Metal Mouth Message Board

I visited an orthodontist today (10 years after going, getting told I needed surgery, and not having it done). She doesn't take surgery cases, suggested I consult with an ortho who does, but would take my case regardless. I've been told by several people I needed the surgery to fix my bite, so I haven't really considered the braces only option. I am concerned about insurance coverage and thinking about doing the braces only route. I have an appointment with an ortho who does take surgery cases in a couple of weeks, and I may have a better idea then. I was told by the staff on the phone that Kaiser is the only group in CO that really covers these surgeries...

My questions are:

-Has anyone who is a true class III done just braces with good results?

-If you did have surgery, did you every think you should have just stuck with braces?

--I have a lot of chewing problems and only my very back teeth meet right now. I have an underbite/crossbite/openbite that has been just loads of fun. I also have problems breathing through my nose, but I'm not sure if that is related?

I think a lot of us have been in your position. I think you will find that most of us here have had surgery (or are going to in the near future), since this is a surgery section of this forum. Your case sounds very similar to mine. 5 years ago (at age 29) I finally got the courage to see an orthodontist for a consult. He tooks some x-rays and photos and then explained to me that I had crooked teeth (duh), and also a class III malloclusion. He said I looked severe enough to need surgery, and gave me a quote of like $5900 for the orthodontic treatment plan, figuring on surgery (which was like $500 more than non-surgery treatment, since more work is involved). He is a very well respected doctor and was actually excited to work with me, since he likes "complicated" cases. I was just about to change jobs though and had a fear of my new insurance somehow denying coverage for a pre-existing condition, so I didn't want to start treatment.

I ended up putting the orthodontics off for the next 4 years. Almost 2 years ago, I decided it was time to do something, so I scheduled a consult with another ortho (I wanted another opinion). I told her I had a consult years ago and was told I would need surgery. She immediately said that surgery is usually not necessary and they will do everything possible to avoid it. She said that a lot of surgeons stopped doing surgery recently, due to reimbursement issue with the insurance companies. Basically, she was very anti-surgery. She gave me a quote for no-surgery and surgery ortho, and the surgery option was around $5800, $500 more than non surgery (due to more work involved). So I said okay and went to a second appointment to get records (x-rays, impressions, photos, etc). When I came in for my 3rd appointment to get my brackets and wires on, they said "surprise, you are going to need surgery, and we want you to see the surgeon first before we get started." They also showed me a new quote, which was $6100. I was pissed because she raised the price on me, and also because the ortho herself didn't even talk to me about my records (she had an assistant go over everything instead). Plus, I had taken the morning off work to allow time to get the braces, and they should have called me to let me know that wasn't going to happen.

So I scheduled an appt with the surgeon, and was going to have to wait 6 wks to get in. I figured that in the mean time, I might as well get a consult with another ortho in the area to see what he says. I mean, I was pretty pissed with the last ortho I saw, so what the heck. This ortho did a quick visual inspection and said he thought he could fix my bite without surgery, but if it didn't work, so be it. I was very skeptical of the non-surgical route working, but it would only set me back a few months if it didn't work. His price was $3700 either way. I said cool, and signed up for the braces and cancelled my consult with the surgeon. We used a plastic appliance on the top teeth/palate called an "anterior push", which had a screw in the middle, and the distal plastic end that basically pushed out on the front teeth (central and lateral incisors). We did one appliance for 6 weeks, and then another for 6 more weeks. The teeth were moving, but not enough, and there was a lot of proclination (tilting) going along with the anterior movement, which I didn't care for. I did some research and saw that too much proclination can lead to gum and root absorbtion. We also still had a way to go to fix my bite, and the ortho originally said it should be fixed after 2 appliances. The appliance was also unpleasant, since it was bulking and interfered with my speech, and of course the general discomfort against the teeth and gums. It was a nasty food trap too. At that point I told the surgery that I was not optomistic the appliance was going to work, and he basically agreed and said we can switch to the surgery route at that point.

I saw the surgeon and he explained my malloclusion and how orthodontics can only move the teeth and not the skeletal structure at my age (I knew this already), and that just pushing my top front teeth forward was not a good idea, because the teeth are not in their natural vertical position, which makes them weak. The chance of relapse (the teeth returning to their original position) is very high. Plus, the treatment was doing nothing to improve my aesthetics, since I would still have a shallow, concave upper jaw and poor upper lip profile. Also, I would continue to have a class III relationship in the molars no matter what. I knew all this already, but I'm just stating this in case you don't know.

