General Category > Functional Surgery Questions

Understanding my bite issues better

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Optimistic:
So according to my orthodontist there is not enough room to decompensate the lower teeth for a BSSO. I'm also edge to edge. So basically if I deduce that I'm led to believe my mandible is roughly in the correct position but with poor chin development.

He has stated that dealing with my edge to edge bite "is his next big challenge" after levelling my dental arches and impacting the third molars back to where they should be.

What I'm starting to wonder and worry is that he's really decompensating what he can with my lower teeth and making up the difference by flaring my front teeth out. I never understood why each new wire kept hurting my top set of teeth when they're already perfectly straight. This could be why. I've seen this before in people and it tends to look crap and lead to gum recession.

Is this something I should confront him about and ask? and what would my options be if he's right?


As I think about it seems a le fort i would deal with the situation nicely. It could fix my maxillary cant, it could rotate the maxilla so as to allow some auto-rotation of the mandible and improve occlusion, plus advancing it slightly would then give me a proper amount of overjet. The movements would undoubtedly be minor. Perhaps just a couple mm. However, this I'm guessing would result in a skeletally proper class I without any orthodontic magic that might lead to problems down the line.

Whilst he may characterise it as extreme and unnecessary I honestly don't care. If I'm going under for a chin wing and ZSO then a le fort to boot makes zero difference to me. Might as well I say.

Reasons for bringing this up are that Dr Triaca in fact suggested this method of Le Fort I and chin wing  after seeing scans as being sufficient to fix my bite despite only ever asking about chin wing, then as I thought about it I tend to agree. He said if the occlusal plane is oblique then a BSSO is also necessary.

Optimistic:
My only concern with all this would be that my nasolabial angle is already at 90?. Whilst soft tissue is unpredictable I'd have to have it anything less than that. 90? is ideal. Under 90? and you start to look a bit strange if you ask me.

Edit: And would there be any reason to consider something like a high lefort i over and above a normal one? I never looked into this stuff much as I always considered upper jaw surgery as being off the cards. I'm asking from an aesthetics and anti-ageing point of view. I understand a le fort i would fix my bite perfectly.

ForeverDet:
Do you have pics or an x-ray? Hard to give even a educated guess without one unless you've posted it before. I will say I would be wary of a an ortho saying this or that isn't possible. Before I found my surgeon, a couple orthos and the surgeon I originally asked about jaw surgery told me it wasn't possible to rotate my jaws to get the result I wanted since my bite was "good".


--- Quote from: Disillusioned on July 28, 2014, 08:46:06 PM ---My only concern with all this would be that my nasolabial angle is already at 90?. Whilst soft tissue is unpredictable I'd have to have it anything less than that. 90? is ideal. Under 90? and you start to look a bit strange if you ask me.

--- End quote ---

I wouldn't worry too much about this, you'll see tons of variation in natural class I people's nasolabial angle because that landmark in isolation means very little even though there is "ideal" range (96-114 according to some docs). Only in extremes does it become aesthetically an issue and can indicate dentoskeletal deformity. Plus I think the angle becoming to obtuse, meaning really flat and retracted in class III cases for example or class II convex cases, then it looks like the person has maxillary deficiency which looks worse then being more acute which a lot of attractive faces have.

PloskoPlus:
I thought your ortho said you're now a class I?  What kind of Le Fort I movements are we talking about.  BTW, I've seen Le Fort I advancements (class III, albeit) and the cheekbones pop after it.  No implants, not HA paste, just moderate ("mickey mouse" according to the surgeon) advancement.  Frankly I don't think any operation can change the face as much as Le Fort I.

Optimistic:

--- Quote from: ForeverDet on July 28, 2014, 09:41:20 PM ---Do you have pics or an x-ray? Hard to give even a educated guess without one unless you've posted it before. I will say I would be wary of a an ortho saying this or that isn't possible. Before I found my surgeon, a couple orthos and the surgeon I originally asked about jaw surgery told me it wasn't possible to rotate my jaws to get the result I wanted since my bite was "good".

I wouldn't worry too much about this, you'll see tons of variation in natural class I people's nasolabial angle because that landmark in isolation means very little even though there is "ideal" range (96-114 according to some docs). Only in extremes does it become aesthetically an issue and can indicate dentoskeletal deformity. Plus I think the angle becoming to obtuse, meaning really flat and retracted in class III cases for example or class II convex cases, then it looks like the person has maxillary deficiency which looks worse then being more acute which a lot of attractive faces have.

--- End quote ---

Here is an x-ray I had taken a quite a while ago, even before I got braces so my bite seems worse. The scan has problems in many ways. My head is face down more than it should and my chin wasn't even included in there. Eventually I got braces to level the dental arches which caused some auto rotation and advancement it seems, because when I look at this compared to my more recent CT scan the angle of the mandible is way steeper. Moreover, it should be clear in even this that there was a lot of lip incompetence which is now gone. Here it is anyway:






Regarding the opinion of the ortho I have to say I'm in a bind. I'm stuck with him. If he doesn't think I need surgery it's going to be very hard to convince him to do anything. Every time I bring it up he goes off about how I look fine and the only thing i MAY need is a sliding genio. Any ideas?


Finally, 96-114 degrees? seems far too obtuse for a male to be ideal. Perhaps in females who have more upturned noses?

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