Relapse.. how would you know?

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#16 Post by **WhiteLurcher** » Mon Sep 17, 2007 3:03 am

Apparently Relapse is the cause of my post-surgical problems. I don't know the how's or the why's but that's what my ortho said!

Openbites are prone to relapse.

#17 Post by **freerideuk** » Mon Sep 17, 2007 8:25 am

hey i was at an appointment with my surgeon today and brought up relapse he conventintly left the room but one of the many guys that were around me tryed to answer my question

they said that a small amount of relapse is exppected and is built into the surgery so that any relapse that happens is positive

he also said that one of the reasons othodontics is combined with this surgery is because if the teeth are in the right osition they kind of lock in together and this helps reduce the amount of relapse tan if thy were miss allinged i have no idea if this is the truth lol but i thought i would just share it with you lot

#18 Post by **WhiteLurcher** » Mon Sep 17, 2007 10:32 am

he conventintly left the room

That sounds about right! I asked about my nice new asymmetric face and he changed the subject back to my bite, just like last time!!!

I'm not asking him to fix it but I'd like an explanation of some sort.

#19 Post by **freerideuk** » Mon Sep 17, 2007 10:52 am

lol ou wont get that from him lol

i had to remind him tody that i was in fact having a le fort impaction he completely forgot bout the impaction lol

xxxxx

#20 Post by **SandraJones** » Thu Sep 20, 2007 10:39 am

I didn't have a relapse of my open bite, but I did have a "relapse" of my class II. When I had my surgery I think my class II was pretty much fixed by autorotation of the mandible. But it's baaaaaack. I initially blamed tongue thrust for the recurrence but now that doesn't make sense. Tongue thrust could explain the forward movement of the anterior teeth, but how did my molars move ? And why do I have anterior crowding ?

#21 Post by **Karigan** » Thu Sep 20, 2007 12:18 pm

Well I asked the OS this week why I relapsed and if it was due to me still growing when they did they op and he said no. However, he kind of side stepped the issue, no surprise there then! He said as he didn't have my notes from so long ago he couldn't say although I'd have thought they'd have a general idea why prognathic mandibles relapse. He just said that my type of surgery was prone to it and then he said he'd get the original OS to see me next visit to answer all my questions!! Way to get out of answering it! So not any nearer actually knowing why I relapsed so much. But apparently the still growing theory is not correct. I don't know if I buy that one or not!

#22 Post by **na2r4** » Sat Sep 29, 2007 7:14 pm

Hey there Karigan,

My ortho here is very popular & has been known to do magic!! Lol! (I'd say, considering i'm a class III maloclussion & also needed bottom jaw surgery, which according to him I no longer need, he's going to do it all with the braces after I had the SARPE! Woo-hoo!). He only refers pts for surgical expansions after the age of 21 and never before (his father also an ortho, was known to do wonders! So he taught his son well! Lol!) due to the bone still growing he said.
Your in Scotland, I used to be in England & my dentist gave me such a run around about my bite, i'm a class III, have been since I was 10-11 but according to one of my dentist, i was not!! Yh, okay!! Lol! Maybe they won't even 'fess up & give you a whole bunch of excuses. But if they don't give u a definite answer, then you might want to go ahead and get a second opinion, that way you can trust them if you start to think about having this 2nd surgery. Good luck.

Naz

#23 Post by **phil** » Sun Sep 30, 2007 10:34 am

Karigan,

Again, keeping in mind that I am not a professional, I would like to respond to your last post.

In my humble opinion, I don't think it's intelligent for a surgeon to rule out late mandibular growth as your reason for relapse, unless he had radiographic proof that you were done growing by 17 (for instance, sutures in the skull are completely fused--that would be an indicator, I think).

Like na2r4 says, I think it's time for a second opinion. And, your surgeon shouldn't be able to rule something out without explaining to you WHY he's ruling it out.

#24 Post by **Karigan** » Sun Sep 30, 2007 12:06 pm

The OS I am seeing this time is one of the top in this field and world renowned so I would trust him totally and to be honest I could ask a few more of them and I doubt I'd get a straight answer! Literally he is like the head guy here. None of them like to answer these questions. He kind of side stepped it without saying absolutely one way or another. But he is a great guy and the best so I have no problem believing he knows exactly what he is talking about.

This OS was not the one who did my first op and as it was so long ago they no longer have my notes so I can understand why he felt he couldn't give me an exact answer but I am sure there must a general idea why bimaxillary surgery on class III malocclusions relapse. Also that wasn't the reason I was there to see him and kind of ambushed him by asking him!

I have read that it is not unusual to do this surgery at 17 on females. Personally in my case I feel it is a number of factors one of which may be growth. I am hoping to speak to my original OS next time I visit and I shall ask him why he thinks it relapsed. If only they still had my records and models but as it was 18 years ago they seem to have misplaced them or lost them altogether which is not unusual. Personally I think it has even moved within the past 5 years and I am in my 30s so I'm going to say that next time and see what I can get from them. I'll keep you posted.

