Orthodontics - Orthognathic surgery

Orthodontics - Orthognathic surgery > My story

My story

I have decided to share with you details about my dental treatments, and more particularly, the orthognathic surgery that I underwent in March 2008. Being an insecure person, I would have liked to find a website on which people could have told me more about their experience following a similar surgery.


Sequence of events of my dental treatments
Diagnosis on my dental problems
Technical details about my orthognathic surgery
Retrospective on my dental treatments
Unveiling of my emails

Sequence of events of my dental treatments

Sequence of events of my dental treatments
Date Part of treatment Description
November 2005 Consultations with orthodontists I went to see several orthodontists to get an idea of what were the treatments I had to go through to enhance my facial appearance. All of them told me the same thing: from 12 to 18 months with braces, an orthognathic surgery to reposition my jaws (something that could not be done with orthodontics) and from 6 to 12 months with braces after my surgery to fine tune the alignment of my teeth. The total timeframe for my treatments was estimated to a period varying between 24 and 30 months.
January 24, 2006 Consultation with the surgeon I first met with my surgeon so he could explain to me what he had to do to fix the oral problems that orthodontics could not fix.
October 20, 2006 Beginning of orthodontic treatments (installation of upper braces) I started my orthodontic treatments. It took me almost a year before I made up my mind because I wanted to make sure that I wanted to go through all that needed to be done. Looking back at this experience today, I wouldn't have waited so long if I had known what the results would be! As I liked to say, the caterpillar locked itself up in a cocoon when my braces were installed waiting to come out as a butterfly with the removal of my braces!
December 13, 2007 Wisdom teeth removal My wisdom teeth were removed in preparation to my orthognathic surgery. It took me by surprise to learn that I had to have my wisdom teeth removed because the orthodontist had told me that I had enough space in my mouth for all my teeth! However, my wisdom teeth would have been an obstacle for my surgeon during the orthognathic surgery... Note: The removal of my wisdom teeth was for me the hardest part of this whole experience! I feared less going through the surgery than having 4 teeth removed! But I must say that after having my teeth removed, it wasn't as bad as I had expected...
March 17, 2008 First orthognathic surgery 17 months after my braces were installed, I went through the surgery. I will let you discover by yourselves what happened to me with technical details about my surgery and with specific emails.
February 10, 2009 Removal of braces The day when my braces were removed! Finally! I had them for almost 28 months in all.
June 17, 2009 Crown lengthening The crown (visible part) of my upper (maxillary) right lateral incisor was too short compared to the other teeth. I went to see a periodontist so he could perform a gingivoplasty, that is lengthening this crown by removing a little bit of gum tissue above the tooth to optimize the esthetics of my upper teeth. It was a minor surgical procedure performed within a few minutes. However, I had to undergo the procedure again during my follow-up appointment with the periodontist a few days later, because the gum had dropped again on the tooth. Note: This step of the dental treatments was purely esthetic and I could have decided not to do it.
October 20, 2009 Teeth whitening Because I wanted to have a smile as perfect as possible, I decided to whiten my teeth and this whitening started at my dentist's clinic exactly 3 years after my first braces were installed! My dentist made whitening gutters adjusted to my teeth to optimize the whitening. These gutters were very comfortable to wear day and night. However, I had to leave them in the mouth with the whitening product a few hours per day, which was a little limiting to me, because I could not eat or drink while I was wearing them. The final result was worth the efforts, although my teeth took a little more than two months to whiten to my satisfaction! I must say that my teeth were not very stained at the beginning, because I don't smoke and I don't drink coffee. Note: This step of the dental treatments was purely esthetic and I could have decided not to do it.
January 29, 2010 Harmonization of my upper (maxillary) central incisors Again because I wanted to have a smile as perfect as possible, after my whitening and after letting the color of my teeth stabilize, I decided along with my dentist to harmonize the shape of both my upper (maxillary) central incisors. A little piece was already missing from one of them and when my dentist fixed the crown with the same material as the one used for fillings, we noticed that the other incisor had a round shape, which was very ugly beside the other tooth that now had a normal square shape. My smile is now as perfect as it can be! Note: This step of the dental treatments was purely esthetic and I could have decided not to do it.

