Pre/Post Surgery Orthodontic Logistics

[BracketBaring]

So, I've been reading lots of posts here about the surgery itself and recovery, but I don't see much about the details of the orthodontic process surrounding the surgeries. I'm supposed to have surgery in 8 weeks, and I guess I'd like to share what's planned leading up to the surgery and see how it compares to your experiences.

Pre Surgery
1) I'm getting getting "surgical wires" put in at my next ortho appointment, which is in 2 weeks from today (so 4 weeks before final impressions, and 6 weeks before the surgery date). These are rectangular wires that apparently do not have any elastic properties like normal arch wires. They essentially "lock" your teeth into place for the impressions and surgery. From talking to my surgeon (OS), I guess the wires only need to be in for a couple weeks before the impressions, but my ortho wants them in for at least 4 weeks. What's your experience with this?

2) How long before surgery were your final impressions/molds and lateral cephalogram taken? My OS said he needs them a minimum of 2-3 weeks before surgery.

3) How long before surgery did you get your hooks installed for the post surgery elastics? My ortho said he plans to do mine 2 weeks before surgery, right after he takes the final impressions and puts the surgical wires back in. Sounds a bit early, I was thinking like a few days before surgery.

4) The OS himself plans to do the facebow transfer. This is when they use the adjustable metal contraption that basically "captures" the relationship of your jaw and bite. He plans to do this in the office within 2-3 weeks before surgery. He will use this to place the molds in the correct position in the articulator, and then he can analyze the jaw relationship, perform mock surgery, and then fabricate the splint that will be used during the surgery to allow proper occulsion and positioning.

Post Surgery

1) How long until you could talk decently well? I have to talk and communicate all day at work (I'm an outpatient physical therapist), as well as dictate all my medical documentation into a recorder. My OS says I should be able to return to work in 2 weeks post op, but that seems a little optomistic for my type of work. What do you think?

2) How long (about) until your first ortho adjustment after surgery? I'm thinking it will be a while since jaw opening will be so limited initially after surgery.

[midnight]

Pre Surgery
1) I had the rectangular wires for about four months before the surgery on my upper arch and about 2 months before on the lower arch. They didn't feel any difference to me as they were put in once my teeth were in the correct position so was used to hold them where they are rather than cause any movement.
2) Impressions etc... were taken 7 weeks before surgery by the ortho and then 4 weeks before my the surgeon
3) Again hooks were put on 7 weeks before surgery (my last ortho appointment before the surgery date)
4) I had this done about 4 weeks before surgery. They then made the wafer based on this and the impressions and I had to go back and check this fitted correctly 2 weeks before surgery.

Post Surgery

1) This will depend on what kind of surgery you are having and whether you will be banded shut. I was banded shut for 10 days and couldn't really talk during this time (trying to make myself understood was too much effort!). As soon as they took the wafer out, although I still had elastics keeping my jaw banded I could talk pretty well. Not as clearly as normal but everyone could understand what I was saying, it was just a bit more effort for me. I got used to talking slightly differently quite quickly though. I went back to work after 3 weeks but could have probably gone back after 2 as I felt physically ok by then although still fairly swollen. Everyone is different and I was advised that for my surgery people usually went back to work at some point between 2 and 4 weeks. Some people might take longer though. Just see how it goes and if it turns out you need longer off then take it.

2) My first ortho appointment was scheduled for about 11 days after surgery (would have been a week but there were lots of bank holidays etc... as it was over Christmas). They didn't actually make me open my mouth or change any of the arch wires and they still haven't 4 months post op. All they did was check everything looked ok and added a few elastics. All my appointments since have been the same. I still can't open my mouth very wide so I'm dreading having to have more impressions done next month

[bmueller]

Pre Surgery

Surgical wires put in two weeks before sugery.

Final impressions taken less than a week from the surgery. Impressions also taken 6 weeks out to confirm that my teeth were "ready" for surgery.

Hooks installed 1 week before surgery

Facebow done less than a week from surgery (same time as the final impressions)

Post Surgery
Had a splint for 3 weeks which made it very difficult to be understood. As soon as the splint was taken out, everyone could understand me even though I could only open my mouth about a finger width.

My first ortho appointment was 4 weeks post surgery. (IE as soon as I could open my mouth after being banded/splinted shut).

[karla3321]

Pre-Surgery

1. I got my wires put in 4 weeks before my surgery.

2.Final impression taken 2 weeks before surgery.

3. Hooks installed 3 days before surgery. They can be very uncomfortable, so my orthodontist wanted to wait till the lst minute possible.

