I finally had my consult with the jaw surgeon. The month I had to wait for that felt like an eternity. But, it gave me good time to get my head on straight about this whole thing and walk into the appointment very informed (too informed is what the doc told me, actually!) and be ready to ask a lot of questions. I even walked in with a list of printed questions. Aside from that, I had my file and my molds that I walked over and got from my orthodontist who is in the same complex. Homeboy (jaw surgeon doc) didn't even look at my molds! Ha! He glanced at my ceph and latest panoramic and basically spit out everything that my ortho spit out to me-- Class II malocclusion, severely under developed upper and lower jaw (my narrow arches), overjet, overbite, and lots of excess gum and bone on my top jaw (my gummy smile). He also said exactly what my ortho said in terms of treatment-- Lefort I, with my jaw being broken in about 5 pieces (OUCH!). This is good news since I thought for a long time I would need both jaws done, and I feel more comfortable with just my top jaw being done since my research has shown that most lingering numbness is usually left in the lower chin/lip. That nerve down there must be bad ass or something, because it always seems to be the one that is bothering people permanently. So, they think if I get the impact (taking my top jaw up by shaving off bone-- think of it cross section wise or removing the filling to an oreo cookie) 4-5mm, have the jaw split to widen my arch, and then place it back to where it takes care of my 8mm overjet but does not give me more lip incompetence up top (since I already have some), then my lower jaw muscles should retrain themselves to autorotate my lower jaw up to meet the new home where my top jaw will be. That's all good and well and all, but then here comes the curve ball....
Doc asks me if I've ever heard of Wilckodontics. Well, no sir, I have not, especially since I've been cramming my head full of nothing but info on the orthognathic surgery stuff for the last 3 or 4 months. He suggests that this will not only speed up my time of treatment (I could be done with all of this by the holidays this year instead of dealing with this all for 2-3 years), but it would be a less invasive alternative to the jaw surgery. This is a surgery too, but definitely less invasive. It's hard to describe, but a quick low down if you didn't follow the link above-- they cut all of your gums around your teeth front and back, and use a bone saw like tool to go in and etch into the bone a certain way and disturb the bone and tissue. This process is supposed to spark this part of the body to go into healing mode, but at the same time leave the bone/tissue soft and malleable to move the crap out of your teeth, and do it very fast. They would put some kind of synthetic or cadaver bone packed over my own bone so my teeth have a place to move outwards to expand my arch, and this bone is supposed to absorb into your own bone making it stronger than it was before the start of the whole thing. They would install metal plates as anchoring devices which would pull my teeth upwards and account for the 4-5mm impaction to clear the gummy smile. AND... there is less chance of having any lingering tingling or numbness, and very little chance of relapse with my teeth shifting back to their old positions. It all sounds to good to be true, but my ortho seems to be on board with it. Now the only issue is that it might cost me another $6-8,000 on top of the $8200 I've already paid for the orthodontia. Insurance rarely covers this, where as the jaw surgery would be completely medical and I'd probably be out less than 800 bucks for the whole thing.
Tough call. Now I'm back to the decision process, but for completely different reasons. Do I go with a procedure that is pretty new and less tested (only been around in the US for about 10 years or so) and will cost thousands, but have less of a chance of permanent issues? Or do I go with the tried and true traditional jaw surgery that will cost me a LOT less, take a LOT more time, and has the possibility with leaving me with a few slightly numb spots for the rest of my life? Le sigh..... I don't know!
For anybody going to see their surgeon and looking for questions to ask, I had them in my last post, but here they are with the answers:
What type of surgery do I need? Lefort I, probably a 4-5 piece break.
What kind of movement? Impact my jaw up about 4-5mm, slight rotation, set it back a little further, and split to widen arches.
What are the chances of permanent numbness? He didn't give me an exact number, but made it sound rare, especially with the upper jaw only.
How long does surgery take? Probably 3 hours.
How long in hospital? 1-2 days.
How long out of work? 4 weeks minimum.
Will this impair my ability to speak at my job past 4 weeks? Most definitely yes with the splint in and banded. Sad face here for me sine my job has a LOT of talking on bad weather days!
Will this fix my clenching and associated headaches? It will most likely help.
Will this fix my lip incompetence? Maybe.
Will the plates and screws impact any of my activities, IE: metal expanding/contracting due to pressure changes like on a scuba dive? No.
Will I need a splint? Yes.... and for a long while probably! :( :( :( PS, if you don't know what this is, google it. It's not fun from what I've read!
What reasons will I benefit from this medically? Probably less clenching/headaches, may avoid tmj or joint issues down the road, no more uneven wear on the few teeth that are taking the brunt of my bite, and I'll be able to bite through anything after this. (yay for biting through lettuce on a sandwich!!)