Okay, so I realized that I left out some information about yesterday's consultation that Dr. Punim discussed with me.
First, she wasn't making any statements of getting my teeth aligned quickly before the surgery. Admittedly, this did kind of raise a red flag with Dr. Graham, though I do trust his judgement and it was nice to have a second opinion.
Something that Dr. Punim brought up that wasn't discussed with Dr. Graham was the amount of bone in the front of my jaw. This is going to make moving the lower front teeth backward or forward take longer than what Dr. Graham was discussing. It seems that there's not too much bone material in the front of my mandibular incisors, so this will present quite a case. Dr. Punim was saying about going somewhat slow so she can monitor the movement to make sure she wasn't inadvertently pulling out the teeth. She also pointed out that my upper incisors have shorter roots than the rest of the teeth. Yet another thing she's going to have to watch for.
Well, next appointment is my cleaning, and then my final orthodontic consult. I'll have more to report next month!
Wednesday, March 24, 2010
Tuesday, March 23, 2010
"Golly, That Looks Tasty!"
Just got home a few minutes ago from seeing Dr. Punim for my consultation. It was much the same as with Dr. Graham, only this time I was charged for my appointment.
Actually, the only reason why I was charged was because I authorized having the impressions of my teeth taken. This fee, as well as the additional fee that will be coming up for my next consultation will be put towards my cost for braces and the retainers.
That alginate for the impressions sure is tasty. I don't care how much mint flavoring they put into it, I can still taste the base of that shit! Now, I gotta go brush my teeth again. =Þ Bleh!
I go back on April 28th at 9 for my final consultation and get this whole thing started. By then, we'll see what can be done with my teeth in general, but also see about correcting my deviated midline, as well as whether or not we're going to be able to save tooth #6.
I'm already feeling my face starting to hurt from smiling. Time for full speed.
Actually, the only reason why I was charged was because I authorized having the impressions of my teeth taken. This fee, as well as the additional fee that will be coming up for my next consultation will be put towards my cost for braces and the retainers.
That alginate for the impressions sure is tasty. I don't care how much mint flavoring they put into it, I can still taste the base of that shit! Now, I gotta go brush my teeth again. =Þ Bleh!
I go back on April 28th at 9 for my final consultation and get this whole thing started. By then, we'll see what can be done with my teeth in general, but also see about correcting my deviated midline, as well as whether or not we're going to be able to save tooth #6.
I'm already feeling my face starting to hurt from smiling. Time for full speed.
Monday, March 22, 2010
Once Again, From The Top
Finally finished reading Stephen King's "Dark Tower" series. It only took about 5 years to get through the last book, or whenever it was that it came out. Hard to believe that it's been 20+ years since I started reading the first book. That story was a hard road to Hell - not trying to read it, I'm talking the actual story! Without giving out a spoiler for those of you who are reading it or are thinking about reading it, I really do think the story is Roland Deschaine's personal Hell.
Tomorrow is the appointment with Dr. Patrice Punim for the orthodontic consult. Will have to bring in the x-rays I have and have them call and get the x-rays from the lab. Glad things are going digital. I'll find out what Dr. Punim has to say about what she can do for me. I'm also going to stop by the OMS office (they're husband and wife and they're in the same building) to see about getting the paperwork started for prior approval or if it's needed (thanks for the suggestion Jaw Nom Nom). I spoke with the medical group already and they said that since I was already seen for the consult that I received from Dr. Archer that I'll be approved by them for the surgery.
My appointment is at 9:30 a.m. Time to relax and watch the 1980 version of "The Empire Strikes Back." See you tomorrow!
Tomorrow is the appointment with Dr. Patrice Punim for the orthodontic consult. Will have to bring in the x-rays I have and have them call and get the x-rays from the lab. Glad things are going digital. I'll find out what Dr. Punim has to say about what she can do for me. I'm also going to stop by the OMS office (they're husband and wife and they're in the same building) to see about getting the paperwork started for prior approval or if it's needed (thanks for the suggestion Jaw Nom Nom). I spoke with the medical group already and they said that since I was already seen for the consult that I received from Dr. Archer that I'll be approved by them for the surgery.
My appointment is at 9:30 a.m. Time to relax and watch the 1980 version of "The Empire Strikes Back." See you tomorrow!
Thursday, March 18, 2010
Once Again
Yeah, this is late. Whoop-dee-fuckin' doo.
Woke up Tuesday having forgotten to turn off my alarm. That was probably a good thing with the time change, much as I hate it. Played around with the ACID Music Studio Pro program, showered and went off to Disneyland before it got too hot and the crowds got ridiculous.
Left the park and headed over to the surgeon's office. The route 29, however, was running late - so late that there were 3 buses coming my way when I transferred off the 70! (Way to cut service, OCTA.) I had the feeling that this might happen, so I had contacted the office prior to let them know I might be a few minutes late, but that I was still coming.
I get to the office and walk into the building after finally locating the front door that's adjacent to the parking lot. Walk through the glass doors into a lobby leading to three offices. Looking from right to left, I find Dr. Levin's office to my left side. I went in, advised them I had an appointment. They gave me my health questionnaire and ask for my license and medical insurance card. Fill out my paperwork and wait to be seen.
