Metal Mouth Message Board

Greetings everyone, here is my story and I would appreciate any insight or advice. 50yo male with 3-5mm overjet / bite and moderate crowding who has never been braced before. Saw an orthodontist twenty years ago but never did anything. Couple of guys in their forties got braced at work and I thought heck if they can handle it I certainly can. So I asked my new Dentist who he would refer me to and got two names. I went to the first Ortho and asked what all my options were. Option number one Invasalign on the top only will result in "straight uppers" with additional 2-3mm of protrusion after 9months of therapy. He really didn't recommend this option. Option #2 remove single lower incisor braces upper and lower braces for 24months. Option #3 remove four biscupids upper and lower braces for 24months end result upper incisor back about 3mm. I figured if thats what it takes to get the best result bite the bullet and do it. Just to be through I decide it is probably best to get a second opinion. So the second Ortho says don't have to extract any teeth upper and lowers for 24months. I really press him on this issue and ask how certain are you that we can accomplish this without extractions and he tells very certain it can be done and if there is a problem we can always do the extractions. Well I figure this is a no brainer and decide this is the way to go. Part of the second orthodontists work up included xrays and pictures. He points out that on the lateral xray my lower jaw point B? Is 12mm behind were the average persons jaw is. I also notice on the lateral photographs that my jaw is somewhat weak. I'm not a vain person and honestly had never noticed this before because I don't spend alot of time looking at myself in profile. Previously I had stumbled across this website while researching adult braces. I was very impressed with this website and found the stories rather supportive and informative. So I started reading the jaw surgery posts and started to wonder if I was a candidate? So I call the orthodontist back and ask him if I'm a candidate for jaw surgery. He replies is that something that you would consider and I say sure I'll consider anything. So I go in a month ago and get ceramic braces on the tops. We discuss the jaw surgery again and he refers me to an OS. I see the OS who is proported to do about 18 jaw advancement surgeries a year. Is this enough or not enough? He seems ok and tells me he recommends extracting two first bicuspids to pull back the lower incisiors and then move the entire jaw forward 5-7mm and a genioplasty of another 5-7mm and this will give me the best esthetic result. So I'm thinking if my occlusion is only a 1/2 step off on the left and on the money on the right how can you move the jaw forward 5-7mm and have the occlusion right? Of course this doesn't occur to me until after our meeting. So I go into my orthodontist for my first adjustment yesterday. I ask him what he thinks about the OS consultation. He tells me to have four biscupids out. We then move the lower incisors back and the upper molars forward temporarily worsening the class II relationship. Then we do surgery and have everything in good alignment after the advancement. So I ask him why the OS only mentioned extracting 2 bicuspids and he is recommending 4. He suggests maybe there was some miscommunication between the two of us, which is probably correct as I can't see how only two lower bicuspids could be removed and the jaw advanced 5-7mm and have a decent occlusion. So I think he is right on this issue. I then ask him what if we don't remove any biscupids as the orginal plan. Line everything up how far forward could we advance the jaw. He says 2-3mm which hardly seems worth it to undergo all this surgery for 2-3mm granted the genioplasty would add an extra 5-7mm. I press him some more on the issue and he tells me that orthodontically the best result would be with the four biscupids extracted. Which is somewhat different than our original discussion, but I realize there is more than one potential treatment plan and result for these complicated issues. So now I am seriously considering the four extractions and the surgery. I think it will give me the most stable orthodontic results and aesthetic result. However, this is not something to be taken lightly I consider this major surgery myself. My question is to those of you that have gone through this is it worth it? Would you go through it again? How bad is the recovery? Could I go back to work after 2 weeks? I figure it is about one week of liquids then soft food? How long before you are on a regular diet again? On a more personal note how do you expain this to people who may think you are having this surgery strickly for vain personal appearance reasons? Thanks.

