Jaw Procedures for a Better Bite and SmileDr. H. Ryan Kazemi (301) 654-7070 4825 Bethesda Ave., #310Oral & Maxillofacial Surgery www.facialart.com Bethesda, MD 20814If your teeth do not fit well together, you have a disproportional face, a gummy smile, an under oroverbite, or a jaw size that is too big or too small, you probably have jaw problems. Many discoverthese problems during their teenage years and have it corrected early. Others may have postponedtreatment and have now developed teeth problems, facial pain, or TMJ disorders related to a poorbite.There are great treatments available to improve facial balance, improve your aesthetics and smile,correct your bite to help you eat better, eliminate jaw or TMJ related pain, and increase your teethhealth and longevity. New techniques and technology now decrease your treatment time, enhancerecovery, and get you back to normal activities sooner.Dr. Kazemi is an expert in correction of dento-facial deformities to establish correct bite, jaw size,and facial balance. He collaborates with several expert orthodontists who are leaders in their fieldto combine orthodontic and surgical techniques to achieve predictable results that meet yourgoals. Most patients can have the procedures done as outpatients, avoid jaw-wiring, and return tonormal activities in as early as seven to 10 days. Insurance and payment options can make theprocedure affordable.Here are some important considerations and information to help you make better decisions. • Long face look with a gummy smile, large lower jaw, and possible open bite • Short face look with deep overbite • A gummy smile look • Short chin look with underbite • Sunken upper teeth look • A combination of the above These problems arise from a poor bite whereSigns of jaw problems teeth do not fit well together and there was an excessive or inadequate development of theIf your bite is off or you have a poor smile and upper and lower jaws.poor facial balance, you may have problemswith either your teeth position, jaw sizerelationship, or a combination of both. Hereare the common signs:
Why is it important 3. Post-surgical orthodontics: Six weeks after surgery, the orthodontist will complete theto correct your orthodontic treatment and do final bitebite? adjustments. This phase typically takes three to six months. Once braces areHaving a normal bite and correct jaw removed, a retainer appliance may berelationship improves chewing, speech, and recommended to maintain position of theaesthetics, and protects teeth from decay, teeth and prevent relapse.gum disease, and chipping. Patients with facialpain or TMJ symptoms also report Key information about jawimprovements following orthodontic andsurgical correction of their bite. Corrective surgery:jaw surgery may also improve breathingproblems and sleep apnea in certain patients. • It’s best to consult with both an orthodontist and oral surgeon before treatment. • Insurance pre-authorization and recordsWhat are the different should be sent early to determine coverage.procedures for correction of bite • The orthodontic treatment is performed withproblems? a plan for eventual surgery. Therefore, it is important to make decisions about the surgery early as it will affect the course ofPatients with jaw size discrepancy may require treatment.one of the following procedures: • Procedure is performed at a hospital under general anesthesia and generally requires a• Upper jaw surgery (known as Lefort-I one- to two-day stay. osteotomy): This procedure corrects excess or deficiency of the mid-face region.• Lower jaw surgery: Procedure that allows Treatment scenario: either advancement of retraction of the lower jaw to its proper relationship to the Initial evaluation upper jaw• Chin surgery: A cosmetic procedure that During our first meeting, we will discuss your either augments or retracts the chin for desires and expectations and the feasibility of better facial balance surgical treatment. A brief overview of our general treatment approach will be presentedWhat are the treatment stages? at this time. A thorough medical and dental history and examination will be completed,There are three phases of treatment to correct and special X-rays and diagnostic studies maya poor bite and relationship of the jaws: be performed.1. Pre-surgical orthodontic treatment: An Records orthodontist levels and aligns teeth. Takes about nine months to one-and-a half years Treatment planning for orthognathic surgery is to complete done after a careful study of several types of2. Surgical treatment: An oral surgeon diagnostic records. We can use existing records manipulates the upper jaw, lower jaw, or obtained by your orthodontist or take new both, to achieve the proper relationship of records at our office: teeth and jaw bones. Surgical correction of each jaw takes about two hours to • Dental impressions for study models of your complete. teeth • Photographs • X-Rays