So surgery it was. We worked to get all my teeth lined up in their arches. With my jaw joints (TMJ) in their natural positions, I was only able to occlude on my canines when chewing once the teeth were lined up properly. I could only occlude on the molars if I protruded my lower jaw forward a lot to clear the canines. It made chewing a real chore to say the least, and I couldn't wait to get the surgery done to fix it. I finally had double jaw surgery 4 weeks ago. Everything so far is going well, and I'm recovering as expected. My insurance approved my surgery no problem. Best of all, most molars now touch naturally!! I can tell my appearance and profile is much better too.

I know this is lengthy, but maybe you can relate and see how not having surgery is not always an option. Get some more consults before you do anything.

I have a very large underbite, as a teenager an ortho straightened my top teeth and left my lower teeth (as straightening them would've made my underbite a lot worse). My parents refused the surgery which the ortho had originally insisted I really needed done.

At 18 years old I had the braces removed and was asked to return in three weeks to receive my retainer. By the time I returned three weeks later, my teeth had FULLY relapsed to their original position.

The ortho said that the teeth will never stay put with my jaw so out of alignment because the lower and upper teeth will naturally try to meet each other and will result in crowding.

Knowing what I know now and what I've been through - I would always choose the surgery option for best result.

Thanks both for your feedback. My second ortho consult appointment is on the 16th. I am definitely interested in what they have to say. I do know that both of my sisters had braces to correct similar problems, but I don't think their bites are as nearly messed up as mine (but my teeth looked fine so my parents did no braces). It sounds like even trying the no surgery route would just lengthen and complicate the process. Ugh.

I've decided to work with an orthodontist who takes surgery cases. I have to have an expander, but I'll have that and bottom braces on in November. I talked with the orthdontist for awhile and he said while I could just do braces and get some things fixes, the skeletal problems will have to be taken care of with surgery. So...I guess I am on that road. Now just to get insurance to cover this all!

Good luck

Speaking for myself, I'd never go to an ortho that states he/she will "never" use a particular part of the orthodontic toolkit. The most common things orthodontists pledge to never do are extractions and surgery. The way I look at it, it's one thing to try and reduce invasive treatments, but it's another thing entirely to make the bold statement that invasive treatments are never necessary.

On the insurance: First, read your policy and search for the word "orthognathic" and "jaw". It's very common for specific policies to exclude it entirely, except for trauma. In my case, I had to look at the policy on my employer's website (they have standard policies for the entire country, no matter the specific carrier.) If that checks out, then Google "InsuranceCarrierName Orthognathic Surgery". With most insurance companies, you will get back their specific coverage criteria; this is a list of under what conditions they'll approve surgery. For my case, my old insurer, Cigna, would not have covered my surgery; they require you to have major functional issues like uncorrectable sleep apnea, TMJD, or such a horrible inability to chew you are losing weight unless you go on a special diet. My current insurer, Anthem BCBS, will cover for those things OR if your measurements are off by a certain amount.

Corrine: Thank you! I've been following your blog lately. It is really helpful! I might have a couple of questions about your experience with the expander once I learn more about the one I will be getting.

sirwired: I called Anthem (I have them as well) and they said it was case by case. So, I'm hoping it is something that is covered. I can't remember my exact measurements that the ortho called out. I do know that I have some offset in both the underbite and crossbite category.

Something I have wondered about is breathing issues with my narrow upper palate. I've always had a lot of sinus issues and feel I can't breathe well through my nose. Not sure if this is related to the upper jaw issues or just plain allergies. Anyone else with a narrow upper palate have similar problems?

Well, ALL surgery is approved case by case, but you can read the guidelines Anthem is going to use here: http://www.anthem.com/medicalpolicies/p ... 053349.htm Your orthodontist should be able to compare those guidelines with the measurements he's taken on your x-rays.

An ENT doctor can evaluate your sinuses, septum, and nasal turbinates to see what effect they have on your breathing. Those can be worked on during a fairly short and straightforward outpatient surgical procedure.

Looking at Anthem's requirements, I'm hoping that I will be covered. I don't remember my measurements from my orthodontist, but I know that I have a pretty significant open bite in addition to the underbite. Only my back two teeth on either side meet.

*sigh*

I've got the process started. Spacers in this week for the expander which goes in on 11/19.