Bite is worse after surgery

[SamBracingForIt]

Hey everybody!

I am just over 3 months post op, djs (lefort 1, impaction for gummy smile, ivro + genioplasty) for a slight overbite... to be honest, I didn't have a ton of functional problems, and i was mainly concerned about my gummy smile and receded chin, the emphasis being on the gummy smile. I started the journey mainly for cosmetic reasons and then found out how my bite would be improved. The functional aspect of a better occlusion, potentially better breathing, less snoring, etc... was why I chose to go down this route instead of camouflage type of orthodontics/cosmetic dentistry. Well, after battles with insurance and moving cities and insurance woes again, I finally settled on a surgeon and orthodontist with impressive jaw surgery and surgical orthodontic resumes. I had met with 3 other surgeons and 5 orthodontists before this (all in the 2 cities I had previously lived in). On the day of surgery, I left all of the judgement calls up to my surgeon because, hey, at the end of the day, he's the professional, and maybe I didn't ask enough questions, but I think we can all attest to sometimes not knowing the right questions to ask until after the fact. Anyway, he chose to perform the IVRO instead of BSSO because my lower jaw autorotated forward enough that the limited forward movement you can make with IVRO was enough. From what I understand, it's a more commonly used procedure for people with Class III malocclusions to set the lower jaw back, but there is literature on it being used for forward movement in Class 2 patients with less severe cases. There is a lesser chance of permanent numbness with IVRO because the doctor isn't operating on the major nerve that so often gets damaged during BSSO. Since my bite already basically occluded to the right position (again vertical maxillary excess was my main complaint), this was a very favorable option. I was able to feel my lower face/chin/lips immediately after surgery. Great, amazing, so I thought. Well, I was wired shut for 4 weeks. That was obviously brutal. When I was unwired, and then instructed to wear my rubber bands basically 23 hours a day, no chewing, all that, there was still a little bit of space/overbite in my front teeth. My surgeon said that would be easy to close up with orthodontics. Oh, I forgot to mention that I had Invisialign, and had surgical hooks put on my teeth a few days before surgery, not braces, but basically brackets with hooks on each tooth, but they weren't connected to each other with a wire, if that makes sense. My orthodontist was fortunately treating another patient who was slightly ahead of of me in treatment who was also a surgical case using Invisalign. Different surgeon, but this patient was also using the hooks. It was reassuring that there was another patient going through the same thing as I was, but who was going first haha. Anyway, I wore my rubber bands diligently, only taking them off to eat and brush my teeth. When I went back for my 6 week post op appointment, my surgeon was still very happy with how I was healing and turned me over to my orthodontist. He told me he didn't need to see me unless, of course, something were to go wrong. I was sad that that was my last appointment because I enjoyed seeing my doctor and I'm also a very anxious patient. I didn't feel ready to be released yet. I went to my ortho the following day, who looked at my teeth and told me to keep wearing my rubber bands, but to start weaning myself off of them during the day but to definitely still wear them at night. He told me to come back in 4 weeks and that hopefully we'd be able to fit the Invisalign scanner in my mouth to get new trays made. Now, during the time I had been wearing my rubber bands, I'd noticed that the upper teeth they were hooked onto (my canines) had come down quite a bit. I looked a bit vampirey. I asked the hygienist about this, mainly because I was concerned my teeth were going to fall out, and she assured me that they were fine. So, with my very vague instructions, I kept on wearing my rubber bands for about half of the day, taking them out in the afternoons (when I do the most talking) and keeping them out until after dinner, putting them back on right before bedtime. I had also noticed that as my canine teeth came down, that the little space/overbite that had been present right after surgery had somehow become bigger. I could fit the tip of my tongue through it pretty easily. I just chalked it up to being part of the process because it was like that when I'd seen the orthodontist at 6 weeks, and he'd just told me to keep wearing the rubber bands. He hadn't seemed concerned about it, so why should I be? Well, maybe he just didn't get a good look at it, but 4 weeks later, when I went back in, as he was having me bite down, and was looking at my bite, I could see the concern in his face. He said, "well, I'd still say you're Class II." Alarm goes off in my head and I say, "Because of all of that space in my bite, right?" and He said yes. I asked if he was surprised by how much space there was, to which he also replied a reluctant yes. He is very nice, and was obviously trying to not freak me out, but immediately I was concerned, thinking, why did I not say something sooner when I noticed things seemed off? I've sent my surgeon crazy emails about literally everything else. He told me he was going to call my surgeon and tell him what he was seeing, and to immediately stop wearing the rubber bands because of how they had pulled my teeth down and created an open bite. I called my ortho later that day because I was freaking out so much, and he was very reassuring, saying that he just wanted me to see my surgeon again, just in case, but that he was confident that a lot of that space was going to close up once we started orthodontic treatment again. My surgeon's office called me the next day (Friday) and set up an appointment with me for Monday. I spent all weekend freaking out, and went into my surgeon's office, fully expecting to hear that I would need to have another surgery, but he looked at my bite and my x-rays and said that everything was fine, that obviously my canine teeth had come down too far and agreed that I need to stop wearing rubber bands for the time being, that those teeth were essentially getting in the way of my bite, also saying that once orthodontic treatment resumed, everything would be fine. He said my canines would naturally start to go back up on their own (which I think they already have done to some degree), but that my ortho could impact them the rest of way if they needed a little help. I left feeling better... I've trusted my doctors and have tried to be glass half full (easier said than done with an anxious person like me). It's been a couple of weeks since then, and I've since seen my ortho who still hasn't put me back into Invisalign, but still says everything is going to be fine. They're making me some regular retainers for the time being so that my teeth don't shift anymore until I can open my mouth wide enough to be scanned for new trays. Long story long, I've started to feel a little discouraged lately because 1) as my upper lip has regained mobility, I've noticed that my smile is still gummy. Certainly not as bad as before, but definitely more than I was anticipating. I've read numerous stories of over-impaction, which I will agree is much worse, but seeing as the gumminess of my smile was my main concern, I am just a bit disappointed. 2) Looking at mold I have of my teeth prior to surgery (ones from another ortho before I moved cities) I can certainly see that my bite is worse than it was before surgery. I know part of it has to do with my canine teeth that are still sitting too low, but I really didn't have an open bite before surgery, and now I do. I have a bit of a lisp when I talk because of the way my current bite is. Again, I know this is in part due to the canine teeth. I'm happy with my profile... my chin looks better and my surgeon did a really good alar stitch because my nose didn't change at all expect that there is a tiny upturn, which I think is kind of cute. I feel like somehow my cheekbones are more prominent. But my bite is just not good... I guess the point of this long story is to ask anybody out there if they had a less than ideal bite after surgery that was fine-tuned and corrected? I've read post of people with posterior open bites being corrected, but I guess I thought the whole point of surgery was to correct anterior malocclusions, and I'm just worried. I have an appointment with my surgeon in 10 days, so of course I'll talk to him about all of this stuff. Hoping to find someone out there with a similar experience! And trying to not pull all of my hair out while I wait for my next appointment because I'm such a nervous wreck! Thanks!

