Your Questions
Your Questions
Q: Dr. Eppley, Thank You so much for your time and your quick response to my questions about maxillary setback surgery. Would there be any possible alternative to the use of orthodontics which I’m hesitant of because of my age? (65 years old0 Perhaps wiring the mouth shut post surgery for a longer than normal period of time?
One reason I chose to contact you is because I could see from your website your practice seems unique in that you do a wide variety of plastic surgeries and are involved with developing research and studying the latest techniques while at the same time you have a of experience in maxillofacial surgery as well. When searching for a doctor I had originally thought of those with practices limited to oral and maxillofacial surgery but I felt led to contact you when I saw your website. I have contacted no other physician as I am praying you can help me.
I know you have to be incredibly busy but I would greatly appreciate it if you could give me a few minutes of examination time and take a chance on me. Thanking you again so much for getting back to me.
A: In traditional jaw surgery the key element is how the teeth will fit together when one or both bony jaws are moved. That is the actual purpose of orthodontics…to get the teeth aligned for their new jaw position and to correct any malocclusion or dental aligment issues that result afterwards. So keeping the jaws more immobilized (wired together) is not a solution for overcoming malocculsion issues that may be created by any jaw movement issues.
At 65 years old it is perfectly understandable, however, that orthodontics in not in your ‘future’ and is not the best from either a periodontal/root resorption issue or the time involved to do so. Thus an alternative approach must be looked at and there are viable options based on the exact nature of your overbite/upper jaw problem. A premaxillary setback (with premolar tooth extraction) is an option that would allow the upper teeth in the front (incisors and canine) to be moved back into the premolar extraction defect. This would also allow your existing molar occlusion to remain as it is which is critically important for eating. This is also a less extensive procedure than a complete maxillary setback and allows more setback movement anyway.
The way for me to know the feasibility of a premaillary setback is to see you and analyze your dental models and x-rays. All I need is for your dentist to make simple stone dental models and a panorex x-rays. (which most dentists can easily do) Looking at you in person with that information will answer the question if this will work for you
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was just curious if you personally perform orthognathic surgery on a routine basis (I know your website primarily focuses on plastic surgery procedures rather than maxillofacial ones) and if so, whether you ever perform it in an outpatient setting? I know that I have a long road with dental work and orthodontics before I could even consider it, unfortunately, but I think the only way I could realistically afford to have jaw surgery is in an outpatient setting as I have heard how outrageously expensive it is in the hospital setting (and I do not expect insurance coverage in my situation). My understanding is that some surgeons do in fact perform it in outpatient facilities (which is a more recent development due to the high cost) and I was wondering if that is something you have personally done or are familiar with.
A: Various forms of orthognathic surgery have been performed in surgery center locations for decades. While it is true that increasingly limited insurance coverage has made the concept of out of pocket orthognathic surgery more common, it is not new to perform it outside of a hospital setting. The key concept is that some orthognathic procedures can be performed this way but not all. Isolated maxillary (leFort 1), mandibular (sagittal split) and chin (sliding genioplasty) procedures can be safely done as an outpatient. It is when these procedures are combined, which often may be needed, that a hospital setting is not only preferred but should not be done outside of it due to aiway and recovery concerns.
Dr. Barry Eppley
Indianapolis, Indiana
Rich Text Area Toolbar Bold (Ctrl + B) Italic (Ctrl + I) Strikethrough (Alt + Shift + D) Unordered list (Alt + Shift + U) Ordered list (Alt + Shift + O) Blockquote (Alt + Shift + Q) Align Left (Alt + Shift + L) Align Center (Alt + Shift + C) Align Right (Alt + Shift + R) Insert/edit link (Alt + Shift + A) Unlink (Alt + Shift + S) Insert More Tag (Alt + Shift + T) Toggle spellchecker (Alt + Shift + N) ▼ Toggle fullscreen mode (Alt + Shift + G) Show/Hide Kitchen Sink (Alt + Shift + Z) Format – Paragraph Paragraph ▼ Underline Align Full (Alt + Shift + J) Select text color ▼ Paste as Plain Text Paste from Word Remove formatting Insert custom character Outdent Indent Undo (Ctrl + Z) Redo (Ctrl + Y) Help (Alt + Shift + H) Q: Dr. Eppley, I was just curious if you personally perform orthognathic surgery on a routine basis (I know your website primarily focuses on plastic surgery procedures rather than maxillofacial ones) and if so, whether you ever perform it in an outpatient setting? I know that I have a long road with dental work and orthodontics before I could even consider it, unfortunately, but I think the only way I could realistically afford to have jaw surgery is in an outpatient setting as I have heard how outrageously expensive it is in the hospital setting (and I do not expect insurance coverage in my situation). My understanding is that some surgeons do in fact perform it in outpatient facilities (which is a more recent development due to the high cost) and I was wondering if that is something you have personally done or are familiar with. A: Various forms of orthognathic surgery have been performed in surgery center locations for decades. While it is true that increasingly limited insurance coverage has made the concept of out of pocket orthognathic surgery more common, it is not new to perform it outside of a hospital setting. The key concept is that some orthognathic procedures can be performed this way but not all. Isolated maxillary (leFort 1), mandibular (sagittal split) and chin ( sliding genioplasty) procedures can be safely done as an outpatient. It is when these procedures are combined, which often may be needed, that a hospital setting is not only preferred but should not be done outside of it due to aiway and recovery concerns. Dr. Barry Eppley Indianapolis, Indiana Path : p » span
Q: I would like to know what the rate of satisfaction is amongst patients that have had chin osteotomies or chin implants when actually they should have had lower advancement jaw surgery? Are they happy with their appearance or do they feel their top teeth extend out too much when they smile?
A: The short answer is yes. But that answer needs a more detailed explanation. The key is proper patient selection and understanding that a chin implant or osteotomy for a mandibular deficient patient is a compromise operation. It is treating the symptoms of the problem and not the primary problem. In other words, one is camouflaging the real defect and accepting whatever (if any) functional problems that may exist.
The idea treatment for a mandibular deficient patient with a malocclusion (Class bite relationship where the lower teeth are behind the upper…an overbite) is orthognathic surgery. Specifically, a mandibular advancement osteotomy with preparatory and postoperative orthodontics. While this is a very effective operation, it requires a commitment of several years of orthodontics, an operation, and the risks of damage to the inferior alveolar nerve. (some permanent change in the feeling of the lip and chin) The decision for mandibular advancement surgery, therefore, should be based on one’s age and the degree of malocclusion. You must balance the risks vs the benefits like any surgery. If one is young with more than several millimeters of overbite, this should seriously be considered and even done. In patients who are older, often with even more significant overbites, the enthusiasm for this surgical effort is often not there. Camouflaging the jaw defect and getting a better profile and improved facial proportions through a simpler chin implant or osteotomy has a lot more appeal.
In my Indianapolis plastic surgery experience, I have never had any unhappiness amongst patients who has chosen the isolated chin route. Nor has it been reported to me that their upper teeth stick out too far when they smile.
Dr. Barry Eppley