Author Topic: Class two surgery or genio+ryno?  (Read 365 times)

Frastolo

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Class two surgery or genio+ryno?
« on: October 28, 2017, 01:59:12 AM »
Hi,
i'm considering surgery, i'm in a class two dental occlusion. I hate my profile big nose/weak chin and protuding mouth while from the frontal i have a strong mentalis muscle hypertrofy due the fact that i have lip incompetence and this ruin the frontal view.
As you can see mandibular plane angle is high (over 40°). I'm also reporting a Clark Analysis. I have a scheduled consultion with 3 different max fac surgeon in november.
When i was younger i have done orthodontics from 12 to 16 in order to camufflage, but slowly the class two is returning back.

From functional aspect i have click and popping while eating and sometimes also when opening my mouth, strain when eating hard food,  tinnitus (ring in the ears) from when i was adolescent and i think also to suffer with sleep apnea.

I'm scared to bring brace again for years to decompensate the work done previusly, i really wish to do a surgery first approach.

Lateral xray: https://imgur.com/a/mMwje

Thanks for the help.

tdawg

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Re: Class two surgery or genio+ryno?
« Reply #1 on: October 28, 2017, 05:18:16 AM »
Definitely DJS with somebody who does CCW rotation, imo.

ditterbo

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Re: Class two surgery or genio+ryno?
« Reply #2 on: October 28, 2017, 05:30:07 AM »
Definitely DJS with somebody who does CCW rotation, imo.

His insurance might even agree, it's that bad.

Frastolo

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Re: Class two surgery or genio+ryno?
« Reply #3 on: October 28, 2017, 06:24:16 AM »
His insurance might even agree, it's that bad.
I'm in Europe so insurance is not avaiable i have to go to in a public hospital and be operated by a random surgeon and wait years or go privately choose the surgeon i want but pay myself the surgery.

Some orto said that i need only a lower surgery, but looking at the xray i'm a little skeptical...

kavan

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Re: Class two surgery or genio+ryno?
« Reply #4 on: October 28, 2017, 03:01:42 PM »
You're a candidate for the surgery. Since you are in Europe, your options are open to consult around for docs who do the surgery first. However, it might not preclude pre-molar  extractions being done during the surgery, class3 are better candidates and there might be some limitations to class 2.
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GJ

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Re: Class two surgery or genio+ryno?
« Reply #5 on: October 28, 2017, 03:46:22 PM »
Ideal candidate...that is severe class 2.

You need advancement and CCW rotation.

Frastolo

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Re: Class two surgery or genio+ryno?
« Reply #6 on: October 29, 2017, 09:33:29 AM »
Thank you, let's wait the first appointment with the surgeon...he is a big name in my country after that i also have scheduled a check with Raffaini.

kavan

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Re: Class two surgery or genio+ryno?
« Reply #7 on: October 29, 2017, 09:56:10 AM »
Although I can't tell you for sure, you might be more of a candidate for the conventional approach which involves the braces before hand rather than the Surgery First method. Of course, being in EUROPE, even though your selected doctor doing the SF approach would be different, to the best of my knowledge, the candidacy for it does not differ a whole lot amoung the doctors who do the SF method.


From one of Alfaro's paper's regarding candidates for the Surgery First method:

http://www.institutomaxilofacial.com/wp-content/uploads/2016/05/Surgery-What-have-we.pdf

[There is a restriction of the SF method to those not needing too much pre-surgical alignment
and decompensation. [In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered.]


[[Despite the evident advantages of an SF approach, it
is unquestionable that careful patient selection, detailed
treatment planning, and constant communication between
the surgeon and the orthodontist are absolutely
indispensable.5 According to the authors’ protocol, patients
with TMJ symptoms or uncontrolled periodontal
disease are automatically excluded from an SF approach
based on an unstable postoperative occlusion or demanding
orthodontic movements, respectively. Regarding
the type of dentofacial anomaly, Liou et al8,10
restricted their indications to cases that did not need
too much presurgical orthodontic alignment and
decompensation; in other words, cases with well
aligned to mildly crowded anterior teeth, flat to mild
curve of Spee, and normal to mildly proclined or
retroclined incisors. In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered. Moreover,
cases requiring SARPE to achieve an adequate
transverse maxillary dimension or severe asymmetries
with 3D dental compensations are currently excluded
from the SF protocol. In the authors’ opinion, these
scenarios seem to be too complex and inaccurate to
anticipate the final occlusion accurately. Moreover,
3D dental compensations can significantly impair
immediate postsurgical stability. The authors prefer
a conventional approach for cases managed by an
orthodontist with limited experience in orthognathic
surgery. Although the current exclusion criteria may
seem rather extensive, the authors expect to gradually
broaden the indications for the SF approach as their
experience increases and current limitations become
reasonably controlled.]

