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I'm 39 and have a Class II Division, increased overbite, increased overjet of 12mm. I've been wearing my metal braces now for 9 months. My ortho said my problem wasn't my teeth it was the size and position of my jaw and said the braces would be used to align and coordinate the arches after which a mandibular advancement osteotomy would be required (lower jaw surgery). My upper teeth rest on my lower lip and I just hate it.
I got a second opinion this week as I'm not so keen on surgery now and he gave me elastics too wear. He said too try them for several months and come back too him and he'd use an alf for the upper arches and a twin block to help bring the lower jaw forward. My current ortho never recommended elastics to me, his treatment plan was braces then lower jaw surgery.
It's a tough decision for me too make and I'm undecided which road to go down or if I should change treatment. My current ortho's plan is for lower jaw surgery next year and it's really worrying me now, or the other option is to try these elastics and the alf and twinblock. I'm just thinking if I stopped wearing the elastics would my jaw not go back to the way it was?
Has anyone had any success with elastics or a twinblock? Does a twinblock really help in bringing the lower jaw forward or is Surgery the only answer? I'm just confused as it's such a tough decision to make and really would appreciate any help or advice!
That's a substantial overjet you have there and there are going to be limits to a non-surgical approach. I'd do a lot of research into how successful adult treatment for such a substantial overjet is before switching treatment methods. Switching methods at this stage will be expensive, and if the treatment doesn't work ("work" defined as a long-term stable result; you may not know for a while), you are going to be back at square one. I'd also find out from this new ortho if he ever treats patients with surgery. ("Yes" is the correct answer. You don't want an ortho that refuses to use all the tools in the toolbox.) If he does refer patients to surgery, find out from him/her where the "decision line" is and how close you are to it.
Lastly, keep in mind that the new ortho (while almost certainly not suggesting a treatment he/she is sure is not going to work) has a financial interest in getting you to switch to the non-surgical plan since you aren't going to switch orthodontists unless there is a plan change. Money can be a powerful (if unconscious) motivator for pretty much every medical professional; this is borne out in countless studies. (i.e. Doctor's offices with an ownership interest in an MRI facility are far more likely to order MRI's than those that merely refer patients to a 3rd-party facility.)
Why is the surgery worrying you now? While not fun by any means, a BSSO is a well-studied and understood method of treating mandibular insufficiency.
Thanks sirwired for your help. I've been doing research and a non-surgical approach seems to work for some adults and not for others so it's a difficult one.
The new man who said too try the elastics first said he treats adults successfully who doesn't want to go down the surgery road. However, he said he has too tell everyone he can't guarantee anything so suppose he's keeping himself right.
I'm currently getting my braces on the NHS and am very lucky that I don't have to pay for it or surgery, however, if I change ortho's I think an Alf and Twinblock appliance will cost around £3,500. Then I think if I go down the non surgery road and it doesn't work for me I'll never have the chance of free surgery again - gee I'm going around in circles!
I got a wisdom tooth extracted several months ago (lower left for surgery purposes) and I had an awful time with it. My lower lip/chin had no sensation for ages but thankfully it came back.
I think that's the main reason why I'm so worried about the surgery as apparently that's a risk involved ie permanent numbness in that area and suppose I've had a taster of it and it wasn't nice. Also, I'm a little worried that Surgery will leave me chiny looking (if that makes sense)??
The discrepancy between your upper and lower jaw is enormous and surgery is the only way to correct it. You will be wasting your time and money with elastics and appliances; they will make zero difference in your case. Those orthodontists you have consulted are nothing more than greedy quacks. You are an adult, 39?, how far do you think elastics can bring your upper teeth? Where would those teeth go ? You are lucky to have a chance to have surgery. Surgery can be risky but with a competent and skilled oral surgeon it can be safe and would correct your problem. I think extractions would not be good, your problem is your upper jaw is normal, it is your lower jaw that is very small. Good luck!
