Author Topic: Class 2 Division 2 Help  (Read 739 times)

shnk

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Re: Class 2 Division 2 Help
« Reply #15 on: August 27, 2017, 06:39:00 PM »
I'm not so sure about CCW in your case. Keep in mind that a rotation of the maxilla is with the aim of getting the occlusal plane closer to the horizontal (but not totally flat). In turn, ANS-PNS (maxilla) also gets closer to the horizont.

Here is example:

The OP is taking on a big downward diagonal (negative slope). So is ANS-PNS of maxilla. The rotation is CCW and both the OP and ANS-PNS are more aligned with the horizont.

In this example:

The OP is too close to the horizont. ANS-PNS is taking on more of an upward diagonal (positive slope). The rotation is CLOCKWISE.

In your case, ANS-PNS is aligned away from the horizont via more of an upward diagonal. So, it would be clockwise rotation that would align it closer. Not CCW--OR something where it's just left to 'linear' advancement with little rotation. So, I don't think it's a question of CCW in your case. But check with your maxfax.

It looks to me like they probably want to MINIMIZE moving the maxilla forward for the above reason where your only option is to move the lower teeth backwards and pluck out the premolars in X-change for MAXIMIZING lower jaw and chin advancement.

Ah ok i see. I thought maybe my lower jaw angle was too steep. So i could get away with just a linear lower jaw advancement maybe? I have an appointment with a maxfac in 15 days so ill talk to him as well. I'll have to talk with my ortho too to see if ill need extractions or not. I think she might be able to push my lower teeth back enough.

kavan

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Re: Class 2 Division 2 Help
« Reply #16 on: August 27, 2017, 09:42:06 PM »
Ah ok i see. I thought maybe my lower jaw angle was too steep. So i could get away with just a linear lower jaw advancement maybe? I have an appointment with a maxfac in 15 days so ill talk to him as well. I'll have to talk with my ortho too to see if ill need extractions or not. I think she might be able to push my lower teeth back enough.

Your mandibular plane angle does not look steep. Remember that the ortho should be one working with the max fax.
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shnk

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Re: Class 2 Division 2 Help
« Reply #17 on: August 28, 2017, 10:43:15 AM »
Your mandibular plane angle does not look steep. Remember that the ortho should be one working with the max fax.

I'm just scared that my face will look longer if i get a linear advancement as i already have a big head and narrow jawline. And yeah the ortho and maxfac will be working together.

kavan

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Re: Class 2 Division 2 Help
« Reply #18 on: August 28, 2017, 10:49:56 AM »
I'm just scared that my face will look longer if i get a linear advancement as i already have a big head and narrow jawline. And yeah the ortho and maxfac will be working together.

It could, but they try to offset that with chin advancement that is not only forward but also UP. But as I said prior, when the narrowness of the jaw comes forward, it looks less narrow in frontal perspective.
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Dean_il_greco

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Re: Class 2 Division 2 Help
« Reply #19 on: August 28, 2017, 11:37:41 AM »
I'm just scared that my face will look longer if i get a linear advancement as i already have a big head and narrow jawline. And yeah the ortho and maxfac will be working together.
If your chin is brought forward as well in a separate procedure (of course), the vertical lengthening won't be that substantial.
Still, I think CCW would be better for you. Just a 2-3 mm anterior maxillary impaction would be perfect.

shnk

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Re: Class 2 Division 2 Help
« Reply #20 on: August 28, 2017, 12:50:35 PM »
It could, but they try to offset that with chin advancement that is not only forward but also UP. But as I said prior, when the narrowness of the jaw comes forward, it looks less narrow in frontal perspective.

Alright got it. Would a linear advancement provide a result similar to jutting my jaw? Or would it be better?

If your chin is brought forward as well in a separate procedure (of course), the vertical lengthening won't be that substantial.
Still, I think CCW would be better for you. Just a 2-3 mm anterior maxillary impaction would be perfect.

