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March 15, 2004

Hi everyone -

About ten months ago I went through the BSSO procedure. My braces

were removed three months later. All of my TMJD symptoms disappeared

after the surgery, but they started to come back after the braces

were removed and I started wearing retainers at night. My bite was

much improved, but not perfect - for the most part, my molars still

don't mesh together very well. The ortho tells me that they'll

eventually " float " up into alignment with the rest of my teeth. I

clench my teeth at night and had to have two different kinds of

retainers made before I could find retainers that didn't seriously

aggravate my TMJ. I currently wear a True-Tain retainer on my upper

front six teeth and an old-style wrap around retainer on my lower

teeth.

With the history out of the way, here's the current problem: in the

past couple of weeks I've noticed that my lower jaw has slid back a

couple of millimeters and it's also rotated to the side about one

millimeter. It doesn't sound like much, but the perfect alignment of

my jaws that I had after surgery is gone and my bite is almost as bad

as it was before I got the braces. One of the first treatments I

tried for TMJD was to wear an appliance that kept the joint from

closing fully in an effort to " de-program " it and release the stress

in the joint. It reduced the pain, but it significantly changed by

bite by allowing my lower jaw to " slide " backwards. I'm wondering

now if the retainers, which also keep the joint from closing fully,

have somehow screwed up my jaw.

I've made an appointment with my surgeon to talk to him about it, but

I was wondering if anyone has had experience with something like

this. Anyone who's undergone orthognathic surgery and braces knows

what a long process it is, and I'm barely fighting off

discouragement. I started treatment for TMJD seven years ago, and

saw seven or eight different orthodontists, dentists, and surgeons

before finally hitting on the solution that made the most sense - the

surgery. It seemed like everything was finally fixed for the most

part, but now I feel like I'm back to square one.

Any thoughts, information, and/or encouragement sent my way would be

much appreciated.

Vicki

March 15, 2004

Hi Vicki,

I too have battled TMJD for a long time. For most people,

orthognathic surgery makes their TMJ symptoms better but for 5-10%

it gets worse. We were hoping that correcting my huge overbite would

relieve the stress on the TMJs and keep the arthritis from

progressing. Instead it got worse and within 6 months of my

orthognathic surgery, I had an 8 mm overbite and open bite again.

There was a lot of bone loss in the joints and the condyles were

pretty much gone. This caused my lower jaw to slide back. I ended up

going through two surgeries on my joints. The first was a temporalis

muscle graft into the joints to replace the cartilage and the second

was to rebuild the condyles using distraction. So far things are

going well and I'll have my final surgery in a few weeks to remove

the distractors and " mold " the jaw into the right position.

I wouldn't know if it was the retainers that caused your problems

but like you have previously had, splints are often used to relieve

stress on the joints. I hope your surgeon and ortho can fix your

bite without surgery. Surgery on the joints themselves is usually a

last resort when all other options have failed. Fortunately there

are a lot of treatments for TMJ that don't involve surgery.

Keep us updated on your progress. Hang in there and try not to get

too discouraged. We'll be here to help you out in anyway we can.

> Hi everyone -

>

> About ten months ago I went through the BSSO procedure. My braces

> were removed three months later. All of my TMJD symptoms

disappeared

> after the surgery, but they started to come back after the braces

> were removed and I started wearing retainers at night. My bite

was

> much improved, but not perfect - for the most part, my molars

still

> don't mesh together very well. The ortho tells me that they'll

> eventually " float " up into alignment with the rest of my teeth. I

> clench my teeth at night and had to have two different kinds of

> retainers made before I could find retainers that didn't seriously

> aggravate my TMJ. I currently wear a True-Tain retainer on my

upper

> front six teeth and an old-style wrap around retainer on my lower

> teeth.

>

> With the history out of the way, here's the current problem: in

the

> past couple of weeks I've noticed that my lower jaw has slid back

a

> couple of millimeters and it's also rotated to the side about one

> millimeter. It doesn't sound like much, but the perfect alignment

of

> my jaws that I had after surgery is gone and my bite is almost as

bad

> as it was before I got the braces. One of the first treatments I

> tried for TMJD was to wear an appliance that kept the joint from

> closing fully in an effort to " de-program " it and release the

stress

> in the joint. It reduced the pain, but it significantly changed

by

> bite by allowing my lower jaw to " slide " backwards. I'm wondering

> now if the retainers, which also keep the joint from closing

fully,

> have somehow screwed up my jaw.

>

> I've made an appointment with my surgeon to talk to him about it,

but

> I was wondering if anyone has had experience with something like

> this. Anyone who's undergone orthognathic surgery and braces

knows

> what a long process it is, and I'm barely fighting off

> discouragement. I started treatment for TMJD seven years ago, and

> saw seven or eight different orthodontists, dentists, and surgeons

> before finally hitting on the solution that made the most sense -

the

> surgery. It seemed like everything was finally fixed for the most

> part, but now I feel like I'm back to square one.

>

> Any thoughts, information, and/or encouragement sent my way would

be

> much appreciated.

>

> Vicki

March 15, 2004