Yeah Xela123 I'm lucky I didn't have any extractions, (apart from lower left wisdom tooth), my ortho said it would dish in my profile if I got extractions.
I still don't know which road to go down I'm also worried that Surgery will leave me chiny looking and I seem to keep going around in circles.
Yes my upper jaw is fine it's just my lower jaw is shorter and I'm not sure how a twinblock could bring it forward as some ortho's claim?
Hi! I managed to get my 12mm overjet to normal without surgery, extractions (except wisdom teeth - but they were coming out anyway) or appliances - only braces and elastics. I think in my case I was lucky in that some of my overjet was dental rather than skeletal but I went in knowing that by refusing surgery I may have only got my overjet down to 7mm or so...I was just very lucky, even my ortho didn't expect such a good fix, although I was only just 24 when I got my braces on so I think the younger you are the better chance you have(???) So depending on your case it is possible and I know there are several people here who have done well with the alf. Good luck whichever path you choose!
Wow that's an amazing outcome for you starfish88, I'm sure you're well chuffed so that's great news! Did you have to use the alf or twin block? Apparently it's the twin block that's meant to work for me ie. bringing my lower jaw forward and I'd love to hear if it has helped anyone who's in a similiar situation like me?
I really don't know all that much about skeletal vs. dental overbites, but wouldn't a conservative approach be the first choice? If elastics or the twinblock don't work, at least you will be sure about the surgery. My overbite has been reduced about 30% with double elastics in the last two months. Yep- double elastics. Ortho very surprised at how fast the progress is going. My jawline is much improved, in fact when I look in the mirror I am surprised to see a different face looking back at me.
No, I didnt use an alf or a twin block. I turned down surgery and my ortho said we could wait and see about extractions. Progress was so good I didn't need them either! Yay
Great news Winkos, that's great you got that reduction in 2 months! At present I'm getting my braces and surgery free on the NHS and if I go down the other road of alf and twinblock it's private so I'll be paying for it. I'm sure if I go down this private road I'll be off the NHS list and wouldn't get free surgery after if I left the NHS now.
You've been very lucky as well starfish88 - I've such a decision to make soon. I've told my concerns to my current ortho on the NHS and he says I need to make my mind up soon if I'm going ahead with their treatment plan, he tells me an alf, twinblock won't help and the private ortho says yes it will help - oh decisions, decisions!
Hi, just thought I'd give a little update. I actually have been wearing the elastics like the other ortho told me (other opinion from the functional ortho I got) and it's helping reduce my overjet which I didnt think it would
My current ortho doesn't know I'm wearing elastics and he probably will notice the difference at my next adjustment!
However, if I stop using the elastics will my overjet not go back to the way it was?
I am happy that the elastics are working! Are you still hoping you can avoid surgery this way? (I hope this with you!).
I don't know about retention, but maybe a good retainer can prevent relapse? Definitely talk to your ortho about this.
Good luck!
I am very happy that the elastics are helping a lot, Harmony! I so much hope that you won't need to get through surgery.
It might not become so perfect as if it would be with surgery, but if you can get a great improvement this way that would be really great!
Definitely talk with your ortho about retention. I think that is were retainers are made for, to prevent relapse! So maybe you don't need to worry about this?
Good luck and keep us updated!
Thanks Anna, yeah it would be great if the improvement would continue with the elastics and I wouldn't have to go for surgery my own ortho doesn't know yet I'm using elastics so he probably won't be pleased! It was the second opinion I got from a different ortho who said why aren't you wearing elastics to see if they help as he felt they would.
It's so frustrating as I've received so much conflicting information ie one said an alf and twinblock would help, others said no a twinblock won't work as it's only for growing children. Then the last ortho said try elastics and I feel they are helping, just the relapse is my only concern! Oh the joys...
I'm also worried that Surgery will leave me chiny looking and I seem to keep going around in circles. 
my own ortho doesn't know yet I'm using elastics so he probably won't be pleased! It was the second opinion I got from a different ortho who said why aren't you wearing elastics to see if they help as he felt they would.