Surgery Alternative for Class III Underbite

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rshap2l@yahoo.com - 27 Jul 2006 17:55 GMT

Our 13 yr old daughter has a Class III underbite with an open bite, the
molars touch and the front teeth touch, but the cannines and bicuspids
do not. She has no problems chewing eating, or speaking. Frankly, she
doesn't look bad to me, but her lower teeth are pretty crooked.

The orthodontist said that the only solution was to have both braces
and jaw surgery. We met with the surgeon yesterday and he said that
both jaws need surgery, to move the upper forward and the lower back.
The surgery sounded pretty serious and the risks high enough that I
asked him the question of what would happen if we did nothing. He said
that the correction was both for functional and cosmetic reasons for
quality of life, but in truth, probably nothing bad would happen if we
didn't do anything.

Lets say that for the sake of a decision, I'm working in my mind with a
probability of success of 80% (which means a probability of a poor
outcome of 20%). This seems like a no brainer to me. The risks of
surgery (death, infection, bleeding, nerve damage to the lower lip, jaw
problems she currently doesn't have now, etc) way exceed the benefits.
But my wife and daughter are not so sure. My daughter is not clamoring
for this, but my wife suspects that as she gets into high school and
becomes more concerned with her appearance, she may change her mind. My
wife says that nowadays, all the kids have braces, and she would
probably be self-conscious as a young adult with crooked teeth. Being
male, its hard for me to fathom undergoing surgery for cosmetic
reasons. I mean, if the motivation is purely cosmetic, why is this
different than a nose job or a boob job both of which seem far less
risky (not that she needs or wants these, but I mean in principle). By
the way if the probability of a poor outcome was 5% (1 in 20) I would
still think its too risky, the even the surgeon said that 15% of the
patients have permanent nerve damage to the lower lip but most people
cope with that, yeah right!

The biggest question noone seems to be able to answer for me iswhat are
the functional problems associated with your canines and bicuspids not
being able to touch. Does it just mean she won't be able to open a bag
of chips with her teeth, or is there a high likelihood of having
serious digestive disorders. Given that she has no "functional"
problems now, what is the probability that she will develop problems
later.

The other question I have is assuming we find the risks of surgery too
high, what alternatives exist that may lead to improved function and
appearance even though they are not optimal.

Can the open bite be cured with dental impants and crowns? I have a
dental implant which wasn't nearly as risky or as traumatic as this jaw
surgery sounds. Mine works great, but I've needed to have it tightened
twice in the last 12 years. It feels just like having a real tooth. I
had to replace one of my lower molars because the gum tissue receded
too far (I think because of the braces and not being able to clean
properly for years when I was a teen).

The orthodontist said they could straighten her teeth, but that it
probably wouldn't hold. Does that mean she would need braces one year
out of every ten for the rest of her life, or one year out of two for
the rest of her life. It was explained to us that if we elect surgery
then the orthodontics actually increase the open bite so that after the
jaw is moved its lined up, whereas if we forgo surgery, the
orthodontics goes the other way to get the teeth to meet "as best" they
can.

Any advice would be welcome.

Reply to this Message

Bill - 27 Jul 2006 18:30 GMT

> Our 13 yr old daughter has a Class III underbite with an open bite, the
> molars touch and the front teeth touch, but the cannines and bicuspids
[quoted text clipped - 59 lines]
>
> Any advice would be welcome.

____________________________________

In any significant case of complex orthodontic treatment or surgery, it
can't hurt to get a second opinion. When Class III treatment is
involved, sometimes a third or fourth opinion can be helpful.

Make sure that the additional opinions are with fully-qualified,
experienced orthodontists who have treated a number of Cl. III cases in
the past. Some people prefer to have the full surgical-ortho treatment,
while others are satisfied with compromise treatment without the
surgery. Since each patient is different, it takes a careful analysis
to determine the probable outcome for each type of treatment.

Best regards,
- dentaldoc

Reply to this Message

Mark & Steven Bornfeld - 27 Jul 2006 18:33 GMT

    As you might expect, this is not black and white. I have a young
patient with severe mandibular prognathism and open bite, contacting on
only his second and third molars. There is no way to correct this
without surgery and ortho. He's a big strapping guy, a freshly-minted
attorney. He decided he wasn't interested.
    I can predict he's going to beat the hell out of the few teeth that are
contacting, and when they are lost his bite will be a little less open.
He'll probably do fine, and he's obviously not malnourished, but I
certainly wouldn't call correcting this problem primarily cosmetic,
whatever the patient's motivation (or lack thereof) may be.
    Your daughter may be fine too, but females have a higher incidence of
temporomandibular disorders, and her situation may or may not predispose
her to problems. I think your concerns about the risks of orthognathic
surgery are understandable but probably overblown.
    There are a couple of yahoo mailing lists related to orthognathic
surgery. I'm certain that everyone considering this type of surgery has
done a risk/benefit analysis in their own heads. Maybe you can speak to
some of them and get some good perspectives.

http://health.groups.yahoo.com/group/Orthognathic_surgery/

http://health.groups.yahoo.com/group/orthognathicsurgerysite2/

Good luck,
Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Reply to this Message

rshap2l@yahoo.com - 28 Jul 2006 17:00 GMT

Thanks for the replay Steve, this is the kind of information I was
looking for. What is a temporomandibular disorder?

Also thanks for a pointer to those groups, although they didn't change
my assessment of the surgery risks. The surgeon flat out told us 15% of
the people have permanent nerve damage, and there were pleny of folks
on those boards who have had relapses and needed a second surgery. I
think my assessment of 80% probability of a successful outcome is
pretty reasonable. Add that together with a miserable and painful life
interrupting experience, its not something to be taken lightly.