What would an impaction of 2-3 mm do to my midface? Would this do something to my nose?

kavan

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Re: Class 2 Division 2 Help
« Reply #21 on: August 28, 2017, 01:56:49 PM »
To my last entry,  I would add that your face, as is, (via the photos you show)  would NOT be considered 'long'. Not by any relative measurements that would go into assessments of 'long'.
What you percieve as 'long' would be attributed to the illusion of such by:

a: ears sticking out which will make the face look more narrow. (illusionary narrowness)

b: Narrow mandible. (real narrowness)

So, narrowness, whether it's an illusion or real or combo thereof will yield the SUBJECTIVE assessment of 'long'. But in terms of OBJECTIVE measures (from your photo), it isn't 'long'. Nor do you have a 'high' mandibular plane. Any anticipated appearance of 'excess' length would tend to be offset by the lower face looking wider when brought forward and also a genio aimed at shortening the chin during the advancement of it.

You could have impaction which is CCW. But you should also be aware that a key objective in favor of CCW is to get the maxilla at ANS-PNS closer to the horizont. In your case, it looks like (from your ceph) is angled away from the horizont and would be angled more away with CCW.

Then there is the MYSTERY of your nose which you have blocked out. A rotation, whether it be CCW or Clock Wise will affect how the nose looks. Just saying that in the absence of visual nose information but in the presence of seeing the orientation of ANS-PNS, I'm just pointing out why i would not be so quick to suggest CCW.  Not telling you not to do it. I'm just explaining why I have not suggested it.

I have no issue with anyone else suggesting it or your asking for it to your max fax. I'm just explaining why I haven't.
---

As to your 'jaw jut' question, let's look at that in terms of a simple mechanical analysis as to the displacements you make while doing it. Do to your front teeth, to get PAST them to jut your jaw out, you have to drop it down to bring it more forward. It looks like you would have to do that just to get the lower teeth to meet the upper teeth edge to edge. Liking that look is a sign in favor of the surgery. Even if after getting the teeth to meet edge to edge, you went beyond that and bit down into an UNDER bite and liked that look (with your mouth shut of course), it another indicator in favor of the BSSO. The former (edge to edge tooth meet) increases the the angle of the mandibular plane because you are dropping the jaw down to make that movement. The latter, not so much. So, some combination of both. Both are indicators in favor of the surgery. But NEITHER jaw juts predict and show you 'exactly' how you will look after the surgery.

A ceph displacement proposal should give you a better idea of the profile contour changes.



Alright got it. Would a linear advancement provide a result similar to jutting my jaw? Or would it be better?


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Dean_il_greco

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Re: Class 2 Division 2 Help
« Reply #22 on: August 28, 2017, 03:11:20 PM »

What would an impaction of 2-3 mm do to my midface? Would this do something to my nose?
That is soft tissue, dude
I don't think it could get worse than it is already.
« Last Edit: August 28, 2017, 10:46:17 PM by Dean_il_greco »

PloskoPlus

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Re: Class 2 Division 2 Help
« Reply #23 on: August 28, 2017, 03:25:41 PM »
You don't have much to impact.  It would be a disaster in your case.

shnk

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Re: Class 2 Division 2 Help
« Reply #24 on: August 28, 2017, 05:09:01 PM »
To my last entry,  I would add that your face, as is, (via the photos you show)  would NOT be considered 'long'. Not by any relative measurements that would go into assessments of 'long'.
What you percieve as 'long' would be attributed to the illusion of such by:

a: ears sticking out which will make the face look more narrow. (illusionary narrowness)

b: Narrow mandible. (real narrowness)

So, narrowness, whether it's an illusion or real or combo thereof will yield the SUBJECTIVE assessment of 'long'. But in terms of OBJECTIVE measures (from your photo), it isn't 'long'. Nor do you have a 'high' mandibular plane. Any anticipated appearance of 'excess' length would tend to be offset by the lower face looking wider when brought forward and also a genio aimed at shortening the chin during the advancement of it.

You could have impaction which is CCW. But you should also be aware that a key objective in favor of CCW is to get the maxilla at ANS-PNS closer to the horizont. In your case, it looks like (from your ceph) is angled away from the horizont and would be angled more away with CCW.

