Jaw Angle Implant Revision
Q: Dr. Eppley, I am in need of a jaw angle implant revision. I am 6 weeks post op from cheek and widening jaw angle implants. I am very pleased with the cheek implants – subtle changes. Now the asymmetry of my jaw angle implants is another matter. Due to some inherent jaw asymmetry I had a small implant placed on the left and a medium implant placed on the right. The asymmetry now is more noticeable than before. Independently I like each one but I prefer the right one. Plain x-rays does seem to show the left one is well positioned and the right one may be rotated up and forward. The screws seems intact and there are no signs of infection. There has not been any problems with the incisions inside the mouth healing.
My surgeon wants to reposition the right implant and secure it with two screws. Yet I also kind of like the right one better… in which case I would need to displace the correct left which seems counterintuitive.
What would you suggest?
A: You have now discovered the most common and hardest problem to solve with jaw angle implants. It is not as easy as it appears to make an adjustment on one of the implants and have it turn out better. I would not attempt a jaw angle implant revision unless I knew exactly what the 3D position of the implants are. The plain x-ray you have shown does not provide enough information to know what to do or to make an informed decision. You need a 3D image of it using an inexpensive cone beam (CBCT) scan. That information will prove invaluable in making the right decision as to which implant to reposition and on how to 3D reposition the chosen implant. If you just eyeball it I can guarantee you will not turn out better…it will just be a different variation of the asymmetry.
Two screws are always better than one but two screws into an implant than has been moved but is still asymmetric will do you no good.
Dr. Barry Eppley