Getting different evaluations for treatment

[riotshield]

I visited three orthodontists for pre-treatment evaluation in the past month - 2 with their own clinics, and one university hospital. My reason for seeking orthodontics/orthognathic surgery is mostly cosmetic. I have a long lower jaw and somewhat gummy smile. I have some issues with popping/clicking in my jaw and mouth breathing, but no difficulties with pain or chewing.

All the orthodontists agreed that I need braces first for about 6-8 months to correct some crowding, and then lower jaw surgery (mandibular setback) to fix an underbite. However, I get different opinions as to whether I need upper jaw surgery as well. Two recommended it, but the other recommended against it. He said I need my palate expanded, and recommended genioplasty. His reasoning was that it was not worth the risks to operate on my upper jaw to fix a mild cosmetic issue. Yet the first two didn't mention palatal expansion or genioplasty at all.

I'm a bit confused as to what to do. The third orthodontist made some really good points and his recommended treatment would certainly cost less overall, but I also want the best possible aesthetic. Is it worth getting upper jaw surgery for mostly cosmetic reasons? I appreciate your responses.

[cersepn]

Hey there,
I really know what you're going through cos i have the same exact diagnosis: underbite with long lower jaw and gummy smile.

I went through 3 different ortho consults - each giving me their own take on what should be done. In the end i went with the non-surgical route. I'm around 8 months in and honestly regret going this route (Had to extract two lower teeth); my lower chin looks really longish now, and basically now i wish i had just went with the ortho who suggested upper + lower jaw surgery.

I guess the treatment approach you should take ultimately depends on whether you yourself are bothered by those minor cosmetic issues. If you're not really affected by the gummy smile and stuff that much, then you probably should just go with the less invasive option.

For myself, i plan to get a genio after all this is done to reduce the height of my lower chin.. and as for the gummy smile i'm not too sure what can be done. Typing this post out makes me feel kinda sad too

[bb]

You should consult with some Oral Surgeon. They are the experts for surgery, after all.
My ortho told me my lower jaw would be moved back but the surgeon told me that it would be my upper jaw moved - forward. I leave it to my ortho to straighten my teeth and my surgeon to decide what would look best with regards to surgery.

[Saffie]

I don't know exactly how to explain this, but sometimes the surgeon wants to move both jaws so that they're in the right place, as well as proportional. Maybe you have an underbite because your lower jaw is too large, maybe your upper jaw is too small and that makes the lower one look bigger, or maybe it's a combination of both (a lot of overbiters seem to have the same thing, only the other way round). If your teeth have tilted to compensate for the underbite then this can mask the size and position of your upper arch, and once they move into the 'correct' position for surgery, you could end up looking like you've taken out a set of false teeth.

[carcan]

i think you have to decide for yourself whether or not it bothers you enough to want to fix it. The orthodontist is there to tell you what would be ideal, but your the one that needs to make the final decision on it , I have read some blogs and the gummy smile is what some people like about themselves. Whatever you think makes you happy.

[riotshield]

I got braces put on today. The orthodontist told me I have a couple weeks to decide whether to go with the upper jaw surgery route (LeForte I osteotomy?). Basically, he said my bite can be corrected with lower jaw surgery + palate expansion alone, and genioplasty can round out my long face. If I go with upper jaw surgery, it would be for cosmetic reasons alone, and he doesn't recommend it.

Right now I show too much gum when I smile (almost the same height as my teeth with a full open smile). On one hand, I don't want to have unnecessary surgery, but on the other, I think I'll be wondering 'what if' afterwards if I don't do it. I'm leaning towards the surgery at the moment...

[brendan]

GET THE UPPER JAW surgery.

Dont have time to explain- but go with your gut- its on point

[archangel689]

I find myself saying this more and more often. Talk to a GOOD maxillofacial surgeon, they are the end all be all in this matter, not the ortho.

Yes they can shift teeth around to force it.... his opinion is good but it is not as good as the opinion of a surgeon...