[kplatt2010]

Hi there-sounds like your facing some big orthodontic challenges. I'm in the same boat with trying to get my teeth to rotate out.

With regards to your situation, did ortho mention just putting you into regular braces? For such a big correction that you are mentioning, maybe you might want to talk about whether applying regular braces would make the challenge a little easier with better results? Braces suck at any age, especially when you're 51 (like me) and have had them on for so long it feels like your new norm. I think though, consider how much invested time and pain that you've done thus far. You want to get this right and if it means wearing ugly braces, then so be it I say.

If the ortho says he's confident that he can correct with Invisalign, then stay the course and ride out the storm. You're going to get through this but the ortho challenge is a toughie. You're not alone as evidence of the huge group that post and follow this message board.
Karla

[SamBracingForIt]

Hi Karla!

I got ceramic braces put on my top teeth about 2 weeks ago. I actually insisted on having them put on versus the Invisalign. I've lost all faith in those dumb things. I think the ceramic ones actually look fine! My canines are already almost back to where they were pre-surgery, which is good news, but my bite is still horrible. I'm not supposed to get the bottom braces put on until my appointment after the next, so about a month and a half from now. To me it just seems so obvious that I need a revision, but I guess I need to face the fact that I have to be a little more patient before they can give me a black and white answer as to whether or not they are going to need to go back in. I'm not a very patient patient.

[kplatt2010]

That's great news! Be patient and let the process work play out. I'm trying to follow the same advise; it's super challenging. My teeth have finally started to shift a little outward. I'm working hard to stretch out the jaw with the tongue depressor exercises as this has been my challenge. I'm one year post-op and I'm hoping to get the braces off by Thanksgiving. If it's earlier than that; it's a bonus.

Best of luck and keep us all posted on your progress.
Karla

[Kmany]

I guess I am in a similar boat, seeing bite issues that surgeon says orthodontist will fix and also concerned my face is asymmetrical and it's not swelling.

No advice here but just empathy - trying to be patient while fearing there's any chance you'll need to do this again is tough.

[eh1253]

Just wanted to add that my bite is far from perfect after surgery (last week) but it’s exactly as the surgeon planned. I had a large open bite gap in the front and they fixed that with the surgery so my front teeth touch. The problem now is my molars really don’t touch on one side and sorta touch on the other. My surgeon said that is really easy to fix with orthodontics and wasn’t anything to worry about. Sounds like a non-perfect bite following surgery is normal. I still am not sure if I trust my current ortho to correct it but I haven’t talked with him yet.

[taylorjb]

How is your bite now? My bite 10 days post op doesn’t feel right & im clenching at night already again. My surgeon said easy fixes for my orthodontist, but I’m nervous. I’m pretty much ok w everything except the clenching. I was expecting that to go away after my surgery. It was really bad leading up to my surgery.