I was led into an operatory where Dr. Levin introduced himself. We immediately started discussing my options for surgery. As I thought, he stated he would most likely be performing the bimaxillary osteotomy to correct my underbite. He stated, however, that he wasn't going to notify my medical group at this time to get approval of the surgery as it was still too early and that I wasn't in braces yet. I advised him of the problems that I had been facing regarding the insurance company and Dr. Levin advised me that this type of condition is covered under my insurance policy.
I went back into the lobby and got a card for Dr. Patrice Punim to get an orthodontic consultation, then realized that her office was right next door and thought, "Fuck it, I'm right here - why use the cellphone minutes?" I went in and spoke to the lady at the desk who scheduled me for Tuesday of next week. I forgot to ask if they were going to need x-rays. That's not a worry, though. I can just contact the x-ray lab to e-mail them over.
Even after all of this, I still have to wonder if I'm going to be having trouble with BCBS in trying to get this approved. I think I'm going to have to contact the medical group myself and ask them, though I may be worried more than necessary.
I found out later that the insurance company and the medical group will only authorize treatment within 60 days of any actual procedure. Upon speaking with the medical group after my appointment, I found that since I was already referred to the OMS by my physician, I should be approved by them for the procedure without any trouble. (Author)
Well, see you back here next week for another update where I hopefully will share the treatment options given by the orthodontist.
Woke up Tuesday having forgotten to turn off my alarm. That was probably a good thing with the time change, much as I hate it. Played around with the ACID Music Studio Pro program, showered and went off to Disneyland before it got too hot and the crowds got ridiculous.
Left the park and headed over to the surgeon's office. The route 29, however, was running late - so late that there were 3 buses coming my way when I transferred off the 70! (Way to cut service, OCTA.) I had the feeling that this might happen, so I had contacted the office prior to let them know I might be a few minutes late, but that I was still coming.
I get to the office and walk into the building after finally locating the front door that's adjacent to the parking lot. Walk through the glass doors into a lobby leading to three offices. Looking from right to left, I find Dr. Levin's office to my left side. I went in, advised them I had an appointment. They gave me my health questionnaire and ask for my license and medical insurance card. Fill out my paperwork and wait to be seen.
I was led into an operatory where Dr. Levin introduced himself. We immediately started discussing my options for surgery. As I thought, he stated he would most likely be performing the bimaxillary osteotomy to correct my underbite. He stated, however, that he wasn't going to notify my medical group at this time to get approval of the surgery as it was still too early and that I wasn't in braces yet. I advised him of the problems that I had been facing regarding the insurance company and Dr. Levin advised me that this type of condition is covered under my insurance policy.
I went back into the lobby and got a card for Dr. Patrice Punim to get an orthodontic consultation, then realized that her office was right next door and thought, "Fuck it, I'm right here - why use the cellphone minutes?" I went in and spoke to the lady at the desk who scheduled me for Tuesday of next week. I forgot to ask if they were going to need x-rays. That's not a worry, though. I can just contact the x-ray lab to e-mail them over.
Even after all of this, I still have to wonder if I'm going to be having trouble with BCBS in trying to get this approved. I think I'm going to have to contact the medical group myself and ask them, though I may be worried more than necessary.
I found out later that the insurance company and the medical group will only authorize treatment within 60 days of any actual procedure. Upon speaking with the medical group after my appointment, I found that since I was already referred to the OMS by my physician, I should be approved by them for the procedure without any trouble. (Author)
Well, see you back here next week for another update where I hopefully will share the treatment options given by the orthodontist.
Monday, March 15, 2010
"Stop It, Stitch!"
Here I sit, watching Voivod on DVD. Awesome band, in my opinion. Sadly underrated. I don't know if you would like them, but if not, that's cool. I listen to a lot of stuff that most people don't understand.
Right now, I feel like Stitch on his first visit to Lilo and Nani's house. "Hey, what's this? RAAWR!" Smash! I'm so tempted to go out and weave a path of destruction, regardless of how it might affect others, but I'm doing what I can to hold back. I can't help it!
Tomorrow, I go in for my consultation with Dr. Levin. This will be my consultation to find out if I can get this whole thing covered under my medical insurance. I know Dr. Graham said that when the surgeon sees my cephalometric x-rays and outline, as well as the panorex that he's going to start drooling, but I'm still the pessimist of the family. I'm doing what I can to calm down. I'm still pretty hyped up, even after being up since 12:45 a.m. for work (1:45 a.m. start time for a 12 hour work shift). Tried watching "True Blood" to relax and that still didn't do much. So many things on my mind, especially after work.
Spent a good portion of my day listening to a couple of female co-workers sitting next to me talking about the physical attractiveness of males...and these were guys that weren't THAT bad-looking. Kind of sucks to be a fly on the wall knowing that I look the way that I do. It also didn't help hearing an insult from one of my other co-workers yesterday about my own appearance. I feel worthless. I know this surgery changes your appearance, but I just want to look NORMAL. =( I hope I'm not asking too much.