4. Done at the same time as impressions, but I did not see it at all. He mainly used impressions. My surgeon didn't even leave it on post surgery.

Post Surgery

1. Let me start off by saying I did not have a wafer in for any part of my post op. I have a job were I need to speak all day to students, so I feel you. I am 4 weeks post op and returned to work earlier this week. I say it is easy to communicate and people understand you. I was okay to speak during week 3, but I was still very drained.

2. I went back to the Ortho after my first visit with the surgeon. The surgeon gave me elastics to wear but the orthodontist asked that I wear them a different format. So I would day 1.5 weeks.

[BracketBaring]

Holy cow Midnight, you had to wait a lot longer than the rest of us. I wonder if that is because of the healthcare system in England?

How long after surgery were you guys in the surgical arch wire? My teeth are not lined up perfect (my right side upper and lower canines are a little off), but supposedly I'm good enough for surgery. My ortho mentioned that he needs to reposition a couple brackets to get the teeth straighter, but if he did that now, we would have to "start over" with a thinner wire, and then "work our way back up" with thicker wires every 4-5 weeks. Of course, that would delay surgery for months, so he (and I) would rather wait until after surgery. So I'm curious as to how long until after surgery I will have to wait to have those brackets moved and start over with a thinner wire.

[bmueller]

I have lingual braces which is unusual with surgery. I was put in my final wires for surgery and am still in the same wires until the end! but again, i'm unusual! they installed brackets with hooks on the outside of my teeth for the surgeon to use during surgery instead of just installing hooks. See my blog if interested.

[tdhenson86]

Thank you for this post! I had all of the same questions. My timeline is similar to yours. So, it's good to know that's pretty normal. I was thinking it seemed drawn out.

1) My final orthodontist appointment is 6 1/2 weeks before surgery to get hooks and surgical wires.

2) Impressions, molds, and scan of my face/jaw are set to be 5 weeks before surgery.

3) Hooks will go in 6 1/2 weeks before surgery.

4) My surgeon is also doing the scans for mock surgery, etc. at the same time as the impressions 5 weeks before surgery.

[glennstanzalone]

1) What's your experience with this? Surgical steel wires are just extra strong so your jaws can be wired to then during surgery. I was in surgical steel wires for 5-6 weeks before surgery. Your team sounds competent. This allows your teeth to get used to the wire before the trauma of surgery.

2) How long before surgery were your final impressions/molds and lateral cephalogram taken? 2 week and a day before my surgery, he needed one week to plan surgery and do models. He invited me to sit in for the surgical planning as well. I would ask your surgeon if you can do that too. It helped my anxiety so much to know what was moving where.

3) How long before surgery did you get your hooks installed for the post surgery elastics? One day before surgery, I wasn't going to walk around looking like a monster for longer than I have to.

4) I didn't have a splint, my lefort was a one piece. Can't speak to this.

Post Surgery

1) My OS says I should be able to return to work in 2 weeks post op, but that seems a little optomistic for my type of work. What do you think? Lmao good luck. My jaw fractured the wrong way during surgery because my bone is thin. I was wired shut for 2.5weeks. I'm 5 weeks out and still puffy and have difficulty speaking clearly. This is the first day where I only have to wear elastics at night. Before this I was in hard elastics 24/7 and you cannot talk against them. It's very difficult to communicate.

2) How long (about) until your first ortho adjustment after surgery? Minimum of 6 weeks for the jaw bone to heal before they start moving teeth again. This is from my surgeon and Ortho.


Best of luck!!

[kachalek]

@glennstanzalone: I apologize this question isn't directly related to the original post. Was your one piece Lefort to widen your top jaw, correct a cant, or move forward/back? My surgeon is going to widen my top jaw (very slightly) and level out my cant. My paperwork said he will doing a one piece Lefort; however, I thought a three piece was always used if you needed width.

[glennstanzalone]

@glennstanzalone: I apologize this question isn't directly related to the original post. Was your one piece Lefort to widen your top jaw, correct a cant, or move forward/back? My surgeon is going to widen my top jaw (very slightly) and level out my cant. My paperwork said he will doing a one piece Lefort; however, I thought a three piece was always used if you needed width.

My lefort was to correct a vertical maxillary excess of 4mm and cant of 1mm. I believe a three piece is required for width and you will also need to be in a splint after that. Maybe he's bringing your jaw forward? That would make it appear wider without splitting it?

[pantlover]

Hi,

wondering how many people got wire ties around their brackets in prep for the surgery? also how many surgical hooks did you get? I only have my regular ligs (no wire ties) and 2 hooks on top and 2 hooks on bottom. wondering if this is normal...