Would having a chin wing prevent you from having a BSSO down the track?

[BlueShark7]

Hypothetically, if you had a chin wing, would a BSSO still be possible down the line?

TIA.

[notrain]

technically yes, once the bone is fully healed from the chin wing surgery another surgery is possible.

the aesthetic outcome of a bsso may be compromised if you had chin wing done before bsso, though.

my advise would be to make up your mind whether you want to take the braces & bsso route or not  and to think about it very thoroughly before going under the knife.

if you are undecided, bear in mind that usually only a bimaxillary surgery will fix a jaw problem for good, chin wing is just a surgical camouflage technique if it isn't combined with lefort / bsso osteotomies.

since you underwent camouflage orthodontics (like most of us) when you were younger, having chinwing surgery would basically leave you with a camouflaged / compensated dentition and a camouflaged face. you'd still have the dentofacial deformity underneath.

[Optimistic]

technically yes, once the bone is fully healed from the chin wing surgery another surgery is possible.

the aesthetic outcome of a bsso may be compromised if you had chin wing done before bsso, though.

my advise would be to make up your mind whether you want to take the braces & bsso route or not  and to think about it very thoroughly before going under the knife.

if you are undecided, bear in mind that usually only a bimaxillary surgery will fix a jaw problem for good, chin wing is just a surgical camouflage technique if it isn't combined with lefort / bsso osteotomies.

since you underwent camouflage orthodontics (like most of us) when you were younger, having chinwing surgery would basically leave you with a camouflaged / compensated dentition and a camouflaged face. you'd still have the dentofacial deformity underneath.

Nothing to add to this other than if you think about it logically a chin wing will create the illusion of a properly developed jaw. A BSSO after that would therefore advance the chin beyond normal proportions.

So possible, yes.

Advisable, no.

[BlueShark7]

Thanks guys, much appreciated.

[Tiny]

Nothing to add to this other than if you think about it logically a chin wing will create the illusion of a properly developed jaw. A BSSO after that would therefore advance the chin beyond normal proportions.

Maybe yes, but not necessarily - it depends on the level of recession.  People have major recession and get an advancement of 15mm or so with a combination of genio and a BSSO.  It depends on the jaw and the level of advancement done with the chin wing.   A majorly recessed person could go for a relatively conservative chin wing (e.g 5-6mm advancement) if they planned further surgery.  Yes, if they got a larger advancement and then got a BSSO, it would look weird
If someone was only moderately recessed then yeah, an chin wing followed by a BSSO would leave too big a chin.  You'd have to do a BSSO and genio

If the jaw is only a little recessed then a chin wing will make it look normal but if it's worse, then it won't.  A chin wing isn't going to change the lip position for example.
That said, personally I wouldn't do it this way round because -

the aesthetic outcome of a bsso may be compromised if you had chin wing done before bsso, though.

I'm glad I got an implant and not a genio, because I got an OK visual improvement while I weighed up and researched surgery, and I can easily have it removed if I need to

[BlueShark7]

Maybe yes, but not necessarily - it depends on the level of recession.  People have major recession and get an advancement of 15mm or so with a combination of genio and a BSSO.  It depends on the jaw and the level of advancement done with the chin wing.   A majorly recessed person could go for a relatively conservative chin wing (e.g 5-6mm advancement) if they planned further surgery.  Yes, if they got a larger advancement and then got a BSSO, it would look weird
If someone was only moderately recessed then yeah, an chin wing followed by a BSSO would leave too big a chin.  You'd have to do a BSSO and genio

If the jaw is only a little recessed then a chin wing will make it look normal but if it's worse, then it won't.  A chin wing isn't going to change the lip position for example.
That said, personally I wouldn't do it this way round because -

I'm glad I got an implant and not a genio, because I got an OK visual improvement while I weighed up and researched surgery, and I can easily have it removed if I need to

Thanks Tiny. The ideal for me would be a modest BSSO alone, however due to camouflage orthodontics, my bite is good but my lower jaw is still recessed. The only way I could have a BSSO would be with extractions which I am very very anti. So a chin wing would be it (+/- some kind of graft for the labiomental fold). I'm just wary of doing something that would prevent me having a BSSO down the track if I ever wanted to go that route (breathing issues etc).