Then there is the MYSTERY of your nose which you have blocked out. A rotation, whether it be CCW or Clock Wise will affect how the nose looks. Just saying that in the absence of visual nose information but in the presence of seeing the orientation of ANS-PNS, I'm just pointing out why i would not be so quick to suggest CCW.  Not telling you not to do it. I'm just explaining why I have not suggested it.

I have no issue with anyone else suggesting it or your asking for it to your max fax. I'm just explaining why I haven't.
---

As to your 'jaw jut' question, let's look at that in terms of a simple mechanical analysis as to the displacements you make while doing it. Do to your front teeth, to get PAST them to jut your jaw out, you have to drop it down to bring it more forward. It looks like you would have to do that just to get the lower teeth to meet the upper teeth edge to edge. Liking that look is a sign in favor of the surgery. Even if after getting the teeth to meet edge to edge, you went beyond that and bit down into an UNDER bite and liked that look (with your mouth shut of course), it another indicator in favor of the BSSO. The former (edge to edge tooth meet) increases the the angle of the mandibular plane because you are dropping the jaw down to make that movement. The latter, not so much. So, some combination of both. Both are indicators in favor of the surgery. But NEITHER jaw juts predict and show you 'exactly' how you will look after the surgery.

A ceph displacement proposal should give you a better idea of the profile contour changes.

My mandible is definitely narrower than average. Also im pretty underweight. Thats probably another reason why it looks narrow.
I've got a slightly crooked nose so a CCW rotation would straighten it a bit im assuming? If you're impacting and advancing a few mm?


That is soft tissue, dude
I don't think it could get worse that it already is.

Yeah i guess so.

You don't have much to impact.  It would be a disaster in your case.

So would you just suggest a linear advancement? I'm getting mixed answers here. Some people are saying CCW rotation.

kavan

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Re: Class 2 Division 2 Help
« Reply #25 on: August 28, 2017, 05:52:50 PM »
My mandible is definitely narrower than average. Also im pretty underweight. Thats probably another reason why it looks narrow.
I've got a slightly crooked nose so a CCW rotation would straighten it a bit im assuming? If you're impacting and advancing a few mm?

The point is that your face is narrow but NOT long.
Because you have blocked vision of your nose, i would make no assumptions that CCW would straighten it. All I can tell you is that the nose can change with ROTATIONS of the maxilla and your ANS-PNS (anterior to posterior nasal spine) is not oriented in the direction consistent with others who benefit from CCW.
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shnk

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Re: Class 2 Division 2 Help
« Reply #26 on: September 28, 2017, 03:51:13 PM »
Need more opinions. Thanks

GJ

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Re: Class 2 Division 2 Help
« Reply #27 on: September 28, 2017, 03:58:58 PM »
Haven't read the responses of what others think, but I think this is a rare case where pulling two lower bicuspids to move linear might be appropriate. Hate to say that because extractions are awful, but I can see it as a legit approach here.

CCW maybe, but I'd fear it would shorten your face too much, and the mandibular plane doesn't look especially steep.

Of course there is the option to do nothing. If profile is the only problem that might be best.

Tough case.

shnk

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Re: Class 2 Division 2 Help
« Reply #28 on: September 28, 2017, 04:04:46 PM »
Haven't read the responses of what others think, but I think this is a rare case where pulling two lower bicuspids to move linear might be appropriate. Hate to say that because extractions are awful, but I can see it as a legit approach here.

CCW maybe, but I'd fear it would shorten your face too much, and the mandibular plane doesn't look especially steep.

Of course there is the option to do nothing. If profile is the only problem that might be best.

Tough case.

Do you know how much extra advancement extractions could give? Something like 3-5m more? I'm scared if i get linearly advanced too much then it might make me look like a horse.

GJ

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Re: Class 2 Division 2 Help
« Reply #29 on: September 28, 2017, 04:58:17 PM »
Do you know how much extra advancement extractions could give? Something like 3-5m more? I'm scared if i get linearly advanced too much then it might make me look like a horse.

I believe a premolar is 8mm, from memory.

You probably wouldn't get that much advancement from extracting the lowers alone because teeth would rotate and whatnot to close the space. I'm not sure what exact mm advancement you'd get from that. Take notes from this thread and bring them to a surgeon to ask.