Oral Surgery/RE: Bite registration pre-surgery
QUESTION: Dear Dr. Parsa,
I just got your response to my question as a patient. For ease of reference I am copying below the question and your answer:
Your question was: I am a candidate for oral surgery. I am curious to find out what is the importance of the pre-surgical bite registration and how this will be used in making the surgical splint and surgical planning via computer modeling. It seems that I have a dual bite and I would like to understand more about this and how this dual bite (choosing one type of bite over the another type of bite) will affect the mock surgery, surgical planning and surgical splint. What does the bite registration produce or how is it important in ultimately helping a surgeon with the surgery. What is the role of the orthodontist in this pre-surgical phase of taking the proper bite registration. Thank you in advance for your kindness. Aura Daraba
Answer: Sorry, but I don't answer homework questions.
Expert: Dr. Reza Parsa DDS, MSc.
Should I appreciate this kind of humor? I did not ask you to make my "homework" but to help me understand, as a patient, what is the best for me before I get into a complicated surgery. For your information, I am a Food safety specialist, holding a Ph.D. You can find me using Google and you will be very amazed to see that you do not make my "homework". However, arrogance does not suit someone who has education. Best, Dr. Aura Daraba
It was certainly not my intention of insulting you,
We have just had in the past students who has miss-uses this forum for doing their homeworks and the nature of your question was very much like that.
I strongly feel that you should consult your surgeon once again prior to the surgery as you apparently have many important questions that has not been answered.
It's very hard for me to answere your question as you have not mentioned what kind of surgery?! I presume it is and orthognatic surgery ( moving of jaws) ?
Any how planing is the most important part of surgery and in this case bite registration is part of that. Prior to the surgery, your orthodontist or surgeon take impressions and bite registration so that they can make study models which they will use in the joint conference in regards to the planning of your case. The bite registration will demonstrate how you bite currently on which then the surgeon knows what changes would be appropriate. Once the surgeon decides on how to change the bite, he/she will implement that on the study models and make a new bite registration which we call wafare. During the surgery once the jaws has been cut loose, we then use the wafer to instruct us to the planned bite/ ocklusion prior to fixation of the jaws with plates.
As you appreciate, this is a complex chapter that your surgeon can explain more in depth.
I hope this will help,
---------- FOLLOW-UP ----------
QUESTION: Dear Reza,
Thank you very much for your answer. Now I feel more informed about things should happen correctly. I asked this question to you because I am in a difficult situation: I had 6 months ago double jaw surgery. The surgeon is wonderful but unfortunately the hospital where I had the surgery did not allow me to have the pre-surgical preparation/planning done by my treating orthodontist; instead the hospital imposed on me their own orthodontist to perform all these steps. When the hospital's orthodontist took the bite registration, he pushed my mandible to the left, which is not my natural posture and way to bite/chew. I told to the orthodontist that this is not my bite but he went ahead taking this type of bite registration. I demonstrated him how I naturally open/close my mandible in relationship with the maxilla; the hospital's orthodontist said then that I have a dual bite...Never, in no instance no doctor (dentist, treating orthodontist, oral surgeon etc) told me that I have this condition "dual bite". Prior to this occurrence, all the dentists who took my bite registration never forced my mandible to the left (to artificially match the position of the maxilla) but they followed the natural closing "trajectory" of the maxilla to record my bite. I have to tell you that I have a congenital hemifacial hypoplasia. To make a long story short: after surgery I acquired pain in my left TMJ, whether I chew or not, pain that irradiate into my inner ear. Also, obviously, the mandible is keeping its straight position and as a result, do not match at all with the maxilla position: a cross-bite on right and an open bite on left side. In few days I am travelling to see the surgeon for post-op visit. I have been seen by my treating orthodontist who just took photos and x-rays of the teeth and jaws position (as described to you previously). The position of the left condyle is modified post-surgery and appears to be more upward , almost touching the bone of the condylar fossa. That would explain my pain in TMJ, that I never had. Also, I suspect that, the forcing to the left of my mandible, for taking the pre-surgical bite registration led to this results and led to the changing of my original surgical plan discussed with my treating orthodontist: one piece Le fort I instead of 3 -piece segmental Le Fort I. I spoke over the telephone with the hospital's orthodontist about this problem that occurred do to his style of taking my bite registration but he is not receptive to my concerns. In his view he did everything alright. I hope you understand my pain and worries and this is why I asked you the initial question. For me , as a non-dentist, facts are clear: the mistake in planing the surgery started with the wrong bite registration but I needed a specialist opinion. I need to be prepared, and as you mentioned "to make my homework" before having a discussion with the hospital's orthodontist. Thank you for your kindness and rest assured I like good humor. Maybe there is a chance to respond me directly using my email address: ? I would love to have my question and your extended answer (excluding our little misunderstanding), which makes a lot of sense to me, to show it to the hospital's orthodontist so that our discussion will not deviate from the facts. Best regards, Aura
P.S: Is there a way to keep this question private?
Yes I do agree that this is quite complex and need good planning,
In my country, we are not as Maxillofacial surgeons use to allow other professions to do the planning for us. All planing to do with surgery is done by ourselves. I know the fact that in many places this is done by the orthodontist which I don't say is not good but not my "cup of tea".
The best thing you can do at this stage is to see your surgeon and raise your concerns.
In hemifacial hypoplasy cases it's not always obvious to do a 3 segmental Lefort 1 osteotomy as we have to take the palate soft tissue into consideration etc...
I am not sure if your questions can be kept privately as they do get published at this forum,
I sincerely wish you good luck and hope that things will get or feel better after you seeing your Maxillofacial surgeon,