Best surgeon in Canada?

[kavan]

Go to a max fac to confirm your occlusal plane and any other number for that matter. Clarks was off 3 degrees compared to what my max facs consult surgeon measured.

Clark's is used for an ortho device that clark designed. So, ya, it might not be consistent with other methods.

[secondtimearound]

Clark's is used for an ortho device that clark designed. So, ya, it might not be consistent with other methods.

Useful to know. There's so many analyses it's hard to know what's what.

Downs analysis provided an occlusal plane angle of 10.48. Normal is 9.3 +/- 3.8.

Those are the only two places the cephx stats provide an occlusal plane angle, and in general while it also suggests I am somewhat clockwise oriented it's not dramatic. Maybe it's not worth going to a different surgeon over regardless of what Caminiti says he's willing to do.

But if there's anything I've learned about jaw surgery it's that every mm counts. I hate being a perfectionist. But it was by neglecting the details the first time that I'm in this position now...

[Lazlo]

Just make sure you see Dr. Stephen Ho, he uses some newer techniques and ask him about SARPE to confirm that will do the trick and the timeline for it. Good luck.

[kavan]

Useful to know. There's so many analyses it's hard to know what's what.

Downs analysis provided an occlusal plane angle of 10.48. Normal is 9.3 +/- 3.8.

Those are the only two places the cephx stats provide an occlusal plane angle, and in general while it also suggests I am somewhat clockwise oriented it's not dramatic. Maybe it's not worth going to a different surgeon over regardless of what Caminiti says he's willing to do.

But if there's anything I've learned about jaw surgery it's that every mm counts. I hate being a perfectionist. But it was by neglecting the details the first time that I'm in this position now...

CephX just gives a LITANY of of different analysis methods. It's not as if you can look at one type of method for one measure and than the other type for another measure. Angles are relative to lines and planes and some of them use different reference lines for the angle measure. For example if the reference 'horizontal' line is S-N in one method but the Frankfurt horizontal is used in the other method, the angle cited will differ and that angle might have same name in both methods.

IMO, the BEST thing to KNOW and really know well is GEOMETRY. Afterall, all ceph analysis is based on defined POINTS and lines, planes and angles with REFERENCE to those points and actually IS a type of geometrical balance. Speaking of points, I think it is pointless to just be looking at a bunch of numbers and angle measurements outside of having underbelt the basic framework understanding of geometrical concepts.

Some points on a ceph are easier to find than others. S, N, A, B, ANS, PNS and also the 'line' of OP (points connected from one place to frontal incisor to other place in back molar) are such examples. From there, you can look at the angles they make with defined horizonts or verticals. Someone, should AT LEAST be able to do that (elementary geometry) for a more holistic understanding (how the parts relate to the whole). Otherwise, just spouting off exact mm measures a program spouts out to you isn't enough. I suggest this type of exercise applying geometry to one's own ceph even if it isn't enough to plan out your surgery. In this way, you get a better appreciation of the many or few things needing to be balanced  or even if it's possible to balance all if there are many imbalances.

[secondtimearound]

Just make sure you see Dr. Stephen Ho, he uses some newer techniques and ask him about SARPE to confirm that will do the trick and the timeline for it. Good luck.

Thanks. I definitely plan to. The only worry as I said about him is if he's mostly doing sleep apnea surgery, I doubt he does much SARPE, and certainly doubt he does much revision work, while Caminiti was quite comfortable with SARPE and revision work.

I mean, I'm sure Dr. Ho is TRAINED in SARPE, but training is not the same as regular daily experience. I'll let you guys know when I see him what my impression was.

CephX just gives a LITANY of of different analysis methods. It's not as if you can look at one type of method for one measure and than the other type for another measure. Angles are relative to lines and planes and some of them use different reference lines for the angle measure. For example if the reference 'horizontal' line is S-N in one method but the Frankfurt horizontal is used in the other method, the angle cited will differ and that angle might have same name in both methods.

IMO, the BEST thing to KNOW and really know well is GEOMETRY. Afterall, all ceph analysis is based on defined POINTS and lines, planes and angles with REFERENCE to those points and actually IS a type of geometrical balance. Speaking of points, I think it is pointless to just be looking at a bunch of numbers and angle measurements outside of having underbelt the basic framework understanding of geometrical concepts.

Some points on a ceph are easier to find than others. S, N, A, B, ANS, PNS and also the 'line' of OP (points connected from one place to frontal incisor to other place in back molar) are such examples. From there, you can look at the angles they make with defined horizonts or verticals. Someone, should AT LEAST be able to do that (elementary geometry) for a more holistic understanding (how the parts relate to the whole). Otherwise, just spouting off exact mm measures a program spouts out to you isn't enough. I suggest this type of exercise applying geometry to one's own ceph even if it isn't enough to plan out your surgery. In this way, you get a better appreciation of the many or few things needing to be balanced  or even if it's possible to balance all if there are many imbalances.

