Treatment decision: open bite, surgery recommended

[mollycat]

Hi all,

I posted this same basic email on the surgery list, but wanted to share it here, too, to get opinions from people who considered surgery (or had it recommended) and then *didn't* have it.

Last week, I got the first recommendations on a treatment plan after a full study of my current bite (anterior open about 4-5 mm, mild overbite, molars line up well (the two on either side that touch), open bite caused by NTI). This was from an orthodontist. He gave two options: orthodontics only and orthodontics + surgery. The costs (for the orthodontics part) and time (total treatment plan) would be about the same, but he is recommending doing surgery because it would be the most stable in the long run. Also, he isn't sure that he could close my bite completely with just orthodontics (and if it isn't completely closed, the stability of everything else is decreased.) He ruled out TADs because I would need them on both the top and bottom and he has seen lots of problems with TADS on the bottom (on the inside one, the soft tissue tends to grow over the attachment point, as I understand it). I haven't meet the surgeon he recommends yet, so that would be the next step. (I've got a fairly restrictive health plan, so the choice of surgeon may be based on my health insurance, or I may need to change my health insurance next year. Fortunately, surgery won't be until 2015, so I can do that.)

A second group is working on their recommendations and I hope to hear something within a few weeks, but that group started from the position of leaning towards surgery, so I expect that to be the primary recommendation.

I am still struggling with justifying the risk, time, and discomfort of surgery for this. I don't like the way my teeth are, but it isn't a major hinderance and my appearance doesn't bother me. My biggest issues are concern of damaging the molars that do touch, because they are doing extra work, and my teeth getting even worse over time. (They are continuing to move to be more crooked.) Eating certain things is a pain (can't bite through a sandwich with leaf lettuce), but I have adapted to eat most things (although I do think I don't chew as thoroughly as I should sometimes). If I just went with orthodontics, I could have a better looking smile, but is that worth it, if it is a constant struggle to keep it that way? Even though the doctors are all saying this surgery isn't a big deal, I tend to think that any surgery is a big deal (although some are clearly worse than this). I'm having trouble with the idea of signing up for surgery (especially general anesthesia and weeks of a liquid diet) that isn't absolutely necessary.

A bit of background: I'm in my early 40's, do research and teach (so surgery would be scheduled around my teaching semesters), and have a very supportive husband who is more concerned about the risks and discomforts of surgery than how my teeth look.

I'm curious to hear about other experiences with making this decision or anything else that could help me sort this out.
Thanks!
Molly

P.S. I'll post bite pictures as soon as my newbie status changes and I'm allowed to.

[cs2thecox]

I'm early 30s but seem to have similar sort of bite issues.
I also considered surgery but didn't go for it.

For me, my open bite is slightly annoying (bacon sandwiches were tricky!) but largely cosmetic. I wasn't ready to spend thousands and put myself through major surgery just to be able to have a Hollywood smile and bite through bacon more easily. There are also risks associated with facial nerve damage, and that wasn't something I wanted to risk for cosmetic reasons.

I work in commercial banking, and frequently see clients. My job is also very full on, and it's hard to find a good time to go on holiday, let alone schedule elective surgery. I was worried about the recovery time, and how much time I might have had to take off work. (My clients aren't the most patient - I ended up on a flight to Oman within 6 hours of having my braces put on!)

In the end, I opted for lingual braces, purely for vanity, and no surgery.
I understand I might not get my bite all the way closed, but I would rather have that risk than the risks + downtime + cost associated with surgery.

In less than 3 months, my open bite has closed drastically, so I am happy with my decision.

Hope that was slightly helpful!

[JohnsonSon]

I know exactly how you feel wrt to the eating thing. I had a similarly sized open bite prior to getting braces. I worked around it but some foods I could just not bite into. I opted against the surgery with the hope of being able to close my bite with elastics.

I've had braces for 9 months now and my bite is 100% closed up with elastics on. Every single tooth touches and it is way easier to eat now. The thing that worries me a little is that I have no idea what is going to happen when the elastics come off. I suspect that will be soon, I just really hope that it stays closed and doesn't relapse too much. If it opens back up, I don't really know what will happen.

I think if I could do it again, I may have gone the surgery route to guarantee an optimal outcome. I just wimped out whereas now I'm not so worried about it.

[Mrs v]

Hi, I'm in exactly the same position as you. Still not sure what I'm going to do, even thinking ofperhaps leaving it. Surgery sounds very frightening although I will see what they suggest for me. I sometimes think orthodontics is constantly advancing and hopefully situations like ours will not need surgery.

Are you in any pain from it? How long have you had it. Mine has developed over the past year. How long did you wear guard for? Will be interested to hear what you plan to do.