Thanks for posting. 50-yr-old woman here who had mandibular advancement in June (no extractions except upper wisdoms at time of surgery as they became superfluous at that point---no teeth to rest on). I am going to answer your last question first.

On a more personal note how do you expain this to people who may think you are having this surgery strickly for vain personal appearance reasons?

Frankly, it's none of their business why you are doing this. People have surgery every day to improve their looks. In your case, it will improve your look and improve your bite. I think it will be up to you to decide what you want to say to these people. I like to fall back on something I heard years ago: "Your opinion of me is none of my business." I don't think you should have to justify yourself to anyone.

I am confused as you as to the extraction issue. Why would your ortho say you don't need extractions for regular orthodontia, and then, when you decide that you want to go ahead with the surgery, he wants to extract 4 teeth? Will this have any effect on your face in general? That is, will it give you a sunken look? Less teeth make a less filled out face, generally.

Thanks for your response. I also am somewhat confused about the extraction isssue and this is one of the main reasons I posted. I believe the plan is to leave the upper incisors where they are and to move the upper molars forward. The lower incisors move backward prior to surgery some 5mm to allow an extra 5mm of jaw advancement. Without the extractions the jaw advancement would only be 2mm which hardly seems worthwhile. Additionally the first ortho I consulted recommended four bicuspid extractions without any jaw advancement simply due to crowding issues. After all of these consults and office visits and changing treatment plans it is hard to keep everything straight even though I write down a summary as soon as I leave the offices.

One another subject, would you recommend this jaw surgery and would you go through it again? In short was it worthwhile and are you happy with the result?
Thanks

Thanks for your response. I also am somewhat confused about the extraction isssue and this is one of the main reasons I posted. I believe the plan is to leave the upper incisors where they are and to move the upper molars forward. The lower incisors move backward prior to surgery some 5mm to allow an extra 5mm of jaw advancement. Without the extractions the jaw advancement would only be 2mm which hardly seems worthwhile. Additionally the first ortho I consulted recommended four bicuspid extractions without any jaw advancement simply due to crowding issues. After all of these consults and office visits and changing treatment plans it is hard to keep everything straight even though I write down a summary as soon as I leave the offices.

One another subject, would you recommend this jaw surgery and would you go through it again? In short was it worthwhile and are you happy with the result?
Thanks

Big H,

I am 16 days post op from both jaws and genio. I will try to answer some of your questions, but not in order. I am 44 and was curiuos about other opinions. In the end, my mouth, my decision. So far I like the results, the swelling has subsided, and my wife says she sees more teeth every time I smile. I think they moved my lower 5mm and the genio got me for another 5.

I would sort of question the number times the OS has done this. The surgeon I used does 3 to 4 a week. I had talked to some of his other cases and was very impressed with his work. Where are you located?

I don't know about your extractions, mine were all done as a child. Another opinion may be a good idea.

Good luck, I am sure this board will weigh in with lots of input.

David

Here's my answers to your questions. I hope they help.

Is it worth it?
Very definitely Yes. My teeth now meet as they should, I can close my lips over my teeth (something I had never been able to do courtesy of my 15mm overjet), my confidence has improved, and the cosmetic changes have been drastic. (This was not, however, why I had the surgery. My reasons were first and foremost functional, and the cosmetic improvement were a bonus). Btw, I had upper and lower jaw surgery and genioplasty (upper jaw up and out by 4mm, right side upper jaw levelled, lower jaw out by 9mm, chin about 6mm)

Would I go through it again and how bad was the recovery?
Probably yes. The recovery really wasn't so bad. There was virtually no pain, just uncomfortableness and within 10 days most of the major swelling had gone. 3 1/2 months post-op I still have a numb spot on my lower lip and chin, and my palate and top teeth still feel numb but this is improving, albeit very slowly.

Could you go back to work in 2 weeks?
That would depend on your job and how you recover. Within 2 weeks I was ready to face the world again, but as I have a job that involves lots of talking (I'm an early childhood teacher), I eased back into work slowly. I went back to work after 4 weeks but didn't feel like I was talking normally until a good 6 weeks post-operatively.