Right now, I feel like Stitch on his first visit to Lilo and Nani's house. "Hey, what's this? RAAWR!" Smash! I'm so tempted to go out and weave a path of destruction, regardless of how it might affect others, but I'm doing what I can to hold back. I can't help it!
Tomorrow, I go in for my consultation with Dr. Levin. This will be my consultation to find out if I can get this whole thing covered under my medical insurance. I know Dr. Graham said that when the surgeon sees my cephalometric x-rays and outline, as well as the panorex that he's going to start drooling, but I'm still the pessimist of the family. I'm doing what I can to calm down. I'm still pretty hyped up, even after being up since 12:45 a.m. for work (1:45 a.m. start time for a 12 hour work shift). Tried watching "True Blood" to relax and that still didn't do much. So many things on my mind, especially after work.
Spent a good portion of my day listening to a couple of female co-workers sitting next to me talking about the physical attractiveness of males...and these were guys that weren't THAT bad-looking. Kind of sucks to be a fly on the wall knowing that I look the way that I do. It also didn't help hearing an insult from one of my other co-workers yesterday about my own appearance. I feel worthless. I know this surgery changes your appearance, but I just want to look NORMAL. =( I hope I'm not asking too much.
Tuesday, March 9, 2010
Information and Explanation, Part II
About the surgery:
While I would be lying if I said that this surgery wasn't completely about my appearance, I have discovered symptoms of other medical problems that could be abated or eliminated with this surgery. Not only is my occlusion a problem, I'm also facing a more serious medical problem.
Originally, I was worried that this condition was causing the bruxism (grinding of the teeth) that was causing damage to the occlusal surface of my right mandibular first bicuspid. However, this is not the only dental problem I've been having. Thanks to the mouth breathing, I've also been having periodontal problems. The last two dentists that I have seen have both agreed that inflammation of my gums is caused by my mouth breathing, and this is in spite of brushing and flossing 3 times a day. This, however, pales in comparison to the reason why my physician gave me the referral. The mouth breathing is an indication that I'm still not getting enough air into my lungs, despite a recent septoplasty. Sinus congestion can be partly to blame, but there is still a physical aspect of the diminished sinus area that I have which is causing or contributing to obstructive sleep apnea (OSA).
Sleep apnea is a disorder characterized by pauses in breathing of the patient. One or more breaths are missed for a period of 10 seconds or longer and this can occur several times during a person's normal sleeping period. The patient is often forced to wake up, often several times, during the night, though many people are not aware of ever waking.
Obstructive sleep apnea differs from central sleep apnea, or Cheyne-Stokes respiration, in that OSA is caused by some obstruction in the airway. Central sleep apnea is caused by an imbalance in the brain's respiratory control center. Neurological feedback mechanisms monitor the levels of carbon dioxide in the blood but fail to react properly to keep even respiratory rates. The body will try to compensate for the apnea by increasing the breathing rate (hyperpnea) when breathing has restarted to acquire oxygen and eliminate waste gases. (Episodes may also happen when the patient is awake.) In central sleep apnea, no effort is made to breathe during this pause in breathing.
OSA is caused by some blockage to the airway. This could be caused by something as simple as the position that one sleeps in; the tissues of the throat (i.e. the tonsils or adenoids); being overweight or obese; the tongue or throat relaxing more than is normal; or physical attributes, such as a deviated septum, enlarged tongue and/or the shape of the neck and head.
In my own case, add the constant sinus congestion with the deformation of the bones of my skull which is causing a lack of air being drawn through the sinuses. There's been plenty of mornings I have woken up even after getting 9-10 hours of sleep and still feeling tired, unrefreshed and sleepy throughout the day. This might also explain the dizziness that I feel waking up most mornings. Originally, I thought the feeling of waking up with the feeling of a hangover from an all-night bender when I hadn't been drinking was a result of my cholesterol medication. This has given me pause. OSA may also be contributing to my hypertension. This surgery, as you will read later in the description of the LeFort I osteotomy, will help open the sinus passageway.
Pre-operative:
In order to prepare for the surgery, the Oral Maxillofacial Surgeon (OMS) will have you go to an orthodontist for braces. Often, this is an orthodontist that the dentist works with closely on surgery cases such as these.
Orthodontics is the field of dentistry where the teeth are aligned. Getting braces prior to orthognathic surgery is much the same as braces without the surgery - the goal is to align the teeth to match up and be straight. However, in this case, the doctors want your teeth properly aligned so that the bite will properly match when the surgery is complete. Often times, necessary pre-operative orthodontic treatment can make a patient's bite look like it's getting worse. It is, in a way, but this is not anything to become discouraged about as it is necessary for this surgery. Anyone who is thinking about going through this procedure should not worry about their appearance because the surgery should happen soon afterwards.
Do not be surprised if the orthodontist recommends having teeth removed. This will help increase the room for the teeth to get into position and can save you time wearing braces. In my own case, Dr. Graham stated that he could help me keep all of my teeth and get my maxillary right canine to be exposed for a balanced look. This would add months, if not years, to my pre-operative work, as well as present complications with getting my deviated midline corrected.