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Frastolo

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Re: Class two surgery or genio+ryno?
« Reply #8 on: October 31, 2017, 11:24:59 AM »
Although I can't tell you for sure, you might be more of a candidate for the conventional approach which involves the braces before hand rather than the Surgery First method. Of course, being in EUROPE, even though your selected doctor doing the SF approach would be different, to the best of my knowledge, the candidacy for it does not differ a whole lot amoung the doctors who do the SF method.


From one of Alfaro's paper's regarding candidates for the Surgery First method:

http://www.institutomaxilofacial.com/wp-content/uploads/2016/05/Surgery-What-have-we.pdf

[There is a restriction of the SF method to those not needing too much pre-surgical alignment
and decompensation. [In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered.]


[[Despite the evident advantages of an SF approach, it
is unquestionable that careful patient selection, detailed
treatment planning, and constant communication between
the surgeon and the orthodontist are absolutely
indispensable.5 According to the authors’ protocol, patients
with TMJ symptoms or uncontrolled periodontal
disease are automatically excluded from an SF approach
based on an unstable postoperative occlusion or demanding
orthodontic movements, respectively. Regarding
the type of dentofacial anomaly, Liou et al8,10
restricted their indications to cases that did not need
too much presurgical orthodontic alignment and
decompensation; in other words, cases with well
aligned to mildly crowded anterior teeth, flat to mild
curve of Spee, and normal to mildly proclined or
retroclined incisors. In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered. Moreover,
cases requiring SARPE to achieve an adequate
transverse maxillary dimension or severe asymmetries
with 3D dental compensations are currently excluded
from the SF protocol. In the authors’ opinion, these
scenarios seem to be too complex and inaccurate to
anticipate the final occlusion accurately. Moreover,
3D dental compensations can significantly impair
immediate postsurgical stability. The authors prefer
a conventional approach for cases managed by an
orthodontist with limited experience in orthognathic
surgery. Although the current exclusion criteria may
seem rather extensive, the authors expect to gradually
broaden the indications for the SF approach as their
experience increases and current limitations become
reasonably controlled.]

The extractions that you are speaking about are on the upper jaw? Every dentist told me to extract them but i think that it's only a way to provide an ulterior camufflage...

XXRyanXXL

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Re: Class two surgery or genio+ryno?
« Reply #9 on: October 31, 2017, 01:05:05 PM »
I agree with the opinions rendered here, CCW rotation and advancement. Your inability to wait is of no concern to any surgeon you see, you must be fully decompensated as it gives room for the surgeon to make the movements necessary and provide long term stability of the class II surgical correction.  Many surgeons dislike surgery first approach. I anticipate you will have a difficult time isolating those surgeons. The braces, also, provide rigid fixation after surgery, many surgeons prefer you be in braces and not arch bars, as these will tear up the gums and also straighten the teeth prior to surgery.

kavan

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Re: Class two surgery or genio+ryno?
« Reply #10 on: October 31, 2017, 01:48:46 PM »
The extractions that you are speaking about are on the upper jaw? Every dentist told me to extract them but i think that it's only a way to provide an ulterior camufflage...

Extractions for bi max for class2 USUALLY refer to the mandibular teeth because they need to be PUSHED BACKWARDS for the decompensation needed to move the mandible forward in the BSSO as there might not be ENOUGH ROOM to push them backwards which is why they remove a pre molar to make SPACE to do that. It USUALLY does not refer to pushing the maxilla teeth FORWARDS during decompensation.

When a 'dentist' tells a class 2 patient to remove the maxilla pre-molars, it USUALLY to make room to push them BACKWARDS but ONLY to get the 'bite right'. That is called 'compensation' or 'camouflage' for ortho ONLY. It is NOT in preparation for a bi-max surgery to correct class 2 skeletal.

Premolar plucking is when the teeth need to be pushed BACKWARDS. But in YOUR situation, the need of the MAX FAX to push you mandible FORWARD (via the mandible pre molar plucking) should be prioritized over any 'need' for an ortho to pluck the upper pre-molars just to 'get the bite right' where the ortho's goal is to AVOID your getting bi-max.
Please. No PMs for private advice. Board issues only.