“I cannot say often enough how much I consider beauty a powerful and advantageous quality.  Socrates called it ‘a short tyranny,’ and Plato, ‘the privilege of nature.’ We have no quality that surpasses it in credit.  It holds first place in human relations; it presents itself before the rest, seduces and prepossesses our judgement with great authority and a wonderous impression.”

from Montaigne, Essays

We can help you look your best.  Oral and maxillofacial surgeons are uniquely qualified to work with you.

Contact Dr. Ornstein at 972 243-5035 or visit our web site (www.renaissanceofs.com) to learn more about dental implants (single or multiple), botox, dermal fillers, chin and cheek augmentation, and orthognathic surgery.

We have invited one of our jaw surgery patients to write about his experience with orthognathic surgery and braces.  Here are his thoughts.

My Journey to Straight Teeth Begins

My journey to correct my crooked teeth and receding jaw began in January of 2009.  I had two overlapping front teeth and an over-bite that also suffered from a very narrow upper jaw.  My oral and maxillofacial surgeon, Dr. Sharon Ornstein, and my orthodontist, Dr. Terry Thames, decided that they would first widen my upper jaw and straighten my teeth with braces.   Dr. Ornstein would then surgically move my jaw forward to correct my over-bite as it was significant enough that braces alone could not achieve the desired result.  In fact, if we had done braces alone, I would have ended up with straight teeth that didn’t line up with my lower jaw, and I was told that as a consequence they would want to move back over time to their old crooked selves.

Jaw Surgery (orthognathic surgery) benefits

Besides straightening my teeth and correcting my bite, the surgery would open my airway and eliminate sleep apnea, a potentially fatal condition in which the patient stops breathing temporarily while sleeping due to a collapse of the airway.  Surgery would also give my face a more balanced look.  I was looking forward to fixing what the doctors liked to call ‘functional problems’ while also making me appear more balanced.

The surgeon took photos and x-rays to establish the baseline and sent me on my way to the orthodontist, Dr. Thames, who also did his preparatory studies.  After an initial consultation I made an appointment to place the braces on my teeth.  The objective was basically to move them into a position in preparation for jaw surgery, which would then bring everything into alignment.

I won’t tell you that braces are an enjoyable experience, but I found that after an initial period of discomfort I started to adapt and their presence became second nature.  Eating was always a challenge, as food would easily get stuck between the braces and the teeth, but there are all sorts of products on the market to help you deal with that.  I especially liked Dentet Easy Brush, sort of a toothpick toothbrush.  I found that, in fact, the whole process improved my dental hygiene regime as I became very committed to keeping my teeth clean.

I returned to the orthodontist periodically over the year I wore my braces for adjustments to guide my teeth into place.  I found that two ibuprofen just before visiting the doctor would alleviate any discomfort I might initially experience as a result of the adjustment.

My orthodontist, Dr. Thames, and his whole team were very welcoming, positive, and encouraging, so my visits for adjustments were always very pleasant.

I have to say that I was very pleased to watch my teeth quickly straighten, including the tooth overlap in the front that I had always wished would go away.  In just a few months, it had gone away.

Time for Surgery

When the orthodontist and the surgeon decided I was ready, we scheduled my surgery, a little over a year after my braces went on.  Some cases can require more than a year with braces, depending on your situation.  In my situation it had all gone rather quickly.

Dr. Ornstein performed the surgery in the operating room in her office, under general  anesthesia monitored by an anesthesiologist.  Her great team helped me feel very comfortable and relaxed, almost like one of the family.

All went well and I was sent home to recuperate shortly after waking up.

Recovery

The surgeon prescribed pain medication and directed me to eat a liquid diet for two weeks.  Although I actually gained some weight following surgery, as much as anything from my own determination to eat well, Dr. Ornstein told me that it’s not uncommon for patients to lose up to ten pounds on the post-surgery diet.  So if it’s an objective you have, consider this an opportunity to lose weight.  It’s also the perfect time to give up smoking.

The first day after surgery was actually the easiest, as my swelling was kept well under control and I was still numb from the anesthesia.  I followed the doctor’s orders, which included, initially, periods of applying ice to the jaw and minimal physical activity.

The following days were more challenging, as much as anything from the elastic bands that kept the jaws stabilized while I recovered.   Similar to wearing a cast to stabilize a broken arm so that it can heal correctly, you must wear elastics to keep the teeth and jaw closed in a fixed, stable position to ensure proper healing.  After the first few days you can remove the bands to rinse out your mouth and clean your teeth, but in the beginning it is 24/7.  The bands stayed on for four weeks to train the jaw to open and close in its new position.

Although the urge to talk was low as a result of the whole process and the presence of elastics, I could make myself understood by forming the words with my lips alone if I wanted.

The first few days I had to sleep propped up to help everything settle and minimize swelling.  It is also important to sleep on your back, avoiding sleeping on your side, for a few weeks so that no lateral pressure is applied to your jaw.

Eating

I ate by drinking various supplements, soups, and very soon eating solid food placed in the blender with enough liquid to make it drinkable.  My favorite turned out to be Boost, a high calorie liquid supplement designed for people who have trouble eating.  You have to plan ahead for your eating and nutrition needs, as it can be a challenge to take in a varied and balanced diet, but it can be done. My soft diet lasted about four weeks.

