Orthognathic surgery vs TADs

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#1 Post by **charlsie142** » Tue Oct 14, 2008 3:00 pm

Hello everyone--I'm new here and have been surfing through all the pages for hours now, but still haven't been able to find someone like me, so I wanted to post a question. Here's my situation:

I'm an extreme grinder/clencher at night, I have an overbite and gummy smile, I'm a mouth breather, my lower jaw midline is shifted left, and both my upper and lower jaw are too narrow. When I was 11-14, I had braces to fix the same overbite and a crossbite. I'm now 25 with severe jaw pain and severely damaged teeth. So after breaking one of my molars, I went to a really comprehensive dentist who has helped me tremendously with fixing some damage, as well as recommending two orthodontists to me. I met with both of them, and here is what each had to say:

The first orthodontist noted the problems mentioned above, and his treatment includes Damon system braces for 18-24 months and at some point while wearing braces (not mentioned to me), temporary anchorage devices (TADs) would be used to fix the gummy smile and receded lower jaw and the midline problems. He told me that the longterm effects of TADs are unknown. Might want to mention all this would only cost $6590.00.

The second orthodontist, who I liked better on a personal level, found the same problems as the first and recommended both upper and lower orthognathic surgery after wearing braces for some time. I don't know if my insurance will cover the surgery, and the braces at this place are over $7200.

My dentist told me that the outcomes of both treatment plans are the same...but it's so hard to find info on the TADs that I'm afraid that a few years down the road, I'll be opting for the surgery if I get the TADs now. Also, I am a full time graduate student who is required to teach courses every semester in addition to course requirements for multiple presentations per class per semester...so speaking is very important to my career...and so is the recovery time of my treatment option.

Has anyone ever been given these options? If so, what decision did you make? What helped you make the decision? Are you happy with your decision? Also, if you have gone through with the TADs in a similar situation, what has your experience been? Most cases I have read about were to fix extraction problems, not overbite/crossbite.

Thank you so much and I hope to hear from someone soon!

charlsie142

#2 Post by **ohmyjaw** » Tue Oct 14, 2008 4:06 pm

Hi charlsie,

If I were you I would do some more research, because I am quite sure the outcomes of the two treatment options will NOT be the same. If you have bite issues that are skeletal in nature, surgery is the only way to go. If the jaw relationship is fine, and it's just the teeth that need to be moved, braces and TADs will be fine. I would go get a consult with a maxillo-facial surgeon, before you commit to anything.

#3 Post by **PuppySmiles** » Tue Oct 14, 2008 5:29 pm

Seconded. This is the first I've heard of anyone claiming that TAD's will produce the same results as surgery.

Maybe get three or four opinions?

If you're interested in relative costs of treatment, I live in Washington State and got three quotes within the last month from three different orthodontists, all of whom were recommending upper and lower orthognathic surgery. For each of them, their cost of braces hovered around $6000.

#4 Post by **PuppySmiles** » Tue Oct 14, 2008 5:30 pm

p.s. WELCOME!!!

#5 Post by **charlsie142** » Tue Oct 14, 2008 8:52 pm

Thank you everyone for the responses!

Meryaten,

I do have a vertical maxillary excess...I didn't know the correct terminology! That's another problem with these orthodontists..I feel like I received almost no info on my "problems."

The TAD doc did provide me with a patient (a young girl) that he had had success with using TADs and showed me before & after pics, which were pretty amazing...but the fact that the long term effects are unknown scares me. Yes, I'd save money now, but in the long run, if I had to have the surgery down the road...geesh.

I'm not sure what my insurance will cover, but I know the ortho that recommended surgery will fight with my insurance company if necessary to help as much as possible...which is nice (and I assume normal). I have blue cross/blue shield, and I'm in Charlotte, NC. The OMSs he recommended are very familiar with orthognathic surgery, and he said he has been recommending to them for over 20 years... he also told me that my case was "black and white" which also made me feel more confident in his abilities..

I'll contact the surgery ortho and find out who the surgeons he recommends are. I just wasn't sure if it was normal to go to the surgeons before I got my braces, but it makes sense to do that before I do anything else.

Thank you PuppySmiles for the welcome and also the quotes from your area. When I had my braces the first go-round, they were around $2000. I almost crapped my pants when I saw these quotes.

