Dentistry/Possibility of a Reverse SARPE?
QUESTION: Hello Dr. Teig,
I had SARPE done over two years, during my sophomore year of college when I was 19 years old, to fix a one centimeter difference between my maxilla and mandible.
The SARPE was definitely the right move( it will be explained later why). Since when I first got braces, during my senior year of high school, my orthodontist kept saying that I did not need surgery. However, when I smiled, it looked literally grotesque. When I finally convinced him and my mom, and had my surgery, the control was finally in my hands and I let it get to my head.
After constantly hearing my orthodontist tell me that I did not need to have SARPE, I perversed it into thinking that he would barely expand the maxilla, and so I got paranoid. I expanded at least an additional 3-4mm on each side (for a total of probably 18mm instead of the 10mm that was required), afraid that if I went in too early, he would take it off before I was happy.
I now know, and knew pretty much right after I made this extremely horrible, horrible mistake two years ago, that my orthodontist was only looking out for my best interests. A surgery that could have been a lifesaver (I was depressed and contemplating drastic measures about my life), ended up putting me in a worst position now, still leaving me considering those same drastic measures.
I say that it was the right move to have this SARPE. When I went to see my OMFS prior to getting my expander off, he told me enough expanding because it was perfect. And it was, I took a smile picture that day, and even with the huge gap between my teeth, I was unbelievably surprised at how incredible and truly perfect my smile was. But for some stupid reason that I believe I will regret for the rest of my life, I kept expanding, knowing that the next time I visited my orthodontist would be the day my expander came out. So even after my expander had been expanded perfectly, I continued expanding, and it has made me even more depressed since before the surgery.
I have told parts of this story, particularly my depression and my belief that I expanded too much to them, but they deny it. (They have every right to, because even when I tell them it is not their fault, they think there is some way they will be liable and get sued... although I would never do such a thing) I got a second opinion from another OMFS, but his goal was to move the lower jaw forward (because I do have an overjet of at least 4-5mm). However, when the jaw is moved forward, my smile looks even worse.
I told this surgeon how I wanted to do a reverse SARPE where I shrunk my maxilla transversely and he said there was no way to do it. It has never been done.
I cannot stress, even though it may not come through in this post, however horrible I feel about my life. I had the perfect smile (even though it lasted for a day), something that I have wanted all my life, and I do not know what to do. I know the right thing for me is to reverse the SARPE, some how.
I understand the ramifications of this. I am not saying to remove a part of my middle jaw through surgery, or something ridiculous like that, and then reconnect the maxilla. What I told the second surgeon and I am asking you now is, the same way the teeth can be molded in the maxilla, why can't the maxilla itself be molded.
What I mean to say is, wrap something around my upper maxilla, above the teeth, that is perhaps 1mm less in width than the size of my upper jaw. After two-three months, repeat the process again, while insuring that the braces stay in so my teeth don't change position, and leaving this "device" in for enough time before creating a narrower device so that the bone in the middle of my maxilla has time to resorb.
I write this incredibly long post not for sympathy, but because I am running out of time. That sounds so ironic because it has to do with the fact that the next time I see my orthodontist, my braces are coming out. I have never reached out for help, but if something is not done, I will never be able to get over this, and my life will be finally ruined.
I am so desperate that as of now, I squeeze my upper maxilla everyday with a vice (of course with a ton of padding) and I do feel the central pain in the middle of my maxilla. This has worked very minimally, but I feel it does add some truth to my desired method of attempting this feat. I know I sound like a lunatic when I say the latter, trust me when I say I am perfectly sane. This is just the state of desperation I am in.
If there is a way to widen the maxilla, how can there not be a way to do the opposite. The body is very reactive, and we as humans have alway been able to find a way to take advantage of that reaction. When there is a need, we have found it. In this case, I am probably the only isoalted incident because I am so stupid, so the need has never been addressed. But more than ever, I really NEED some solution.
Thanks for the help Dr.Teig.
P.S. Please do not take the desperateness of the situation and let it affect your answer (and I doubt it ever would). Is such a method truly possible? Is there really a way for me to still salvage my life? I have spent the last 5 years of my life being completely introverted, and I have still gotten into a professional school, scoring 99% on the entrance exam. I want to make a difference, but I just don't know how to with this constant obsession.
ANSWER: Bob - A reversal of the widened maxilla can definitely be done, but only surgically. The procedure is a LeFort I osteotomy. The maxilla is completely separated from above and then it is sectioned after removing some bone in the middle of the upper jaw.
There are skilled surgeons throughout the country who can handle this procedure, but no surgery should be attempted unless your psychological problems, initiated from the original procedure, is addressed. So as tough as this sounds, see a psychologist or psychotherapist to help treat this overbearing and controlling psychological situation.
Have yourself treated and then get back to me and I will be happy to refer you to an appropriate surgeon.
---------- FOLLOW-UP ----------
QUESTION: Hello Dr. Teig,
Thanks for the quick response! I am very sorry for all the emotion I put into that email, and after reading it over, I realize it was a bit too much. I was in just one of "those moods," and I am sorry that it put you in an awkward position. Also, I will certainly take your advice about seeing a psychologist,
However, I do have a few follow up questions.
If such a surgery is possible, I find it odd that my surgeon, orthodontist, and the surgeon I received a second opinion from did not tell me about it. I know that with regards to my "psychological state," it makes sense for my orthodontist and SARPE surgeon to have not told me. The surgeon I received a second opinion from, however, did not know of my "state" and while of course you cannot know what he is thinking, I was wondering if you could tell me a couple of reasons why you would hide such a procedure from a patient?
And with regards to my original ludicrous proposal about putting a device on my upper maxilla and narrowing the device every 3-4 months, what are the exact biological consequences of doing so? I understand the bone is fused and has growned into the gap since, and that is of course the primary reason why it would not occur? But then, what would happen to the maxilla if such a device were put in. Would the central incisors just fall out because the pressure would be concentrated there, would bone give away to pressure overtime and just resorb, or would the maxilla just stay put and never move, even if the pressure was constant and unwavering?
Finally, all the gaps between my teeth are closed. How would that affect the surgery, if it were to occur? What would be the exact ramifications on my teeth, jaw, time I would continue to have braces for, and recovery? If the upper jaw were narrowed through such a surgery, and the gaps are closed, then where would the central incisors go as there is no gap and the jaw would be narrowed?
Once again Dr. Teig,
I really appreciate al the time you are taking to answer these questions!
All the best,
Bob - Honestly, the surgery can correct the width of the maxilla, but to regain good dental relationship of the upper to lower jaw, orthodontic treatment will be necessary in preparation for surgery and afterwards to hone in the final result.
Any device that is now attempted to constrict the maxilla on its own will just not work. The teeth will suffer and the bone can develop micro fractures - so it is not the appropriate method.
Address the changes as I stated earlier and then surgery can be considered.