Hi all,
I have been reading this board for a while and it has been hugely helpful. I am in my 30's and have never had any orthodontic treatment. I have an 8mm overjet and crowding on the top and bottom. I've been told by 3 dentists that I would require jaw surgery to correct the alignment between my upper and lower jaws and that was my best option for straight teeth and a proper bite. I went on a consult with an oral surgeon and he recommended upper and lower jaw surgery. Unfortunately, once I looked into it it turns out my insurance won't cover any part of the surgery and I simply can't afford it.
This summer, I've started over, seeing orthodontists and telling them that I can't have surgery but would like to straighten out my teeth and improve my smile. I've seen two orthodontists and one said we could straighten my teeth out with top and bottom braces but I would still have an overjet and my bite would not be greatly improved. The second recommended I have two extractions on my top - the premolars right behind my cuspids. He said he would pull the top teeth back into those gaps and would actually be able to improve the bite. He said I would most likely have upper and lower teeth that actually meet in the front of my mouth.
Obviously, these two treatment plans couldn't be more different and I'm confused. The first orthodontist specifically said he wouldn't do any extractions and would NOT try to pull the front teeth back. But he mentioned that he didn't want to do anything to compromise a surgical solution down the road some time. I talked to my regular dentist and she wasn't much help, besides saying she generally doesn't recommend extractions in adults. I'm wondering if anyone has had similarly divergent treatment plans? It seems I might have a better, more dramatic final result with the extractions, but it also seems like there may be more chance of something going wrong. I might not have as great a final result without the extractions, but I would keep all my teeth, which are healthy and in great shape. Any advice or suggestions would be greatly appreciated!
p.s. Sorry to make this so long but I do have another consultation scheduled for tomorrow and I had another one yesterday with a doctor who said he might or might not do extractions - completely unhelpful!
To extract or not?
Moderator: bbsadmin
Personally, I'd probably go the extraction route, if it meant a better bite and smile. As far as the dentist saying they wouldn't recommend extractions in adults, it just shows their ignorance on the topic. Extractions in adults actually make more sense than in children, because children's jaws can be manipulated to grow a lot better than an adults can, whereas with an adult, you know what teeth and what bone there will ever be to work with.
I had 6 mm overjet and I was told to have jaw surgery for optimal result.
I was told also that extarction of teeth would affect my looks negatively. Finally I found an ortho who said he can fix my bite without exractions.
The reason I did not go for jaw surgery is that I did not have any serious pains caused by my bite, like TJM etc. I did not want to take the risk to fix something that was not wrong, so to say.
Now I have had braces of 1.5 years and my bite is pretty good.
I was told also that extarction of teeth would affect my looks negatively. Finally I found an ortho who said he can fix my bite without exractions.
The reason I did not go for jaw surgery is that I did not have any serious pains caused by my bite, like TJM etc. I did not want to take the risk to fix something that was not wrong, so to say.
Now I have had braces of 1.5 years and my bite is pretty good.
Thank you very much for your responses!
The orthodontist who recommended the extractions actually thinks it will improve my appearance slightly, because I have a very full upper lip area. Not just my upper lip, but the area above it. He thinks having the two extractions will reduce this fullness and actually be a positive for my face.
And, I too, have absolutely no problem with my jaw function or bite. I can't see spending $100K on a major surgery when I have no problems with how my jaw works. Funny, the orthodontist who said no extractions also mentioned that he didn't know how I eat a sandwich with my bite being what it is, but I eat sandwiches all the time!
The orthodontist who recommended the extractions actually thinks it will improve my appearance slightly, because I have a very full upper lip area. Not just my upper lip, but the area above it. He thinks having the two extractions will reduce this fullness and actually be a positive for my face.
And, I too, have absolutely no problem with my jaw function or bite. I can't see spending $100K on a major surgery when I have no problems with how my jaw works. Funny, the orthodontist who said no extractions also mentioned that he didn't know how I eat a sandwich with my bite being what it is, but I eat sandwiches all the time!
I'm in my 40s and I had a 12mm overjet that was reduced via 2 extractions and can only say that it worked for me, I am delighted with the results. Extractions aren't for everybody but for some they work. I also had a really messed up bite with an openbite but never had any problems eating. Human beings are very adaptable!
