If you had SARPE - can you tell me this - please

Message

#1 Post by **supo** » Tue Mar 31, 2009 10:31 pm

Did you have ANY (I mean - ANY) gum recession or loss of the pink triangle (papilla) anywhere?

Did you have any root resorption or any other problem?

Thank you SO much.

#2 Post by **sauerkraut** » Wed Apr 01, 2009 3:04 am

My gums were in pretty poor shape to begin with, but yes, I think the SARPE did make the recession a bit worse. And I only have black triangles, not pink ones

My dentist has already started making noises about gum grafts when this is all over.

I think the roots are OK so far.

#3 Post by **sirwired** » Wed Apr 01, 2009 4:30 am

While I don't know about SARPE specifically, any trauma to teeth or the underlying bone can cause gum recession. It's a well-known risk of pretty much all orthodontic work.

I'm on pins and needles because I'm having my orthodontic work for the sole purpose of stopping gum recession; I've just accepted that things may get worse until they get better. In the meantime, I am seeing either my regular dentist or my perio every three months to keep an eye on things while I am undergoing treatment.

SirWired

#4 Post by **supo** » Wed Apr 01, 2009 4:49 am

So, if I'm hearing everyone correctly.....I "will" lose gum tissue?

Here's my dilemma, I was a surgical case treated non-surgically and I've lost interdental papilla, had some gum recession too. I have an ortho that wants to yank my teeth some more (exand me with wires and elastics). I have an oral surgeon that said, you've lost that papilla because of that very reason, you need surgery...it'll be less trauma on the gums. The other ortho says that is not true because you'll have to move all the teeth from A to B towards the center....a LONG movement and if you lose bone, the gum goes with it, plus, when you have the surgery it stretches the gums because it's basically supporting the arch.

I have yet to see the ortho recommended by the oral surgeon. I get scared because sometimes I feel nobody really cares, they're just padding each other's pockets so they can get part of the money tree.

Aren't there diagnostics, a software program that take subjectivity out of this - or are all these guys just not doing they're job and I need to go to a major dental program somewhere?

#5 Post by **sirwired** » Wed Apr 01, 2009 6:10 am

No, it is not certain you will lose gum tissue. Since you are getting conflicting opinions, it is time get a third opinion or do research of your own. To do research, PubMed is your friend.

http://www.ncbi.nlm.nih.gov/pubmed

A search for "surgically assisted rapid palatal expansion gingival recession" produces a link to an article entitled: "Periodontal evaluation in patients undergoing maxillary expansion", and "Surgically assisted rapid palatal expansion: orthodontic preparation for clinical success".

The abstract of the first article states that SARPE is half as traumatic as expansion via other means. The second article mentions it is very important that the ortho adjust treatment speed after the SARPE based on how the surgery came out, or you are going to have roots ripped from bone. So, if you do have SARPE, definitely use an ortho that thinks it is a good idea.

All PubMed will give you is abstracts, so you need to then schlep to the nearest dental school, (or medical school, if they subscribe to those journals) and start reading (or pay an exhorbinant fee to download the articles from the journals directly.) The bibliographies of the articles may provide hints for further research.

I'm in an interesting position in that the only oral surgeons in my area that are covered under my medical insurance are all professors at UNC dental school. My ortho had my OS attend his wedding, and my regular dentist was a senior at the time the OS was taking his exams to become an official oral surgeon. In short, I think I am lucky to have a good team...

SirWired

#6 Post by **Delag** » Wed Apr 01, 2009 11:32 am

I had SARPE one year ago and had no gum loss. I did have black triangles, but that is because my teeth are(were) triangle shaped - as they straighened out I had them shaved down a bit.

It sounds to me like you need to get a few more opinions. It is very important to have your ortho and surgeon on the same page.

#7 Post by **K Willie** » Wed Apr 01, 2009 7:47 pm

All good advice. I strongly agree with Delag. The most important thing is to have the OS and Ortho or who ever else is involved to be on the same page and clear about what is being done and why and what are the possible side effects and what can be done about that. I hate to say it because I know what you are talking about (ie) the good ole boy network, but there are good OS and Ortho practices that do have the very best at mind. Ultimately you have to cover your ass and let them know that you are informed prior to having anything done. There is power in knowing what is going on.

With that being said, I just had SARPE, LeForte1 on the 26th and I am doing great. No noticable tissue loss but keep in mind that stuff is moving around at a very fast rate now so, nothing looks like it did before. My two front teefs do look a bit longer but, I am not going to be too concerned until things are moving back where they need to be. I passed a milestone today, Had biscuits and gravy today. MAN IT WAS GREAT!!! First solid food since last Thursday. I am going to try a bean burrito tomorrow. I feel so bad for those that have had to be on liquid diet for a long time. A week almost killed me and not eating was the worst part.

I know that I have deviated off subject but that is the way I am. Please take your time and research all of your options. The one thing that is consistant about all of the comments on this site is, when you find someone that has had a bad result because of a surgery, they usually wish they could go back in time to reconsider or ask more questions or most importantly, not just accept what the OS or Ortho is telling them because they assume that everyone is a professional that is looking out for the patients best interest.

Good luck. PS Praying about things could never hurt either.

#8 Post by **badbite** » Thu Apr 02, 2009 9:55 am

Well, my gums weren't in great shape, but not too bad. I have black triangles now but have not noticed any gum loss. I will get the IPR (teeth shaving) to help correct it.