I remember my first appointment with my orthodontist; when she told me that I had to go through an orthognathic surgery, I wanted to run away from her clinic and never come back! Can you imagine how I felt when I first met with my surgeon a few weeks later? I wanted to faint right there, and he had not started giving me details! I had searched the web for this kind of surgery after my appointment with the orthodontist and I must admit that it had scared me a lot. Looking back at the whole experience, I realize today the importance of trusting the dental health professionals who have followed me through it all.

The goal of this part of my website is to share my personal experience. I don't hold the truth and other people might end up living a totally different experience from mine by undergoing the same kind of dental treatments and surgery. One thing is for sure, I've been really honest with my feelings.

Diagnosis on my dental problems

Following my consultation appointment with my orthodontist and my surgeon, the problems listed below were detected. Some expressions can seem impressive; this is why I added a few definitions easier to understand.

Diagnosis on my dental problems
Type Name Description
Skeletal Maxillary constriction My upper jaw was narrower than normal. It is thus not surprising that my upper teeth were crowded and that my upper canines did not have enough space to come down to their position on the dental arch (see below).
Skeletal Maxillary vertical hyperplasia This problem is sometimes designated as extrusion of premaxilla, the premaxilla being the part of the upper jaw which spans from canine to canine. This part of my upper jaw was too far down compared to its normal position. This resulted in showing an important quantity of gum when I smiled (gingival smile), 10 mm in height to be exact.
Skeletal Mandibular retrognathia This problem can also be called mandibular anteroposterior hypoplasia or mandibular retrusion. My lower jaw was too far back compared to the upper jaw, which was demonstrated by an overjet of 8.5 mm.
Dental Canine and molar Class II relationship My lower teeth were too far back compared to the upper teeth. This problem is directly related to the mandibular retrognathia skeletal problem (see above).
Dental Crowding of anterior teeth My upper and lower front teeth were almost all crowded, making my smile far from optimal with all these crooked teeth.
Dental Maxillary canine ectopia Both my upper canines were not in the right position, but above all other upper teeth instead.
Physiological Severe lip incompetence I was unable to maintain my lips together without contracting my mentalis (chin muscle), meaning that my chin had to force a lot to be able to close my lips completely. Thus, my lips did not touch at all, because there was a 14-mm interlabial gap (space between lips) at rest. In detail, we could see the whole length of my central incisors as well as 1 mm of gum at rest, which is abnormal; it is normal to see from 3 to 5 mm of incisor length with the upper lip at rest. My problem was worse by the fact that the length of my upper lip (from underneath the nose) is 16 mm while the average length is between 20 and 22 mm instead. Therefore, I have an upper lip that is 4 mm shorter (or rather higher) than average, thus worsening my lip incompetence.
Physiological Disproportionate face height The lower third of my face (from the base of the nose to the chin) was longer than average.
Physiological Convex profile My profile that was qualified as being "convex" was caused by my lower jaw and my chin being too far back compared to the upper part of my face. The convex profile is more of a consequence of the class II relationship rather than a separate problem.

Technical details about my orthognathic surgery

The following surgical procedures were performed throughout my appointments with my surgeon to reposition several bones of my face. I don't provide below the technical details of each surgical procedure; I rather give the results of these procedures that can be viewed in my mouth and on my face.

Technical details about my orthognathic surgery
Part Technical term Description
(Before the
Wisdom teeth removal To allow the surgeon to have more space to perform the sagittal split osteotomy described below. The removal of my wisdom teeth was performed 3 months prior to my first surgery. Note: For most people, this has to be done at least 6 months prior to the orthognathic surgery to make sure that the jaws have time to heal completely.
Le Fort I osteotomy

To move the upper jaw (maxilla) upward by 6 mm and at the same time, my upper teeth. This part of the surgery resulted in the reduction of the amount of gum shown when I smile.

