Clockwise Rotation / Anterior Downgraft

[Tati]

Hi everyone,

I'll make this brief, I'm seeking revision and was suggested an anterior downgraft by a local surgeon to improve teeth show (my upper teeth show about a mm when I smile big).

I sent him scans and am waiting for a proper proposal before sharing any photos or asking for personal advice.

In the meantime, I wanted to know if someone could mention what sort of changes can be expected from said movement, and also ask if anyone out there has photos of cases or are willing to share their own.

[kavan]

Clockwise rotation of the mandible given the mandible rotates in same direction as maxilla.

[XXRyanXXL]

You could have an alternate operation of a upper lip lift, less invasive and costly. Another alternative is advancement of both jaws, as every 3mm advancement gives you 1mm more tooth show, due to the elastic nature of the upper lip.

[GJ]

Hi everyone,

I'll make this brief, I'm seeking revision and was suggested an anterior downgraft by a local surgeon to improve teeth show (my upper teeth show about a mm when I smile big).

I sent him scans and am waiting for a proper proposal before sharing any photos or asking for personal advice.

In the meantime, I wanted to know if someone could mention what sort of changes can be expected from said movement, and also ask if anyone out there has photos of cases or are willing to share their own.

Aesthetically, it's likely the philtrum area will elongate a bit with CW rotation.
Your airway will likely get smaller as the lower jaw moves back.

[Tati]

Thanks for the info everyone!

My maxilla was advanced 10mm and my jaw 5mm (was class III) in a previous surgery. Airway space wasn't an issue before, much less now.

I actually want the subsequent setback that comes with CW, given I don't like how advanced my lower third is and the smile is somewhat unnatural.

Maybe my question should have been if these aspects could improve to a certain degree.

Concerns in mind would be a steep jaw angle and more strain on the chin.

Also note, before any procedure, even if I lifted the upper lip all the way up, I couldn't begin to see my gums (in case anyone is wondering how a maxilla could be advanced so much, and result in little to no teeth show).

[Tati]

Another functional concern is that, since surgery, if I laugh a lot or smile for a while, my nasal base begins to hurt and soon after that my septum.

Does anyone have a clue what it might be?

[Tati]

Here's a recent ceph..

[kavan]

Thanks for the info everyone!

My maxilla was advanced 10mm and my jaw 5mm (was class III) in a previous surgery. Airway space wasn't an issue before, much less now.

I actually want the subsequent setback that comes with CW, given I don't like how advanced my lower third is and the smile is somewhat unnatural.

Maybe my question should have been if these aspects could improve to a certain degree.

Concerns in mind would be a steep jaw angle and more strain on the chin.

Also note, before any procedure, even if I lifted the upper lip all the way up, I couldn't begin to see my gums (in case anyone is wondering how a maxilla could be advanced so much, and result in little to no teeth show).

Subsequent CW rotation to lower jaw is back and down. Make sure you understand the 'set back' aspect you want comes with downward aspect too. Your concerns are consistent with basic geometry concepts that apply to rotations. The inclination of the mandibular plane would increase in steepness consistent with the degree of CW rotation. With that, the chin orientation displaces back and down as in more angled away from a vertical where more 'effort' would be needed to lift the lower lip UP.

[PloskoPlus]

Not sure if CW is a good idea in your case - your occlusal plane is moderately steep as it is. How long is your upper lip?  It seems to be folding over your lower lip.

[Tati]

I understand there's a give and take with most anything, which is why I'm not completely sold on the idea.

As far as lip length, I can say I have very plump lips and my philthrum is short-ish, per what I see in the mirror.

I can touch the tip of my nose with my tongue and still have trouble reaching the upper part of my teeth with a toothbrush, specially where the anterior nasal spine lies. It's tough to imagine room for a lip lift.

- The photo is the bottom half of my face. I had a plate removed last week which caused the swelling and bruising seen on one side.

[kavan]

Normal distance relationships from the front. Balance of '1/3rds'
Chin area will project longer with (back and down) CW.

[Tati]

So, bad idea?

[kavan]

So, bad idea?

It's not an idea, good or bad. It's a concept where some understanding of basic geometry is needed to embrace it. Your wanting to increase tooth show by increasing the angle of the occlusal plane, will in turn increase angle of of mandibular plane and in turn, the rotation rotates chin back and down where you would see the downward displacement of the rotation as a 'longer' chin in frontal view.

The concept to understand is that CW rotates backwards and down and that your request for wanting to do that for the PROFILE resolves to one where you are also asking for your chin to project a little longer in frontal view.

[Tati]

I understand the concept of rotating, though was unaware it made your chin alone appear longer.

I figured you were saying it would make the front disproportionate in some way, or give me a long face.

My concern is not profile AT ALL to be clear, it's three-quarter and frontal view.

Anyhow, the surgeon said he'll see what can be done. He might suggest other movements, he might say there's nothing to be done, or he might just offer CW and leave me to evaluate the pros and cons..

I'll update as I recieve an answer..

I appreciate your feedback.

[kavan]

I understand the concept of rotating, though was unaware it made your chin alone appear longer.

I figured you were saying it would make the front disproportionate in some way, or give me a long face.

My concern is not profile AT ALL to be clear, it's three-quarter and frontal view.

Anyhow, the surgeon said he'll see what can be done. He might suggest other movements, he might say there's nothing to be done, or he might just offer CW and leave me to evaluate the pros and cons..

I'll update as I recieve an answer..

I appreciate your feedback.

The easiest way to conceptualize a rotation is to look at a clock. Let's say the big hand is on 3. Extrapolate a straight horizontal from there. Let the big hand rotate to 6. Extrapolate a straight line horizontal from there. The horizontal extrapolated from 6 will be lower than the horizontal extrapolated from 3.

The next part is kind of hard for some people but if you can conceptualize (rotate in your head) the clock 90 degrees away from the plane you are used to viewing the clock as to project the extrapolation lines on to a 2-d plane, you won't see the lines but only the points where they hit the plane. The point where the '6' line hits plane will be lower than where the point of '3' line hits the plane.

The clock as you are used to looking at one, is equivalent to 'profile' of face with regard to rotations. The rotation of the clock itself 90 degrees away from the plane you are used to looking at it would be the 'frontal' view.