Author Topic: Thinking of surgery  (Read 13102 times)

Zane75

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Thinking of surgery
« on: July 28, 2015, 02:41:26 PM »
My jaw is underdeveloped. I’ve attached 2 photos, one with my jaw relaxed, and the other with my jaw forced forward. I’m sure I have an overbite, but all the dentists I have seen over the years have never actually mentioned it. The overbite doesn’t concern me too much. If I could have jaw surgery without going through orthodontics that would be ideal. Anyway, I’m thinking of jaw surgery, I think I need the lower jaw moved forward, possibly a genioplasty, but unsure if the upper jaw also needs to be moved forward too. I’m curious on what others think I would need? Also, not sure where to start, go direct to a surgeon, or find and book an orthodontist? I'm not interested in implants.


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Zane75

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Re: Thinking of surgery
« Reply #1 on: July 28, 2015, 11:34:51 PM »
Thanks for the reply Facenit. I don't really like getting x-rayed more than I need to. Is it acceptable to get copies of the x-rays from one surgeon and give them to others. Or do surgeons need to have their own done? I'm i the UK. I'm fine to get braces if it's needed

PloskoPlus

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Re: Thinking of surgery
« Reply #2 on: July 29, 2015, 12:12:17 AM »
Thanks for the reply Facenit. I don't really like getting x-rayed more than I need to. Is it acceptable to get copies of the x-rays from one surgeon and give them to others. Or do surgeons need to have their own done? I'm i the UK. I'm fine to get braces if it's needed
get the cone beam ct scan done once.  Get the CD.

Gregor Samsa

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Re: Thinking of surgery
« Reply #3 on: July 29, 2015, 01:13:18 AM »
Thanks for the reply Facenit. I don't really like getting x-rayed more than I need to. Is it acceptable to get copies of the x-rays from one surgeon and give them to others. Or do surgeons need to have their own done? I'm i the UK. I'm fine to get braces if it's needed

If you paid for them then you own them. I had no trouble getting my x-rays from Paul Johnson. I recommend getting a cone beam scan if you haven't already gotten one though.

ForeverDet

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Re: Thinking of surgery
« Reply #4 on: August 07, 2015, 11:32:31 PM »
With that level of jaw recession, you must certainly have a overjet/overbite however it's probably been masked via natural compensation during development if you haven't had braces. Do you show a most/all of your upper teeth when you smile? And show 1-2mm of your upper front tooth when your upper lip is relaxed?

I hope that after they decompensate your teeth with braces, you only require a large mandibular advancement and moderate genioplasty to correct your retrognathia. If you don't have upper jaw surgery and can getna aesthetically/functionally stable result, you avoid the often drastic nose changes (nose widens and/or the tip move up) and will have a much easier recovery.

chinnychinchin

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Re: Thinking of surgery
« Reply #5 on: August 09, 2015, 09:18:05 PM »
Do you have any sleep apnea problems? Also, Arnett/Gunson would probably see this as a CCW (counter-clockwise rotation) solution, so it might also require surgery of your upper jaw (rotation). Basically, it would appear as if your jaw is rotated too far clockwise (or from your pictures, too counter-clockwise) which would require rotating your entire jaw counter-clockwise (or clockwise in your pictures). Simply advancing your lowing mandible with a genio is usually insufficient and doesn't bring about facial imbalance. Hope that makes sense.

ForeverDet

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Re: Thinking of surgery
« Reply #6 on: August 10, 2015, 12:23:15 AM »
Do you have any sleep apnea problems? Also, Arnett/Gunson would probably see this as a CCW (counter-clockwise rotation) solution, so it might also require surgery of your upper jaw (rotation). Basically, it would appear as if your jaw is rotated too far clockwise (or from your pictures, too counter-clockwise) which would require rotating your entire jaw counter-clockwise (or clockwise in your pictures). Simply advancing your lowing mandible with a genio is usually insufficient and doesn't bring about facial imbalance. Hope that makes sense.

