SEATTLE JAW SURGERY

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Do you need to replace an entire row of teeth? In many cases our doctors at Seattle Jaw Surgery can replace an entire row of teeth in one surgical appointment. There are several ways to replace your teeth and each situation is different. Some options allow for a removable denture that is held more tightly in place by dental implants. Other options allow for a denture that is permanently fixed to the dental implants and can be removed for cleaning by a dental professional. Learning about the best option for your individual case starts with a consultation appointment with one of our doctors at Seattle Jaw Surgery. Once a method for replacement of your teeth is established, we will obtain a CT scan of your dental arches and a digital impression of your teeth. This data is used to plan for and make your new dentures. After the planning phase you are ready for surgery. Often your teeth can be removed, implants placed, and a temporary set of dentures inserted all in the same appointment.

What are my options for replacing a full arch of teeth?

It is important to realize that the following options will not work for all patients.  Each treatment plan is custom tailored to the specific situation.  With that in mind the general categories for full arch replacement are as follows.

  1. Single implants for each tooth
    There are some advantages to this option.  With implants for every tooth there is good implant stability and preservation of your bone.  In select situations this option may be used.  The disadvantages include increased surgical time and increased cost.  For most cases, another option will provide a very good restoration at a reduced cost.

  2. Removable implant overdenture
    For this option, most commonly two or four implants are placed in each arch that is to be replaced.  A denture is then made with special attachments that allow it to snap in and out of the implants.  The denture is removable much like a standard denture, the implants help to provide additional retention and stability.

  3. All on four fixed complete denture
    The all on four procedure, also know as teeth in a day is an excellent option for full arch replacement for many patients.   This procedure most commonly involves the placement of four implants, however there are situations where more implants are required.  Often a temporary denture can be secured to the implants on the day of your procedure resulting in new teeth in a single day.  The denture is held to the implants using screws and can be removed by your dentist from time to time for cleaning.

Replacing teeth with implants and dentures is possible for many patients. Implants can be placed on an angle permitting use even in patients with significant bone loss. This also minimizes the need for bone grafting. If you would like to explore your options, contact our office for a consultation with one of our doctors.

The specifics of what to expect with be discussed at the consult appointment. Often sedation is used during the surgery. If this is the case, you will have to refrain from eating or drinking after midnight the night before your procedure. The duration of the surgery varies from about one hour to a few hours.

Yes. You will be on a soft diet for several weeks after surgery. It is also very important to keep the surgical area clean. You will be prescribed medications. These medications vary but often antibiotics and pain medication are prescribed. Your doctor will go over the specific instructions for medications on the day of surgery. Any questions that you may have will also be answered on the day of your surgery.

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It can be a scary thing hearing from your dentist or doctor that you need a biopsy. If you or your dentist notice changes to the soft tissue of your mouth or something abnormal on x-ray, call us for an evaluation today.  There are several pathologic processes that can be associated with the soft tissue, teeth, and bones of the mouth.  Thankfully, many of these processes are benign (noncancerous).  We offer same day biopsy appointments where we look at the area, discuss the likely possibilities and either remove or sample the area.   The results of your biopsy take 5-10 days and will guide further treatment.

Depending on the location and size of your lesion, your procedure may be completed with local anesthesia or sedation.  There are many factors that contribute to this decision and the type of anesthesia is determined on a case by case basis.  

Your surgery may involve complete removal of your lesion or taking a small sample of the lesion to send to a pathologist for a diagnosis.  After a diagnosis is made, a final treatment plan is formulated.

The treatment for pathology varies greatly based on diagnosis and so does the recovery process.  You will be given post-operative instructions on the day of your appointment and a general idea of what to expect can be determined at your consultation.

For cancer, we will refer you to one of our colleagues in Head and Neck Surgery. For noncancerous lesions, we have many possible treatments available. These can range from decompression, removal, curretage, injection, medication, and ablation.  Reconstruction options exist as well, but the first step is diagnosis.  

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Traditionally, if your orthodontist suspects that you may need jaw surgery you will be referred for a jaw surgery consultation prior to the initiation of your orthodontic treatment.   At that time we will discuss the surgical options that are available and the typical timeline.  After your consultation with our office your orthodontist will begin your orthodontic treatment.  Keep in mind that you will typically be in braces for 6 months to 2 years prior to your jaw surgery.  When you are ready for surgery your orthodontist will notify you and our office.  We will see you in clinic 2-3 months prior to your planned surgical date to be sure that we are ready for your surgery.  You will be seen in our clinic one additional time 2-3 weeks prior to surgery for your pre-operative appointment.  After your surgery is completed you can expect to spend one night in the hospital.  Typically patients are discharged home the day after surgery.  We will then see you for follow up appointments at 1 week, 3 weeks, 6 weeks and 6 months.  About six weeks after your surgery your orthodontist will see you and begin the final stages of your orthodontic treatment to fine tune your teeth.

