Metal Mouth Message Board

Context: I live in a small town in California. Every dental expert knows everyone else, and nobody’s willing to rock the boat. I have had two professionals refuse to take my case citing said “boat rocking” and “high risk” - and the nearest city is a four hour round-trip drive. I may be able to move to another state, but it would be very costly - but if it gets me out of this… it may be worth it.

Had severe Class III, did SARPE and year later Le Fort (now 2.5 years ago). At first, all was well. Then I started to lose millimeters. Ortho wanted to do revision surgery, extremely well known west coast university hospital refused. Vitriol ensued, and the two aren’t speaking (each claims the other committed malpractice).

Ortho is paid in full, so unless we have a complete falling out, I have to press on with him.

Ortho tried to compensate tilting my front teeth out. Severe pain resulted, but he insisted I should keep trying. Turns out he was wrong, and I lost “10-20%” root resorption.

At my insistence, and a second opinion local oral surgeon, upper braces were removed to allow teeth to adjust and heal. Six months later, pain persists, and the teeth keep swinging inwards. They are now crashing into the lower teeth (Class I), so I’m not sure they can move inward any more.

Here’s the part pushing me to seek third-and-fourth opinions… the oral surgeons are refusing to pull my upper front teeth with root resorption. They seem to think they’ll keep tilting inwards and stop hurting.

If those teeth (upper front six center - canine to canine) went, and implants held, this would be a simple fix. Bow out the implants, which don’t have nerves to complain, and fillings on the molars to occlude.

Instead… My ortho wants to put several TADs in and pull my lower back teeth back, and tilt my lower teeth inward. My concern is, the upper teeth are permanently damaged, and this is a waste of time.

My overall health has gone from good to very poor during all this. I have to have a caregiver to move me around, and my primary doc is fuming mad at all of them. If I could do it all over again, I wouldn’t have done orthographic and instead just had one set of teeth replaced with implants. But infuriatingly - my two oral surgeons (first and second opinion) refuse now to do that - claiming they trust this ortho - who damaged my teeth insisting he wasn’t.

Any advice on this? Should I push more to have my upper front six (canine to canine) pulled with another oral surgeon / OMFS? Or try the TADs and see what happens?

You know your situation better than anyone here. That said, I have some additional questions: what was wrong with the LeFort movements, and why won’t they redo it to correct said movement problem? There may be plenty of blame to go around here. I’m not an expert on dental implants but I’ve heard they lead to receding gums over time, and while it may seem like they’d be a good solution, they might not be a good fit for you, especially if you’re young.

Everyone except my (already paid in full) ortho agrees I shouldn’t have a revision Le Fort. Even my second opinion ortho advised against a revision Le Fort.

The main reason my primary ortho wanted the Le Fort I redone, was that we didn’t get the target expansion. We aimed for 8-10 mm advancement. In the end, we only got 5 mm.

This has resulted in my inner track of all my teeth not occluding. All the teeth are landing on a knife’s edge.

The surgeons refuse to redo for a few reasons:

* They feel a single jaw revision is high risk, and is unlikely to gain more growth
* I am in poor health today and doing any surgery may cause more harm than good

Doing double jaw surgery has been described by both first and second opinion surgeons as “barbaric to gain 3 mm” and agree extraction and implants would be preferable in that scenario. Additionally I have damage to my TMJs from years of the malocclusion, which is still worsening (but slower now that I have 50% occlusion).

The implant risk I think is why they are digging on on wanting me to try.

My suspicion is most of these experts feel it’s a long shot, but want me to waste 6 more months in pain on the off chance it works.

I’m not sure what to tell you. Frankly, I don’t think you’ll be happy with the results either way. Maybe try to see a surgeon who specializes in VSP? Virtual Surgical Planning allows for precise movements that aren’t possible otherwise.

Thanks, my OMFS did use VSP. As I mentioned, it's a world class hospital most in the OMFS profession would instantly recognize.

The second opinions have concurred the surgeon at most (and I stress at most) was off by 1.5 mm. My jaw almost certainly suffered relapse and bone loss post-op. This is supported by post-op CTs that show significant bone loss in the maxilla, and excessive scarring. That wasn't the surgery, that was just my bad luck.

But it's also supporting why all the OMFS's say I shouldn't do a revision op at all. That may be their liability insurance talking, but I've seen them point at enough things to tell me no.

I'm mostly posting here because my case skips across the atmosphere of all the topics. Right now it's mostly a choice between extracting teeth or attempting painful ortho, and taking the risk of more root resorption - and if it fails, extracting teeth.

I get my final opinion on Friday, and if they all concur I should try the extreme ortho, I'm probably moving ahead with that.

But this time I'll have two orthos reviewing each adjustment, concurring on pain tolerance, and scanning more to detect root resorption. if any of that goes out of bounds, I'm pulling the ripcord and going with implants.

Well, that was interesting...

Second opinion ortho came back, and called the rest of my team.

His view: No more ortho, no more surgery. Take all the braces off and let the upper-fronts settle, then do whatever is needed to extend the molars.

Second opinion ortho thinks fillings are still possible... unless rejection relapse gets to the point I'm at a 0-degree slant with the upper fronts.

If that happens, I'll have to choose between crowning all my back teeth, or taking out the upper-fronts and doing implants.

But he was totally offboard with tilting the lower fronts inward and TADs on the molars. He feels my lower fronts are way too small for that, and tilting them that inward will trigger root resorption - especially since my oversized upper fronts did exactly that bent outward.

Now I have to go back to my "project manager" dentist, and my first opinion orthodontist - they both want to go hands on with my face again based on this ortho's view.

Hi,

My little sister case is very similar to yours… she was a Class II with a gummy smile, and was left a severe Class III with tmj, mastication problems, and her mouth unable to close comfortably or fully.

The surgeons and orthodontist here also all know each other and are disregarding our concerns, and none will help… this is a nightmare.

We thought of seeking doctors in another state but unsure of who would understand her case, or who we can trust.

Be very careful because some of this doctors will do as they please if you don’t stand up for yourself and say NO, it happened in my sisters case. They’ll just experiment on you and treat you like Frankenstein.

I pray that you find the right help and a solution.

Stay positive and strong

As a dentist who has extensive post-graduate training in cosmetic and restorative dentistry, I would NOT allow an oral surgeon to "pull" your upper anterior teeth. Yes, your teeth are tilting inward, but this is not abnormal. Instead, what you need to do is replace your missing teeth in the upper front with a dental implant. The issues that you are facing are the result of a failed root canal. This can be easily treated by removing all of the root canal materials and filling the root canals with gutta-percha. To replace the missing teeth in the front, you can replace three teeth at the same time with one dental implant. This will prevent the inward tipping of your front teeth. I recommend that you see a dentist who has extensive training in both dental implant surgery and root canal( https://www.emergency-dental-365.com/procedures/emergency-root-canal/
). You would be amazed at the high quality of your smile that you will have after this treatment.