Surgery:
The general medical name for the corrective jaw surgery I am looking to have done is known as dentofacial osteotomy. What occurs in this surgery is bone is cut, modified, moved and realigned until it is in the proper place to enable the patient to chew, talk, breathe properly, swallow, etc.
Dentofacial osteotomies have been in use since the 1940's and were developed to correct malocclusions and maxillary and mandibular prognathisms. Technology for these surgeries has greatly improved resulting in ease for the surgeon and comfort of the patient.
20 years ago, I was told that I would be looking to have a surgery known as a bi-maxillary osteotomy. This is actually 2 surgeries, usually performed at the same time; the LeFort I osteotomy and the sagittal split osteotomy.
Le Fort I Osteotomy: this surgery, as well as the LeFort II and III surgeries, were named after René Le Fort (1869 – 1951), a French army surgeon who developed a classification system for fractures of the bones in the face that were usually caused by some form of trauma. The three LeFort surgeries can all be used to adjust the facial area. A LeFort I fracture usually runs above the teeth of the maxillary arch from just below, or including, the nasal entrance.
The LeFort I surgery recreates this type of fracture, but in a controlled setting. When this surgery is performed, it allows mobilization of the palate so that it may be moved up, down, forwards or backwards. Not only does this help to increase the area of the midfacial region of the patient, it also helps to open the sinus cavity, allowing more air through. In my own case, my physician believes that this will help with my obstructive sleep apnea (OSA).
This surgery would be used to bring the maxilla forward and down. My maxillary incisors are behind the mandibular incisors with an open bite (an open space between the maxillary and mandibular incisors) greater than 7 millimeters. The mandibular teeth also come up in front of the maxillary teeth over 5 mm making the upper teeth look completely covered.
Sagittal Split Osteotomy: This surgery is used to correct both overbites and underbites by moving the mandible forward or backward. In my own case, the jaw would be moved back. Cuts are usually made at the bottom of the jaw, usually near the molars, and then up to the center of the jaw and straight back to the ramus (the trapezoidal-shaped part of the bone that connects the jaw to the skull). This keeps as much bone contact as possible to facilitate healing.
The surgeon uses specialized electric saws and burs, as well as manual chisels for this operation. The purpose is to use the saws and burs to make incisions in the bones, but not go through the nerves. When the desired cuts are made, the surgeon then uses the chisels to break apart the bones, sparing the nerves from being severed. However, this does still result in trauma and many patients will feel numb for days, weeks or months after surgery - in some rare cases, the numbness is permanent.
In the case of patients having this surgery to correct an open bite, bone grafts will be used to help fill in the space that is left open between the bones that were cut. The material for the grafts usually comes from the patient's hip. There are also artificial bone materials that can be used. I may need this if the maxilla is moved down to help correct the vertical displacement of my incisors.
When the surgery is completed, the doctor places metal plates and screws to assist in keeping the patient's bones in their proper places until the bone heals. The surgeon will also most likely keep the patients jaw shut. Originally, this was done with wire, and someone having this surgery done would have to carry around wire clippers in the event of vomiting. With the advances in surgery, many surgeons now use heavy elastic bands to keep the teeth together. Also, with the introduction of rigid internal fixation, the amount of time that a patient spends with their jaws closed shut has been greatly reduced.
Post-Surgical:
Once the surgery is completed, you will still need to be seen by the orthodontist. This is to continue to ensure that the teeth are put into their final positions after surgery, as well as to fine tune the occlusion.
Often, the surgery will result in an appearance that is not only different from what the patient originally looked like, but will result in a look that is much more "normal." In some cases, the difference is dramatic, resulting in a heightened sense of self-esteem for most patients. The change in appearance is so great for some, people who have known the patient their entire lives don't even recognize them. Some patients are recommended to see a psychologist during this process.
http://en.wikipedia.org/wiki/Dentofacial_Osteotomy
While I would be lying if I said that this surgery wasn't completely about my appearance, I have discovered symptoms of other medical problems that could be abated or eliminated with this surgery. Not only is my occlusion a problem, I'm also facing a more serious medical problem.
Originally, I was worried that this condition was causing the bruxism (grinding of the teeth) that was causing damage to the occlusal surface of my right mandibular first bicuspid. However, this is not the only dental problem I've been having. Thanks to the mouth breathing, I've also been having periodontal problems. The last two dentists that I have seen have both agreed that inflammation of my gums is caused by my mouth breathing, and this is in spite of brushing and flossing 3 times a day. This, however, pales in comparison to the reason why my physician gave me the referral. The mouth breathing is an indication that I'm still not getting enough air into my lungs, despite a recent septoplasty. Sinus congestion can be partly to blame, but there is still a physical aspect of the diminished sinus area that I have which is causing or contributing to obstructive sleep apnea (OSA).
