Today I saw Dr. #3. I took the copy of the Marx book with me. I wasn’t so full of questions, I wanted to shut up a bit and listen. I was also afraid of giving the perception of the “difficult patient”. I really don’t want to be a pain in the butt and after #1 am self-conscious about letting too much of myself through.
So far, I’d guess, this doctor seems to be the most straight-shooting of the 3 I’ve seen. He was fairly up front about the success rate he’s had in treating this and what can go wrong. I don’t want some rosy, “everything is going to be alright if you trust in how awesome of a surgeon I am” type experience.
One thing that was substantially different from what Dr. #2 said. He said that pre-extracting the molars before doing the surgery didn’t really have much affect unless you were going to let it heal for 6 weeks to 2 months. Dr. #2 said that he’d do the surgery 2-3 weeks after extraction. Dr. #3 said that extracting teeth all of the time, he knows it takes at least 6 weeks for it to heal up well enough to matter.
He basically said there were two options:
1) Do the procedure all at once
2) Do the removal, wait till it heals up, then do the graft.
Option #1 has about a 10% chance of infection, probably much higher with a cadaver allograft. Option #2 has a maybe less than 5% chance of infection, but is 2 surgeries. The risk with option #2 of cutting the medial nerve due to scar tissue he thought wasn’t as high.
In both cases, he’d use a rigid bone plate. What to use as a crib was an open question. He said that he’s done some without a crib and they’ve been successful. I asked him about PLA/PGA cribs, which he said he could look into. He said they didn’t always resorb. They are a very new thing, with not a lot of case history.
One of the things he pointed out was that after the graft and this always happened, the thickness of the cancellous (marrow) graft was always going to be much greater than the thickness of the bone that grows in. If it isn’t thick enough, he’d probably have to do a future graft to build up enough of a ridge to take implants.
He also said that he’d provide follow-up care if I decided to go to one of the “big names” to get my surgery done. I thought this was particular nice (and reassuring) since both oral surgeons I’ve seen so far seem to not want to share care. He discussed the risks of this though … there are always miscommunications between people and that could have issues.
Another thing that surprised me was that he said that there was a chance that I may not be completely numb. He pointed me to the section in chapter 14 of the Marx book which talks about nerve sparing techniques. I expressed my concern that ameloblast cells might reinfect the graft. He said he could remove the nerve if I wanted, but the ameloblasts weren’t like a cancer; they didn’t invade the nerve cell. According to Marx, they actually lack the enzyme needed to invade nerves. He however said that decortication was a pain in the ass and usually caused more problems than it fixed. We talked about the “nerve pullout method” and I said I’d think about it. I’d rather have a numb lip/chin than have this damned thing come back.
Another thing that was surprising was that he said that I could have my former orthodontist put temporary braces on me, then wire them shut for the surgery, then pop them off later on. I’d imagine I’d wait quite a while into my recovery before I’d let them take them off of me, just in case.
I asked him about rubber bands vs. wiring me shut and told him sometimes that I am a mouth breather. Would I be able to breath if my nose stopped up? He said that not wiring me shut, I could have micro-movements. And I’d still be able to breath in that case. He’d keep me wired up for a few weeks.
Of the 3, this doctor has the best credentials. He said that in Texas, if I wanted to go to a larger research university type environment, he’d recommend Baylor or Parkland.
He also looked at the pocket or dimpling in my back left corner. He poked around back there with what looked like a Q-tip on a wooden stick and told me that the gum was thinner back there and that might have issues.
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Ameloblastoma: My Experience 