How long did I have liquids for?
My case was unusual when you compare my experiences with others. (This is a Western Australian perspective, so my experiences with hospital and post-operative care are a lot different from yours since our standards of care are different) .I was allowed to have soft food (no chew) the day after surgery ie porridge, flaked fish, pureed apples, scrambled eggs etc and within 9 days had the go ahead to soft chew food.

How long until I was on a regular diet?
Several weeks before I could manage bread crusts, steak etc and I still have trouble with really hard foods such as apples since my palate goes numb when I eat this sort of food.

Explaining my reasoning for surgery?
Anyone who knows me, knows that my overjet was horrendous but when I explain my wearing down of teeth issues and my periodontal issues etc caused by my bad bite they all agree that it was well worth it. It really came down to me keeping my own teeth into my later years (I'm 41).

I have only had positive feedback from everyone. I should have done this years ago (I should have had it done when I was 12), and my self-esteem and confidence has improved dramatically. I no longer hide my teeth behind my hand when I smile.

One final word - on the day of my surgery the surgeon operated on 4 other cases so 18/year does seem a bit on the lower side of experience. Can you ask to see some before and after photos of cases that he's dealt with?

Good luck with your decision.

No regrets whatsoever. None. My bite is normal now, and I no longer have a pinched look to my mouth. That part is the aesthetic part of it, the bite being the functional part.

Not much pain, really...just sore from the trauma and the swelling, which go down. I had a bit of a problem with night-time clenching after the surgery so my OS prescribed muscle relaxers to help that go away. The issue is that it takes your muscles a little while to get used to the new location of your jaw and one of the consequences of that can be clenching and grinding.

My OS had 27 years experience and in fact, did two BSSO's on the day of my surgery. I never asked him how many a year he does. However, he practices in Reno, NV and I am not sure how many of those procedures are done in our relatively small population anyway.

Thanks everyone for all the feedback and information. This issue about the number of surgeries is somewhat concerning. I'm in a metropolitan area of approximately one million. I have no idea how many BSSOs are done per day or per month in a metro area this large, but I wouldn't think it is a large number and this has to be divided amoung a fair number of OSs. In any event I asked to see the OS who was the most experienced. This person has been in practice 25 years but I really don't know what percentage of his practice is jaw surgery and what percentage is extractions etc. In fact I don't know what the practice spectrum of oral surgery all includes. In any event I am very much in tune to this concept of getting a surgeon who is very experienced and does a large number of the procedures that one is contemplating. I made this very clear to the ortho on two occassions so I hope he referred me to the right person. In fact I chose to go across town to see the second of two people he suggested just because he characterized this individual as more experienced then the other person in his same building. I asked the OS that I saw how many of these procedures do you do per month. And his response was about one and one half. I guess I should have asked him how many total jaw surgeries per month does he do. The problem is, if you start grilling these people to much they start getting offended. I suppose I could go back and ask him what percentage of his surgeries are jaw surgeries. But these guys get touchy when you start questioning their experience. Any other ideas how I could find out if there is someone locally who does more of these surgeries?
Thanks

Hi Big H
Greetings from the Emerald Isle. I am now 51 years old and have been in braces top and bottom since June 13 2005. Time really goes fast so that should not be considered a problem. I teach and so I would be in front of over 500 students per week.....all girls. I can assure you that the kids think nothing of it at all. I had nightmares thinking about what "other" people might think ...at my age!. I was very surprised as 99% of people do not even give you a second glance. My students who have braces sometimes will ask if I have some dental wax as they will have forgotten theirs. I am sorry I did not go for this years ago (did not even know it was possible), but now that I have its great.
Even if it was strictly for personal appearence reasons then its still perfectly OK. We all get one chance at life so go for it.
All the best
Dave