Double Jaw Surgery-- Not Sure if I want to Do It.

[Anna5]

Dear Lyra,

Yes, surgery sounds very scary and if you could avoid it, I would! (especially because I don't think your teeth look bad, and I find your face very pretty). I am sure it must be possible to make some improvements with only braces, including decreasing your open bite (which is very minor I think) and overjet, at least too some extent. At least I hope braces can at least improve my open bite a bit....
That is very good that you talk to your ortho tommorrow. I wish you a very good talk and lots of wisdom! Keep us updated!

Greetings from Anna

[LyraM45]

Thanks, Anna! You're super sweet and just made my day

I saw the ortho again, and he sent me next door to the periodontist to check on my #19 that needs the implant (and I think he wanted a look over from him to hear if my gums are OK). Perio thinks I have enough bone to wait the 2 years through ortho first, and then come back for the implant (yay!). AND... this is the best part.... he said my gums are in pretty good shape! No signs of gum disease or inflammation, and all healthy bone. This is great news for me since I have still been coming up with pocket numbers around 4 and even an isolated 5 on my back teeth at my 4 month check ups/cleanings, which is what I had yesterday, but he said I just have a ton of gum around those teeth and the pockets aren't from infection or gum disease. I can get some of the gum removed down the road if I want, but for now, it was great hearing that I'm in good shape there!

I have an appointment with a surgeon (not the surgeon who will be doing my work next year, but one who is in my network right now and can at least consult me and answer questions) on April 17th. I asked the ortho particularly what procedure he thought I would need done, and he said probably a Lefort I, and maybe the lower jaw brought forward, but he thinks it might rotate around enough with just the Lefort. We'll have to see what the surgeon says. I am keeping an open mind, and will have to make my decision after the consult. Non surgical and I'll be doing invisalign at the end of April, and surgical will put me in full on braces-- yikes!!

There happened to be a patient of his, scheduled just before my appointment, who just had surgery a few months ago on both jaws to fix her underbite. She sat and chatted with me a few minutes, and she looked great. Said it felt great to have an aligned bite and function better. Hearing that makes me want to get the surgery-- I would LOVE to be able to bite through a sandwich and get through everything like the lettuce and all!

[LyraM45]

This is kind of off topic, and one of the questions I have for the surgeon when I go see him, but maybe somebody can help me here-- does anybody know how the hardware in your face handles in certain situations, IE: pressure changes while scuba diving, or being at altitude flying a private plane? I'm very active outdoors with flying, skydiving, scuba, snowboarding, backpacking, etc, etc. Just wondering how the plates/screws would handle with certain activities. I think I'm most worried about scuba. I can always feel pressure changes in my face and I would have to assume that could be an issue with this surgery.

[Anna5]

Hello Lyra,

Good that you talked to your ortho again! And great to hear that your gums are in good shape!
That is exciting that you are having a talk with the surgeon on the 17 of April. I so much hope you will make the best decision, whether it will be surgery or just Invisalin. My ortho told me that Invisalin is only suitable for the simple orthontic cases, so your teeth are probably not too bad....
You wrote that you can't bite through a sandwich or lettuce yet. I honestly don't see your open bite on your (nice) pictures, so again, if I were you I wouldn't do surgery if it were just cosmetic, but I can understand that you want your functional issues solved and in that case surgery might be best. I wish you lots of wisdom with your decision!

Greetings from Anna

[LyraM45]

Since my teeth don't meet in the front, I have never been able to bite all the way through thin things like lettuce. I can do it if I kind of take a bite on the side of my mouth and not really straight from the front, but it sucks to have to do that. The other functional issue is uneven wear on my teeth-- the few teeth that take more of the brunt are classified as moderate-severe wear and will end up needing restoration down the road soon if I don't do anything about fixing the bite. I also have trouble closing my lips comfortably, so I'm a mouth breather, which is bad for my already troubled gums.

I have been told by other dentists and ortho's over the last 2 years that I am not a candidate for invisalign. The only reason this ortho is comfortable doing it, even though I'm not the easiest case, is because he is the guy who invented invisalign. What luck I have finding the doc responsible for that little gem! So, he feels he could make it work since he knows it better than anybody else.

I still have a lot of thinking to do, and a lot more research to get done about this. April 17th will come up sooner than I think!

[Anna5]

So you definitely have some functional issues as well, and I can understand that you would be very happy to get them solved, and surgery might be the best way then....
Me the same, I can only bite through small food with one side of my mouth, personally I don't mind that much because I am used to it, but sometimes it is indeed annoying. And I am a mouth breather too. But my reasons to get my teeth fixed are mainly cosmetic.
WOW, that is great that you might be treated by the inventor of Invasalign!! He will surely do a great job if you chose for this!

[bmueller]

All,
I've put my jaw surgery blog up. Keep in mind this is just MY experience, but maybe it will give you something to think about surgery/not surgery.

Wishing you the best!

[LyraM45]

Thanks a bunch! I am going crazy reading everybody's experiences and taking in as much info as I can. I hate to sound all dramatic, but this feels like one of the biggest decisions of my life and every little bit of info from everybody helps!

