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Jaw Surgery and Dental Implants in Singapore Blog

Dental implants in an underbite patient

underbite_2Rising affluence and awareness among patients in Singapore have led to an increase in demand for specialist procedures such as orthognathic surgery. Underbite deformity, where the lower jaw is disproportionately longer than the upper jaw is possibly the most corrected dentofacial deformity in Singapore today. However, not so a generation ago. Baby boomers, or in the Singapore context, the Merdeka Generation, often did not have the benefit of such services when they were young and many have uncorrected underbite. With advancing age and a lack of proper care in their younger days, total or partial loss of dentition is common. Many seek to replace their missing or decayed teeth with dental implants. In replacing teeth in a patient with an underbite, do we set the teeth in the original cross bite position or do we aim to reconstruct the dentition into an ideal Class I bite?

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Camouflaging an underbite with veneers instead of orthognathic surgery

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Skeletal Class III dentofacial deformity, commonly referred to as underbite, is fairly common in Singapore. Those seeking treatment are usually teenagers or young adults, and are still dependent on their parents for consent as well as finances. While some parents are supportive, others are dead set against the idea of surgery. Those who are against surgery may look for less invasive alternatives to mask the underbite. Such masking can be done by camouflage orthodontics or in some cases, veneers and crowns. Such compromised treatment is not ideal and may lead to other problems.

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Who calls the shots in orthognathic surgery- orthodontist or surgeon?

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Many conditions require multi-disciplinary management. For example, ischemic heart disease may require the expertise of the cardiologist and the cardiothoracic surgeon. In the same, way, dentofacial deformities require the expertise of the orthodontist and the maxillofacial surgeon. The best outcome is achieved when surgical and non-surgical options are considered, balancing the treatment objectives and the risks involved. However, very often, the treatment plan depends on who is primarily in charge of the treatment planning.

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Is undergoing corrective jaw surgery worth it?

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Dentofacial deformities are common in Singapore. In fact, there is not a single day that I can walk around Singapore without seeing someone in the streets who has a face that can be improved aesthetically with corrective jaw surgery. Some people are not bothered by their deformities and can live happily without seeking any kind of correction. To this group, the issue of whether corrective surgery is worthwhile is a non-starter. However, for a much larger group who are bothered, albeit to different degrees, about their dentofacial deformities, the question of whether to undergo surgery is often perplexing.

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Computerized simulation of underbite corrective surgery in Singapore

 

long_face.pngA 19 year old male Chinese patient was referred by his orthodontist for surgical correction of underbite deformity. It is commonly believed by most patients looking for underbite corrective surgery that their problem lies with the lower jaw being too long. However, it is rarely a problem of just the lower jaw. In most cases, it is also a case of the upper jaw being underdeveloped.

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Planning for corrective jaw surgery for underbite deformity

underbite_photo.pngUnderbite deformity in Singapore is the most commonly correct dentofacial deformity. With advances in understanding of the healing process and orthodontic movement of teeth, it is usually treated in a surgery-first approach today. This is in contrast with the old practice of going through a year or two of pre-surgical orthodontics to prepare the teeth for surgery. The use of CT scans and 3D modeling software enable both surgeon and patient to visualize the facial aesthetic treatment outcome that is desired. Let’s take a look at a typical case of surgical correction of an underbite deformity.

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“Descendants of the Sun” and Facial Feminization


bigstock-Closeup-Smiling-Young-Asian-W-84454724.jpgI learnt recently that I am from another planet. All because I thought “Descendants of the Sun” (DOTS) is a sequel to Bruce Willis’ “Tears of the Sun”. The revelation came when I was running a bone grafting course and teaching the participants how to draw blood to make platelet rich plasma. One of the participants joking said he wanted to draw his own blood just like a particular character did in “DOTS”. Until then, I have not heard of “DOTS. When I got home that night, I Googled “Descendants of the Sun”. I was glad that I was at least half right, that like “Tears of the Sun”, it was also about the military. However, what struck me was how feminine the male actors look, especially when compared to Bruce Willis.

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Corrective jaw surgery and facial feminization in Singapore


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Corrective jaw surgeryis a functional surgery that seeks to correct the bite disharmonies due to disproportionate growth of the jaws. This jaw bone disproportion can give a face a very aggressive or “man-ly” look. Some men may actually like that kind of look if their job requires them to look fierce-some, e.g. night club bouncers and security guards. However, it may be liability in some other occupation. For women, it is almost always never an asset to look masculine. Hence, there is facial feminization surgery, of which corrective jaw surgery can play a part in.

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Underbite – upper jaw surgery or lower jaw surgery or both?


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A protruding lower jaw is a fairly common facial deformity in Singapore. While it may not be the most common, it is one which for which surgical correction is most sought after. Underbite, as it is commonly called by many patients, poses significant functional challenges, depending on the degree of deformity. When the lower jaw grows disproportionately more than the upper jaw, the lower teeth are brought forward and causing an open bite. This disproportionate growth also cause the facial profile to resemble what some people call the “shoe horn”. Many patients coming for consultation usually assume that the problem can be solved by surgery to set the lower jaw back. However, in reality, most patients actually need something else.

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Are there alternatives to corrective jaw surgery ?

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About half the number of patients who see me for a consultation on corrective jaw surgery are not sure if they need surgery. For this group, the first question that they ask is whether I think they need surgery. The other half has already done their research, they may even have consulted some other surgeons, and they have a fairly good idea what they need and want. This latter group knows that corrective jaw surgery can help them achieve their aesthetic as well as functional goals. However, they also know that the surgery is no walk in the park and they are often looking for alternatives that are less invasive and has a lower morbidity and downtime.  What are the alternatives?

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