Here is a short animation simply showing the surgical procedure.
Mandibular bilateral sagittal split osteotomy (MBSSO)

To move the lower jaw (mandible) forward by 7 mm so I can finally close my mouth without effort.

Here is a short animation simply showing the surgical procedure.

To move the chin bone forward by 6 mm. In reality, my chin bone was so far back that it almost gave the impression that my chin didn't exist!

Here is a short animation simply showing the surgical procedure.
Turbinectomy Inferior turbinates removal to ensure an adequate air flow (breathing).
Redo of the sagittal fixation 4 weeks after my first surgery, my surgeon had to operate on me again to redo the sagittal fixation because my lower jaw was still too far back. Note: It was necessary to redo the sagittal fixation to correct an inadequate alignment of my upper and lower jaws. It's a rare complication, but it can happen. My surgeon had told me about this before he operated on me; I was already a severe case, it seems like I was a rare and severe case!

Retrospective on my dental treatments

If I had to do it all over again, I would do it without hesitation. I keep very good memories of this experience despite all that has happened and I'm really happy to have gone through it all. The benefits from my dental treatments exceed widely their disadvantages, as they are described below.

Retrospective on my dental treatments
Benefit / Disadvantage Type Description
Benefit Physical

My facial appearance was extremely improved because of my dental treatments. One simply needs to see before/after pictures of me to notice it!

Since my teeth are straightened and my jaws are aligned, I noticed that it's easier for me to pronounce the "th" in English.

Since my surgeries, I breathe a lot better through the nose. In effect, the quality of the air flow was improved during my first surgery with the repositioning of my maxilla and the removal of my inferior turbinates.

Four years after my surgeries, I'm still amazed by my jaws when I crunch or bite into various foods, such as a hamburger or salad. The efficiency of my chewing is 10 times better than it was before my dental treatments.
Benefit Psychological

I have gained more self-esteem than I could have ever imagined before. I no longer fear taking my place in the world and I don't care as much about the other people's opinion about my actions and my decisions anymore.

Furthermore, I have gone through major psychological changes throughout my dental treatments. Being able to sit back and think during my recovery helped me a great deal. My loved ones have seen that I'm more mature now than I was before and I strongly believe that all this is due to that thinking period I was fortunate enough to have.
Disadvantage Physical Four years after my surgeries, I haven't gotten back 100% of my chin sensibility. I feel liquids and food go down my chin and I feel when something (a utensil, a finger, etc.) touches my chin. However, it still gives me the light numbness sensation that we feel during appointments to the dentist's office involving a kind of local anesthesia. I think that there is still improvement regarding the sensibility, so I don't lose faith in getting my whole sensibility back one day.
Disadvantage Physical My mentalis (chin muscle) contracts a little bit when I close my lips together. As it was mentioned above, my upper lip is 4 mm shorter than average. It is thus not surprising that my lower lip has to go up higher so I can close my mouth completely. With time, my upper lip will come down with gravity, so by aging, my mentalis will contract less.

Unveiling of my emails

When I was recuperating from the surgery at home, I was sending emails to my loved ones regularly to tell them how I was feeling, how I was living this whole experience. These emails are revealed to you today, I hope, to help others in making that difficult choice to go through such a surgery. These emails were slightly altered to add more information that I had forgotten and that I wanted to share with you. I have also included other texts that I had not sent to my loved ones and which describe other important milestones of my dental treatments.

I hope that I can convince other people that will read the following to jump right in and dive into a similar adventure.

Read the first email


I would like to thank my friends and family for their support throughout my orthodontic treatments and my whole experience around my orthognathic surgeries. Without them, my spirits would have been very different!

I would also like to take the time to thank my surgeon, Dr D, and my orthodontist, Dre N, as well as their staff for the good care they have given me. They know how grateful I am and I lived this whole adventure a better way because I knew I was in very good hands. I wish that all health professionals were as good and human as them. You have given me a new life and I will be forever grateful to you. The ugly duckling that I was before was able to turn into a beautiful swan because of you! I cannot thank you enough!


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