Sleep apnea is a disorder characterized by pauses in breathing of the patient. One or more breaths are missed for a period of 10 seconds or longer and this can occur several times during a person's normal sleeping period. The patient is often forced to wake up, often several times, during the night, though many people are not aware of ever waking.
Obstructive sleep apnea differs from central sleep apnea, or Cheyne-Stokes respiration, in that OSA is caused by some obstruction in the airway. Central sleep apnea is caused by an imbalance in the brain's respiratory control center. Neurological feedback mechanisms monitor the levels of carbon dioxide in the blood but fail to react properly to keep even respiratory rates. The body will try to compensate for the apnea by increasing the breathing rate (hyperpnea) when breathing has restarted to acquire oxygen and eliminate waste gases. (Episodes may also happen when the patient is awake.) In central sleep apnea, no effort is made to breathe during this pause in breathing.
OSA is caused by some blockage to the airway. This could be caused by something as simple as the position that one sleeps in; the tissues of the throat (i.e. the tonsils or adenoids); being overweight or obese; the tongue or throat relaxing more than is normal; or physical attributes, such as a deviated septum, enlarged tongue and/or the shape of the neck and head.
In my own case, add the constant sinus congestion with the deformation of the bones of my skull which is causing a lack of air being drawn through the sinuses. There's been plenty of mornings I have woken up even after getting 9-10 hours of sleep and still feeling tired, unrefreshed and sleepy throughout the day. This might also explain the dizziness that I feel waking up most mornings. Originally, I thought the feeling of waking up with the feeling of a hangover from an all-night bender when I hadn't been drinking was a result of my cholesterol medication. This has given me pause. OSA may also be contributing to my hypertension. This surgery, as you will read later in the description of the LeFort I osteotomy, will help open the sinus passageway.
Pre-operative:
In order to prepare for the surgery, the Oral Maxillofacial Surgeon (OMS) will have you go to an orthodontist for braces. Often, this is an orthodontist that the dentist works with closely on surgery cases such as these.
Orthodontics is the field of dentistry where the teeth are aligned. Getting braces prior to orthognathic surgery is much the same as braces without the surgery - the goal is to align the teeth to match up and be straight. However, in this case, the doctors want your teeth properly aligned so that the bite will properly match when the surgery is complete. Often times, necessary pre-operative orthodontic treatment can make a patient's bite look like it's getting worse. It is, in a way, but this is not anything to become discouraged about as it is necessary for this surgery. Anyone who is thinking about going through this procedure should not worry about their appearance because the surgery should happen soon afterwards.
Do not be surprised if the orthodontist recommends having teeth removed. This will help increase the room for the teeth to get into position and can save you time wearing braces. In my own case, Dr. Graham stated that he could help me keep all of my teeth and get my maxillary right canine to be exposed for a balanced look. This would add months, if not years, to my pre-operative work, as well as present complications with getting my deviated midline corrected.
Surgery:
The general medical name for the corrective jaw surgery I am looking to have done is known as dentofacial osteotomy. What occurs in this surgery is bone is cut, modified, moved and realigned until it is in the proper place to enable the patient to chew, talk, breathe properly, swallow, etc.
Dentofacial osteotomies have been in use since the 1940's and were developed to correct malocclusions and maxillary and mandibular prognathisms. Technology for these surgeries has greatly improved resulting in ease for the surgeon and comfort of the patient.
20 years ago, I was told that I would be looking to have a surgery known as a bi-maxillary osteotomy. This is actually 2 surgeries, usually performed at the same time; the LeFort I osteotomy and the sagittal split osteotomy.
Le Fort I Osteotomy: this surgery, as well as the LeFort II and III surgeries, were named after René Le Fort (1869 – 1951), a French army surgeon who developed a classification system for fractures of the bones in the face that were usually caused by some form of trauma. The three LeFort surgeries can all be used to adjust the facial area. A LeFort I fracture usually runs above the teeth of the maxillary arch from just below, or including, the nasal entrance.
The LeFort I surgery recreates this type of fracture, but in a controlled setting. When this surgery is performed, it allows mobilization of the palate so that it may be moved up, down, forwards or backwards. Not only does this help to increase the area of the midfacial region of the patient, it also helps to open the sinus cavity, allowing more air through. In my own case, my physician believes that this will help with my obstructive sleep apnea (OSA).
This surgery would be used to bring the maxilla forward and down. My maxillary incisors are behind the mandibular incisors with an open bite (an open space between the maxillary and mandibular incisors) greater than 7 millimeters. The mandibular teeth also come up in front of the maxillary teeth over 5 mm making the upper teeth look completely covered.
Sagittal Split Osteotomy: This surgery is used to correct both overbites and underbites by moving the mandible forward or backward. In my own case, the jaw would be moved back. Cuts are usually made at the bottom of the jaw, usually near the molars, and then up to the center of the jaw and straight back to the ramus (the trapezoidal-shaped part of the bone that connects the jaw to the skull). This keeps as much bone contact as possible to facilitate healing.