 

Joint replacement is a commonly performed surgical procedure. Each year in America, hundreds of thousands of knees, hips, and shoulders are replaced. For the temporomandibular joint (TMJ), it is more unusual. Despite the rarity, many patients can benefit from the procedure. TMJ replacement is useful for patients with severe arthritis, severely limited mouth opening (ankylosis), joint tumors, trauma, infection, or failed previous devices. In fact, it is the most predictable treatment for the worst situations. 

Most commonly, people see us because their mouth can’t open and/or their joints hurt.  The TMJ is one of the most used joints in the body and issues with joint function can influence overall well being.  Talking, eating, breathing, and speaking can all be influenced by severe TMJ disease. The goal for TMJ replacement is to restore function of the jaw joints. Replacing the TMJ can not only help reduce pain and improve mouth opening, but it allows the lower jaw to move to fit your upper teeth. This can make your upper airway bigger, correct a poor occlusion, and improve facial balance. Overall, our focus is to allow patients to improve their quality of life.

Dr. Bobek is known in the Pacific Northwest for his surgical expertise with TMJ joint replacement. He has treated more than 150 patients with joint replacement.  Our most frequently used device is the Stryker TMJ Concepts device.  They fabricate custom titanium joints based on your actual anatomy. This allows for a customized and precise surgical planning with positive patient outcomes. 

Unfortunately, the history of TMJ replacement in America started with failure. The first devices in the 1960s and 1970s were taken off the market by the FDA in 1991. Government oversight picked up from there as people were getting worse with some TMJ replacement devices.  Four devices were followed by the FDA starting in 1998 to evaluate outcomes. Over the next 30 years, two devices have demonstrated the safety and good patient outcomes to be still be on the market in America.  Since the 1990s, we have learned extensively from our orthopedic surgery colleagues.  Modern TMJ replacement has very similar outcomes as orthopedic hip or knee joint replacement. 

Once you have exhausted all nonsurgical methods or are in a situation where nonsurgical methods don’t help, replacement should be considered. There are replacement options using your own body (autogenous grafts), but you will notice those parts missing. Costochondral (rib) grafting involves removing your 5th or 6th rib to be placed into your jaw joint. With this operation, there is at least a 50% reoperation rate in the first 10 years. The other options involve removing your lower leg bone (fibula) or second toe (metatarsal) through free flap transfer. These are very invasive operations that require connecting the blood vessels of your flap to the neck or face.  For most people, TMJ replacement devices are the best bet.

Orthodontics are often used in the care of patients who are having a TMJ replacement.  Orthodontists use braces or invisalign to help align the teeth prior to and after TMJ replacement surgery.  For many people, orthodontics are not necessary but we will discuss the pros and cons in your situation. 

Metal allergy, specifically nickel allergy, is a common issue with TMJ replacement.  While the device is largely made up of titanium, the condylar component has a Cobalt-Chromium alloy.  The FDA allows for compassionate use of a device that does not contain that alloy (all titanium device) if you have a documented metal allergy to one of the components. We can arrange for your blood to be tested through orthopedic analysis to verify your allergy. 

While the percentage risks are low, the consequence of complication is high. Joint infection happens 1-2% of the time and often requires further surgery to manage. The expected life of the devices is thought to be at least 20 years but we don’t currently recommend device replacement until they break. 30 year data seems encouraging thus far.   Bone growth over the devices can happen over time and we place abdominal fat over the devices to minimize bone growth. Lastly, typical surgical complications like nerve injury, scarring and bleeding are possible. We will talk with you about your risks at your visit. 

With just TMJ replacement, you will be able to chew soft foods right after the surgery. We want you rehabilitating as soon as possible after the surgery and we will give you a jaw stretching device immediately after your surgery.  We will also want you to meet a physical therapist before surgery as everyone who has TMJ replacement will need physical therapy after the operation. Luckily, we have many options in the Seattle area. 

For some people, upper jaw surgery happens at the same time as joint replacement. When this happens, we need the upper jaw to heal before chewing. This is a process that can take 2-3 months. 