During this visit we will discuss your diagnosis This begins about six weeks after surgery.and explain the treatment alternatives to you. During this time, your orthodontist will beginAmple time is spent answering any questions fine-tuning your bite and finalizing position ofyou may have, and reviewing the sequence of your teeth. This phase may take three to sixtreatment. A predetermination letter will be months. At that time, you will be given asent to your insurance company and the fees retainer to maintain position of your teeth andwill be reviewed with you. It’s best to bring prevent relapse.your spouse, parent or close friend for thisimportant consultation. Post-treatment dentistryPre-surgical orthodontics Any required dentistry such as crowns, bridges, or any other restorative work that was delayedYour orthodontist will discuss in detail the until your braces were removed, can now beorthodontic aspects of treatment. Prior to completed. Your family dentist will be keptsurgery, the orthodontist will level and align informed throughout treatment. The timing ofthe upper and lower dental arches required post-treatment dentistry will beindependently. This can sometimes worsen coordinated in cooperation with youryour bite until the surgery is performed. orthodontist.During this treatment period, it may benecessary to have minor procedures Post-treatment recordsperformed, such as removal of wisdom and/orother teeth. Once all treatment is completed, a final set of records will be taken. These records serve as aFinal pre-surgical records baseline for stability studies. At this point, you will enter into a period of long-term follow-upWithin two weeks of your surgical date, final care to ensure the long-term stability of yourrecords will be taken. They will be used to treatment.finalize the treatment plan, to perform modelsurgery, and fabricate the surgical splints used Before & Aftersduring surgery. This helps to make the surgeryaccurate and predictable. The treatment planis thoroughly discussed, consent forms arereviewed, and additional photographs areobtained. Pre-surgical testing and a physicalare completed as part of your hospitalizationwork-up.SurgeryYou will arrive at the hospital at yourscheduled time in preparation for yourprocedure. You will be seen by ananesthesiologist and nurses who will care foryou during your operation. Following surgery,you will be taken to the recovery room andthen to your room. Most patients go home thenext day.Post-surgical orthodontics
What is the recovery from jaw What are the possiblesurgery? complications?• Most patients return home in one to two days • Infection: This is very rare. Any infection can after the procedure. be successfully treated with antibiotics.• Significant swelling develops in the first 24 to • Prolonged numbness over lips and chin. 36 hours and gradually diminishes over seven • Relapse: Teeth may drift in rare situations. to 10 days. It usually resolves completely in two weeks. What are the fees and insurance• Pain is usually fairly minor and readily managed with Tylenol #3 or Vicodin. benefits for jaw surgery?• Antibiotics are prescribed for 10 days.• A liquid diet is recommended for two to four The fees depend on the type of jaw surgery, weeks. Patients may then advance to a very whether it requires upper, lower, or both, its soft diet (mashed potatoes, soft pastas, etc.) complexity, and other adjunctive procedures up to week six and then gradually return to a such as a chin procedure or cheek regular diet from the sixth to 10th week. augmentations. Corrective jaw surgery and• Oral rinses are recommended every one to hospitalization costs may be considered for two hours for the first two weeks. benefits under some medical insurances,• In most patients, the jaws do not require although many have excluded jaw surgeries or wiring, therefore allowing normal mouth offer very little coverage. opening which gradually increases after two weeks and returns to normal by the sixth During your initial consultation, we can assist week. you in submitting a pre-treatment letter and• Numbness over the upper and lower lips and obtain your available benefits. Following the chin diminishes gradually and returns to a procedure, claim forms are submitted for normal sensation usually within six months. reimbursement. Insurance coverage is never guaranteed and final amount of payment is not determined until a claim has been submitted.Is jaw surgery safe? For those with no insurance, we offer short-Corrective jaw surgery is safe and predictable and long-term payment plans with no interestwhen performed by a skilled and experienced through CareCredit and ChaseHealthAdvance.oral surgeon. Specialized instruments and We can also arrange a fixed hospital cost fortechniques are used for jaw surgery. Dr. you that will include all aspects of yourKazemi specializes in this procedure and has hospitalization, including operating room,performed it successfully on hundreds of anesthesia, materials, recovery room, andpatients. The procedure is performed in the nursing care. This fee is paid directly to thehospital under general anesthesia with a team hospital on the morning of your procedure.of experienced anesthesiologists and nurses.Methodical, exacting, and detailed protocolsare followed strictly to make sure everypatient has a safe, comfortable, and successfulprocedure.
