Advice needed!!! Double Jaw surgery

[Miss01Herself]

Heya everyone,

I really want to have a double jaw surgery and I already had a consultation with dr. D in Belgium. He wants to first widen my upperjaw for 2 incisives implants (extracted when I was young), widen my lower jaw to align with uppers teeth and BSSO...So I dunno, what do you guys think? Based on my pictures. PS I also going to have a consultation with dr Z in Germany. Will keep you guys updated.

Many many thanks

https://ibb.co/dCooSG
https://ibb.co/eDkDuw
https://ibb.co/nmSREw
https://ibb.co/h3MKZw

[kavan]

Heya everyone,

I really want to have a double jaw surgery and I already had a consultation with dr. D in Belgium. He wants to first widen my upperjaw for 2 incisives implants (extracted when I was young), widen my lower jaw to align with uppers teeth and BSSO...So I dunno, what do you guys think? Based on my pictures. PS I also going to have a consultation with dr Z in Germany. Will keep you guys updated.

Many many thanks

https://ibb.co/dCooSG
https://ibb.co/eDkDuw
https://ibb.co/nmSREw
https://ibb.co/h3MKZw

In the profile ceph scan, do you hold your head like how they have positioned you?  It looks like your head is positioned down and you might hold it up more in 'real life'. It looks like you could have bi-max. They would first need to push the front teeth forward (braces) to prepare for it and that the lower jaw most definitely could benefit by advancement.

[kavan]

The lateral ceph is kind of weird as to head position.

The combination of the SNA AND SNB values (ANB) look right: Class 2 bone structure.

But the sna angle value is really low suggesting a lot of upper jaw retrusion
The snb angle value is really low too suggesting a lot of lower jaw retrusion.

But on one of your photos that's almost a profile, you don't look THAT retruded even though you can see the lower jaw could use some forward advancement relative to the upper jaw.

The head position in this photo suggests a BOAT LOAD of bimax advancement which is why I think there is something wierd about how your head is positioned in this ceph.

What was this particular head position pose for?

[ODog]

Heya everyone,

I really want to have a double jaw surgery and I already had a consultation with dr. D in Belgium. He wants to first widen my upperjaw for 2 incisives implants (extracted when I was young), widen my lower jaw to align with uppers teeth and BSSO...So I dunno, what do you guys think? Based on my pictures. PS I also going to have a consultation with dr Z in Germany. Will keep you guys updated.

Many many thanks

https://ibb.co/dCooSG
https://ibb.co/eDkDuw
https://ibb.co/nmSREw
https://ibb.co/h3MKZw

How is he going to widen your lower jaw?

[kavan]

How is he going to widen your lower jaw?

That's a good question.  From the description given where she states space needs to be made to place tooth implants (also to the lower jaw), she could be referring to making space in the anterior-posterior direction (profile direction) where the term; 'width' or 'too widen' the lower jaw is incorrect use . To 'widen' the lower jaw refers to increasing jaw to jaw distance seen frontally.

[Miss01Herself]

The lateral ceph is kind of weird as to head position.

The combination of the SNA AND SNB values (ANB) look right: Class 2 bone structure.

But the sna angle value is really low suggesting a lot of upper jaw retrusion
The snb angle value is really low too suggesting a lot of lower jaw retrusion.

But on one of your photos that's almost a profile, you don't look THAT retruded even though you can see the lower jaw could use some forward advancement relative to the upper jaw.

The head position in this photo suggests a BOAT LOAD of bimax advancement which is why I think there is something wierd about how your head is positioned in this ceph.

What was this particular head position pose for?

 I honestly don't know, the nurse positioned me that way and it felt a bit unnatural but I have to say that I have a strong chin. Could that potentially mask away the retrusion of my lower jaw?

[Miss01Herself]

How is he going to widen your lower jaw?

With a lower-jaw expander or maybe only repositioning the teeth with braces (not truly widen the lower jaw). Still, it's his advice based on one consultation only, he hasn't made a plan for me just yet. I have to visit the orthodontist first.

[kavan]

I honestly don't know, the nurse positioned me that way and it felt a bit unnatural but I have to say that I have a strong chin. Could that potentially mask away the retrusion of my lower jaw?

Who's nurse, Dr. 'D's or the ortho's nurse?

[Miss01Herself]

Who's nurse, Dr. 'D's or the ortho's nurse?

