Occlusal plane tipped down

[kavan]

Ok got it. Thanks a lot.

I guess my surgeon rotated CCW to open even more my airway, but given that my occlusal plane was flat preop, it gave a worse bite and aesthetic result than linear advancement would have given in my opinion. Linear advancement would not have changed my appearence as much in my opinion too.

If I got a revision, I guess I would just want the rotation undone.

Sorry to say, but the moral of the story is that your opinion isn't based on accurate observation or assessment of the angle changes but rather on the fact that you DON'T LIKE the result. I understand you don't like the result. But that can be expressed without trying to buttress it with statements that imply you know what linear advancement or this or that angle of rotation would have done.

I might be wrong. I sometimes am. But if you really think you have a good grasp of what all these planes are and how they should be manipulated, than I invite you to do a geometrical ceph displacement on the after to SHOW how linear displacement or any other displacement he should have done would look like.

[kavan]

I have no idea to be honest. But I suspect it is not. I don't know how to get the change in OP.

Anyways the after ceph is not valid, right? Ill get a proper ceph done on Monday.

What's not valid is the act (yours) of subtracting the after SN-OP angle (of 6) from the before SN-OP angle (of 16) to claim a 10 degree CCW in the absence of observing the angle of inclination the S-N line had with the horizont differed by 4 degrees. It was 16 degrees away in the before and and 12 degrees away in the after. That is to say, the angle the S-N line makes with a horizont should not change that much at all and that needed to be observed before just taking the numbers from the ceph read out and subtracting them from each other.

Ceph analysis read outs like that are only as helpful as one's familiarity with geometry and what those points and lines are and one must be familiar enough with that and also be able to just measure the angles directly so the read outs are self evident such that discrepancies are easily spotted. I think that's one of the reasons the company does not like to send out if they know you are not actually an ortho. They expect a type of familiarity with what the measures are  how they are measured and relative to what.

[kavan]

Ok I apologize for my ignorance.

So I was not rotated 10 degrees. I was rotated 6 degrees.

The problem is that an occlusal plane that is flat does not need ANY CCW rotation. If any it would need CW rotation. In my case (since I had OSA) it just had to be left alone and just perform LINEAR advancement.

So my statement that I was over rotated unnecessarily is still valid. Even if the rotation was 1 degree, but it happens to be 6 degrees, leading to an unfavorable result. I emailed Gunson with my cephs and pictures and he AGREED.

It's 'valid' mostly in subjective terms of YOU DON'T LIKE IT. That subjective assessment is uber valid to you despite the subjective response of others who see your result and say a favorably impressed; 'WOW'. However in OBJECTIVE terms, relative to rotations in a surgery needed to open the airway (sleep apnea), CCW maximizes the extent the mandible can be advanced to open the air way (plenty of room). So, you can't just patently take the perspective that 'because' your ANS-PNS line and OP line was 'flat', he 'should not' have done the CCW and instead 'should have' done CW or just linear advancement.

You went to a doctor, world KNOWN and flocked to for giving DRAMATIC results, especially for the lower jaw advancements which are had via CCW.

As to Gunson 'agreeing' with you, no doubt he agreed with possibly being able to revise some things based on what you DON'T LIKE. But, did he 'agree' with your assessments that your ANS was 'cut off' or that you need to be counter rotated so your ANS-PNS and OP line are 'flat' again?

[kavan]

I didn't know he was world known for dramatic results, he was just referred to me as 'the best' in Europe so I went with him. Never could I have imagined such a dramatic change in appearance.

I know that I look much better post op and that people think that, but is it so difficult to understand that I believe I would have looked better with linear advancement and would not have had such a dramatic change and ID issues. I should have done better research, AND he should have warned me about the dramatic change he was going to give me, which is WAY bigger than the ones he has on his website.

As for Gunson, I told him that I feel I was overotated leaving me with a class III relationship, poor nasolabial angle, bad bite, and grinding TMJ. After examining my photos and cephs he agreed with that. I dont think he would be open to revise my case if he though I had a good outcome on the first one.

You are only basing your opinion on 'you look better post op and other people agree with that'. I AGREE I look better Kavan. BUT, again, the rotation I got left me with a class III relationship, poor nasolabial angle, bad bite, and grinding TMJ.

So, you can't just patently take the perspective that 'because' your ANS-PNS line and OP line was 'flat', he 'should not' have done the CCW and instead 'should have' done CW or just linear advancement. I think I can. I feel I would have been cured just with linear advancement, the same way many people on this forum have been cured with linear advancement. I wanted my sleep apnea cured, but not at the expense of 'losing' my ID. If I knew that was the price needed to pay to cure it, I would have stuck to the CRAP machine.