Swelling reduced rapidly over the first few weeks and I was able to return to work within two weeks.

The elastics came off after four weeks, a much-anticipated event.

Braces come off eight weeks after surgery

While I was recovering from surgery, my braces remained on the teeth as part of the stabilization process.  But finally the day came to take them off – a wonderful, liberating, happy day that brought the whole process to its final end.  It was like releasing a tight spring holding my teeth together.  But more important, at last I got to see the final product, something that I was so anxious to see after a little over a year of work; at last I could smile and see only straight teeth; at last I could feel the smoothness of each tooth against my lips.

The irony, at least at first, was that my teeth didn’t feel quite right without braces on, if you can imagine that.  You really get quite used to having the braces in place. The teeth sort of felt ‘naked’ and unsupported.   But this feeling rapidly goes away and the joy of having your teeth returned to you, and a new smile, soon takes over.

I am very pleased with the result.  My bite is normal and my teeth come together as they should.  My crooked teeth are only a memory and my face has a more balanced look.

My only regret is that I didn’t do it many years sooner.

Will anyone notice?

You probably have heard the saying “it’s as plain as the nose on your face.”   Well the truth of the matter is that it’s not so plain – not so obvious.  What I mean is that, while you yourself may be very sensitive to any changes to your appearance, the rest of the world generally isn’t.  If you’re a man and have ever grown a beard or mustache and then shaved it off, you’ll know what I mean – few will notice that you shaved. (For an over-the-top dramatization of a change that no one notices, see the movie The Mustache).  At some level they might be aware that something is different about you, but they quite frequently won’t be able to say what it is.  It’s the same with your changes following braces and jaw surgery.  I found that with the exception of those closest to me in my life, the world didn’t seem to notice, at least overtly, and if they did notice a change, they didn’t know what it was.

What I think is true is that having straight teeth and a more balanced look is something that people unconsciously respond to, and in a positive way.  If you think of comparing two people, one badly dressed and not well kempt, and the other well dressed and well groomed, you tend to have a more positive reaction towards the latter, though you might not even realize it.  It’s the same with surgery and the resultant changes.  People often respond to things about you about which they themselves aren’t even aware.

So, yes, people will notice, but – and I know this sounds contradictory – they’ll very probably not realize it.

What is Orthognathic Surgery?

When uneven jaw growth occurs, or when injury or birth defects affect jaw alignment, the dental-facial relationship can become imbalanced.  Jaw misalignment can affect chewing, speech, breathing, appearance, and long-term health.  In these cases orthognathic surgery may be required to reposition the jaws.  An Oral and Maxillofacial Surgeon is the specialist best trained to perform these types of procedures.

Orthognathic surgery involves surgical manipulation of  elements of the facial skeleton – upper jaw, lower jaw, nose, cheekbones, chin, and orbital sockets of the eyes – to restore proper anatomic and functional relationships in patients with skeletal anomalies. 

While appearance may be dramatically improved, orthognathic surgery is usually performed to correct functional problems. 

Conditions that might indicate the need for surgery

Specific conditions which indicate that surgery might be necessary include: 

  • crooked, misaligned teeth
  • excessive tooth wear
  • a facial appearance which is not balanced, whether from the front or the side
  • difficulty biting food or chewing
  • receding chin
  • a protruding  jaw
  • sleep apnea
  • excessive showing of gums when smiling
  • excessive mouth breathing
  • jaw or jaw joint paint
  • lips do not meet without effort
  • injury to the face
  • birth defect

Although braces alone can correct certain bite problems, orthognathic jaw surgery may be necessary in conjunction with braces to correct jaw misalignment so that the braces may be effective.  Braces can only move the teeth so far, and if the mechanics are wrong, correction with braces may not be permanent.

Planning for surgery

For patients considering orthognathic surgery, the surgeon uses computer imaging technology and three-dimensional models to illustrate exactly how the jaws will be repositioned.  Comprehensive digital facial and oral photographs, digital X-rays and computer imaging are used to simulate the treatment plan, how the teeth will fit together (occlusion) and general appearance.  This helps the patient understand the surgical process and the anticipated outcome. 

Once the treatment plan is approved, surgical splints are custom-fabricated to ensure a highly predictable result, guiding the surgeon in the operating room.

Treatment will often include a period where braces are placed on the teeth prior to surgery.  This is done to move teeth into position so that they will fit together correctly after surgery. 

Incisions are usually made inside the mouth to reduce scarring.  Depending on the patient’s needs, jaws or other facial bones will be repositioned and stabilized using surgical plates, screws, wires, and rubber bands.   These hold jaws in their new position following surgery.

Braces may remain on the teeth for a period after surgery to ensure stability as the bone heals.

Following surgery

Following surgery, the patient often must eat a modified diet, which can include soft-foods and liquids.  The surgeon provides patients with diet instructions as well as a plan to transition to a normal diet.  Patients must also refrain from smoking and strenuous physical activity.  The patient can usually return to work or school within two to three weeks.  Initial healing takes about six weeks, but complete healing takes between six and twelve months.

The positive impact of surgery

Orthognathic surgery can have a positive and dramatic impact on a person’s quality of life.  Although the goal is to improve function and health, it is not uncommon for patients to experience a more balanced appearance and improved speech.  What could be more satisfying than to do something that improves your health while making you look even better?