Good luck with your decision.
Regards
Joney
Good luck with your decision.
Regards
Joney
2 Extractions 2nd November 2006
Brace On 10th November 2006
Top brace off 26 June 2008 (19 1/2 months)
Brace On 10th November 2006
Top brace off 26 June 2008 (19 1/2 months)
Before assuming insurance won't cover it, ask the surgeon's insurance specialist to look into it. Mine won't touch ANYTHING related to TMJ. They will cover surgery to correct skeletal defects and imbalances. Hopefully that means mine will be approved any day now.
Don't accept a compromised end result until you know that is the only option.
Mike
Don't accept a compromised end result until you know that is the only option.
Mike
I wore braces (this time) for 1294 days or 3 years, 6 months and 17 days.
But who's counting?
Jaw Surgery June 1, 2009
Thanks for praying for me and thinking happy thoughts.
But who's counting?
Jaw Surgery June 1, 2009
Thanks for praying for me and thinking happy thoughts.
Thanks for your response, Mike.
Unfortunately, I've confirmed that my insurance absolutely won't cover any part of jaw surgery - it is specifically excluded in my employer's policy. The insurance "guru" at my oral surgeon's office confirmed this for me after reviewing the policy. Apparently, this type of blanket exclusion for orthognathic is becoming very common. So there is really no way to have surgery.
After reading how common extractions are and how they generally provide a great final result, I'm leaning towards them. Thanks again for all your help!
Unfortunately, I've confirmed that my insurance absolutely won't cover any part of jaw surgery - it is specifically excluded in my employer's policy. The insurance "guru" at my oral surgeon's office confirmed this for me after reviewing the policy. Apparently, this type of blanket exclusion for orthognathic is becoming very common. So there is really no way to have surgery.
After reading how common extractions are and how they generally provide a great final result, I'm leaning towards them. Thanks again for all your help!
I have an "edge to edge" bite. That is why I am currently wearing braces. This is a slight underbite. You are supposed to have some overjet in the front. I don't. I was given two options:
1. Extraction of tooth #24 (lower incisor)/braces 15-18 months.
2. Orthognathic Surgery and braces 18-24 months.
I chose option 1. My insurance only covers orthognathic surgery if it is medically necessary too. One of the orthodontist that I saw said this is definately not medically necessary in my case. I couldn't afford the surgery out of pocket and I never wanted to go through with it. My orthodontist would have preferred to go surgical because if you go the compromised route you will not have the option to go surgery in the future. He said he would only go the compromised route if I told him I would never have the surgery. I decided for the compromised route and I am one month plus into treatment. I am also minus one tooth.
The compromised route usually isn't a bad option, but it is not the best option. Maybe your orthodontist can somehow show you what your bite may look like with the extractions. My orthodontist made one mold of the upper arch made and two for the lower arch. One of the lower arch molds they removed the tooth and closed the gap. The other mold they left the teeth as they were. I was able to see how the new bite would look for the most part without the new teeth alignment and compare it to my current bite. You can't align teeth on a mold, but you can move them. Maybe, your orthodontist could do that for you? Also, if they use Orthocad or some similiar technology they can show you computer images of the end result. They may charge you for this, but it wouldn't hurt to ask. Mine didn't charge me.
In a way orthodontics is basically a gamble. So many things may go wrong. You may not get the expected result in the end, root resorption, TMJ, etc. We're humans and sometimes our mouths don't cooperate. Sometimes the orthodontist isn't any good. It is all about how much faith do you have in your orthodontist skills. Maybe he can show you pictures of someone with a similiar case that went that route. In the end it is up to you. I hope I was helpful.
1. Extraction of tooth #24 (lower incisor)/braces 15-18 months.
2. Orthognathic Surgery and braces 18-24 months.
I chose option 1. My insurance only covers orthognathic surgery if it is medically necessary too. One of the orthodontist that I saw said this is definately not medically necessary in my case. I couldn't afford the surgery out of pocket and I never wanted to go through with it. My orthodontist would have preferred to go surgical because if you go the compromised route you will not have the option to go surgery in the future. He said he would only go the compromised route if I told him I would never have the surgery. I decided for the compromised route and I am one month plus into treatment. I am also minus one tooth.