#25 Post by **Karigan** » Sun Sep 30, 2007 1:22 pm

I had bookmarked this article whilst researching this subject a few weeks ago and have just got round to reading it. It would seem to suggest that growth is not the primary factor in relapse in my type of surgery. I thought I'd had bimaxillary surgery to correct my bad class III malocclusion which included a sagittal split of the mandible but actually I think it was one of the other types mentioned in this article, possibly the IVRO type. I honestly can't say for sure exactlly what they did but that seems to be more likely for my type of problem. Anyway, this article says that in large movements like mine relapse is expected and also the way the segments are placed and also the type and strength of fixing can play a big part in relapse. This would tally with what the OS seemed to hint at. I always wondered about the growth theory, it seemed most likely but then they were very thorough at the time in determining if I had stopped growing so looking back I probably had. Whereas I always felt that the extent of the shift was so big that my jaws did not like being in the new position and were trying to go back!! I think the size of the shift along with the other possibilities mentioned in this article and my tongue pushing out my teeth have all contributed to the relapse.

'Relapse following a mandibular osteotomy depends on the amount of mandibular movement and the type of fixation. Relapse is expected with mandibular advancements greater than 7mm (van Sickels et al. 1997) In the study of Panula and co-workers, severe relapse was seen in 3% and mild relapse in 8% of the patients (Panula et al. 2001). One method to prevent skeletal relapse include orthodontic over correction. Also the type of fixation plays an important role in preventing the relapse. If no internal fixation is used between the proximal and distal fragments in a BSSO, then significant skeletal and occlusal relapse will occur (SÃ ndor et al. 1984). Bicortical screws either alone or in combination with a plate work better than a plate and monocortical screws (Murphy et al. 1997).'

Anyway, this is a good article, perhaps it has already been posted on the board but here is the link if you want to read it in full.

http://herkules.oulu.fi/isbn9514267508/html/c237.html

#26 Post by **PCPFORMULA** » Sun Sep 30, 2007 6:05 pm

is it quite easy for the jaws to move position post op? if they do, how long do you normally have to wait under surgery can be performed again?

What happens to all the screws, plates etc, are these removed altogether and they start again?

#27 Post by **WhiteLurcher** » Mon Oct 01, 2007 1:37 am

I had my jaws repositioned a fortnight after the initial bimax surgery. They apparently repositioned my jaws three times before they were finally happy!

Alas my bite still relapsed even after all that!!!!

#28 Post by **Karigan** » Mon Oct 01, 2007 11:04 am

Meryaten, yes I thought you had probably quoted that artcle before, you do such good research! It is very interesting going through it all, I'm going to ask all about this when I go back and hopefully the original OS will be able to shed some light on my particular relapse.

Whitelurcher, is your bite still out of position now and if so why did they say it has continued to relapse even after correction? Are you contemplating anymore surgery? I wonder because I am thinking of going back now after 18 years to get mine corrected but I would be worried it might relapse again and so then there'd be no point doing it. That is why I want to pin them down on exactly why my jaw position and bite relapsed.

#29 Post by **WhiteLurcher** » Mon Oct 01, 2007 12:05 pm

Karigan, my bite still looks much like the last pictures I posted here:-
viewtopic.php?t=19113&postdays=0&postorder=asc&start=30
With the wonders of elastics my ortho has managed to extrude my right molars, so I do have some contact now and my bite is functional.

It's just not how it was meant to turn out! My ortho said relapse was the cause due to my open bite. My surgeon hasn't given any explanation and I'm not sure he actually has one

As you know getting answers from a surgeon is like juicing a stone!

You will just have to make it clear that you need answers before you can make any decisions about surgery, unfortunately the answers you get might not help.

Good luck and all the best!

#30 Post by **Karigan** » Mon Oct 01, 2007 12:32 pm

Whitelurcher, I looked at your pics, it doesn't look too bad although not as you'd hoped of course. Mine is much worse although it has gradually gotten worse over the years. I have contact between two molars on the right side and one on the back left and that is it now. The gap between my lower jaw (pronathic) and top jaw is about 5mm on the left and then gradually reduces as you go round to the right. My original position pre surgery all those years ago was over 7mm. As I say it is noticeable but compared to pre op it still looks good!

It is so difficult to pin them down on this topic and they all seem to avoid it if possible as you say! I really did think for a while it must be the growth theory mixed with other reasons but now I don't think that is the case with me so I will have to really put them on the spot this next time. I gather they are monitoring your bite closely? They moitored mine for over 10 years post op and it gradually got worse over that time. I do actually wonder if it is still moving over the past 5 years or so which would indeed scupper the growth theory and also now that I have been giving it a lot of thought, which I haven't done for years, I had stopped growing by my mid 20s and still it moved during that time.

If yours continues to move, would you go in yet again to correct it?