Anyways, I understood that I am not going to convince you. My occlusal plane was left OUT OF THE NORM, leading to things that are objectively bad (bad bite, TMJ, poor nasolabial angle, protruding mouth, class III relationship), as well as subjective things (ID issues), BUT I agree with you that I still look much better post op. I dont want to convince you anymore, I think I kind of needed to convince you for some reason (I guess in order to feel that it was not all in my head). But well, now that Gunson agreed I feel much better.

I agree that YOU DON'T LIKE IT and also, it is likely that some of the things you don't like can be revised by Gunson.

What annoys me is blanket assessments of yours as to such things as the QUANTITATIVE extent of of CCW you 'should' or 'should not' have had when you're not even conversant in what those points, lines, planes and angles formed from them are. For example, somewhere on one of these strings, you had to ask what 'S', 'N' was (S-N line) was. Then you didn't observe it's angle of inclination was changed in both ceph tracings. IMO, that's an example of not being conversant or familiar enough with the QUANTITATIVE subject matter and not enough to content what the QUANTATIVE angle rotations--what ever-- 'should have' been.

So, ultimately you are buttressing your QUALTATIVE assessment of 'you don't like it' with quantitative measures where I end up taking a closer look at those quantitative measures and find they are off.

Don't tell me my opinion is based (soley) on the aspect that you look better when CLEARLY I showed you a GEOMETRIC demonstration of why my 'opinion' differed from your 10 degree angle assessment and also gave you a CLUE that the S-N differed too much and due to this CLUE you were able to find out you did not even KNOW you submitted a CT slice as your 'ceph'.  Your assessment of my 'opinion' disregards I'm familar with geometrical angle relationships, points, lines, planes etc used in these ceph relationships.

Perhaps, it's particularly annoying to ME because I'm an MIT grad and it's just frustrating to me to discuss angle relationships against the back drop of 'I don't like it'.

That said, I AGREE that you don't like it. But you are on your own to make what ever quantitative assessments you like as far as angle rotations that you 'should' have. If I think you are off on those, I'm not going to frustrate myself anymore cross referencing or taking a closer look at those assessments. I've reached the limit of my annoyance with this and especially so with your statement that my opinion is based 'ONLY' on your looking better. Screw that.

Reminder to myself: Poke eyes with hot steel rods before giving feedback in the realm of logic or geometrical relationships to mazilla. Leave mazilla to his own opinion. Do not interfere.

[kavan]

I apologize for saying that you base your opinion on my looks. Should not have said that.

Its true that I have no idea about those angles, points and planes used on cephs.

Its true that you demonstrated with logic that I made a mistake with the 10 degrees measurement. Thus you assume that I am OVERALL wrong. I was wrong about the quantitative assessment, not the qualitative one. I don't mind if it was 6 degrees or 10 degrees Kavan. The point im trying to make is that my occlusal plane was fine as it was. Flat occlusal planes do not need CCW rotation, even if you have OSA. It does open the airway, but it can lead to unwanted consequences such as the ones I had: class III relationship, closed nasolabial angle, protruding mouth, open bite... DESPITE this, I ended looking better than preop, but I believe all these could have been avoided.

So IN MY OPINION (I might be wrong, let's see what Gunson will say), and based on the results I got, I think that I should have had no rotation.

Not 10 degrees, not 6 degrees, not 1 degree. NONE, NADA.

I didn't assume that you were OVERALL wrong. I agreed that you did NOT LIKE your result (on qualitative grounds).

[kavan]

Well that is a subjective statement, which cannot be refused. If you tell me you don't like spaghetti meatballs, I cannot say you are wrong Kavan, spaghetti meatballs is a delicious meal. But im sure you know that and you are just playing with me.

Well, I could not find any other case of a flat occlusal plane being rotated CCW any degrees, let alone 6 degrees. OSA or non OSA. Could not find it. In cases of flat occlusal planes I just found linear advancements.

Is it wrong? Well it does open more the airway so it is not technically wrong. Does it lead to an optimal aesthetic and functional outcome? I don't think so, definitely not in my case. Was it necessary? I don't think so either.
Can you agree with those? Or you can just agree with me not liking my result? Well it does not really matter if you agree or not. Well see what Gunson says, but lets imagine for a second that he does agree with me: CCW was not necessary to cure your OSA as you OP was flat, and it lead to unwanted aesthetic and functional outcomes. What would you say in that case? Spaghetti meatballs as well?

I agree you have the opinions you have and you are entitled to have them without my input.

[mazilla]

I had a proper CT scan and study done.

It does say I have mandibular prognathism and that I am severe brachiocephalic. I am an outlier in several measures.

Secondtimearound, if you want any measures or diagrams I can post them.

I am still considering revision.