Bone Grafting - when is it indicated?

[kjohnt]

For those familiar with bone (or other material) grafting, when is it indicated?  Is it case-specific or are there general guidelines?

Using my case for reference, I have 10mm mandibular advancement plus 6-7mm maxillary advancement planned, with no planned correction of vertical or transverse planes.  Because not bringing the maxilla down, there will be bone-on-bone contact and that seems okay I'd think?  But what about the 10mm gap on either side of my mandible? 

(though I know technically with BSSO not true 10mm gaps since the cuts are made halfway in then cut anteroposteriorly a bit then the the other half so there is still boney contact after fixation)

[PloskoPlus]

Afaik whenever you have gaps. The surgeon may use the bone scraps from the osteotomy for minor gaps (Bear in  mind that just the osteotomy line in the maxilla is an automatic impaction by 1 mm). Having said that I don't think you need surgery (I'm repeating myself I know). You'd be probably the least deformed person that I know to go through this. I hope it works out for you. Have you considered lip competence with such large movements? It would suck to end up a mouth breather after all this.

[kjohnt]

Lol, I know PloskoPlus, I know.

I have considered lip incompetence and it is a concern.  Well pretty much everything I like currently is a concern, because I don't want the things I like currently to change.  My upper gum show is the biggest concern, and lip incompetence is also right there.  But aesthetically I need projection and I need my mandible to line up with my maxilla, functionally I need a larger aiway and my bite to come together properly.

Regarding lip incompetence, I believe it won't be an issue as I have a lot of lower lip curl going on right now, which I think will come back a little bit once my mandible is more projected.  Upper not sure... it's the same question regarding increased gum show with horizontal advancements and whether or not mild impaction is necessary to offset.  I'd think lip incompetence would parallel gummy smile.  I need to ask my surgeon about these things.

[PloskoPlus]

Lol, I know PloskoPlus, I know.

I have considered lip incompetence and it is a concern.  Well pretty much everything I like currently is a concern, because I don't want the things I like currently to change.  My upper gum show is the biggest concern, and lip incompetence is also right there.  But aesthetically I need projection and I need my mandible to line up with my maxilla, functionally I need a larger aiway and my bite to come together properly.

Regarding lip incompetence, I believe it won't be an issue as I have a lot of lower lip curl going on right now, which I think will come back a little bit once my mandible is more projected.  Upper not sure... it's the same question regarding increased gum show with horizontal advancements and whether or not mild impaction is necessary to offset.  I'd think lip incompetence would parallel gummy smile.  I need to ask my surgeon about these things.

Another thing is more tooth show... lower tooth show.  You definitely don't want that.  Who's your surgeon, BTW?
EDIT: and another thing... I don't think there is any other surgery on earth with the potential to make one look uglier than a LF1 over advancement.

[kjohnt]

The lower tooth show thing is a result of the bsso yeah?  I'm not concerned there as my lower lip should continue to cover.  I have a lot of extra soft tissue via lower lip.

Do you have any examples of overly-advanced maxilla?  I've searched a bit.  But yes the maxillary movement is the piece that concerns me the most... I think the mandible is easy in that it just needs to come forward and fall into place determined by the maxilla.

[PloskoPlus]

The lower tooth show thing is a result of the bsso yeah?  I'm not concerned there as my lower lip should continue to cover.  I have a lot of extra soft tissue via lower lip.

Do you have any examples of overly-advanced maxilla?  I've searched a bit.  But yes the maxillary movement is the piece that concerns me the most... I think the mandible is easy in that it just needs to come forward and fall into place determined by the maxilla.

Not sure if bsso can affect the lower tooth show, I know that genioplasty certainly can. Whenever you see a convex lip, that's over advancement. Mine was.

[kjohnt]

I'm not getting any genioplasty as I'm okay with my chin.  Forgot to answer, my surgeon is Bloomquist.

[GJ]

Another thing is more tooth show... lower tooth show.  You definitely don't want that. 

Anyone know what causes this?

Is it over-impaction, improper genio, etc?