Your Questions

Q: Dr. Eppley, Thank You so much for your time and your quick response to my questions about maxillary setback surgery. Would there be any possible alternative to the use of orthodontics which I’m hesitant of because of my age? (65 years old0 Perhaps wiring the mouth shut post surgery for a longer than normal period of time?

One reason I chose to contact you is because I could see from your website your practice  seems unique in that you do a wide variety of plastic surgeries and are involved with developing research and studying the latest techniques while at the same time you have a of experience in maxillofacial surgery as well. When searching for a doctor I had originally thought of those with practices limited to oral and maxillofacial surgery but I felt led to contact you when I saw your website. I have contacted no other physician as I am praying you can help me.

I know you have to be incredibly busy but I would greatly appreciate it if you could give me a few minutes of examination time and take a chance on me. Thanking you again so much for getting back to me.

A: In traditional jaw surgery the key element is how the teeth will fit together when one or both bony jaws are moved. That is the actual purpose of orthodontics…to get the teeth aligned for their new jaw position and to correct any malocclusion or dental aligment issues that result afterwards. So keeping the jaws more immobilized (wired together) is not a solution for overcoming malocculsion issues that may be created by any jaw movement issues.

At 65 years old it is perfectly understandable, however, that orthodontics in not in your ‘future’ and is not the best from either a periodontal/root resorption issue or the time involved to do so. Thus an alternative approach must be looked at and there are viable options based on the exact nature of your overbite/upper jaw problem. A premaxillary setback (with premolar tooth extraction) is an option that would allow the upper teeth in the front (incisors and canine) to be moved back into the premolar extraction defect. This would also allow your existing molar occlusion to remain as it is which is critically important for eating. This is also a less extensive procedure than a complete maxillary setback and allows more setback movement anyway.

The way for me to know the feasibility of a premaillary setback is to see you and analyze your dental models and x-rays. All I need is for your dentist to make simple stone dental models and a panorex x-rays. (which most dentists can easily do) Looking at you in person with that information will answer the question if this will work for you

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was hoping I could be a candidate for upper jaw surgery to correct an overbite caused by over the years involuntary tongue thrusting while sleeping. Hopefully a procedure to pull back the upper jaw? I’m not sure if it would be possible as I’m 65 years old but am in excellent health and very active. Thank you for any help or advice you may have!! 

A: Thank you for your inquiry. While it would be unusual to have maxillary surgery at 65 years of age, that age does not necessarily preclude one from doing it. What is more relevant is the current state of your bite (occlusion) and how much maxillary setback is needed. (as judged by the amount of overbite) Almost all cases of such jaw surgery require orthodontic correction so when the upper jaw is moved back the upper and lower teeth will fit together properly. There are also aesthetic issues of your upper lip position and your facial profile to consider.

Please send me some pictures of your face and your bite and I may be able to give you some further guidance as to its advisability for your face and bite relationship.

Dr. Barry Eppley

Indianapolis, Indiana