The surgeon uses specialized electric saws and burs, as well as manual chisels for this operation. The purpose is to use the saws and burs to make incisions in the bones, but not go through the nerves. When the desired cuts are made, the surgeon then uses the chisels to break apart the bones, sparing the nerves from being severed. However, this does still result in trauma and many patients will feel numb for days, weeks or months after surgery - in some rare cases, the numbness is permanent.
In the case of patients having this surgery to correct an open bite, bone grafts will be used to help fill in the space that is left open between the bones that were cut. The material for the grafts usually comes from the patient's hip. There are also artificial bone materials that can be used. I may need this if the maxilla is moved down to help correct the vertical displacement of my incisors.
When the surgery is completed, the doctor places metal plates and screws to assist in keeping the patient's bones in their proper places until the bone heals. The surgeon will also most likely keep the patients jaw shut. Originally, this was done with wire, and someone having this surgery done would have to carry around wire clippers in the event of vomiting. With the advances in surgery, many surgeons now use heavy elastic bands to keep the teeth together. Also, with the introduction of rigid internal fixation, the amount of time that a patient spends with their jaws closed shut has been greatly reduced.
Post-Surgical:
Once the surgery is completed, you will still need to be seen by the orthodontist. This is to continue to ensure that the teeth are put into their final positions after surgery, as well as to fine tune the occlusion.
Often, the surgery will result in an appearance that is not only different from what the patient originally looked like, but will result in a look that is much more "normal." In some cases, the difference is dramatic, resulting in a heightened sense of self-esteem for most patients. The change in appearance is so great for some, people who have known the patient their entire lives don't even recognize them. Some patients are recommended to see a psychologist during this process.
http://en.wikipedia.org/wiki/Dentofacial_Osteotomy
Tuesday, March 2, 2010
Information and Explanation Part I
This was started on Wednesday, January 27th, 2010 and is broken into 2 parts. I'm hoping to have Part II completed by next week.
"I do not recognize the vessel, but the eyes seem so familiar."
I suddenly realized that I had not written anything about the procedure which will most likely be done in order to correct my bite. I also discovered yesterday while at the Barnes & Noble in Huntington Beach, CA that there are no books dealing with mandibular or maxillary prognathism, or other corrective jaw surgeries, what to expect or what can be done as far as anything from the patient's perspective. Yes, there are textbooks that deal with such maladies, but nothing like this. A look at Amazon.com shows 4 books written about malocclussion, but only one of these is written about humans and this is from the perspective of a dentist.
Well, if they can write libraries about giving birth and what to expect with that medical procedure, why not corrective jaw surgery? It seems to me that this is a market that, while small, isn't being tapped. However, unlike childbirth, this is not something that is a result of a choice made by the patient - this occurs by accident or genetics.
So, let's get to it!
Originally, I thought that this was something that was attributed simply to a genetic malady; however, after doing more research, I have found what may truly be the cause. Around the age of 8, I began having serious allergy problems. Not only was this caused by enviromental factors, such as allergies to grass, weeds, dust and other contaminants aggravating my sinuses, my septum was deviating. This helped to twist my nose so that the tip is now deviated to my right by about a full centimeter. According to the Atlanta Dental Group, an underbite may be caused by "nasal obstruction, mouth breathing and tongue thrust. The tongue has to stay down so it doesn't block air from getting in. Many tongue thrust patients brace their tongues against the sides of their lower jaws and lower teeth when they swallow. This constant pressure causes the lower jaw to overgrow and creates a mismatch between the larger lower jaw and smaller upper jaw. The result is that only the back teeth touch."
With my mouth always open to breathe, the teeth stopped fitting together and there was nothing to control the growth of my jaw in comparison to the palate. If left unchecked and without proper orthodontics, it continues to grow. In spite of shots twice a week to control my allergies, I continued to have the problem of constant sinus congestion. My deviated septum was also a contributing factor, and would be made worse by the polyps that developed along with a ping pong ball-sized cyst that would develop in my left maxillary sinus.
Early intervention from an orthodontist could probably have prevented or abated the growth of my jaw, but I was never taken to a dentist as a child. Living with divorced parents, I was never really with my father long enough for him to take me on the weekends, and he may have assumed that my mother was taking me to see one. As I found out a few years ago, my mother had not gone to a dentist in many years thanks to her odontophobia caused by a dentist visit when she was a child where she was unanesthetized for a filling. While my friends were being taken to the dentist for exams, braces and cleanings, I was left out of that experience due to her own fear. It was only after twisting her arm to convince her to go when she had a dental emergency due to constant pain that she finally went in to see a dentist.
In December of 1987, I enlisted in the US Navy and was waiting to go in after the summer of 1988. It was within a few days of my 18th birthday that I had my first examination at the Recruit Training Command of the Naval Training Center in San Diego. It was there I learned the measurement of my underbite - 8 millimeters.
Part of the problem with being in the service of the military is that while you are being kept in as healthy a condition as possible, the needs of deployments still need to be met. All through my time of working in the clinics of 2nd and 11th Dental Companies (in the 2nd and 3rd Dental Battalions, respectively) I was not a candidate for this surgery as I was with Marine units and had to be deployable. I was told that I could look into having this procedure done once I had returned to an actual Dental Clinic on a land-based duty post. This idea was shot down when I inquired into getting this done as I only had a year and a half left on my enlistment and I would have reached tenure on a 2nd enlistment and been out of service for not making rank.
