Surgery, here I come!

Yep, as I expected, surgery is indeed in my near future. I went in for the verdict today and Dr W pretty much confirmed what he had planned for me right from the beginning. Once he looked at my records it was very clear to him that class III elastics wouldn't be sufficient and that surgery is required. He began by showing me tracings from the ceph x-rays, one from pre-treatment in 2005 and the other from two weeks ago. He superimposed them to illustrate to me the changes that have taken place since 2005. I wish there was some way to show you all online, so instead I will give you his observational notes below.

Notes on the ceph from May 9, 2005 to August 12, 2007:

1. The maxilla has slightly tipped down and rotated counter-clockwise.
2. The maxillary teeth have extruded 2mm.
3. The mandible has been rocked 8mm down and 2mm backward because of the interference of the incisors.
4. There is no posterior occlusion at this time in centric relation.

Summary:

1. The maxilla is still behind the mandible in an Anterior Posterior position. The face is still concave. The photos confirm this with flatness under the eyes and the upper lip tipped backward.
2. The lower dental midline is 2mm to the left characteristic of a mandibular asymmetry.
3. The lower occlusal plane is not level on the left side: the 34 needs to be elevated and uprighted with the root moved more mesial.

Directions:

1. Surgical simulations point to maxillary advancement of 6-8mm as a very good solution.
2. Most likely the mandible will not have to be reduced in size surgically, however the surgeon will make this decision.
3. The 34 should be rebonded to correct the root tip and infra-eruption.
4. The 33 should be rebonded more mesially to correct the rotation.
5. Light Class II elastics can be started to procline the lower incisors.
6. The maxillary surgery can probably be scheduled for November or December 2007.

So, to put it simply I'll be having upper surgery and possibly lower. I forgot to ask about whether the upper will be segmental or not but I guess that's a better question for Dr T when I see him. Despite point #2 above, Dr W said he suspects the lower jaw is too long and that once my lower incisors are proclined to the proper angle this will be more apparent.

I'm going back on Wednesday to have the 2 lower brackets rebonded and the class II elastics put on. Just to clarify, as most of you know I have a class III jaw relation, but the class II elastics are used to procline the lower incisors. So my under bite is going to appear worse up until surgery. There might be a benefit to that however - it might mean my teeth will touch again before surgery. Oh to eat a veggie stir fry again!

As far as scheduling goes, I'm already on the surgeon's list for October. The question now is whether I will be ready by then since Dr W needs time for Wednesday's adjustments to take effect. We're really close to the wire (no pun intended!). :) Arlene wasn't sure what would happen if we had to push me into November, so we're going to talk about it more on Wednesday.

Overall I'm happy with the information I received today. Everything makes sense and I'm on my way to getting what I've wanted all along. Not exactly looking forward to recovery but I know this should be the one last big push I need to get through on my way to a killer smile!