Recovery after joint replacement can take several weeks to months. Your surgery is done at either the hospital or our surgery center. At the hospital, you may be admitted for one night after surgery.  Life is pretty different for the first week and you are followed in clinic with post-operative appointments at 1, 3, and 6 weeks and 6 months. Patients start TMJ physical therapy about 2 weeks after surgery. At this time, they can generally return to work and begin many normal jaw functions. Given the core functions that the TMJ supports, we generally estimate that it takes 6 months before patients stabilize into their new normal state following joint replacement

Many medical insurances do have coverage for TMJ replacement.  We will be able to send your information to your insurance company to find out about coverage. Unfortunately, we are aware of plans that do not cover TMJ surgery. In those situations, cash pricing and payment plans exist.  

Orthognathic Surgery is the medical term for Jaw Surgery. It is a surgery to reposition the jaws to correct alignment. This realignment allows teeth to fit when misalignment cannot be solved by orthodontics alone.

We think it is reasonable to consider going through jaw surgery for a few reasons. Most frequently, the upper and lower teeth fit in a way that makes chewing and biting difficult. This match between the upper and lower teeth is referred to as your bite (occlusion.)   

If the occlusion is incorrect, you will hear the term malocclusion (bad bite.)  Common malocclusions are referred to as overbites, underbites, crossbites, and open bites.  These conditions are frequently related to the underlying structure of the bone being mismatched to the opposing bone.  Those two bones are the maxilla (upper jaw) and mandible (lower jaw).  When the lower jaw is too far forward (mandibular hyperplasia), or the upper jaw is too far back (maxillary hypoplasia), an underbite is present.  When the lower jaw is too far back (mandibular hypoplasia), or the upper jaw is too far forward (maxillary hyperplasia) there is an overbite.  the front teeth don’t touch (anterior open bite), the back teeth don’t touch (posterior open bite)

While malocclusions can lead to difficulty with biting and chewing, the cause of the malocclusion can cause other functional problems.  Small lower and upper jaws are associated with difficulty breathing during the day and night.  This is because there is less space for the tongue and soft palate to live.  You are good at compensating for this and the most common compensation is head position. People come in with neck pain and postural concerns because the are chronically adapting to their poor jaw position.

Underbites and open bites are associated with speech difficulty.  The tongue forms many sounds by touching the roof of the mouth behind the front teeth. If the front teeth are far away from the tongue, it can be difficult to speak.  Air escape can happen as well with front teeth that don’t touch. 

Jaw joint (TMJ) issues are complex but with severe malocclusions, people often find fatigue with chewing. This is because only a few teeth work to chew. Many chewing cycles can wear out the joint. 

Upper and lower jaws are mismatched for variable reasons. Common causes are TMJ arthritis, trauma, congenital issues, growth abnormalities, open mouth breathing, low muscle tone, jaw tumors or systemic issues. 

Jaw surgery is completed under general anesthesia as an outpatient surgery.  It is used to treat several conditions including a severe underbite or overbite, open bite, jaw or facial asymmetry, sleep apnea and others.

Typically, patients find themselves in our office after seeing an orthodontist. The orthodontist will make the recommendation based on your jaw alignment.  Surgery may be needed in addition to orthodontic treatment to correct your bite. They would refer you to discuss orthognathic surgery with a maxillofacial surgeon.

Your initial consult in our clinic will consist of one of our surgeons taking a history, doing an examination, reviewing your clinical photos and any available imaging. They will then discuss what is involved with jaw surgery and anticipated surgical intervention. You will also be shown a cartoon demonstration video of how jaw surgery is used to reposition the jaws. After this consult you return to your orthodontist to begin orthodontic treatment.

The traditional timeline for jaw surgery patients is to be in braces for a period of time, on average this is about 6-18 months to straighten and align the teeth prior to surgery. Then the orthodontist will tell the patient when they are close to being ready for surgery. It is then that you follow up in clinic for a recall visit. One of our maxillofacial surgeons will do another exam and we will take updated photos. The surgeon will then have a better idea of what surgical treatment they recommend. At this recall if you are ready for surgery you will meet with one of our care coordinators to schedule a surgery date.

You return to clinic to obtain presurgical records. These records include an updated CT scan and an optical scan of your teeth. These are used by the surgeons to complete your virtual surgical planning (VSP). This is a way to customize the surgery to each individual patient. At your preoperative visit we will discuss the process of surgery at the hospital, review your specific plan for surgery, and review instructions for recovery after surgery.

Surgery takes place at the hospital; you spend one night in the hospital after surgery and are discharged the following day. We see you in clinic for your post operative visits at 1, 3, and 6 weeks after surgery and then 6 months after surgery.