Thanks. That's useful as well. I am already recognizing the degree of compromise needed based on the fact that we are juggling so many variables with these surgeries. For many of us it is likely not possible to get every parameter within the normal range.

For example, my Wits analysis still puts me at a -4 mm alignment (class 3) despite my teeth tips overlying each other (upper incisors tilted forward, lower tilted back, thanks ortho). During my SARPE I will be asking my ortho to try to return both to as neutral and natural a tilt as possible and then I will be having my upper jaw advanced by whatever amount needed to create a good bite.

But I notice already my SNA and SNB are slightly above the exact average. And no one would call me one of the "antefaced" types that some people jerk off over. My midface still looks retruded, but this can be all relative, as depending on the angle of the SN component, the angle will change, and we can't change the SN with surgery.

In my photoshops I definitely look better with further maxillary advancement than with mandibular retrusion, even though maxillary advancement pushes my SNA even higher. Retruding the lower jaw just makes me look like I have a weak lower jaw, which I don't want.

Currently my SNA is 83.67 (normal 82.0 +/- 2.0) and my SNB is 81.59 (79.0 +/- 2.0).
 
Regarding CCW and the occlusal plane, I'm pretty sure my prior surgeon did a bit of CW impaction during the prior surgery to try to close my bite a bit. I will try to take my own measurements of the occlusal plane to cross reference, and I will certainly ask the surgeons I see for reconsultation on this in advance of any decisions.

I will also make a separate thread with my cephs and cephx.com analysis another time to get feedback and opinions. No f**king around this time! There's no room for unnecessary error or poor planning again at this stage. Thanks for the feedback everyone so far. It's a fascinating subject and so important to really understand thoroughly.

[kavan]

Thanks. I definitely plan to. The only worry as I said about him is if he's mostly doing sleep apnea surgery, I doubt he does much SARPE, and certainly doubt he does much revision work, while Caminiti was quite comfortable with SARPE and revision work.

I mean, I'm sure Dr. Ho is TRAINED in SARPE, but training is not the same as regular daily experience. I'll let you guys know when I see him what my impression was.

Thanks. That's useful as well. I am already recognizing the degree of compromise needed based on the fact that we are juggling so many variables with these surgeries. For many of us it is likely not possible to get every parameter within the normal range.

For example, my Wits analysis still puts me at a -4 mm alignment (class 3) despite my teeth tips overlying each other (upper incisors tilted forward, lower tilted back, thanks ortho). During my SARPE I will be asking my ortho to try to return both to as neutral and natural a tilt as possible and then I will be having my upper jaw advanced by whatever amount needed to create a good bite.

But I notice already my SNA and SNB are slightly above the exact average. And no one would call me one of the "antefaced" types that some people jerk off over. My midface still looks retruded, but this can be all relative, as depending on the angle of the SN component, the angle will change, and we can't change the SN with surgery.

In my photoshops I definitely look better with further maxillary advancement than with mandibular retrusion, even though maxillary advancement pushes my SNA even higher. Retruding the lower jaw just makes me look like I have a weak lower jaw, which I don't want.

Currently my SNA is 83.67 (normal 82.0 +/- 2.0) and my SNB is 81.59 (79.0 +/- 2.0).
 
Regarding CCW and the occlusal plane, I'm pretty sure my prior surgeon did a bit of CW impaction during the prior surgery to try to close my bite a bit. I will try to take my own measurements of the occlusal plane to cross reference, and I will certainly ask the surgeons I see for reconsultation on this in advance of any decisions.

I will also make a separate thread with my cephs and cephx.com analysis another time to get feedback and opinions. No f**king around this time! There's no room for unnecessary error or poor planning again at this stage. Thanks for the feedback everyone so far. It's a fascinating subject and so important to really understand thoroughly.

You need to be able to measure YOUR OWN angles via marking out the points yourself and using a protractor. Yes, it might be off by a few degrees but still being able to apply simple geometry is needed. IMO, no good can be gained by looking at a bunch of measures in a bunch of  different ceph analysis read outs. Geometry is needed so it can be SELF EVIDENT to someone that ALL might not be able to be balanced and alsos self evident why certain 'trade-offs' (deviations from desired outcome or 'perfection') are so.

I have seen cases where the S-N line was 15 degrees from a horizont.  Yet the 'norm' for this line is 7 degrees away. S-N is used for a 'horizont' in some analysis.  But it will be OFF when you got a deviation of 15 degrees from a 'pure' horizont. That's an example of using geometry to question even measures you get in a ceph analysis. Especially so SNA, SNB and ANB measures.

ETA: even the Franfort 'horizontal' is NOT a horizont in SOME people.