[mollycat]

Thanks everyone for the feedback. I have been getting headaches, which may or may not be directly related. I've been told that getting my bite fixed may help that, but I shouldn't base my decision on that hope. Some of the people I've talked to are concerned about the long-term health of my teeth and TMJ. (All good so far, except tight muscles from clenching.) The current leading contender to be my orthodontist is stressing the cosmetic piece, because there is so much uncertainty about the rest. (Yes, I could have TMJ problems and broken teeth, but there's also a good chance I never would regardless of what I choose now.) And, yes, most sandwiches are a problem for me.

I wore an NTI for about 10 years. My bite started opening within a few years (I'm not sure at this point how long it took). I kept being able to touch with my back teeth, so my dentist kept adding to the NTI until I was wearing both top & bottom and both built up to be fairly large (1 cm or more). After a few years, we talked about orthodontics and possibly surgery, but it didn't seem like big of an issue. Somehow I had been convinced that wearing the NTI was protecting my teeth and that doing anything else was a risk. I didn't understand about tooth super-eruption then, but my molars must have already been doing that. I also didn't have headaches then. When I first stopped wearing the NTI, my bite was open almost 10 mm. It has since closed a bit on its own, but my teeth have also shifted. (My front top teeth are starting to overlap after being nicely symmetric for years due to braces as a teenager.) The continued tooth-shifting is one reason I feel like orthodontics is a good idea. And, if I'm going to do that, should I just go ahead and get it done "right" with surgery?? My concern with "just" braces is if my bite would open again after a few years.

Just figured out how to add a few pictures. Kind of embarrassing, but I guess none of us would be on this board if we were happy about our teeth...

thanks

[mmkay]

Note that there are also aesthetic considerations - a surgical impaction can cause your nose to widen, for example. It can also have a negative affect on your airway. And that's if they do a good job. A bad job and you can look like an old lady due to overimpaction - choice of surgeon is definitely important. I think that stating the surgery is no big deal is disingenuous.

My advice would be to find an orthodontist who is really experienced with closing open bites via TADs and grill them about the stability issue in your specific case. My orthodontist told me he believed it is as stable as surgery, it's not like TADs are new. Although of course he would say that :/

[jenrocks4]

I was in a similar position as you before I started treatment. I had about 3 mm open bite due to a poorly made night guard (by a dentist, nonetheless) and only my 2nd molars were contacting. I have had braces for almost 1 year and my bite is 100% closed due to elastics. I didn't have to get TADS. I had 4 consultants and everyone said surgery except for the last ortho I saw, which is the one I chose. Ironically, my orthro was not very optimistic that my bite would close completely, and he is trilled with the results (as am I!). I was against surgery because 1) it's expensive 2) my bite issues were caused by a dental device I wore, not a skeletal issue so, aside from an "easy" fix for the ortho and surgeon, I felt like surgery was unjustified. I would say try the braces and see how it goes...

I will be getting my braces off at the end of March, and I am so happy I did it!

[jenrocks4]

PS, my ortho has never been concerned about an open bite relapse because my open bite was caused by a night guard, so unless I get another poorly made night guard, there is no chance of my bite opening up again. A lot of times there is a risk with open bites opening again after treatment with braces because they are caused by behavioral issues that aren't changed (like tongue thrusting) or skeletal issues that are not fixed by surgery. That doesn't sound like your situation, so I'd said the outlook is promising.

[Anna5]

This thread (about succesfully closing open bites non surgically) may also be interesting for you:

http://www.archwired.com/phpbb2/viewtop ... 13&t=44572

[Nozzelnut]

Surgery was mentioned in my treatment as well. I have to get back to zero (from TMJ issues) before we decide which way to go.

[JohnsonSon]

Circling back on my post, I had my rubber bands (box configuration) off last week. I wore them for 6 months in all. My ortho wants to test the stability of my bite. In the ~6 or so days, my bite has moved a little, but it's not opening up. It's staying closed. They did however remove my powerchains and did some sort of MacGyver situation on top with 3 different wires which is slightly annoying because gaps are forming again and it hurts, but oh well.

I think this is a pretty positive sign though. I wouldn't be surprised if I went back to the box elastics at some point, but it would be a much simpler issue this time around.

[mollycat]

JohnsonSon,

Do you know how long your ortho is going to test the stability of your bite? My concern is more over the course of years than days.

thanks

[ajs604]

Hi, have a look at my thread. I am currently undergoing treatment to close my open bite without surgery as I felt the risks of surgery were too great.

If you are after perfection then surgery may be an option. Try an and get 3-4 opinions before you make your mind up.

At first my orthdontist was not confident they could close my open bite but after 8 months of treatment they seemed convinced it will close. I went from a 6-7mm open bite doen to 1.5-2mm in 9 months. I can also eat way better now than ever before. I still have another 15- 21 months of treatment to go.