Custom Jaw Angle Implants

Q: Dr. Eppley, I’m looking to obtain some information about posterior jaw or jaw angle implants. I had three surgeries approximately 20 years ago on my upper and lower jaw to correct the alignment and preserve my teeth.  After I healed from my last surgery I was to have jaw inlays placed however I did not opt for it at that time due to the need for external incisions. Attached you will find several photos from today and one from (many years ago) just prior to my maxillofacial surgery to give you an idea of how my face once looked. What is the approximate cost for the entire procedure?  I’m looking for an approximate amount for the entire process, from beginning to end.  Does having previous maxillofacial surgery have an impact on this procedure?

A: Undoubtably you have as one of your orthognathic surgery procedures sagittal split of the mandibular ramus (SSRO) osteotomies. In some cases this can cause some partial resorption of the jaw angle particularly if it was done more than once. You can clearly see in your before and after pictures that have lost the shape in the back part of the lower jaw. (loss of angles) While jaw angle implants is the correct procedure for jaw angle restoration, your prior surgeries have undoubtably caused some uncommon and uneven posterior jaw anatomy. To get the best result in terms of shape and symmetry you would be best served by custom jaw angle implants made from a 3D CT scan. That would not only show the shapes of your two jaw angles before surgery but would allow the computer design to make right and left angles that would match. While standard jaw angle implants would be better than nothing there at all, there undoubtably would be some persistent asymmetry. What is unique about restoring lost jaw angles is that a significant portion of the implants has to lie off of the bone. So custom making and fitting of the implants to the altered anatomy (with the use of microscrew fixation) would be invaluable in terms of implant stability.

Dr. Barry Eppley

Indianapolis, Indiana