Jaw Surgery

Did you know?

Though only an oral surgeon can let you know if jaw surgery is right for you, there are some signs and symptoms that the procedure could be right for you:

  • Your lips do not meet in your natural bite
  • Your jaw protrudes noticeably forward
  • Your chin is receded backward
  • Your face seems unbalanced
  • You have open space between your upper and lower arches when your mouth is closed
  • You have breathing difficulties during sleep
  • You find yourself breathing primarily through your mouth
  • You have difficulty chewing and/or swallowing food
  • You have excessive wear on your teeth
  • You have ongoing jaw joint pain
  • You suffer with chronic headaches

You may be a candidate for corrective jaw surgery if you have a malocclusion (bad bite) that is caused by poorly aligned jaws. Only a complete consultation with an oral surgeon can help you determine whether jaw surgery is right for you.

At Seattle Jaw Surgery, you will be evaluated by Dr. Bobek to determine if surgery is right for you.  If you can avoid surgery he will be honest with you! If you could benefit from surgery, he will discuss the pros and cons.  

The decision to recommend surgery is based off of the individual. Functional troubles, clinical examination, radiographs (xrays), history, orthodontic exam and dental impressions are all considered when recommending for or against surgery. 

On the day of your operation, you’ll be placed under general anesthesia. An incision will be made on the inside of your mouth, through which your surgeon will reposition your jaws. Some jaw surgeries involve bone shaping, which may include shaving some bone away or grafting new bone into the jaw. A combination of plates, screws or wires may be used to hold the jaw in place before your incision is closed.

Please view our jaw surgery techniques on our videos page.

 

Yes. The initial healing phase is usually a few weeks long. During this time, you’ll be placed on a modified diet and instructed to avoid certain activities. It is important to take all medications as prescribed and to keep the incision site clean and free of debris. Your jaw may be swollen and sore for several days after surgery. Be sure to contact your doctor if you experience fever or any discomfort that worsens with time. Keep in mind that your jaw will continue to heal over the course of several months – a process that can take up to one year to complete.

 

Seattle Jaw Surgery Invisialign

Am I able to have Jaw Surgery without Traditional Braces?

There have been many advancements in orthodontics over the years, particularly with the option of Invisalign orthodontics. Dr. Bobek strives to be on the cutting edge of orthognathic surgery and therefore has developed multiple techniques to perform predictable outcomes with Invisalign jaw surgery. He is one of the only Maxillofacial surgeons in the pacific northwest who is consistently preforming Invisalign surgery.

For patients to be eligible for Invisalign jaw surgery there needs to be coordination and agreement between your orthodontist and Dr. Bobek. During the initial consult with Seattle Jaw surgery, patients can be evaluated to see if they are eligible for Invisalign jaw surgery.  Unfortunately, not all situations can be set up with invisalign alone. 

  • For Invisalign jaw surgery we do not have the traditional hooks. Instead, during surgery Dr. Bobek will place posts (also known as skeletal anchors or TADs) in the mouth. The posts are used in replacement of the hooks to provide a similar function during surgery. These posts will stay in the mouth during recovery to allow the patient to wear rubber bands. These posts are removed in clinic 6 weeks after surgery. To remove the posts, it is a simple procedure and we numb the area prior to removal. 

Orthodontics are needed in conjunction with jaw surgery to level and align the teeth, but also the hooks on the braces and surgical hooks on the wire are used during surgery to allow positioning of splints and holding the teeth in correct alignment to carry out the surgical plan. After surgery, the hooks on the brackets and wires are used to place rubber bands.

One of the reasons many adult patients with malocclusions or uncontrolled sleep apnea delay having orthognathic surgery is due to the fear of having to have braces for two years. Invisalign jaw surgery can be a great option for patients to allow for a less noticeable orthodontic treatment. 

Patients who have otherwise straight teeth can start with surgery – something known as surgery first.  In these situations, surgery is done near the start of orthodontics and after surgery, the final alignment is completed. 

The main problem with invisalign jaw surgery seems to be efficiency. Because you are recovering from surgery, you will be unable to open your mouth widely to have a dental impression for 1-3 months. This delays wearing finishing trays for many months. Additionally, after surgery, you are not wearing your trays and the teeth may move. This may increase the time to finish invisalign.  

To combat these two problems, temporary braces can be used. These are not used during surgery to carry out the plan but are used after surgery to retain the orthodontic progress and speed up the completion of orthodontic therapy.  Commonly, these are placed the week of surgery and taken off when you are completely healed. Here are some examples:

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