Author Topic: Deep Overbites and BSSOs (+ wilckodonitcs/segmental subapical osteotomy/crowns?  (Read 1297 times)

Tiny

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Hello all, my first post here.

So, my story. My lower face/mandible is pretty underdeveloped both vertically (ramus) and horizontally (mandibular body) (i.e.retrognathia and microgenia). This is mainly genetic as I have the same face shape as my father (ie round and IMO very unattractive)

I had my original braces on the NHS a teen, starting around 13 with retainers and finishing at 16. I had 4 molars removed due to crowding. No palate expansion, MARA, twin block, dahl appliance or headgear - just retainers and archwires. I got my wires later than most as I was waiting for my 2nd molars to be fully erupted - my ortho chose to remove the first molars as they had developed with poor enamel. The 2nd molars were then moved forward, so that my wisdom teeth had space to come in (which they did at 17.)

I don't really remember what my teeth were like before the braces - despite the retrognathia I don't recall having a huge overbite, but I would have had some. I can't recall what the depth was like before and after the braces either.

Currently my top teeth are basically fine, but I have a slight overbite and crossbite with significant deep bite (about 80%), and a tiny posterior open bite on one side. My face looks absolutely awful front and side when I fully close my mouth :(  Like a frog!  I am going to assume that it's skeletal (rather than dental or soft tissue) as I have a deep sublabial fold and everted lower lip. I recently got a chin implant+neck lipo+sublabial filler to improve the retrognathism - it looks better but it didn't help with the length of my face (maybe I should have got a custom made one). The sublabial fold is still significant despite getting radiesse put in it.

According to all the reading I've done, traditional treatment of deep bite is - anterior intrusion (in the case of gummy smile) or posterior molar extrusion (in the case of short face, like me). HOWEVER, molar extrusion via braces is apparently not terribly stable in adults and will often relapse. It also rotates the mandible down (good) and back (bad) ie. makes the face longer but the overbite/retrognathism worse (which would be desirable if I was going to get the BSSO as my overbite at the moment is not that bad, even though my profile is!)


I want to get a BSSO to improve my profile, so am seeking experiences of people who also had deep bite and short face and needed extrusion of the posterior molars rather than intrusion of the anterior incisors to correct the deep bite.  I would like both more vertical length and horizontal length but think it would be unlikely that I can extrude my back molars enough to still meet if I got a ramus BSSO to lengthen.

Questions
- to those who had a deep bite and an underbite, how did you do your extrusions, has is been stable, and did it result (as it is supposed to) in increasing the overbite?
- does anyone know if it's possible to get wilckodontics before a BSSO?  The way I see it this would speed up the time in braces and also make the extrusion more stable, but does it mess up the jaw too much to get further surgery?
- has anyone had their deep bite corrected with crowns or segmental subapical osteotomy as opposed to regular extrusion using braces?
- has anyone used powerprox to speed up braces?
- has anyone with a lower lip significantly behind the upper lip had significant improvements without surgery?  Custom facial implants can massively improve the jawline but I don't see them improving lip position

thanks all for any insight  :)

overbiter

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Hi, I have similar problems to you. I don't look like a frog lol, I just have an ugly short face. My overbite was corrected with extractions/braces but my facial aesthetics are now screwed.

As many people on this board will tell you, your getting a chin implant was a mistake. You should have researched more and done your homework. If only you had read more posts here rather than on plastic surgery forums you would not have had that done. You should have had jaw surgery and genioplasty, that is always preferable to any implant. Plastic surgeons try to sell you the idea that implants are a safe/good alternative to orthognathic surgery because it is something that they can do. In short they are quacks.

I don't know anything much about Wilckodontics. I stumbled across a mention of it on Archwired when I was reading something about SARPE. It sounded very strange to me, like some kind of voodoo orthodontics. It is in no way a standard procedure from what I've read about JS in the past 12 months. It seems to come from an orthodontics background, and is therefore probably complete bullshit. Other posters here will tell you that orthos are never to be trusted, they have ruined more than one face, mine included. Don't get this procedure - AVOID.

If you want to correct your deep bite/short face you probably need your maxilla lowered a few mm, as well as advancing it. Something like this guy got. By the way, some of your ideas about how to fix your facial problems seem wrong to me. You need to go for a purely orthognathic approach. Don't just try to mask your skeletal problems with orthodontic work/plastic surgery. Do some more research before you ruin your looks for life.

Tiny

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Actually the chin implant and lipo did improve my profile a lot.  I think that chin implants, while not ideal for most people with retrognathism, actually look pretty similar to a plain genioplasty.  I think I got a better result with an implant than I would have with a genioplasty because the implant I got extends to the prejowl area - a genioplasty would have just given me a pointed chin.   I am aware that implants have their issues but they do remain an alternative for those who are not ready to commit to surgery.

I agree that Wilckodontics is not a standard procedure but I don't think it's total bullshit.  It's a periodontal surgery that works by partially degrading the bone, allowing for teeth to move faster, and then bone is naturally remineralized.  I am interested in it because I think it will make any extrusions I have done faster and more stable.  I can't exactly avoid orthos entirely as I will need to see one or more if I do decide to get surgery

I presume you mean advance the mandible, rather than maxilla?  This guys profile is similar to mine but I don't have nearly such a protruding chin pad.  I think my bottom lip is about 8 or 9mm behind my top.  My overbite really isn't that significant which makes me worry that I will need a long time in braces to move everything back before a BSSO

pekay

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There are some world class surgeons in Egypt who are on the verge of revolutionizing modern day orthognathic surgery



Chopsticks > Spoons

Tiny

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There are some world class surgeons in Egypt who are on the verge of revolutionizing modern day orthognathic surgery

Any names?  Are they in Cairo? 

pekay

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Any names?  Are they in Cairo?

Yes it's in Cairo, it's a team rather than a single surgeon I think the head guy is Dr. Yehya Mostafa

Chopsticks > Spoons

Tiny

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Yes it's in Cairo, it's a team rather than a single surgeon I think the head guy is Dr. Yehya Mostafa

Thanks for the tip - I will check it out.  There's a lot of anti-western feeling in Cairo right now but luckily I'm only half British so I should be safe enough.  The flight is only 4hrs

pekay

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Thanks for the tip - I will check it out.  There's a lot of anti-western feeling in Cairo right now but luckily I'm only half British so I should be safe enough.  The flight is only 4hrs

Np, if traveling isn't an issue you can always consult with British or Belgian surgeons
Chopsticks > Spoons

Lazlo

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There are some world class surgeons in Egypt who are on the verge of revolutionizing modern day orthognathic surgery

in what sense? can you give some details?

Lazlo

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in what sense? can you give some details?

sorry you seem to have indeed answered this, regardless would be interesting to know more... see some real results...

Tiny

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Np, if traveling isn't an issue you can always consult with British or Belgian surgeons

I'm going to consult with British ones as I travel to London frequently.  Belgium I'm not so keen for.  I really have no idea who in London is good - a lot of British surgeons won't treat you unless your jaw/bite is a total disaster