Last adjustment before Orthognathic Surgery question

[tdhenson86]

I was wondering if anyone knows what to expect at my last orthodontic visit pre-surgery. My last visit with my orthodontist is on September 26 to have surgical hooks, surgical wires, etc. placed. My surgical work up with scans, etc. is on October 14 and surgery isn't until November 10. At my last adjustment, will they still use the power chains I've had on? Or, should I just expect the normal bands on the surgical wires? I still have a spot where there is a 2mm gap and another 1mm gap.

Three things:
1. Can I expect the gaps to reopen if they take the power chains off?
2. I don't know if these gaps need to be closed before surgery. Can I expect them to postpone surgery because of that?
3. Has anyone had experience and know if they might keep the power chains on over surgical wires to continue closing the gaps before surgery?

Any guidance from others who have been through orthognathic surgery and have experienced gaps like that would be appreciated!

Thank you!
Tim

[littlebird]

Hi tdhenson86, my surgery is scheduled for Nov. 7. I already went through the last orthodontist appt./surgical wire/hooks process (surgery was originally scheduled for Sept. 12 but was cancelled at the last minute) so hopefully I can answer some of your questions.

My orthodontist removed the power chains and put regular bands on with the surgical wire, and added surgical hooks between every tooth. The surgical wire is very heavy so it's unlikely that your teeth would move. Mine shifted maybe just a little bit but no noticeable gaps. As for whether or not your gaps need to be closed prior to surgery, I recommend asking your surgeon when he/she takes the models. My teeth are not perfectly aligned; one of my molars is tilted a bit, and my front teeth aren't quite right, but the surgeon is satisfied enough with the current position of my teeth that we are proceeding with surgery. The orthodontist is going to fix all the issues post-surgery.

One thing that my surgeon was very cautious about was not moving my teeth after he took all the models, because then they would be wrong and the splint he creates from the models wouldn't fit. He consulted with my orthodontist and both agreed on the plan to remove power chains and stop using rubber bands about a week before he took the models. The stiffness of the surgical wire is holding everything in place. I have an appointment scheduled with the surgeon three weeks before surgery to double check that the splint still fits; he said that if he needs to make some small adjustments that's fine, he will have enough time to do so prior to surgery.

Hope that helps! But really, every case is different and ultimately my recommendation is to call your surgeon and orthodontist and make sure everyone is on the same page and satisfied with where your teeth are.

[EWUgal15]

I had wire ties for every bracket when I had my surgical hooks and wires put in. No rubber bands, no elastic anything of any kind. I had to have gaps closed prior to surgery and they didn't reopen without power chains.

[uneunsae]

I also had wire ties put on every tooth. Some brackets were even broken during surgery, but my teeth didn't move at all.

[Nozzelnut]

I had wire ties too. Plus surgical hooks.

Don't worry about gaps or unevenness; the surgeon is working with "generalities" based on his measurements and your ortho can and will make adjustments as necessary after things have healed. The surgeon is positioning jaws; your ortho moves the teeth in those jaws. I had a similar issue; from the time of surgical impressions (when I had a 1.5mm gap,) an ortho appt, and then surgical mold fitting appt in about 7 days. At the ortho appt he put a powerchain on and the gap closed over night. At the mold appt a couple days later, I brought it up to my surgeon and he said that if my teeth were that mobile he wouldn't have any problem fitting the mold during surgery and don't worry. Things worked out fine for me. But if you see similar changes it can't hurt to tell your surgeon.

[sirwired]

x3 (4?) on metal everything.

The idea is to latch everything down TIGHT. The surgeon needs to be ABSOLUTELY sure that your bite will not change between now and surgery. If there are still cosmetic problems to solve, they can be fixed after the surgery is over. (Not to mention that it's a LOT easier for braces to fix things when not fighting against the awkward pre-surgical ortho and its de-compensated bite.)

[tdhenson86]

Thank you all for the replies! I ended up having a normal adjustment today. The orthodontist decided to try and close the gaps before surgery. New wires and power chains on bottom with a double power chain between the two teeth with the bigger gap. So, I will not have the surgical hooks and surgical wires put on until 6 days before surgery. (Which is 3 weeks after the CAT scans, etc. to make the surgical molds).

I'm hoping for the best possible outcome. So, thanks to those who have experienced this before, for the reassurance. Also, thanks for the reply about gaps with reassurance from the surgeon that it would not impact surgery.