[LyraM45]

Bmueller, I noticed you and I have a similar case! My ortho mentioned to me on the last visit that there as a possibility that I would only need the Lefort 1 to bring the jaw up (take care of the gummy smile), and then rotate it in a way that will take care of the overjet too. This confused me since I thought with an overjet that the lower jaw would need to be brought forward for sure, but he said exactly what you mention in your blog-- he's hoping the surgeon will think that my lower jaw will just be able to auto rotate up and take care of all of it and I would not need the lower jaw sugery. Now having the lower jaw surgey would be a huge relief for me, as I am VERY concerned with the lingering tingling/numbness that results from many of the lower jaw advancements. I know it can happen up top too, but seems like I always hear more complaints of lip/chin numbness.

My ortho also mentioned expanding my upper pallet in this surgery. Did you need anything like that done?

Thanks again for your blog. Very to the point and well put together. I especially love your summary!

[Anna5]

Hello Lyra, How great to read that you probably don't need the lower jaw surgery! I am sure that would make it easier to choose for surgery. It is indeed a huge decision that you have to take-whether to go for surgery or the non-surgical route. But I think there is no good or wrong, just decide what your heart tells you, and I think that may be surgery?

[LyraM45]

ha-- the jury is still out! So far it's an emotional roller coaster. Today is one of the days, especially after reading Becky's blog, that I am like "wow-- yea, lets go for this!" And then other days I am just so down in the dumps about it and can't believe I am even thinking about this. If I'm already going this crazy over this, what will it be like just before/during/after surgery?! Doh!

[bmueller]

Not sure if I mentioned this before, but I waffled over the decision for about a year. Best of luck deciding. I'm here if you have any questions.

[LyraM45]

FINALLY had my consult with the jaw surgeon. The month waiting felt like a million years! At least it let me get down to business and read a ton of blogs and really get my head on straight to walk in to the appointment prepared and ready to ask questions. At least that's how I thought it was going to go, but then I got bamboozled about 5 minutes into the consult......

Surgeon doesn't even look at my molds. Glances at my Ceph and xray and basically tells me everything everybody else has already told me: severely underdeveloped lower jaw, upper jaw, crowding, class II, overjet. Then he tells me exactly what my orthodontist said would probably need to be done: Lefort 1 to expand my arch, impact up about 4-5mm to take care of the gummy smile, and set everything in it's place. He mentioned my jaw would probably be broken in 5 pieces.....OUCH! But, there is good news with all of this-- despite my 8mm overjet, both the ortho and the surgeon agree that I can probably get away with doing only my top jaw, and my bottom jaw will learn to autorotate up and meet where they set my top jaw. For me that was awesome to hear since I have been thinking I needed both jaws done for a long time.

But here comes the bamboozle.... he then asks me if I've ever heard of wilckodontics. He explains the whole procedure and sequence of events to me and seems to think I could do that instead of jaw surgery. I still can't fathom how they can impact, or take up my teeth 4-5mm to get rid of the gummy smile, but he said they can do it with anchoring devices implanted up in my upper jaw/cheeks. So, I totally was not expecting to hear about anything different than the jaw surgery. He and my ortho talked about it the next day, and it seems like they're both on board for this. Only thing now is finding out if there is any insurance coverage for this. From the little research I've done, I might be out another $6-8,000 on top of the $8200 I'm already out just with the ortho. The jaw surgery will only be $500 with another insurance company I was switching to at the end of this year during open season. Is it worth having the more invasive procedure done, not to mention one with a lot more risk of permanent tingling or numbness, just because it will save me the money? Ugh.... I thought all of my decision making was going to be done once I settled on the surgery option!

Anybody else get presented with the wilckodontics option? What was your experience like?

Sorry for the long update!

[Anna5]

Hello Lyra,

Thanks for your update! It was very interesting to read.
I have never heard of wilckodontics, but is sounds good! Does the surgeon think the results of
wilckodontics will be as good as the results of jaw surgery?
I can understand that you are not looking forward to letting your jaw cut into 5 pieces, so if there is a non surgical way to fix your problems that would be really great!
I hope there are others with experience with this non surgical route, so that you can hopefully make the right decision. I wish you very good luck!

Greetings from Anna

[katsface]

It sounds like you're describing TADs, not Wilckodontics. Wilckodontics is a procedure to detach your gums from your bone, pull them back, and score your jaw to make the bone malleable. The process makes the work of braces go faster since the bone goes into a malliable healing stage after the surgery damages it. I looked into it before I learned I needed jaw surgery for other reasons. It's still surgery on your jaw.

TADs are Temporary Anchor Devices (little screws) that provide an anchor point that lets braces intrude your upper teeth into the bone. Wilckodontics is not necessary to use TADs (but I suppose it might make them work faster). TADs won't expand your upper jaw at all (as far as I know) but some people seem to have good results with them to reduce gummy smiles (3-4mm sounds like it's within the range I read about) but more refined and drastic results are probably only possible with a LeFort.

I'm not an expert so please take my advice with a grain of salt. But I'm not sure that the suggestion to skip lower surgery makes sense to me if your jaw is truly underdeveloped. The rotation of my jaw to compensate for its underdevelopment has caused the bone to ware down in the joint. I wouldn't want to intentionally create a situation where your lower jaw has to rotate to compensate for being in a less than ideal position. I certainly don't know as much about your case or anatomy as your surgeon (duh!) but if I were you I might ask some further questions about stability and jaw health if you are leaning toward skipping the lower surgery.