Also, I would do it again in a heart beat!

#9 Post by **ohmyjaw** » Fri Apr 10, 2009 8:18 pm

Well, I didn't have SARPE but I had a Lefort 3-piece, and I have no gum problems at all on the upper teeth. All the problems are on the lowers. I have an exposed root that still hurts, despite the fact that I brush with Sensodyne, which costs twice as much as regular toothpaste. I also have black triangles between all four front lower teeth. As far as understand, this was unavoidable because of the amount of crowding I had before. My gums just never grew up in between my teeth, and now that the teeth are straight, there is no gum tissue in between.

I know you have been through a lot with your teeth, and it is now hard to find an ortho you can trust. I agree with Delag and K Willie - keep looking around until you find someone that you are confident in.

#10 Post by **chicago29** » Sat Apr 11, 2009 8:18 am

ohmyjaw,

Can I ask if you've visited a periodontist to look at fixing the gum issues? The exposed root sounds like a simple fix, but the "black triangles" may be difficult to treat. From the limited amount of research I've done, it seems that it can be difficult if not impossible.

I'm not sure what stage you are in with your surgery & orthodontic treatment so this could be something you're planning soon...

I'm curious because I'm likely to have a very similar situation on my lower due to the extensive crowding I had (and still have). Already after the MSDO, I can see there is gum recession which exposes some of the root of the incisors. I'm hoping when all this is said and done that simple gum grafts will help me.

Thanks!
Chicago29

#11 Post by **ohmyjaw** » Sat Apr 11, 2009 5:14 pm

No, I have not been to a periodontist. I am finished treatment and in retention. My ortho told me, basically there is nothing to be done. Gum grafts will not help this situation. I asked my dentist about the exposed root, and he said "brush with Sensodyne". This worked for a while, but recently the sensitivity has come back.

As far as I know, the best solution for the black triangles is IPR (shaving down the teeth, so that they are more rectangular in shape. Unfortunately I was not a candidate for this, because my teeth are too narrow.

#12 Post by **chicago29** » Sun Apr 12, 2009 6:54 am

I won't be able to tell until things are lined up on the bottom, which is months away, but I have a feeling I'll be in the same situation with the black triangles with the lower incisors. I just don't have much gum tissue down there to begin with after the crowding I had.

ohmyjaw, do you feel this is something that compromises your result? Clearly it would be best if you didn't have this issue, but I'm curious what your thoughts are about it. I've seen people that you'd never notice the black triangles in a million years unless you looked for it, and sometimes in others it is more noticeable.

One thing though, an exposed root should be "fixable" by any periodontist. If it is sensitive, I'd get it checked out. My understanding is that a gum graft is pretty quick and painless, with only minor inconvenience for a few days post-procedure.

But then again, some people say the same thing about jaw surgery

Thanks for sharing your details...

-Chicago29

#13 Post by **Sleclerc** » Thu Apr 23, 2009 3:28 pm

I think Im going to have this issue, but my Ortho has not even mentioned it. It sounds like my gums, wouldnt he bring it up, if he thought I should go see a periodontist? I want to do it all right and if I need to go I sure hope someone tells me.

#14 Post by **chicago29** » Thu Apr 23, 2009 8:21 pm

I don't think this issue comes up, because it could scare some people off. I'm not trying to be pessimistic but no orthodontist is going to cover every exact thing that could go wrong during treatment. And, I personally don't see how the benefits of orthodontia don't outweigh this potential issue.

When you get braces you are likely going to have to sign a consent form, and one risk is always gum loss. This issue with the loss of interdental papilla would qualify as such, so in a way I guess they are telling you.

On another note I did do some more research and it seems many times the "black triangle" issue can be fixed with veneers. There are a few success stories with gum surgery but for the most part it seems hit and miss from a periodontal perspective.

For those of us that have had braces and 1 or more rounds of surgery, the idea of spending even more money to fix gum issues is scary. And, there is no chance at all of veneers being covered by any insurance

Veneers seem to run $1200 to $2000 per tooth depending on geography, so if this issue was bad and you had to put veneers on the "social 6" you are going to be up over $10,000 in no time.

#15 Post by **sauerkraut** » Fri Apr 24, 2009 1:59 am

Sleclerc: I'd definitely say it's a good idea to have a dentist and periodontist check your teeth and gums are in good condition before braces are fitted, whether your ortho suggests it or not. Then if anything does need doing you can get that sorted first. Perhaps my ortho is ultra cautious but he wouldn't even proceed until he had a letter from my dentist (who is also my periodontist) confirming it was OK to go ahead.

Ohmyjaw: I also have exposed roots which can be quite sensitive at times. My dentist recommends Elmex Sensitive toothpaste (do you get that in the States?) which really does seem to help. I am also supposed to use a fluoride gel (also from Elmex) once a week, tho' I don't always remember

. And there's one particular root which the dentist occasionally paints with a foul-tasting fluoride preparation. As I've said, she's also a periodontist and did my periodontal surgery so I suppose that's why she pays particular attention to it.

Incidentally the dentist did warn me beforehand that SARPE would stretch the gum tissue and likely make the recession worse, but she didn't advise me against doing it. I was likely to start losing teeth anyway if I didn't go ahead with the ortho treatment, so in my case at least the risk seemed worth it. And there's always things like gum grafts and maybe even bone grafts to look forward to for the future (I've actually heard a few horror stories about gum grafts but I'll worry about that when I get to it...

)