The compromised route usually isn't a bad option, but it is not the best option. Maybe your orthodontist can somehow show you what your bite may look like with the extractions. My orthodontist made one mold of the upper arch made and two for the lower arch. One of the lower arch molds they removed the tooth and closed the gap. The other mold they left the teeth as they were. I was able to see how the new bite would look for the most part without the new teeth alignment and compare it to my current bite. You can't align teeth on a mold, but you can move them. Maybe, your orthodontist could do that for you? Also, if they use Orthocad or some similiar technology they can show you computer images of the end result. They may charge you for this, but it wouldn't hurt to ask. Mine didn't charge me.
In a way orthodontics is basically a gamble. So many things may go wrong. You may not get the expected result in the end, root resorption, TMJ, etc. We're humans and sometimes our mouths don't cooperate. Sometimes the orthodontist isn't any good. It is all about how much faith do you have in your orthodontist skills. Maybe he can show you pictures of someone with a similiar case that went that route. In the end it is up to you. I hope I was helpful.
Last edited by NYG2007 on Fri Aug 29, 2008 12:41 pm, edited 1 time in total.
NYG,
Thank you very much for your detailed response! I appreciate it.
The "extraction" orthodontist did discuss a few similar cases and the after pictures were very impressive. I will check with his office to see if he can make molds or use Orthocad to render my probable after result. You clarified a point for me - he is recommending the extractions because I was VERY clear with him that surgery wouldn't be an option for me, ever. The first "non-extraction" orthodontist mentioned numerous times that nothing he would do would prevent me from getting surgery down the road at some point if I choose. I think I wasn't as emphatic with him that I don't see myself having surgery. If I go through two years of braces and end up with a nice straight smile, I don't see how I would end up opting for surgery to correct a bite that has always worked for me, in my own way (I guess).
Thank you very much for your detailed response! I appreciate it.
The "extraction" orthodontist did discuss a few similar cases and the after pictures were very impressive. I will check with his office to see if he can make molds or use Orthocad to render my probable after result. You clarified a point for me - he is recommending the extractions because I was VERY clear with him that surgery wouldn't be an option for me, ever. The first "non-extraction" orthodontist mentioned numerous times that nothing he would do would prevent me from getting surgery down the road at some point if I choose. I think I wasn't as emphatic with him that I don't see myself having surgery. If I go through two years of braces and end up with a nice straight smile, I don't see how I would end up opting for surgery to correct a bite that has always worked for me, in my own way (I guess).
Gee golly whiz.....Meryaten that's the kindest way that I've ever heard that the poor ortho work when I was a kid left the lower part of my face ugly.... err less attractive than it should be. 
Seriously before I'd go the extraction route I'd have several consults and TRULY understand what the results would be including final appearance, bite and long term stability. If you aren't COMPLETELY satisfied with the expected outcome unless there was a compelling reason to start the process now, I'd postpone it until I could either afford the surgical route or knew non surgical was what I wanted.
Mike
Seriously before I'd go the extraction route I'd have several consults and TRULY understand what the results would be including final appearance, bite and long term stability. If you aren't COMPLETELY satisfied with the expected outcome unless there was a compelling reason to start the process now, I'd postpone it until I could either afford the surgical route or knew non surgical was what I wanted.
Mike
I wore braces (this time) for 1294 days or 3 years, 6 months and 17 days.
But who's counting?
Jaw Surgery June 1, 2009
Thanks for praying for me and thinking happy thoughts.
But who's counting?
Jaw Surgery June 1, 2009
Thanks for praying for me and thinking happy thoughts.
Thank you for your reply! I have been searching the boards for someone with my exact same condition and am having 2 extractions tomorrow! I have a 13mm overjet and am having 2 upper bicuspids removed. The head gear just didn't work for me.joney wrote:I'm in my 40s and I had a 12mm overjet that was reduced via 2 extractions and can only say that it worked for me, I am delighted with the results. Extractions aren't for everybody but for some they work. I also had a really messed up bite with an openbite but never had any problems eating. Human beings are very adaptable!
Good luck with your decision.
Regards
Joney
Please see my post here:
viewtopic.php?t=28264