Adjunctive procedures various sizes. They are inserted through a small incision in the mouth. Augmentation canAdjunctive procedures are frequently also be performed at the same time as upperperformed as part of the overall treatment jaw surgery.plan. Liposuction for double chin and neckWisdom teeth The sagging of tissues under the jaw and chinremoval region may be due to aging or to the presence of fat deposits (otherwise known as a doubleIn preparation for jaw chin). This hanging mound of fat or excesssurgery, it is best to tissue blocks the ideal concavity of the chin-remove the wisdom neck profile, and definitely contributes to theteeth nine to 12 months prior to the operation. appearance of aging.This allows proper bone healing in the areawhere the jaw surgery is performed. However, Liposuction of this region can be performed atif time is not available, then it is acceptable to the time of corrective jaw surgery. It requireshave jaw surgery and wisdom teeth removal at a skin incision in the crease below the chin.the same time. There is minimal post-surgical discomfort, and the scar is obscured in a natural skin fold as itChin augmentation/reduction matures. A chinstrap-like bandage is usually applied for six days after surgery.The chin may be augmented or reduced toimprove facial profile, symmetry, and Nasal and septal reconstructionaesthetics. It is often performed at the sametime as the corrective jaw surgery. There are Cosmetic nose surgery or rhinoplasty affects the overall facial harmony and balance,two techniques for augmentation:Advancing the chin bone: This technique especially when performed with corrective jawinvolves sectioning the chin bone and sliding it surgery. It is best to perform the cosmeticforward to augment. This is done through the rhinoplasty after jaw surgery has beenmouth and no outside incision is necessary. completed to allow the surgeon to achieve aChin implant: This involves use of preformed more ideal result and facial balance. We canand anatomical implants that are available in recommend several very skilled andvarious shapes and sizes. The implant is placed specialized cosmetic surgeons.on top of the chin and fixated. They create avery natural feel and appearance. A small skinincision under the chin is required for thistechnique.Cheek-bone augmentationPatients with a flat cheek bone appearancemay augment it using cheek implants. Theseimplants are pre-formed and available in
About Dr. H. Ryan Kazemi Dr. H. Ryan Kazemi is an oral and maxillofacial surgeon certified by the American Board of Oral and Maxillofacial Surgeons. He received his dental degree from the University of Pennsylvania, School of Dental Medicine in 1990. Following a one-year internship at the Albert Einstein Medical Center in Philadelphia, he pursued surgical training at The Washington Hospital Center in Washington, DC, where he received his certificate in Oral and Maxillofacial Surgery. Dr. Kazemi has practiced in Bethesda, Maryland, since 1997, providing a full spectrum of oral and maxillofacial surgery procedures with emphasis on extractions, dental implants, bone grafting, and corrective jaw surgery.Dr. Kazemi is a diplomat of the American Board of Oral and Maxillofacial Surgeons, and an activemember of the American Association of Oral and Maxillofacial Surgeons, American College of Oraland Maxillofacial Surgery, Academy of Osseointegration, American Dental Association andEntrepreneur Organization.He has served as the founder and president of several dental and implant study clubs in theWashington DC area. Dr. Kazemi has published and lectured extensively on dental implants, bonegrafting, and practice management. His newsletter, To-The-Point is read by more than 2000dentists every month. He is also the founder of DDSForums.com, a professional networking site fordentists.Dr. Kazemi serves on the medical staff for D.C. United, the major league soccer team inWashington, D.C. and the US national soccer team for the care of their athletes.Our expertise and service allow you to:• Be treated by a specialty trained and skilled doctor• Achieve the results you expect• Have a speedy recovery• Make appointments easily and efficiently• Be seen quickly and on time• Feel safe and comfortable• Experience a warm and personal service Experience oral surgery care that... Patients talk about Referring doctors brag about appointment And our team delivers everyday emergency solutions (301) 654-7070