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Got referred for SARPE & Lefort 1 - insight needed
So, I went in to my dentist complaining of tooth wear. They diagnosed me with bruxism but in hindsight, it's probably due to a combo of me biting my fingernails along with a malocclusion. He sent me back to my childhood ortho who then sent me to an orthognathic surgeon who wants me to get a surgically assisted rapid palatal expansion and either a lefort 1 or tooth extractions on the bottom. It seems like a lot of people on here want a lefort 1 just for appearance purposes?
My maxilla is narrower than my mandible and my lower front teeth were tipped to get them underneath my front teeth, but due to not wearing a retainer and time I've relapsed a bit. I have teeth that are worn down from where they're contacting the lower teeth. I'm not really looking to do all of this because of any issues with my face (I'm not a model, but I get by) but I just want to correct my bite. Is looking at these two surgeries insane? I found this forum while looking into alternatives. I live in a pretty remote area of New York so I'm not sure there's a whole lot of alternative orthodontics around here. I'm 29 so my sutures are definitely closed. I attached some photos of my bite. Thanks in advance.
I don't need surgical extractions, they just discussed either a regular tooth extraction because my lower jaw is still large in comparison to my upper jaw, OR having the lefort 1 instead of the extraction. I don't have bruxism. I don't grind my teeth at all. I've had sleep studies and my partner is a doctor and she's never heard me grind my teeth in over a year of living together.
Lefort is a very extreme procedure considering the lacking severity of your problems. Of the options you have listed, SARPE is the most benign procedure. There are even less invasive solutions available, such as mini-screw assisted rapid palatal expansion (MARPE) and maxillary skeletal expander (MSE), which is a newer type of MARPE. Bone-anchored expanders are able to split the mid-palatal suture in most adult patients, especially when combined with cortical puncturing. Ronald Ead has documented his own journey with the MSE in his blog: https://ronaldead.com/blog/my-custom-maxillary-skeletal-expander-mse
Not sure what type of sleep studies you’ve had. Here’s the deal...your teeth look like this: https://m.youtube.com/watch?v=I46wahn6K8s (this patient’s teeth look worse...but you will see what I mean). Ask Dr. Mahony for any info and he will reply.
FYI - I’d consider Vivos or Dr. Sue Lee over surgery. But I still wonder if you are clenching forward. Check out that video. A sleep test may look okay if you are adjusting the same way as the vid. There may not be a grinding sound. Hard to say.
Thanks for the replies guys. I have some additional information I forgot to mention and some new insights. My orthodontist also referred me to an ENT who wants to do a septoplasty and turbinate reduction following an exam and a 3d CT scan. I hadn’t seen my ortho since I was a teenager but he always commented on how I was a mouth breather and had me get my tonsils extracted back then to try to address it. So while I don’t have sleep apnea, I do have impaired nasal breathing. Perhaps it’s worsened since I last had a sleep study done, not sure. I also thought the lefort1 was extreme but when I searched around on here people seemed to be pining after getting one so I wasn’t sure. It’s financially realistic for me to get both surgeries and orthodontic treatment, but obviously no one wants to get (or pay) for surgery. I scheduled another consult with my ortho to discuss something like the MSE which is something I came across while researching, I may have to shop around because I showed the MSE to the surgeon and his attending at my consult and they just were like “oh yeah that’s basically a SARPE, that’s what I want to do for you.” I definitely don’t have (sleep) bruxism -kinda gross, but realized that I chew on my fingernails after I bite them and then constantly grind them together. So now I see where the grinding was coming from at least and imo it is easier to manage than it was trying to wear a mouth guard at night when I don’t nasal breath well to begin with.
“oh yeah that’s basically a SARPE, that’s what I want to do for you.” NO, it's not basically SARPE. He justs wants to make money with you, avoid this guy at all costs