Dr. D's nurse

[kavan]

Dr. D's nurse

The angle measures are significant from that head posture. They most likely want to advance you out a LOT. You would need to ask for a ceph displacement diagram based on that ceph where they show what they propose to do via using the contour of that ceph with a new proposed contour which will have a bunch of numbers and angles on it.

[girl]

https://ibb.co/eDkDuw - there's absolutely no way are you as retruded as that x-ray suggests. Did you rest your chin on something or bite down on a piece of plastic? That's what they usually make you do beforehand.

I have a significantly steep occlusal plane and look like I'm watching the floor on mine a bit, but it's natural and more or less reflected in candid photos as well.

Your chin/jaw actually look to be well projected in your own photos.

In all, I think you're really attractive as is, maybe with a bit of a gummy smile - you don't have a long face look.

[girl]

Just checked my cephs against yours. The forehead rest (top right) looks to be touching the middle of your forehead rather than just below the glabella where it meets the top of the nose. That could explain the unusual downward facing position.

[Miss01Herself]

First of all a big belated "thank you" for reading and replying, haven't been much on the forum lately but I have news!!!

I finally visited Dr. Z and pretty much the scan made before were not correct, he asked me to make new ones, which  I will upload when dr. Z have send it to me.
 
1. He agrees with fixing the inwards positioning teeth via orthodontic treatment.

2. Based on the scans I send him prior the consultation, he suggested a CCW.. after seeing me in person (and seeing the new scans), also hearing about my mandibular joint problems, a CCW is not going to be the case anymore, because it will only worsen my TMJ.

3. For the gummy smile: impaction of maybe 3mm and bringing the maxilla forward, not sure tho, it depends on the orthodontic treatment before the surgery, if the maxilla is brought forward enough.

4. For my side profile he wants to do a chin-wing and also bringing the lower jaw a bit forward (BSSO I guess? He didn't use the term)

5. I asked him about the incisor implants, that Defranq brought up in his consultation with me, and he told me that SAPE is going to change my bite completely and I have to walk around with a huge hole in my upper jaw for a couple of months. I dunno guys, he was a bit skeptical about that.
He told me that my teeth, in their current position, are good aligned and the bite is correct. If I want to widen the upper jaw for the implants, I have to fix the lower jaw afterward, is it worth it? With the TMJ in mind, how less surgery how better indeed.. I have bad joins unfortunately. It hurts when I chew long and it pops in and out every time I open up my mouth.

5. Or SKIP everything, and only go with a chin-wing, so chin-wing without the bimax guys! Because I don't look that bad. But first I have to visit my orthodontist. I scheduled an appointment for over two week.

Oh and let me know what you think! Feedback is very much appreciated

[girl]

Thanks for the update!

I honestly see nothing wrong (orthognathically) with your top jaw or midfacial proportions, irrespective of your small teeth and minor gum show. I guess that's because you really don't have the syndromic appearance of someone with a jaw-related issue. You are very attractive and appear to have a decent occlusal plane with no recessed looking facial features. Also, you don't look as if you have an overbite. Your midface doesn't look narrow, so jaw widening seems pointless (I know it's to do with the arch too, but I feel it only really works for those who have a narrow midface). I'm going by visuals from the pics you provided, and to me you look like a really pretty young woman. I think the ceph created a lot of confusion due to the incorrect angle, with you looking right down at the floor.

You might be the best candidate for a chin wing alone. I don't think moving the upper jaw forward in order to allow movement of the lower will give you a pleasing appearance. I think cosmetic dentistry with some minor gum removal and veneers could work for you and camouflage any perceived issues here.

If you had an element of "horse" I'd say jaw surgery, but I can just see your lower jaw is slightly weak. And I mean, even that's not bad. You still have a very nice silhouette in profile.

[Framboise]

Hi Miss01Herself,

As far as I know, extractions can entail TMJ disorder. You are missing your incisives and maybe your wisdom teeth,don't know if they have been extracted or if they are congenitally missing.  You don't have bad joint, it's the extractions which had probably hurt them. So don't blame on your joint but on your former dentist or orthodontist.

Defrancq's idea is not absurd, your jaws are really narrow and if the only issue is the gap between your teeth, it's not a big deal if it can alleviate your pain.

Your chin is prominent comparing to your lower jaw, so I won't do nothing ith the chin alone, that is without a BSSO.
Still, you look very pretty.

If I were  you I would go for a SARPE first and implants and then see. Take your time.