Jaw line: need for advise

[BrazilianJaw]

Hello everyone,


I'm new to the group. I have seen several posts in the group about problems similar to mine. I would like your opinion, I am an orthodontically corrected class 2. I would like a greater definition in the mandibular line. I do not have functional problems nor gum smile, just a minor overbite.
What's the best option for me? Implants?
Im going to a nose job too.

Sorry for english, greetings. I Appreciate your opinion.

https://imgur.com/a/yEivY

[The Quest for Aesthetics]

Lower third lengthening and rhino would benefit you more than anything else. But yes you're a good candidate for bimax, I'd be curious to see what your front looks like since profile doesn't really matter in the real world. You would benefit from orbital rim implants and paranasal implants, mostly straightforward stuff in your case

[Lefortitude]

I think youre one of the rare cases that could benifit from implants alone

[BrazilianJaw]

I really appreciate your opinion. Here in Brazil, we dont have many surgeons that will do a Bimax for aesthetic reasons. 
Most of them indicated a BSSO or just genioplasty. What do you think about these options in my case?
Will a chin implant have some benefit? Is there any chin implant technique that doesnt increase the mentolabial fold?

Thank you

[CCW]

That's not a slight advancement. It's a realistic morph but would require a great surgeon.

An isolated genio would most likely cause a witch's chin appearance.

[PloskoPlus]

That's not a slight advancement. It's a realistic morph but would require a great surgeon.

An isolated genio would most likely cause a witch's chin appearance.

Very much this.  Without CCW rotation, OP would still look recessed and have a longer face from the front for his trouble.

[kavan]

I think you could get bi max. It would (most likely) involve tipping forward the upper front teeth and tipping backwards the lower front teeth (short blue lines) in the pre-prep brace stage. You would want to minimize maxilla forward displacement but maximize mandible forward displacement where it might take a posterior down graft and/or plucking the lower pre-molars.

Rhino is certainly in order (long diagonal blue line).

Kind of a conundrum though because your ANB angle is 0 (approx)--inner red vertical and re the outer red vertical your face is forward to that.

The s-n line deviates a lot from the horizont (green line) which is usually associated with the orientation of the cranium, it being 'tipped' back more than those with more horizontal orientation of the cranium. So, you would want to be careful about too much forward advancement to the jaws because it can accentuate the cranial tipping.

As to jaw implants, they don't increase in the  posterior-anterior direction. But they can elongate (drop down) the border of the mandible and also increase jaw to jaw distance and angle articulation.

[BrazilianJaw]

Kavan, very good points. This my natural head position (not parallel to Frankfort), which accentuates my sloping forehead, but reduce the lower third recession. If I want to SNA to be in a more normal range, I will have to change (tilt down) my natural head position and make a CCW?

Thanks

[kavan]

Kavan, very good points. This my natural head position (not parallel to Frankfort), which accentuates my sloping forehead, but reduce the lower third recession. If I want to SNA to be in a more normal range, I will have to change (tilt down) my natural head position and make a CCW?

Thanks

There are some adjustments they need to make for what I call 'cranial tipping'. It's not a matter of tilting your head down more. It's a matter of the cranium being oriented on an incline at an angle kind of far from the horizont. Those types of orientations CHANGE how one's face projects relative to some vertical drop lines.

I'm finding that people with 'wierd' ANB angles and forward faces to those red drop lines but when you look at them also look like they have some recession that the lines don't reveal, seem to have the tipped cranium in common. 'Weird' ANB in the sense one looks for something more than '4' for the class 2 skeletal.

Anyway, the cranial orientation, (well according to my observations) is somewhat parallel to the S-N line. Not exactly, but somewhat. Orientation in terms of drawing a line from one part of the forehead to the back of the skull such that THAT line is the LONGEST. The length of the skull is basically, the longest line you can get to where my line starts to somewhere in back where it ends.

S-N lines that are inclined a LOT away from the horizont often reveal the tipped cranial orientation. Also, not everyone actually has a horizontal Franfort line.

Here are some full cephs.

Person 'A' has the S-N line angled far away from the horizont and the maximum cranial length is somewhat parallell to the S-N line. So, you see the cranium is tipped relative to a true horizont.

Person 'B' has the S-N line closer to the horizont and the maximum cranial length is found somewhat parallel to that.

It really isn't a matter of either tipping their heads. In fact the S point does not change that much with slight head tips which is one of the reasons Steiner used it in his analysis. (Also easier to spot on an X ray than the porion point from which they draw the Frankfort horizont.) Person 'A' does not have a 'true' horizontal FH either. Person B does.

[BrazilianJaw]

So in people with this "cranial tipping", SNA and SNB could be very misleading in acessing protusion or recession? Soft tissue cephalometrics would have a better result in making the correct diagnosis?

Thanks

[kavan]

Hard to explain because it involves knowing where some points are to look at the line orientation drawn from the points.


They are kind of a conundrum to treat because there are trade offs.  For example in person, 'B', ANS-PNS (anterior to posterior nasal spine) is pretty level with the horizont but person 'A' has a positive slope to ANS-PNS. It's angled away from the horizont. Rotations of the maxilla are done to bring the maxilla (ANS-PNS) closer to a horizont. Not exactly level with it but within a degree range. So, in person 'A' a rotation of the maxilla to bring it closer to a horizont would be counter-clockwise BUT that might not look good on him. CCW might not do it for him either.

Anyway, SNA and SNB might be less than the norm but that's because the SN line is so far away from the horizont than is the case with minimal cranial tipping. ANB (which is SNA-SNB) can be 0 to about 2 which is close to the norm. So, when you look at the ANB it's close to norm but 'weird' in some people because you can still see where they could be advanced outward in anterior posterior direction.

In your case, you could most likely advance both out but they most certainly would have to make alterations to the nose to compensate for it possibly looking worse.

Basically, there are more trade offs

[Lazlo]

you're fine. stop wasting people's time with your neurosis. next.

[GJ]

you're fine. stop wasting people's time with your neurosis. next.

Should be our board motto.

[kavan]

you're fine. stop wasting people's time with your neurosis. next.

Brazilian guy is not 'bird's nest hair' guy although i did use the ceph of the latter to show another example of ANB angles with the cranial tipping.

[Framboise]

If you wanted a beautiful jaw line, you should have kept your wisdom.