Amount of CCW?

[Dharma]

Had MMA performed 3/21...

My surgeon reported that my maxilla was rotated so that my incisors were ~3 mm superior to where they were formerly when compared with my molars via cephalometric analysis.  He stated that this is a moderate, maybe slightly more, amount of rotation.

I've looked in the literature and its hard to get a solid idea of whats typical for amount of CCW.  Of course, each case is different  but I imagine that, just as a 10mm genio is "huge," there is a bell curve for CCW. 

So, anyone in the know?  Does my amount of rotation seem about on par with most?

Thanks!   

[kjohnt]

I don't have an answer, but 3mm is what my surgeon has initially suggested as well.  Do you know the before/after angles of your occlusal plane?

[Dharma]

Unfortunately I don't know the exact change in occlusal angle--grossly, it appears minimal (a few degrees or less?).  My post-op occlusal angle is about 12 degrees or so. 

[Dharma]

My surgeon has stated on several occasions that a typical smile becomes quite distorted the flatter the post-op occlusal angle becomes, particularly bad with a negative occlusal angle.  Paraphrasing:  "You lips go up and and back and your teeth are going straight back or down--its not a good look." 

[PloskoPlus]

My surgeon has stated on several occasions that a typical smile becomes quite distorted the flatter the post-op occlusal angle becomes, particularly bad with a negative occlusal angle.  Paraphrasing:  "You lips go up and and back and your teeth are going straight back or down--its not a good look."

Wolford says  8-12 degrees is ideal. Doesn't ccw prevent the dreaded convex lip where the teeth are too vertical and the upper lip simply hangs there?

[Dharma]

Exactly--despite my CCW, my teeth are still vertical and my lip just hangs there! 

Thing is, have you ever seen any post-op pics of people smiling?  Wolford has some serious courage (or disregard for risk?) and radically alters peoples occlusal plane.  Check out the difference in the cephs he has on his website.  He also replaces TMJ at the same time as other procedures--crazy!  Anyway, his post-op's look great with mouth statically closed but I wonder what their smile looks like--also, I don't think anyone yet understands the full implications on the TMJ long term after such drastic leverage/dynamic force changes after such movements. 

[kjohnt]

Well a negative occlusal angle isn't good so it would obviously have negative aesthetic implications.

Arnett's analysis says occlusal plane to TV (vertical) line should be 95.6 ± 1.8 degrees for females and 95.0 ± 1.4 degrees for males, so close to 95 degrees.  (http://www.arnettgunson.com/education-materials/7-step-cephalometric-treatment-plan)

When comparing to horizontal line, this would be 5 degrees, so a little bit flatter than Wolford's ideal of 10ish.

The first thing one must do is make sure the dentition is correct, i.e. get incisors positioned within the arches at ideal angles.  Then alter occlusal plane to ideal as part of surgery.  At that point, lip support should be perfect.

edit: Also, upper incisors ideally do not look perfectly vertical from a profile view but actually procline slightly (from everything I've seen, including my own analyses saying mine are "too upright" and pictures of attractive people)