Braces

Toothsmith

Where did your proceedure take place?

I'm unfamiliar with the size of a dime, but car25 reported in post #313 that he'd lost all feeling in his lower lip.

So far in my career I have come across 3 patients who have had osteotomies. Not one of them would have gone through the proceedure again knowing now what it's like, and none of them felt the 'improvement' was worth it. Especially after a few years when the body's genetics start taking over again, and things begin to alter back.

If we include car25 and yourself, my personal statistics run at 5 proceedures, 4 against, 1 in favour.

All 4 of those against are more years post-op than you are so far.

I hope you continue to be pleased with your results, but I will still counsel patients against the operation in all but the most extreme cases.

Incidentally, what was the problem that necessitated it, and do you feel it has improved your health, or just your appearance?

OrthognathicSurvivor

I feel badly for car25 - definitely that falls far to the bad end of the spectrum in terms of numbness - such extensive permanent numbness is uncommon. But yes, that's why I agree with you entirely that this shouldn't be approached lightly - we, as patients, need to understand that there are risks, and maybe we get lucky and maybe we get unlucky.

A dime is about 18 mm in diamater. So I am sure you can envision how a little numb patch like that on the chin could eb something many people would be able to dismiss as not bothering them.

For myself, my decision was not at all motivated by cosmetic considerations, since I have a good chin button that disguised the retrognathia extremely well. In point of fact, one consideration that gave me pause was whether my chin might end up looking too large as a result of the advancement. (In the event, I've been happy with the resulting aesthetic.) My orthodontist basically told me that my options were to be treated to a best-possible compromise using orthodontia alone, or to undergo surgery to get as close to a perfect bite as my poor old worn teeth could allow. My initial decision, and one that my OS supported entirely was to go for the compromise, but the more I learned, the more I wanted to get the best bite possible, so I started to do my research, and tried to understand what I would be getting myself into; I did a lot of reading online, as I mentioned, but for me the bigger deal was being able to talk to people who'd gone through the same sort of procedures, and moreover who had done so with the OS I would be using. At one level I bitterly regret not doing this many years earlier, then my teeth might not have been so badly worn - without the benefit of a canine protected occlusion, the havoc that has been wreaked by bruxism over the years has been extensive. (At another level I am glad I did it when I did, since I do not know how well it all would have worked out had I been treated by a different OD and OMS.) One unexpected benefit for me is that my jaw joints no longer exhibit a tendency they did have pre-treatment to try to lock open from time to time, nor do they click and pop as much as they did (which admittedly wasn't much at all.) Nobody would promise me better TMJ function going into this, but that's how it worked out in my case. I do gather though that for a few patients worse TMJ function can sometimes result - again, if I've corrrectly understood what I have read, the likelihood of this is very much tied into specific details of the surgery, or rather to the precise anatomy that will result. (Angles created and so forth, going well beyond my level of understanding) I'd definitely caution someone with existing TMD to do more extensive research, get multiple opinions, and seek an OMS who specialises in, or has extensive experience with TMD patients, before moving forward. Mind you, if you caution against orthognathic surgery in general, my message is to be very cautious about any proposed surgery on teh jaw joint itself, and certainly I feel that some OMS are a little too quick to embark on that. (I know, that sounds presumptuous coming from a layman)

I am a little puzzled by the mention of genetics kicking back in and causing relapse - I'm all done growing, and have been for more years than I care to admit! The only real possible cause for relapse for me now, as far as I can determine, would be remodelling of the condyles, but there is no reason to expect that to happen. Indeed, BSSO advancement is one of the most stable and predictable orthognathic procedures. (Although there are certain caveats there where angles created come into play, and there we get far beyond my "informed patient" level of understanding!) My OS categorically told me that there was essentially no chance of relapse in my case, and with the number of these procedures he's done over the decades, I am very much inclined to believe him. I do understand though that not all procedures will render results that are equally stable, and indeed this is a consideration when planning what procedure to perform.

Your data set is (as you admit) small. I can hardly say mine is large I've met five others in person (SARPE - a couple of years ahead of me; BSSO advancement - same timeframe as me; BSSO set-back - several years ago; bimax for overjet, plus genio - a couple of years before me; and another bimax plus genio for overjet many years before me) all of whom have been very happy they went through with it. Then I know a much larger group of people online, who between them have gone through an array of different procedures - SARPE, BSSO advancement, BSSO setback, IVRO, bimax for overjet, Lefort I only (some one-piece, some segmented), MMA, genio only (for OSA as well as cosmetic considerations) ... and almost every one of them, when asked, will tell you that they are glad they went through with it - and mark you that some of these folks had a far rougher time of it than did I.

