braces + lower jaw surgery or braces only?

[LoveofScotch]

Hey Ginger,

Just out of curiosity, what side do you have TMJ/TMD issues on?

[Ginger]

Hey Ginger,

Just out of curiosity, what side do you have TMJ/TMD issues on?

Hi LoveofScotch, TMJ is on the right side. Right side of my jaw is forced more to the right due to the longer jaw length on the left. It puts the right joint in a weird position.

[PloskoPlus]

Impaction is aging.  It's only necessary if you have lip incompetence or severe gum show even with a faint smile.  Don't do it.

[Mark32]

is it aging because the soft tissue isn't as 'stretched' vertically over the underlying bone structure? you know, given more slack which in turn leads to future wrinkles.

also, how many milimetres of gum show when smiling would put you in the severe bracket?

[PloskoPlus]

Previously I thought 1 mm when smiling hard is considered normal. ( I have none, BTW) I just saw my surgeon, and he said "it depends". Gum thickness, tooth crown length.. But the point is, as you get older, soft tissue descends. So you will notice on older people less upper tooth show, more lower tooth show. Conversely people with slightly gummy smiles look younger than they are.

[Modigliani]

I'd say that anything more than 2mm could be considered too much.

[PloskoPlus]

IMO, while upper jaw surgery is easier to recover from, and a retruded upper jaw is the main cause of underbites in caucasians (hence a Le Fort I advancement being the major movement and often the only one in whites) , I would be very hesitant to touch it in your case.  No operation has as big of an impact on a person's appearance as a Le Fort I (for better or worse).  And your mid face looks just about perfect.

[Mark32]

the thing is, in my case, i think that my anterior teeth have longish crowns (does this feature go with a skeletal anterior open bite pattern?) so in my case i'd worry that if my maxilla was dropped down at the front enough to fully expose my upper anterior teeth i could end up looking a bit toothy when i smile, if you know what i mean.

do surgeons ever take this into consideration, leaving some of the upper teeth concealed when dropping the maxilla so as to avoid 'toothiness'?

...a retruded upper jaw is the main cause of underbites in caucasians (hence a Le Fort I advancement being the major movement and often the only one in whites)...

that's very interesting. is there some connection between this and the varying frequency of cleft palates found amongst east asians, caucasians and black people? i wonder does this increase the likelyhood - i'm caucasian (sounds odd to say) - that it's my maxilla that's the sole cause of my underbitish alignment?

[Ginger]

Impaction is aging.  It's only necessary if you have lip incompetence or severe gum show even with a faint smile.  Don't do it.

Plosko, thanks for the info about impaction being aging. After looking at some before/after pics of people who had impaction, I can see what you mean. One woman in her 30's I looked at had a just a bit of gumminess. After impaction she looked at least 5 years older. The slight gumminess must have helped her look at bit younger.

[Tiny]

Ginger - wow you're gorgeous! (and I'm not going to say "for 40" because I loathe the assumption that women over 25 are unattractive by default).  Anyway, I personally don't think lower alone is the most ideal plan for your because your lower jaw doesn't look significantly too big for your face.  I'd advise to go for advancement of the upper, plus maybe a small genio if you want a smaller chin.  Or bimax if the asymmetry is top and bottom


Yes, impaction is aging because faces become shorter with age as the teeth wear down and the lip droops too, meaning less tooth show

Go with an ortho who is supportive of surgery, but start out trying to see where you can get with braces alone. About 6 months in you can evaluate and see if you still want surgery.

Hmm, I'm not sure about this.  If you start to close your underbite with orthodontics and then decide you want surgery then you will have to open it again!!

[Ginger]

you look really good to me.

Thanks! Your surgery is soon, right? Good luck!

[Gregor Samsa]

How big is your underbite? I'm concerned that moving your jaws will make you look worse because your profile looks good right now. Is it just one side?

[Ginger]

Ginger, I think you look really good as well - you have very good skin. I suppose if you go for surgery and end up with something close to a perfect smile/jaw shape you really will have a very attractive face. but then your in the happy place of being attractive to begin with.

it's good to hear that your sister and husband are supportive. as surgery must be an intensely emotional ordeal having your nearest and dearest fully behind you is probably really important, don't you think?

Thanks Mark - that's very nice of you to say.
I think my jaw was supposed to look like my little sister's jaw. If that's how I end up kind of looking after surgery, she'll be happy because we'll look more like we're related. 

Do you have friends and family who will be supportive if you decide to have surgery?

[Ginger]

How big is your underbite? I'm concerned that moving your jaws will make you look worse because your profile looks good right now. Is it just one side?

Hi Gregor -- the underbite is on both sides, but more on one left. I don't have the exact measurements but I remember the ortho pointing out to me on the xrays how the underbite on the right side was about width of 1/2 the upper back molar. On the right, about 3/4 to almost the full upper back molar.

My braces go on today -- I'll see if I can get my xrays from the ortho to put up here.

[Ginger]

Ginger - wow you're gorgeous! (and I'm not going to say "for 40" because I loathe the assumption that women over 25 are unattractive by default).  Anyway, I personally don't think lower alone is the most ideal plan for your because your lower jaw doesn't look significantly too big for your face.  I'd advise to go for advancement of the upper, plus maybe a small genio if you want a smaller chin.  Or bimax if the asymmetry is top and bottom

Tiny, thanks for the lovely compliment and your thoughts on this.

Hmm, I'm not sure about this.  If you start to close your underbite with orthodontics and then decide you want surgery then you will have to open it again!!

I think you're right... I have a bit of wiggle room to change my plan but not much. My braces went on yesterday. I probably need to decide for sure by my next appointment in 8 weeks.