I'm now trying to further assess the risks of not doing the surgery.

I spoke with her orthodontist yesterday she is quite in agreement of my
assessment of the risks. She said that the surgery is elective, but for
my daughter it would be primarily functional not cosmetic. We both
agreed that she was a very pretty girl anyway. She said that the
biggest problem is the likelihood of her wearing down her back molars
or chipping teeth from so much stress. She also recommended either
going the ortho+surgery route or doing nothing except getting
nightguard to prevent her teeth from grinding at night. She said that
any orthodontal work to straighten out her teeth will make her bite
worse. She also pointed out that this treatment is pretty effective
even into the early twenties, and doing nothing unless she develops
problems is not an unreasonable approach at this time.

While there is no family history for an underbite, my family does have
a history of early peridontal disease, which for me was greatly
accelerated by my having braces, and that's perhaps another reason not
to do the surgery.

My question is how are worn teeth ultimately treated and if tooth loss
is the ulitmate result, aren't dental implants a satisfactory treatment
especially for molars. This seems to me to be much less painful and
much less disruptive than the surgery, and may never even be necessary,
but in the worst case is not that bad in the scheme of things.

Any thoughts?

> females have a higher incidence of
> temporomandibular disorders, and her situation may or may not predispose
[quoted text clipped - 8 lines]
>
> http://health.groups.yahoo.com/group/orthognathicsurgerysite2/

Reply to this Message

Steven Bornfeld - 28 Jul 2006 21:45 GMT

> Thanks for the replay Steve, this is the kind of information I was
> looking for. What is a temporomandibular disorder?
[quoted text clipped - 34 lines]
>
> Any thoughts?

    IMO implants would NOT be a suitable replacement for teeth that have
been lost due to hyperfunction. There is no reason to believe that
implant-borne prostheses would hold up under that kind of pounding if
natural teeth could not. And they would do nothing to change the
underlying skeletal deformity.
    Temporomandibular problems are a whole catchall of problems and
symptoms related to functioning of the jaws. While these problems
sometimes involve the joint responsible for function of the lower jaw,
often the problem is more in the ligaments and muscles that surround the
joint.
    While it is logical to assume that patients with significantly altered
occlusion (bite) would suffer a higher incidence of orofacial pain as a
result, I don't know that this has been demonstrated. In fact, I can't
say that orthognathic surgery patients do better than patients with
similar jaw deformities that have NOT had surgery. That might be an
interesting question to pose in the forums I referenced.

Steve

>>females have a higher incidence of
>>temporomandibular disorders, and her situation may or may not predispose
[quoted text clipped - 8 lines]
>>
>>http://health.groups.yahoo.com/group/orthognathicsurgerysite2/

Reply to this Message

Alexander Vasserman DDS - 30 Jul 2006 07:42 GMT

> Our 13 yr old daughter has a Class III underbite with an open bite, the
> molars touch and the front teeth touch, but the cannines and bicuspids
[quoted text clipped - 4 lines]
> and jaw surgery. We met with the surgeon yesterday and he said that
> both jaws need surgery, to move the upper forward and the lower back.

HOLD ON THERE. Why it the oral surgeon making the decision which jaw
is parked in the wrong place. The only way to tell this is from a
cephalometric analysis such as a Sassouni Plus and the only person
qualified to make that decision unless this oral surgeon has
orthodontic background and looked at this study, is the orthodontist.
We do not go doing jaw surgery blind not knowing which is the offending
jaw unless you want to have your daughter suffer TMJ pain for the rest
of her life. This jaw problem that may look normal to you is most
likely 1) genetic and hense looks normal in your family 2) as a result
of your daughter not able to breathe fully. And it could have been
spotted and avoided at a much younger age had she seen the right
professional.
At 13 there is not much time left to do orthopedics that growth is
about 2/3 completed so you need to move fast with whatever the
treatment plan is.
Also you need to address the breathing problem which was probably the
cause of this problem in the first place. Check the ceph to see if her
adenoids are not blocking her airway.

> The surgery sounded pretty serious and the risks high enough that I
> asked him the question of what would happen if we did nothing. He said
> that the correction was both for functional and cosmetic reasons for
> quality of life, but in truth, probably nothing bad would happen if we
> didn't do anything.

HMMMMM "Lets see what happens"
not very reasuring try to get him to back this up with scientific data
from the patient.
I'm sure this OS knows how to do jaw surgery I just do not think he
should be deciding where each jaw should be parked. It may well be that
she needs both jaws done but this is very rare and you should get the
study done to confirm this.

> Lets say that for the sake of a decision, I'm working in my mind with a
> probability of success of 80% (which means a probability of a poor
[quoted text clipped - 28 lines]
>
> Can the open bite be cured with dental impants and crowns?

Not easy and i would nor recommend it.

I have a

> dental implant which wasn't nearly as risky or as traumatic as this jaw
> surgery sounds. Mine works great, but I've needed to have it tightened
[quoted text clipped - 7 lines]
> out of every ten for the rest of her life, or one year out of two for
> the rest of her life.

She would need a perm retainer bonded to her teeth.

It was explained to us that if we elect surgery

> then the orthodontics actually increase the open bite so that after the
> jaw is moved its lined up, whereas if we forgo surgery, the
> orthodontics goes the other way to get the teeth to meet "as best" they
> can.

If you are going to do surgery you should make it easy for the surgeon
by first straightening the teeth within the arch.

> Any advice would be welcome.

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