The idea of getting this done was nearly forgotten until the middle of last year when I again thought of having it done and I started watching videos of patients who had this surgery. What I saw shocked me. The transformation of these people - many of them young adults - was dramatic. This is what I wanted after years of hearing comments about my appearance. I went first to one dentist where I heard one of those same comments, then went to another dentist as you've already read earlier in this blog.
What typically happens after seeing the general dentist, you will be given a referral to a consultation with an orthodontist. However, if you wish to have this surgery covered under insurance and you do receive a referral to an orthodontist, immediately contact your physician. This is a medical procedure, not dental. Dental insurance will not cover this surgery - it's not their area. If only the teeth were involved, then it would be a dental matter. Yes, the surgery is done by a dentist, but an oral maxillofacial surgeon is a specialist with extensive medical training.
Depending on your medical insurance, if the malocclusion is severe enough, they will view surgery to correct it as a medical necessity.
Many companies view this surgery as being medically necessary when accompanied by one or more of the following functional impairments: obstructive sleep apnea; impairment of speech; temporomandibular joint disorder (TMD); the inability to bite (incise) or chew (masticate) solid food (masticatory misfunction) leading to malnutrition; choking on incompletely masticated solid food; and, damage to the soft tissues caused by the teeth being out of alignment.
These can be caused by any of the following malocclusions, as defined by the American Association of Oral Maxillofacial Surgeons:
Anteroposterior discrepancies of greater than 2 standard deviations from published norms defined as either of the following:
Maxillary/Mandibular incisor relationship: overjet of 5mm or more, or a value less than or equal to zero (norm 2mm). (Note: Overjet up to 5mm may be treatable with routine orthodontic therapy); or
Maxillary/Mandibular anteroposterior molar relationship discrepancy of 4mm or more (norm 0 to 1mm).
Vertical discrepancies defined as any of the following:
Presence of a vertical facial skeletal deformity which is two or more standard deviations from published norms for accepted skeletal landmarks; or
Open bite (defined as one of the following):
No vertical overlap of anterior teeth; or
Unilateral or bilateral posterior open bite greater than 2mm; or
Deep overbite with impingement or irritation of buccal or lingual soft tissues of the opposing arch; or
Supra-eruption of a dentoalveolar segment due to lack of occlusion.
Transverse discrepancies defined as either of the following:
Presence of a transverse skeletal discrepancy which is two or more standard deviations from published norms; or
Total bilateral maxillary palatal cusp to mandibular fossa discrepancy of 4mm or greater, or a unilateral discrepancy of 3mm or greater, given normal axial inclination of the posterior teeth.
Asymmetries defined as the following:
Anteroposterior, transverse or lateral asymmetries greater than 3mm with concomitant occlusal asymmetry.
If they feel that this surgery is not a necessity or for reconstruction of the bones after a traumatic injury, it will be regarded as purely cosmetic. Most, if not all, medical insurance companies will not cover cosmetic problems, resulting in an out-of-pocket expense to you. For many, this will require a loan. If an underbite or overbite is slight enough, it can be corrected using orthodontics alone - in extreme cases however, surgery is required. Contact your physician to get prior approval for the referral to an oral maxillofacial surgeon.
"I do not recognize the vessel, but the eyes seem so familiar."
I suddenly realized that I had not written anything about the procedure which will most likely be done in order to correct my bite. I also discovered yesterday while at the Barnes & Noble in Huntington Beach, CA that there are no books dealing with mandibular or maxillary prognathism, or other corrective jaw surgeries, what to expect or what can be done as far as anything from the patient's perspective. Yes, there are textbooks that deal with such maladies, but nothing like this. A look at Amazon.com shows 4 books written about malocclussion, but only one of these is written about humans and this is from the perspective of a dentist.
Well, if they can write libraries about giving birth and what to expect with that medical procedure, why not corrective jaw surgery? It seems to me that this is a market that, while small, isn't being tapped. However, unlike childbirth, this is not something that is a result of a choice made by the patient - this occurs by accident or genetics.
So, let's get to it!
Originally, I thought that this was something that was attributed simply to a genetic malady; however, after doing more research, I have found what may truly be the cause. Around the age of 8, I began having serious allergy problems. Not only was this caused by enviromental factors, such as allergies to grass, weeds, dust and other contaminants aggravating my sinuses, my septum was deviating. This helped to twist my nose so that the tip is now deviated to my right by about a full centimeter. According to the Atlanta Dental Group, an underbite may be caused by "nasal obstruction, mouth breathing and tongue thrust. The tongue has to stay down so it doesn't block air from getting in. Many tongue thrust patients brace their tongues against the sides of their lower jaws and lower teeth when they swallow. This constant pressure causes the lower jaw to overgrow and creates a mismatch between the larger lower jaw and smaller upper jaw. The result is that only the back teeth touch."
