Pallet Expander vs Jaw Surgery

Message

#1 Post by **Graceful58** » Wed Mar 07, 2007 6:59 pm

I was told over 25 years ago I would need jaw surgery to get a correct bite. After having my braces removed back then I never followed through on jaw surgery. I was very young, naive and was working jobs that didn't have insurance coverage and I was quite pleased with the results then.

I'm now 46 and my teeth have shifted and the ortho is suggesting being as I would rather try to avoid jaw surgery he thinks we can achieve a look I'd be quite happy with using a pallet expander on top and bottom. I've heard controversy about using pallet expanders (tipping out of teeth, which I don't want) and I'm just wondering if that is the best sollution.

Another question to you is what constitutes Insurance Coverage for getting jaw surgery...from what I've read many people have sleep APENA, is it usually have to be something pretty serious for insurance to cover it. We have Delta Dental and I haven't looked to see what they'd cover etc.

Forgive me if this question has already been answered in here.

#2 Post by **Brandyleigh35** » Wed Mar 07, 2007 8:22 pm

Hey Graceful 58,
Well hopefully I can answer a few questions for you. First, the palate expansion stuff. While the reviews on this are sorta split, it is believed that palate expansion on people our age has to be done surgically. Otherwise you will most likely deal with tipping issues. Also, it is considered to be not as stable. I had a SARPE (surgically assisted rapid palate expansion) last year to widen my arch. I'm currently thrilled with the results, however, I will be going in in May for Upper, Lower, and genio (chin augmentation) to finish things up.

I did not have braces as a child, but it was recommended then that I have palate expansion, and lower jaw advancement. My parents could not afford it so I'm doing it now. So...sorta similar story to yours, in that I never followed through on the surgery part, and honestly didn't want it then. I was young, vain, and the last thing I wanted was to have to walk around with my mouth wired shut for 8 weeks.

Anyway.....as for insurance. Since my jaw is recessed it has created sleep apnea over the years. So, my surgeries are medically necessary. Jaw surgery is not covered by dental insurance but is considered a medical procedure since it is done in the hospital. We have Delta Dental also (secondary insurance) and I can tell you that in my opinion they pretty much suck. For anything you have done in your mouth you are requred to see only Delta Dental approved providers (most of them are also pretty lousy ) I have not submitted anything to them yet, as my stuff has pretty much been covered by my primary insurance thus far. The only part of my procedures that has been submitted to dental is like the xrays. My SARPE was covered under medical, and my surgery will be covered 100% minus a $1,000 dollar annual out of pocket contribution.
To the best of my knowledge Delta Dental would most likey not cover any type of surgical procedures, and for medical to cover them then they would need to be considered medically necessary, or the cause of some known issue such as TMJ etc.

I don't think any of us wants surgery but at our age, I would be very skeptical of any doctor who says he thinks he could give you good results with non surgical palate expansion. I would definitely get another opinion. Hope this helps!

Brandy

#3 Post by **Graceful58** » Thu Mar 08, 2007 7:42 am

Hi Brandy,

Thank you for the great info, it certainly gives me a lot to think about. I originally just went in because my teeth on the top have shifted and that's when he told me my bottom teeth are caving inward as well. I'm not as much concerned with the overbite, I have a lot of questions for him though concerning the pallet expansion. I worked for an orthodontist years ago, after I had my braces on as an adult and I remember him distinctly saying that pallet expanders don't work well in adults that is why I was a bit surprised when my son's ortho told me that it would be a possibility for me since I really wasn't interested in jaw surgery. He said he could fix my bite to make it 50% better than it is now without surgery.

I can live with the overbite I just want my top teeth brought back to where they were when I got out of braces last time. I am not interested in spending a large amount of money to go through jaw surgery although the ortho did mention that even though I don't have problematic issues with my jaw right now it's not to say that I won't in the future. As a teenager I remember my jaw would lock when I would try to open it and when he mentioned the clicking when he put his fingers in my ears I was thinking that it's all part of my misaligned jaw, not sure that would be enough for insurance to cover it.

Anywhoo, thank you so much for the info, this board is a great wealth of information.

#4 Post by **science teacher** » Thu Mar 08, 2007 8:49 am

having just gone through this myself I'll answer what I know.
I was having TMJ issues. the popping of my jaw that your ortho mentioned and an earache.

When it got bad enough that it was driving my husband nuts. I went to an ortho. My jaw would pop so bad when eating meat you could hear it across our kitchen.

My ortho told me that he wouldn't treat me at all unless I had surgery. This jived with everything my dentist and chiropracter and research said. So I said ok.

I also have Delta Dental they flat out denied it. My medical insurance BCBS didn't even blink they just covered it. I think it is more about how the oral surgeon words the predetermination than how "medically necessary" it is.

I have not had problems with my surgery. In fact, I had it done the day before thanks giving and went to work on Monday after.

Kim

#5 Post by **Graceful58** » Thu Mar 08, 2007 12:59 pm

Science Teacher,

Thank you, that is really helpful. I have a consultation in another few weeks, I'm going to bring it up and see what the orthodonits thinks is a better way of going and if he thinks insurance would cover it or not. THanks again...I'm still not quite sure if I want to go through it...I'm thinking although I don't have problems now...who knows about tomorrow.

#6 Post by **loulou123** » Sun Mar 11, 2007 7:00 am

Hi there

I dont no if im just really unlucky or if my ortho was having a bad day but ive gotta have a pallette expander before my double jaw surgery

So maybe its not a question of one or the other, im guessing that sometimes both may be necessary.

Everyones different tho so id suggest the best thing to do would be to talk to the orthodontist and see what he says.

Good luck

#7 Post by **teresa5855** » Sun Mar 11, 2007 3:29 pm

yeah, I had the palette expansion surgery (sarpe) first, in Sept. 2005 and I just had double jaw surgery last month on the 16th. They were apparently both necessary to achieve the final result. I had the same surgeon for both surgeries...it was all apart of the plan when I had my initial consult with my orthodontist. Anyway, I think it's after the age of 18 or 20 where we need surgery to move our jaws, width of our bites, etc. Kids just need to wear appliances to move things. And yeah, if an adult were to try to move their teeth, as in a palette expansion, without surgery first to split the bone, their teeth would definately tilt and there would probably be a lot of pain, I'd imagine!

#8 Post by **Graceful58** » Mon Mar 12, 2007 6:58 am

It's funny the different stories you hear about adults in pallet expanders. There's people on this board who as adults have used a pallet expander and it's been very succesful and then others who's teeth didn't budge. So, it all is very individual as I'm finding out. I'm going to pray that I'm the exception and not the rule and my pallet will expand.