Generally class II/retrognathia without vertically maxillary excess traits (lip incompetence, excess incisor exposure, gummy smile, maxillary retrusion, etc.) does not indicate CCW as the occlusal plane tends to be flat rather than steep. In the OP's case, if upper is necessary, CW aka clockwise rotation would be necessary but again, that is assuming his maxillary vertical is deficient w/ flat occlusal plane.

It is actually incorrect to state that a mandibular advancement and a genio is "usually insufficient" as it's always dependent on numerous factors. A steep occlusal plane alone does not automatically indicate CCW. Just as a flat occlusal plane does not automatically indicate CW. Same with having a deep bite or recessed chin or gummy smile. Because each of these dentofacial issues by itself means very little in how one should go about correcting them or if it's really aesthetically or functionally necessary to correct them at all.

There is actually a young woman with a class II bite/jaw in Arnett's book (Facial and Dental Planning for Orthodontists and Oral Surgeons) where they used lower jaw surgery/genio only to give her an excellent result. They left her occlusal plane relatively sleep but avoided upper because her tooth display and maxillary projection were within the normal range despite not being optimal .

Would doing the upper marginally improve certain other issues, like flattening her occlusion and reducing her slightly excess incisor display? Probably but it does not guarantee her facial aesthetics would be any better. She also had the luck of avoiding any maxilla related complications and much easier recovery with less costs.

Here's another good example. His before pic isn't identical to OP but there has been decompensation of the upper incisors to maximize overjet pre-surgery in a case. His retrognathia is fairly severe like OP. His doctor wisely chose to just do a mandibular advancement and genioplasty which gave him great bite and strong profile.



Back to OP, without an x-ray and facial shots w/ smile, relaxed, etc, it's hard to give advice with certitude. There could be a need for upper jaw surgery too for full correction.

terry947

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Re: Thinking of surgery
« Reply #7 on: August 10, 2015, 12:30:20 AM »
^ Wow talk about an amazing after result!!!!

@foreverdet- what do you mean by decompensation? Did they move the incisors forwards with braces?

Also he must of had a big over bite to just move the lower jaw..... Anymore info on this guy?

ForeverDet

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Re: Thinking of surgery
« Reply #8 on: August 11, 2015, 03:47:44 AM »
^ Wow talk about an amazing after result!!!!

@foreverdet- what do you mean by decompensation? Did they move the incisors forwards with braces?

Also he must of had a big over bite to just move the lower jaw..... Anymore info on this guy?

Yes in the case of Class II bite where surgery is indicated.

Decompensation is the process of removing the natural or orthodontic induced masking of a malocclusion. So for example when someone is a class III w/negative overjet, an ortho may opt to flare out the upper incisors to create an overjet closer to a class I via braces. And in mild cases, compensation may be appropriate.

In surgical cases, by decompensating teeth fully, you reveal the actual severity of the person's misdeveloped bite/jaw so you can (hopefully) fully correct it with sufficient rotation/advancement. It also accomplishes the need for proper alignment if there's crowding and revealing any other bite issues that were not obvious before the decompsation. 

The guy I posted had a 18mm advancement (10mm bsso + 8mm genio). It is an excellent result.

I had a 20ish mm advancement total (12mm bsso + 8mm genio) but as you can see, my dentofacial deformity was fundamentally different than that guys despite both of us having similar levels of chin retrusion. And while I love my profile now, I think his after result is more impressive because of how evident his recession was before. I did not have the severity of his overjet even after decompensation (my bite was borderline class 1/2 after my first round of braces) so I required double jaw surgery with CCW, which allowed the doc to move my jaw 12mm forward. I had already gotten the 8mm genioplasty 6 years before.


terry947

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Re: Thinking of surgery
« Reply #9 on: August 13, 2015, 01:43:59 AM »
Ahhh i get it.

Your results are great btw.

I was thinking of doing something similar pre-surgery as well.

I have dental arches on the narrower side and i want to expand them and at the same time push back the incisors so that I could avoid getting extractions. one surgeon mentioned I might need lower jaw extractions cuz my ortho flared my teeth+tongue trusting.

SGseeker

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Re: Thinking of surgery
« Reply #10 on: September 15, 2015, 12:09:27 PM »
REALLY AMAZING RESULTS!!!! HA worked well !!!