(I still had sizable gaps), my new orthodontist said it would be easier to reopen them.

I wouldn't even call my old dentist an orthodontist, he was so bad that I had a bracket pop off all the time. I maybe went to see him 40+(not exaggerating) times to glue a bracket back on during the duration of my treatment(which lasted about a year and half). I would go back to have it reglued again, but then even after regluing, the bracket would pop off immediately, sometimes instead of going back to have it reglued I would just leave it alone and I waited till the next appointment because I didn't want to bother going back knowing that it would just pop off again .

It is very important that you get treatment from a dentist who really graduated from an orthodontic program; as in someone who really graduated from an orthodontic program from a university, which takes several years after graduating with a dental degree, while also having board certification to be an orthodontist in your country. These certifications should come from recognised/accredited groups in your respective country, for example; the American Association of Orthodontists, etc.

With my new orthodontist, I never had a bracket pop off and treatment time was about 2 years.

When I had my braces with the new orthodontist. Alignment and levelling first started and I didn't notice much improvement with regards to the retraction of my teeth, I was even worried that the retraction would not be reversible. But then the decompensation stage started several months later(maybe after 4 or 6 months) and that is when I really started noticing the reversal of what was done wrong.

Fortunately with the decompensation, my upper lip support came back and I was able to push out my lower jaw forward again to hide my overbite. I could see the improvement every time the orthodontist adjusted my braces to decompensate further so I was excited every time I had an appointment with my orthodontist.

[abro884]

Wow that is super interesting. I'm stoked it went back to how it was! That must've been a massive relief!

I had invisalign retraction. So it was an extremely noticeable process without the brackets. You could see the results in real time!

I am hearing 3 -4 ish months for the front teeth to start looking more proclined. That isn't too bad in terms of time frame and sounds around about the same as yours. The whole treatment, surgery included, is 15 - 18 months. I just got confirmation this will start next month, and the surgeon is about to send through the images. This is definitely an ortho working with me. In NZ, only orthos can do jaw surgery. It is a shame because some dentists are extremely talented who trained under orthodontists overseas, but they still can do jaw surgery.

It's unfortunate because often, these dentists are more inclined to encourage jaw surgery in class 2 and 3's than they are to extract/retract. And these sorts of practitioners are really needed here in our traditional indoctrinated island. Equally, we have far too many dentists who set people up for jaw surgery and then can't do it as they aren't qualified. Generally, it starts because they didn't realize the patient was class 2. Which is pretty terrifying. If you don't know what a class 2 is, you probably shouldn't be putting braces on anyone. I did have a dentist do this originally which resulted in a 7mm overjet. Not fun. They literally told me that it was ok to hold my jaw permanently forward. So messed up! And yes the brackets popped off all the time. Sometimes I too would get sick of going back a third time and just leave it.

I can't wait to go on the same journey you did. I know what I'm in for this time around and so beyond ready for it! Having tried both, I know it isn't an option to camoflague. I think people get scare their face will change. The reality is that it's going to change any way, regardless of extractions or advancement. Best go with the prettier change.

I think jaw surgery will happen 10 -12 months in, from what I gather.

[Kc2470]

Any updates? Did your guys looks go back to normal?