Metal Mouth Message Board

so, in my initial consultation my ortho told me i could get braces and sarpe or i could chose to just get the braces. (i have a cross bite) when i asked him if i would have to get teeth extracted if i didn't get the surgery, he told me he couldn't be sure.

i decided to go ahead and do braces only and when i come in to get my uppers on he tells me that if i don't get the surgery i will have to get extractions. when i ask him how many extractions, he again says he can't tell. i'm now not sure what to do. he put my uppers on & said we could see how happy i was with my teeth in 6 months & then decide what we want to do from there. (does this mean i can chose to not have surgery or extractions if i'm happy enough?) another ortho i had a consult with told me that he could file my teeth to get the space so i wouldn't need the extractions. i decided not to get treatment from him however because he was located far enough away that it would be hard to get to appts during work hours.

i think i'm going to ask my ortho about filing and see what he says. i really do not want to do the surgery.. i don't have any current health problems from my bite. however, i'm afraid i might not like the shape of my face after extractions. i have a round face with chubby cheeks & i've read that most people say their face is elongated, so perhaps it might even look better with extractions? at the same time i have some fullness around the bottom of my face too, so perhaps the extractions would just make that even more prominent?

anyone have any thoughts?

Personally, I'd chose the SARPE, unless they can prove to you that your profile would not change significantly with extractions.

yeah, my ortho has not mentioned anything about my profile as of yet.

thoughts from anyone else?

I would choose sarpe, but I have had the surgery so I would say that! I would rather not have healthy teeth pulled out personally... My ortho wasn't keen to treat me unless I had sarpe, but my main reason for me wanting braces was a very narrow v-shaped upper bite, he couldnt get rid of this without surgery, and results would have been unstable without surgery. Your case could be quite different to mine, maybe get a second opinion from a different Dr? In my area, initial consultations are free.

i went to about 4 orthos & they all said something different. the first one said he could put an expander on me without any surgery and acted like it was no big deal. he was the one my dentist referred me to & i wasn't into him.

the second one told me he could do the expander with no surgery, but he might have to pull a tooth too.

the third one (current) said surgery or just braces.

the fourth one said surgery (he recommended it over anything else), but said we could do just the braces w/o correcting the cross bite & he would just file down the teeth to get the extra space he needed.

Eeeek! How confusing! I have to admit, I did not get any second/third opinions when deciding on an ortho. This was because I chose a Dr who is the President of the Ortho' association for my region, an assistant Professor at the local dental school and also specialises in cleft palate treatment, basically anyone else in my geographical region wasnt as qualified, and I was happy with his treatment plan. If you have that many differing treatment opinions, maybe go for the person who has the most experience?

I just had SARPE (in a 3 piece le fort1 style) done a month ago today. My ortho would not take me on without my doing it. Pulling teeth was not brought up, but given a choice, I'd rather have the surgery. In my mind, one a healthy tooth is gone, it's gone. May I ask how old you are? Simply because, in most cases, once you are about in your mind 20's an expander doesn't really move much.

i'm 27, yeah... i def did not want to get the expander without the surgery. there were 2 orthos that i went to that were older (the ones that said surgery), i really preferred the one that said he could file my teeth to make space if i didn't get the surgery. but his office would have been harder to get to for appointments or emergencies. (i work a 9 - 5 job and it was about a 30 min drive 1 way)

the ortho i chose however, my friend went to when she was 30 & she liked him. she had more problems than me, she had a bad bite too.. but she was also getting migraines because her jaw was misaligned. so she had the sarpe with him + another jaw surgery + braces. the ortho i chose is the president of my states association of orthodontics & he was the top rated ortho in our city's magazine as well.

he definitely explains less than the ortho that said he would do the filing however. i didn't even know i was getting spacers put in until i came out of my appointment & looked up what these things were in the back of my mouth.

the thing i'm confused on is he said we could do the braces for 6 months & then i could see how i felt about my teeth. does that mean they could possibly move enough that we might not have to pull teeth? i think i mentioned he said he couldn't tell me how many teeth he'd have to pull yet. i'm planning on asking him about it more next week when i get my lowers on.

i'd also like to know if i'm just adding more time onto my treatment, the longer i wait to decide. or if there's at all a possibility my teeth will move enough that it will affect how many or if he has to pull teeth.

if anyone knows ortho jargon, the ortho that i didn't go to that was going to do the filing gave me this diagnosis list:

Class I Left Molar, Class II Right Molar
25% Overbite
2 mm Overjet
Right Posterior Crossbite
Anterior Crossbite Maxillary Right Lateral
Moderate Maxillary Crowding
Mild-Moderate Mandibular Crowding

I have photos too, but I have to scan them in

SPShelly wrote:I just had SARPE (in a 3 piece le fort1 style) done a month ago today. My ortho would not take me on without my doing it.

FYI, a SARPE and 3-piece LeFort are two entirely different surgeries; a LeFort is not a "style" of SARPE. In a SARPE, the surgery consists of making an incision in the palate and then using an RPE to expand the arch, just like would be done in a child (but a child doesn't need the incision.) No osteotome, no screws, no plates, no splints.

A 3-piece Le Fort (as I'm sure you know) involves separating the upper arch from the skull, cutting it into three pieces, trimming, adding, and shifting as necessary, and then using screws and plates to re-attach the parts to the skull. Sometimes a SARPE is done early on and a LeFort later, but I don't think they are ever done at the same time. (youch!)

sirwired wrote:

SPShelly wrote:I just had SARPE (in a 3 piece le fort1 style) done a month ago today. My ortho would not take me on without my doing it.

FYI, a SARPE and 3-piece LeFort are two entirely different surgeries; a LeFort is not a "style" of SARPE. In a SARPE, the surgery consists of making an incision in the palate and then using an RPE to expand the arch, just like would be done in a child (but a child doesn't need the incision.) No osteotome, no screws, no plates, no splints.

A 3-piece Le Fort (as I'm sure you know) involves separating the upper arch from the skull, cutting it into three pieces, trimming, adding, and shifting as necessary, and then using screws and plates to re-attach the parts to the skull. Sometimes a SARPE is done early on and a LeFort later, but I don't think they are ever done at the same time. (youch!)

My surgeon kinda used both terms. All I know is he made made an incision from one side of my upper gum to the other, broke that and broke the palate down the middle and I've been expanding since the week after the surgery,

Ouch! I guess you did have a SARPE and 3-piece LeFort at the same time.

You learn something new every day; I apologize.

lochnessimposter
Although SARPE may look attractive, it is a drastic and invasive measure. Once done, it cannot be undone. This is a surgery. Surgeries tend to have side effects. I have read somewhere that SARPE has about 2% of those "unlucky" cases. Seems like not much but somebody has to be in that 2%... A very common side effect with SARPE is uneven expansion. This will influence your facial profile... Don't get me wrong, SARPE may be a lifesaver for somebody with a very narrow upper palate, breathing problems etc. But, at the same time, if you think of benefits vs side effects, what is the balance in your particular case? I of course have not been in your shoes, but I'd think, teeth removal is safer and less hassle if you ask me.
You have to also consider your facial shape. Do you have a long and narrow face and wish to make it look fuller? In that case SARPE may be beneficial for you. If however, your face is already round and full enough, maybe teeth removal is better.
There are so many things to think about... I would not be thrilled to have a surgery myself, but I don't know your case. But whatever you decide, good luck!

archwired, i have a round face with chubbier cheeks (not overweight, just naturally round) so i definitely don't want to make it any wider. yeah, def something to consider. i am leaning towards extractions, even though most othos push the sarpe.