With my mouth always open to breathe, the teeth stopped fitting together and there was nothing to control the growth of my jaw in comparison to the palate. If left unchecked and without proper orthodontics, it continues to grow. In spite of shots twice a week to control my allergies, I continued to have the problem of constant sinus congestion. My deviated septum was also a contributing factor, and would be made worse by the polyps that developed along with a ping pong ball-sized cyst that would develop in my left maxillary sinus.
Early intervention from an orthodontist could probably have prevented or abated the growth of my jaw, but I was never taken to a dentist as a child. Living with divorced parents, I was never really with my father long enough for him to take me on the weekends, and he may have assumed that my mother was taking me to see one. As I found out a few years ago, my mother had not gone to a dentist in many years thanks to her odontophobia caused by a dentist visit when she was a child where she was unanesthetized for a filling. While my friends were being taken to the dentist for exams, braces and cleanings, I was left out of that experience due to her own fear. It was only after twisting her arm to convince her to go when she had a dental emergency due to constant pain that she finally went in to see a dentist.
In December of 1987, I enlisted in the US Navy and was waiting to go in after the summer of 1988. It was within a few days of my 18th birthday that I had my first examination at the Recruit Training Command of the Naval Training Center in San Diego. It was there I learned the measurement of my underbite - 8 millimeters.
Part of the problem with being in the service of the military is that while you are being kept in as healthy a condition as possible, the needs of deployments still need to be met. All through my time of working in the clinics of 2nd and 11th Dental Companies (in the 2nd and 3rd Dental Battalions, respectively) I was not a candidate for this surgery as I was with Marine units and had to be deployable. I was told that I could look into having this procedure done once I had returned to an actual Dental Clinic on a land-based duty post. This idea was shot down when I inquired into getting this done as I only had a year and a half left on my enlistment and I would have reached tenure on a 2nd enlistment and been out of service for not making rank.
The idea of getting this done was nearly forgotten until the middle of last year when I again thought of having it done and I started watching videos of patients who had this surgery. What I saw shocked me. The transformation of these people - many of them young adults - was dramatic. This is what I wanted after years of hearing comments about my appearance. I went first to one dentist where I heard one of those same comments, then went to another dentist as you've already read earlier in this blog.
What typically happens after seeing the general dentist, you will be given a referral to a consultation with an orthodontist. However, if you wish to have this surgery covered under insurance and you do receive a referral to an orthodontist, immediately contact your physician. This is a medical procedure, not dental. Dental insurance will not cover this surgery - it's not their area. If only the teeth were involved, then it would be a dental matter. Yes, the surgery is done by a dentist, but an oral maxillofacial surgeon is a specialist with extensive medical training.
Depending on your medical insurance, if the malocclusion is severe enough, they will view surgery to correct it as a medical necessity.
Many companies view this surgery as being medically necessary when accompanied by one or more of the following functional impairments: obstructive sleep apnea; impairment of speech; temporomandibular joint disorder (TMD); the inability to bite (incise) or chew (masticate) solid food (masticatory misfunction) leading to malnutrition; choking on incompletely masticated solid food; and, damage to the soft tissues caused by the teeth being out of alignment.
These can be caused by any of the following malocclusions, as defined by the American Association of Oral Maxillofacial Surgeons:
Anteroposterior discrepancies of greater than 2 standard deviations from published norms defined as either of the following:
Maxillary/Mandibular incisor relationship: overjet of 5mm or more, or a value less than or equal to zero (norm 2mm). (Note: Overjet up to 5mm may be treatable with routine orthodontic therapy); or
Maxillary/Mandibular anteroposterior molar relationship discrepancy of 4mm or more (norm 0 to 1mm).
Vertical discrepancies defined as any of the following:
Presence of a vertical facial skeletal deformity which is two or more standard deviations from published norms for accepted skeletal landmarks; or
Open bite (defined as one of the following):
No vertical overlap of anterior teeth; or
Unilateral or bilateral posterior open bite greater than 2mm; or
Deep overbite with impingement or irritation of buccal or lingual soft tissues of the opposing arch; or
Supra-eruption of a dentoalveolar segment due to lack of occlusion.
Transverse discrepancies defined as either of the following:
Presence of a transverse skeletal discrepancy which is two or more standard deviations from published norms; or
Total bilateral maxillary palatal cusp to mandibular fossa discrepancy of 4mm or greater, or a unilateral discrepancy of 3mm or greater, given normal axial inclination of the posterior teeth.
Asymmetries defined as the following:
Anteroposterior, transverse or lateral asymmetries greater than 3mm with concomitant occlusal asymmetry.
If they feel that this surgery is not a necessity or for reconstruction of the bones after a traumatic injury, it will be regarded as purely cosmetic. Most, if not all, medical insurance companies will not cover cosmetic problems, resulting in an out-of-pocket expense to you. For many, this will require a loan. If an underbite or overbite is slight enough, it can be corrected using orthodontics alone - in extreme cases however, surgery is required. Contact your physician to get prior approval for the referral to an oral maxillofacial surgeon.
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