What causes masseter dehiscence in gional and mandibular implant patients and how to prevent it?

[moltisantichincel]

with placing implants comes a risk of masseter dehiscence which just fucks things up. the rate seems to vary between studies with some saying its as high as 20% while others saying its about 2% which makes me wonder if the material and method of placement has to do anything with it.

I notice that majority of jaw implants placed are likely silicon with little planning compared to ones that are scrwed (titanium and peek) and the silicone ones always look retarded, I don't know if its the ill informed retarded patients that just think bigger jaw = better which then puts too much preassure on the masseter, which makes sense because if you look at wrap around jaw implants which are always silicone they tend to flare the gonions too much and overall look retarded. (look at the image posted)

Could also be due to the amount of surgical planning, like I said before majority of jaw implants seem to be silicone with less planning than peek or titanium due to them having to be screwed and usually 3d planned. I read this one article from ramieri about his "implate" technique (large titanium bsso plate that also acts as augmentation of the gonions and ramus) and from his 7 patients none of them needed revision or experienced any dehiscence, despite analysis showing a mean mandibular width increase of 18.1 ± 6.2 mm and vertical ramus height gains of 6.0 ± 3.1 mm which is decently significant and is sure to put preassure on the massater, it was only 7 patients tho.

I myself will be getting ramieris mcw implate technique by late 2026 and am worried shits going to go bad, does it covering more of the mandible than his old implate that had a step off increase the risk of dehiscence or does it not matter since the added volume doesn't center around the masseter? (his mcw technique will likely resemble the second image posted except it being a bsso plate and titanium)

But what does everybody else think? is it because of silicone implants, or surgical planning or jewish surgeons, or all of them combined?

@RealSurgerymax from what you have seen which one is the most likely and what do you personally do to mitigate the risk of dehiscence

 

[Whirr22222]

I think he said before, bigger the implant, higher chance, also sharp edges and also silicone.

 

[moltisantichincel]

I think he said before, bigger the implant, higher chance, also sharp edges and also silicone.

thanks I couldn't find shit about dehiscence for some reason,

 

[Whirr22222]

thanks I couldn't find shit about dehiscence for some reason,

Search Jaw Implant on realsurgerymax user theres a lot of old posts of him talking about it very interesting

 

[moltisantichincel]

bump

 

[Mr.Proper]

ill informed retarded patients that just think bigger jaw = better

Many such cases...
Regarding topic - in Google, write site:looksmax.org masseter dehiscence
or prompt in chatgpt:
"masseter dehiscence with jaw implants - reasons and how to minimize the risk"

 

[Win200]

I've been told by two surgeons that it's very rare when placing implants, but rate goes up upon removal or removal/replacement. I had an implant that I had Eppley try to remove and replace, but he stood down on removal in the OR due to bony overgrowth over one gonial angle. He thought chances of dehiscence were too high to justify making the attempt. (A bimax surgeon removed it later with no complications.)

Bottom line is that any competent implant surgeon who does these regularly shouldn't have any issues with dehiscence.

 

[moltisantichincel]

I've been told by two surgeons that it's very rare when placing implants, but rate goes up upon removal or removal/replacement. I had an implant that I had Eppley try to remove and replace, but he stood down on removal in the OR due to bony overgrowth over one gonial angle. He thought chances of dehiscence were too high to justify making the attempt. (A bimax surgeon removed it later with no complications.)

Bottom line is that any competent implant surgeon who does these regularly shouldn't have any issues with dehiscence.

didn't even read your reply, wish I replied earlier, especially considering you arguably have some of the most experience, I am probably going to end up asking my bimax surgeon who will end up placing it for conservative measurements, to simply add definition and correct asymmetry and add some angularity, and emphasize that my goal isn't to replace my jaw. Hopefully I won't have such complications, I have high hopes tho since ramieri is very careful in such cases, and from the case study that he did on 7 patients that did his implant technique none of them got dehiscence despite the implant design not being very anatomical. (you can see based off of
the picture) he has since updated his design tho and it now is more anatomical and more conservative overall,

 

[jackinthebox]

don't think this matters, it's just a slightly suboptimal aesthetic result

 

[lurking truecel]

If you have decent width and jaw, then jaw implants will descend you hard as hell. If you got extremly narrow cucked jaw its worth a try. If anyone does it good its giant

 

[DonaldJTrump]

dont do this bs. get condyle widening during bimax instead, or experiment with jaw filler.

 

[moltisantichincel]

I’m going to ask Ramieri about it during my next consult, it looks like he’s offering it, do you know what risks are associated with it?

 

[lurking truecel]

I’m going to ask Ramieri about it during my next consult, it looks like he’s offering it, do you know what risks are associated with it?

Let him explain exactly how it works and then share it here

 

[moltisantichincel]

Let him explain exactly how it works and then share it here

I will but my next consultation will be 6 months away from when I’m ready for surgery so it will be a while

 

[monecel]

didn't even read your reply, wish I replied earlier, especially considering you arguably have some of the most experience, I am probably going to end up asking my bimax surgeon who will end up placing it for conservative measurements, to simply add definition and correct asymmetry and add some angularity, and emphasize that my goal isn't to replace my jaw. Hopefully I won't have such complications, I have high hopes tho since ramieri is very careful in such cases, and from the case study that he did on 7 patients that did his implant technique none of them got dehiscence despite the implant design not being very anatomical. (you can see based off of
the picture) he has since updated his design tho and it now is more anatomical and more conservative overall,



View attachment 4409533

Yeah the jaw is too flat here

 

[monecel]

dont do this bs. get condyle widening during bimax instead, or experiment with jaw filler.

That doesn't help with inward gonions though

 

[monecel]

I think he said before, bigger the implant, higher chance, also sharp edges and also silicone.

A lot of case reports most likely use the dogshit non-custom sharp corner jaw implants

 

[moltisantichincel]

View attachment 4417713
Yeah the jaw is too flat here

Yeah ramieri since has updated his implate design and it looks pretty good