You ask where my procedure was done. It was in the Swedish Hospital Day Surgery Facility in Seattle WA, and my surgeon was Dale Bloomquist. He's done literally thousands of these procedures in his career, and I tend to think I was in one of the best pairs of hands in the country.

looby75

hmm is it just me or is there something a bit strange about Orthognathic Survivor posts?

Never mind the content, the formatting alone looks much like it's been copied from a text book:rolleyes:

suki1964

looby75 wrote: »

hmm is it just me or is there something a bit strange about Orthognathic Survivor posts?

Never mind the content, the formatting alone looks much like it's been copied from a text book:rolleyes:

Not at all. i think he is American and he has also said he is a scientist who has taken it upon himself to educate himself about the procedure he had. he is also have a "conversation" with another medically qualified person so of course the conversation is more technical then would prolly be used for the layman

Toothsmith

It would probably be a useful study to compare U.S. and U.K. experiences of orthognathic surgery.

I think with the differences in funding arangements for the two healthcare systems though, it would be a different set of patients undergoing the proceedure in the U.S. to the U.K.

OrthognathicSurvivor

I think it would indeed be interesting. One thing that I have noted is the vast difference in the ways different surgeons manage patients post-op. Partly it is just a surgeon to surgeon difference. But there is also some inherent bias based on the general healthcare practices in the country in question. For example, it is pretty much the norm (of course, there are exceptions) here in the states for these surgeries to involve only an overnight stay in hospital; in Canada and Australia, post-op stays seem more commonly to be of a few days, but it is still (if I am remembering rightly) not uncommon to be admitted only on the day of the procedure; in the UK, the post-op stay seems to mirror Canada and Australia, but patients are more often admitted the evening prior to surgery.

I agree that the groups of people undergoing these procedures are likely different between the USA and UK, but perhaps not in the way you might initially expect. Contrary to popular belief, there remains very limited availability of orthodontic treatment for adults on the NHS - availability that is limited only to more extreme cases, which can often be surgical. I am not sure if it is possible to pay for private orthodontia but have surgery on the NHS. In the USA, by contrast, this type of "surgical orthodontic" treatment is only available either to those with good enough health benefits (many health plans explicitly exclude any and all orthognathic procedures, excepting only that involved with trauma) or those who are either wealthy enough, or resourceful and lucky enough to find a means to pay out of pocket. (Some oral surgeons will actually cut deals with the facilities where they operate, so that they can offer cut price "package" deals to uninsured patients who need this treatment). I think though that one upshot of this may be that sometimes less severe cases may be treated this way in the USA compared to the UK.

Keeping_Motivated

Hi I was wondering if people could give me their opinions on the difference between ordinary metal fixed braces and ceramic please?

I am in my 30s and I am going to have a fixed brace for approx 9 mths to have the ordinary brace the cost will be approx £1100 plus the cost of retainers etc at the end. If I have the ceramic it will cost £150 per arch extra (no idea how many arches I need I've not had chance to ask yet?) So my question is, is the difference in appearance actually worth the extra cost? I mean surely you can tell you are wearing braces even with the ceramic ones, infact would people think 'what is that on her teeth' more with a ceramic one, as opposed to the metal one which will be obvious? Does that make sense?

I must admit I am mortified at the thought of being seen with a fixed brace. However I do not like my smile at all so I am willing to do it. The brace is to make my gum line more pleasing and to build out the back teeth. I have crowns on some of my teeth so I thought I would not be able to have braces but I can so I am really pleased. I so wish I had known I could have braces before my last dentist recommended I had these crown for cosmetic reasons :mad: Anyway its done now and thankfully I can still have braces.

So back to my initial question is it worth me paying extra for the ceramic do you think?

Thanks

KM x

choccyface2006

Don't be mortified at the idea of a fixed brace!!! I have had mine on for 18 months now and am not at all embarrassed by it (I'm in my 30s too)

It was hard to imagine how I would feel before it went on, I was dreading it and how people would react but I am really pleased that the only comments I have had about it have been positive ones and often from other adults who are interested in having them too.

I have full metals, like you said I think if I had ceramics then they wouldn't be be as obvious but I might get more people staring and trying to work out what they are!

Good luck with whatever you decide KM.

Sarah x

Keeping_Motivated

Thanks Choccyface funny you should post I have just signed up to Metal Mouth to ask if anyone has had braces on crowns and ask their opinions. I don't seem to be able to get my head round braces working on crowns but obviously they do or my dentist would not have suggested it.

How long left have got to go?

KM x

choccyface2006

Hiya!

Another 6-18 months! (probably more like 18 months I think)

I have had alsorts going on since I began, molar bands, elastic bands, powerchains, springs, tooth re-shaping and even a titanium screw in my jaw!

Its all going well though, I had an adjustment today actually and my measurements (gaps, overbite, overjet) are going down each time so its all looking good.

Did you see me on Metal mouth? I have a diary on there

Maybe you should start your own diary on there?

Sarah x