[Tiny]

You could still do a BSSO and a reduction genio

[BlueShark7]

You could still do a BSSO and a reduction genio

Do you mean after chin wing?

[Tiny]

Do you mean after chin wing?

Yes.  The chin wing will move your chin forward.  If you then get a BSSO you will need to move the chin back so would need an additional genio

[BlueShark7]

Yes.  The chin wing will move your chin forward.  If you then get a BSSO you will need to move the chin back so would need an additional genio

Gotcha, thanks Tiny.

[notrain]

however due to camouflage orthodontics, my bite is good but my lower jaw is still recessed. The only way I could have a BSSO would be with extractions which I am very very anti.

FWIW even without camouflage orthodontics you would likely have needed extractions in the deficient jaw anyway because the jaw is lenghtened in the back but the natural compensation (which occurs regardless of orthodontics or not) makes the teeth erupt too far forward in the jaw to compensated for the size discrepancy. To remedy this, you need to take out either the first or 2nd premolars and move the front teeth back towards the molars so you can then in turn advance the lower jaw via a bsso behind the 2nd molars (where the wisom teeth would be).

It is very very rare that the natural compensation can be removed entirely without extractions and still yield an optimal result as you'd need copious amounts of rotation (either cw or ccw) to increase the dental overjet to make any meaningful surgical advancement possible. also, in most class 2 cases, the lower front teeth are proclined beyond the bony base of the mandible which can cause issues once you age and lose bone volume (you might lose those teeth and good luck getting an implant to replace a proclined and overly erupted tooth).

TBH i think the forum bias against extractions is exaggerated. yes, they are bad in the upper jaw because it will lessen tongue space but in my opinion (i had 2 lower premolars taken out ~3 months ago) it is pretty much irrelevant in the lower jaw. the only thing bothering me right now is the gap that the braces have to close, because it's awkward to brush and chew but once the gaps are closed and the lower jaw has been moved forward in its correct position, the extractions will not be noticable to me.

[BlueShark7]

FWIW even without camouflage orthodontics you would likely have needed extractions in the deficient jaw anyway because the jaw is lenghtened in the back but the natural compensation (which occurs regardless of orthodontics or not) makes the teeth erupt too far forward in the jaw to compensated for the size discrepancy. To remedy this, you need to take out either the first or 2nd premolars and move the front teeth back towards the molars so you can then in turn advance the lower jaw via a bsso behind the 2nd molars (where the wisom teeth would be).

It is very very rare that the natural compensation can be removed entirely without extractions and still yield an optimal result as you'd need copious amounts of rotation (either cw or ccw) to increase the dental overjet to make any meaningful surgical advancement possible. also, in most class 2 cases, the lower front teeth are proclined beyond the bony base of the mandible which can cause issues once you age and lose bone volume (you might lose those teeth and good luck getting an implant to replace a proclined and overly erupted tooth).

TBH i think the forum bias against extractions is exaggerated. yes, they are bad in the upper jaw because it will lessen tongue space but in my opinion (i had 2 lower premolars taken out ~3 months ago) it is pretty much irrelevant in the lower jaw. the only thing bothering me right now is the gap that the braces have to close, because it's awkward to brush and chew but once the gaps are closed and the lower jaw has been moved forward in its correct position, the extractions will not be noticable to me.

Interesting. I feel kinda lucky to still have all premolars post orthodontics as a teenager. I was anti extractions prior to reading the forum so I haven't acquired any bias as a recent thing. A surgeon I went to said my lower incisors aren't proclined that much as they are still sitting at 90 degrees to mandible, I think it's mainly my upper teeth that were pulled back. I am worried about gum recession etc though as I get older. I have like this extra bony growth around the bases of my lower teeth (exostoses??) maybe from clenching but maybe that might have a protective effect as I age I don't know.

The surgeon I saw said I could have extractions and prepare for surgery but in his eyes it would be a long time and a lot to go thru when realistically I'd only get a 5-6mm advancement and I agreed with him when he said I'd probably look back afterwards and say "was this really worth it."

A modest chin wing appeals to me. I do already have a medium labiomental fold but quite a decent amount of soft tissue there so hopefully that would soak up some of the movement if I got a chin wing. That said I really don't rate a deep sublabial fold as high on my list of things to worry about.

[earl25]

do bsso first