Lefort 1 coming up

[ikn91]

Hi!
I´m a norwegian girl, age 26, and my surgery is supposed to be at 9th of may this year. It took 2 years from the reference from the dentist was sent to the day i first met the public surgeon. He said a "surgery first" lefort 1 is a good alternative. However he told me he did not think i would get the surgery (in Norway there´s not really a private (cosmetic) option, but if they think you need it you will get it all covered even as an adult). He saw my problem which is a skeletal class III bite, but with teeth that have compensated to a edge-to-edge bite.

After going to dental school myself, i startet thinking more about my bite ang how it affects my profile while smiling. First time I thought of it was back when I was 12 years old, and some boys in my class made fun of my underbite. I startet looking in the mirror on my profile, and saw what they saw. Since then I´ve heard a couple of comments, but not much. I´m just so tired of manipulation my smile when someone sits next to my profile. I´m also bothered by my lack of tooth display at rest. I think there is about minus 1-2 mm. This make me smile harder to show more of my teeth. Working with teeth all day makes me more aware of my issues.

Anyways, what my surgeon sad was that my teeth had compensated nice, and that i should leave it, but said he would discuss my case with others before a decision is made. A few months later he called and told me that my surgery would not be covered, but he could offer me a Lefort 1 privately as he has contacts that will loan him a surgical office. He told me he don´t know the price yet, but it will be maybe 8700 $. The plan is 2,5 mm forwards and downwards movement of the maxilla. He also told me that he think i don´t need braces afterward either, and that my bite after some months should stabilize. As a dentist my self i have taken plaster molds of my jaws, and tried to put the top jaw 2,5 mm foreward, but i can´t understand how it can be stabile. I think because of the lack of decompensation, they will not match no matter how i place them. I have a stabile bite now.

I will of cource talk with him about my conserns next time we meet, but at the same time i just love the thought of no braces. I just wanted to put it out there for you to give your thoughts. This surgery is literally a dream for me, even though my boyfriend and everyone I know don´t understand my concern, and I have never had problems with boys liking me. It´s just something that i really want to fix.

[ikn91]

Please give some opinions

[snapdresser]

That's really useful that you've created your own molds. The surgeon wants to do maxilla-only? I agree with your plan to bring up your concerns with your surgeon and see if you're satisfied with his response. If he has a good plan, he should be able to show you what the movement will be using your molds. Does he use VSP? If he does, he should be willing you send you the .pdf of the surgical plan there too, to give you some insight into how things will fit together afterwards.

Just from reading your comment about how things don't match up if you move the molds according to your surgeon's planned movements, I would be concerned. It sounds to me like if he's planning on doing maxilla-only, you may well need braces to make the teeth match up. Otherwise, if they match up at all, it seems likely that your midline or cant may be compromised. This may seem insignificant right now, but there are a number of people on this forum who regret having the surgery because it resulted in a crooked midline or canted maxilla.

[ikn91]

Thank you so much for your comment. Yes it´s only my top jaw. I have sent an email telling about my consern, so I will see what he says. Earlier when i told him that the palatinal cusp on one premolar seems to be in the way for a OK okklusion, he said that he will maybe file away a little bit of the enamel. After i removed a little bit of the cusp from the mold, I got somewhat of a bite. I´m so curious about what he have to say now, but he´s quite relaxed, so I guess he´ll say it´s no problem. I could always get braces afterwards if there´s a problem, but because of the lack of decompensation i´m afraid the anterior movement of the maxilla is´nt sufficient. Since I´m a dentist myself I can´t belive that he would do anything bad willingly as we´re in the same work environment.

I´s just so good writing my concerns somewhere, even though I will ask my surgeon all the questions. My boyfriend won´t talk to much about it as he does not really approve, but somewhat have come to to turns with it.

[snapdresser]

If you're seriously considering braces, maybe you should consider getting them sooner rather than later to make sure your results are the best they can be? That may be cost-prohibitive, however. Good luck and I'm glad you found a place you can write down your concerns

[ikn91]

Ok, so I have now spoken to the surgeon. First off all he tells me that my operation will cost under 6400$, which is such a relief. He also tells me that I`ll be wearing a splint for 5-6 weeks, and after that we will see if anything needs to be corrected with braces. If my teeth don´t fit properly after some time with natural teeth movement (I´m curious about this part!), I will have to get braces on my own, and pay for it. That´s OK by me.

I wish I could post pictures, but this rule about 7 post or something.........

My upper incisors protrude a bit because of dental compensation, and i hope that won´t look to obvious once the surgery is done. He´s going to rotate my maxilla down so that most of the 2,5 mm movement is anterior. I guess that will reduce some of the proclination.

So next meeting with my surgeon will be the day before my surgery, that is the 8th of may, to try in my splint. Im so excited!

[ikn91]

OMG...! My appointment is delayed :´( My surgeon just called and said that the boss at the office he´s renting cancelled the appointment as they thought the surgery was to late in the day (something about they not having room if my awakening is delayed. He said they wanted me and my surgeon there at 2 pm on Wednesday so they can say hi and take my health form. They will then give me a new date. This is so disappointing just 2 days before!!! My surgeon was also very sad and had obviously dreaded telling me this as he did not think this would happen.

I have prepared everything now, the apartment is totally cleaned, I´ve bought everything i´ve needed etc. So sad right now.

[ikn91]

New date is on the 20th of june...

[PierreDeFermat]

In my opinion if you're going to seek treatment you should go all the way and make sure your bite is perfect. That means you will most likely need pre-operative braces, Lefort 1 advancement (or bimaxillary surgery), and post-op braces.

I know it sucks to have braces for a year or two but it's better to do everything correctly and have the bite and face you've always desired; a compensated/camoflauged bite is not acceptable for patients that have gone through surgery to fix their occlusion.

"Surgery first" is somewhat rare and although it might work in your case I suggest you talk to another surgeon and see what they have to say. Also, don't forget to explain exactly which aesthetic changes you expect from the surgery.

[ikn91]

Thanks for your reply!

My surgeon said that my teeth are not that compensated, and that he thinks the results will be good in some time. However, he said that I could of course contact a orthodontist and have braces afterwards. My surgeon is experienced in "surgery first", and said I was a good candidate for that, but is not sure if i need braces at all.

About contacting another surgeon; in Norway there are no one offering orthognathic surgery for those that don´t have a severe functional problem (witch then give 100% financial coverage). The surgeon just want to help me, and eventually others that don´t get offered surgery. He´s planning on working privat part time. He talked about another girl in the same situation that he might operate on in the future. The public dental care have decided that they wont use that amount of money just because she only has complexes for her smile. He tolk me that she´s devastated and is always covering her mouth when smiling.

I will go for the surgery, and then take eventual occlusion problems later with a orthodontist.

[ikn91]

I have posted my before pictures in the june/ july 2018 surgery group, but will add them here to. My surgery is only 2 days away, and I´m heading to my surgeon on 1 hour to try my splint and get some questions answered.

[ikn91]

This is my my bite AFTER the surgery.

[DoubleJawOrthoCrowns]

Hello do you mind if I view your photos? I have an upcoming laforte 1 and trying to learn!

[ikn91]

Hi DJOC! I have uploaded a bunch of photos in the june/ july 2018 group