3 Consultations and Still Confused... (class ii division 2)

[shnk]

What i've noticed about myself:
-class II division 2
-if i bite down and try to open my mouth from the bite position i have lock jaw. If i open wide, my jaw slides forward slightly and clicks on the left side. And from this jutted position, if i try to bite down again, i hit my reclined front two teeth but it seems like my jaw has the normal range of motion from this position.
-upper teeth are not crowded too bad
-lower teeth are more crowded (front 4 teeth)
-crowding got worse (i believe) as my wisdom teeth came in. Got my wisdom teeth removed
-i have a sunken jaw but my chin is still pretty strong

I've been to 3 orthos and they've recommended the following:

1. First one recommended surgical treatment. She said when she lined up my teeth i would be left with an overjet and i would need to have a lower jaw advancement of about 7mm.

2. Second one said my bite is already lined up pretty good and surgery is not needed but my profile would most likely not change at all. He would not want to go the surgery route because that means he would have to most likely do extractions on my bottom teeth and push my bottom teeth back to force an even worse overbite so then a surgeon could come in and move my mandible forwards. He also mentioned i think a 5mm difference between upper and lower jaw. Recommended i get invisalign treatment and might need elastics. Didn't mention me being left with an overjet.

3. Last one told me we could go the surgery route if i wanted to change my profile but hes not sure if i'll need extractions or not. He also said that i could opt out of surgery and just get invisalign treatment. He said i might be left with an overjet. And the most surprising part was when his assistant made a 3d model of my teeth and did a simulation of what my teeth would look like after invisalign, it was almost a perfect bite... with literally 0 overjet. This is what confused me the most. Even the ortho was shocked.

Now i'm super confused.. if i go the surgical route then obviously, i'm going to need extractions of some sort to push my lower teeth back so a surgeon can move my mandible forward. That sounds so stupid. And if i don't go the surgical route then my bite will be perfect but will my profile stay the same? I don't like my sunken jaw. I'm not sure if i have an actual skeletal problem or its that my bite is messed up and i've just trained my jaw to slide backwards?

[Tyrantblade]

It seems likely that you will need oral surgery to get the best, if you don't you could maybe still end up with a good result.

But I'm no expert so this is just speculation, I would probably go with the 3rd and see how things go, hopefully they go better than expected and surgery won't be needed, but it seems like you would get a much better results if you did get surgery.

Better to use caution and then do something further if it's needed than to do something that may not be needed and possibly regret it.

Of course maybe another couple opinions could help to narrow it down and help you find out the best course of action.

[shnk]

[quote="Tyrantblade"]It seems likely that you will need oral surgery to get the best, if you don't you could maybe still end up with a good result.

But I'm no expert so this is just speculation, I would probably go with the 3rd and see how things go, hopefully they go better than expected and surgery won't be needed, but it seems like you would get a much better results if you did get surgery.

Better to use caution and then do something further if it's needed than to do something that may not be needed and possibly regret it.

Of course maybe another couple opinions could help to narrow it down and help you find out the best course of action.[/quote]

Sorry, i should add, the simulation he did was just invisalign and no surgery. So if i wanted surgery, then i would probably need extractions to move my lower teeth back to create an overjet which then could be corrected through surgery. I really don't like the idea of this process.. it doesnt really make sense to me. I mean if i can achieve a perfect bite with just invisalign and no surgery then there surely must be something else going on aswell right? With the clicking of the left side of my jaw and having to jut it forward just a little to achieve normal range of motion of opening and closing my mouth (and with this jutting i seem to have a more normal profile).

[Hammykid]

I also went to three orthos. I have an open bite and a slight overbite.
Ortho 1 said I have a tongue thrust and my teeth are flaring out, and recommended braces with tongue thrust therapy which is extremely expensive. He wanted to extract eight of my teeth.

Ortho 2 said braces as well and wanted to extract as well. She was very vague on the plan but she had a very nice office.

Ortho 3 was the cheapest of the three and gave me the options of either surgery or Invisalign. I asked for a third option, braces, and he said he would do braces as long as I promised to wear my elastics regularly.

Ortho 2 is my favorite, but ortho 3 isn't going to extract my perfectly healthy teeth and even was willing to bend and give me braces even though he was against it. He also gave me an 800 dollar discount and is the cheapest option.

[Tyrantblade]

It seems likely that you will need oral surgery to get the best, if you don't you could maybe still end up with a good result.

But I'm no expert so this is just speculation, I would probably go with the 3rd and see how things go, hopefully they go better than expected and surgery won't be needed, but it seems like you would get a much better results if you did get surgery.

Better to use caution and then do something further if it's needed than to do something that may not be needed and possibly regret it.

Of course maybe another couple opinions could help to narrow it down and help you find out the best course of action.

Sorry, i should add, the simulation he did was just invisalign and no surgery. So if i wanted surgery, then i would probably need extractions to move my lower teeth back to create an overjet which then could be corrected through surgery. I really don't like the idea of this process.. it doesnt really make sense to me. I mean if i can achieve a perfect bite with just invisalign and no surgery then there surely must be something else going on aswell right? With the clicking of the left side of my jaw and having to jut it forward just a little to achieve normal range of motion of opening and closing my mouth (and with this jutting i seem to have a more normal profile).

The consensus around here is to go with the opinion of the majority, so if 2/3rd seem to say you need something it seems like you would be better off, plus you mentioned a lot of things that perhaps just braces wouldn't fix; primarily your "sunken jaw".