If need be, I will also contact my dentist again for more recommended orthos...this city is way to large to randomly pick people, and I don't know anyone here really (especially who has braces).

Thank you again for all your quick replies. I'll keep y'all updated!

#6 Post by **charlsie142** » Wed Oct 15, 2008 5:36 am

Pre-teen to teen. I think she was a teenager when everything came off for good.

#7 Post by **PuppySmiles** » Wed Oct 15, 2008 8:40 am

I'd advise reading your medical insurance coverage book carefully. I have Regence BCBS, and mine has a specific clause saying that they do not cover orthognathic surgery, ever.
Here's hoping yours covers what you decide on!

#8 Post by **charlsie142** » Wed Oct 15, 2008 8:44 am

My mom has it my insurance stuff in another state...but with my luck, I'm sure it won't be covered. I think I may also have a deviated septum (hence the mouth breathing), so would that help to cover some of the costs if my oral surgeon also performs that surgery?

I've contacted my dentist about other referrals to orthodontists..so now it is the waiting game. I'm hoping to hear something soon so I can at least find out whether surgery is truly needed (although I am pretty sure it is).

#9 Post by **charlsie142** » Wed Oct 15, 2008 2:27 pm

I'm not sure why but my messages aren't showing up after I respond..so if I duplicate things, sorry in advance...

Meryaten--I agree about the age difference...that yes, he may have had success with someone young, but I just don't see how it could lead to permanent changes in an adult...

As for my insurance, I called today and they do cover orthognathic surgery, as long as certain (unspecified) requirements are met...so at least I'm off to a good start with them. I'm waiting to hear back from my dentist for ortho recs to make sure this is what I will need since I only have one ortho who recommends surgery at this point.

#10 Post by **charlsie142** » Thu Oct 16, 2008 9:26 am

Wow! Thank you so much for finding that article...I'm at school now so could only browse, but will give it more attention when I get home. I found an orthodontist last night by searching whose website discusses orthognathic surgery and TADs a lot, and then my dentist recommended the same ortho! So, this guy should be able to give me more info since he's more familiar with both types of treatment. My appointment is on Monday...and I cannot wait!

Here is his website (Dr. Webb) and the page that discusses TADs. http://webbandallenortho.com/TAD.html

Also, I will try to get some pics up over the weekend and post them, although I absolutely hate my teeth and this will take a lot of courage to do!

#11 Post by **charlsie142** » Mon Oct 20, 2008 10:17 am

So I just got back from my third ortho consult, and it looks like I'll be having surgery after all! I have a Class II Division I overjet/overbite...I couldn't write down the numbers since I was sitting there with my mouth open and forgot to ask afterwards, but I remember 3mm (overjet, I think) and 5 or 6mm (assuming overbite)..makes sense when I look at my teeth.
So, I ended up going with this ortho based on personality, cost, and his knowledge. He said I was not a candidate for the TAD procedure I mentioned in my first post (as did my old dentist who my parents talked to)...which is actually kind of a relief. While the other orthodontist that recommended surgery said I would definitely need upper & lower surgery, this ortho didn't know for sure and said I'd have to meet with the surgeon to find out.
So, I went ahead and did all the x-rays and messy impressions and mugshots at the ortho today, so I'll go back soon for a consult after the doc's had a chance to look those over. I was referred to an oral surgeon, and I tried to call to set up an appointment for a consult, but he's booked for the rest of the year! Wow. So, I'll call back next week when his 2009 schedule will be ready.

Crazy stuff, but what a relief to know what I'm going to do.....

#12 Post by **likemysmile** » Fri Nov 07, 2008 8:29 pm

Did your ortho give you any idea as to why you were not a candidate for TADs? I very recently had TADs put in at the same time as my SARPE. In all likelihood I will need a LeFort I along with a bss osteotomy in a little over a year, however the hope is that the TADS will reduce my maxillary excess. If however my ortho is able to get enough impaction with the TADs then I may not have to have one or possibly both surgeries. From what I gather it is sort of a wait and see process as it all depends on how my body responds. Anyway, I am just curious what conditions would make one not a candidate for TADs? Any ideas anyone?