[djspeece]

If I am reading the surgical option correctly, you would gain a 7mm advancement of your lower jaw. To me, that seems like it would hardly make a difference in your profile. I am not certain what your priority actually is: a good bite, or an improved profile. I would lean toward the nonsurgical approach (as a nurse I am conservative in this way unless surgery is clearly the best option), and based on the limited information here, would choose door #2. I would recommend that you IM sirwired as he has gone down the surgical route and is extremely well-informed. Include a link to this thread.
Best of luck to you.

[shnk]

I feel like my case is a lot more complicated. I should go for maybe one or two more consultations i feel.

[Jason245]

Here is a silly question:

What are the qualifications and years in practice of each of the three?

How much experience do they have with cases like yours?

As an aside, traditional braces can treat everything that invisilign can at a lower proce, invisilign can not treat everything traditional braces can. Any ortho that pushes invisilign as a first option is one who is focused on their profit over patient care (imho)...

I think you need to look for additional ortho options... and maybe look for some who are the best of the best you can find (education and training wise).. no good ortho should ever be shocked at how the results turn out because they have done it enough to know what is and isn't possible and how the outcome will go given their own experien with countless paitients over years.

Personally, I would avoid surgery if at all possible. ..

[shnk]

[quote="Jason245"]Here is a silly question:

What are the qualifications and years in practice of each of the three?

How much experience do they have with cases like yours?

As an aside, traditional braces can treat everything that invisilign can at a lower proce, invisilign can not treat everything traditional braces can. Any ortho that pushes invisilign as a first option is one who is focused on their profit over patient care (imho)...

I think you need to look for additional ortho options... and maybe look for some who are the best of the best you can find (education and training wise).. no good ortho should ever be shocked at how the results turn out because they have done it enough to know what is and isn't possible and how the outcome will go given their own experien with countless paitients over years.

Personally, I would avoid surgery if at all possible. ..[/quote]

I'm really not sure how much experience/qualification each ortho had. I just read there reviews and they seemed the best. Your right tho, I should've asked them how many cases they've treated like mine. I don't have a wide selection of good orthos here unfortunately. I wan't to do my very best to avoid surgery as well. Thank you for the advice. I'm going to book 1 or 2 more consults.

[Jason245]

You can still ask the 3 doctors.

Other questions I asked were about retainers (I wanted permenant, a HAwley and a Essix mostly because this was second time through for me and I stopped first time because retainer broke..and DO NOT want to ever go through this again), and follow-up visits (I wanted to see Dr at least 1 time a year into perpetuity to check retainers etc..

I also researched medical licenses, schools and doctors that they went to... and how long they have been licensed (I am data driven).

After my initial consult, I actually went back to my ortho for a second discussion (I wanted to be 100% sure that I trusted him with my smile).

[dianaioanab]

I don't know if it helps you, but my case is similar I think. I have a class 2 division II. If i open my jaw from the bite position, my jaw clicks. If I open wide, it slides slightly towards the right side though, like the bone is longer on one side (which is not excluded since my face is pretty asymmetrical). I have a sunken jaw, but strong chin. My upper teeth are more cowded then my lower, but not by much. I saw 2 orthos and while neither of them recommended jaw surgery (it's not really practiced in my country), they had different approaches. The first one was convinced I would need extractions and my treatment would last 3 years. The second one said given my profile, he would not extract anything, but I would need to wear elastics, and that the treatment is more like 2 years tops (even less if i wear the elastics properly). I went with the second one and while it's still too early to say anything, I don't regret it. It's up to you really, especially if you're bothered by your jaw (in which case surgery is the best), but I'd rather try no extractions and elastics, even if I am left with a little overjet.

[shnk]

[quote="Jason245"]You can still ask the 3 doctors.

Other questions I asked were about retainers (I wanted permenant, a HAwley and a Essix mostly because this was second time through for me and I stopped first time because retainer broke..and DO NOT want to ever go through this again), and follow-up visits (I wanted to see Dr at least 1 time a year into perpetuity to check retainers etc..

I also researched medical licenses, schools and doctors that they went to... and how long they have been licensed (I am data driven).

After my initial consult, I actually went back to my ortho for a second discussion (I wanted to be 100% sure that I trusted him with my smile).[/quote]

Ill definitely look more into their background and try to have a second discussion before i make any big decisions. Thanks!



[quote="dianaioanab"]I don't know if it helps you, but my case is similar I think. I have a class 2 division II. If i open my jaw from the bite position, my jaw clicks. If I open wide, it slides slightly towards the right side though, like the bone is longer on one side (which is not excluded since my face is pretty asymmetrical). I have a sunken jaw, but strong chin. My upper teeth are more cowded then my lower, but not by much. I saw 2 orthos and while neither of them recommended jaw surgery (it's not really practiced in my country), they had different approaches. The first one was convinced I would need extractions and my treatment would last 3 years. The second one said given my profile, he would not extract anything, but I would need to wear elastics, and that the treatment is more like 2 years tops (even less if i wear the elastics properly). I went with the second one and while it's still too early to say anything, I don't regret it. It's up to you really, especially if you're bothered by your jaw (in which case surgery is the best), but I'd rather try no extractions and elastics, even if I am left with a little overjet.[/quote]

Which country are you from? Did they offer you any functional appliances aside from elastics?

[dianaioanab]

I'm from Romania. The first ortho just wanted to pull two premolars, no appliances. The second one (the one that's treating me) said he'd much rather try elastics and if they don't work, i can pull my top wisdom teeth and he'll try distalization and basically move the rest of my molars, correcting crowding and the overbite, but he didn't say which appliance he was going to use (though i'm guessing distal jet).

[Lovespain5]

I think the second solution is the best.
Surgery isn't the best choice for correcting a class 2 division 2.
Moreover, elastics can correct the profile very well.