Advice needed!!! Double Jaw surgery

[Miss01Herself]

I didn't know that extractions could worsen the TMJ issue, but I don't think my teeth were extracted, I think they where probably congenitally missing, I found these molds made before and after the braces when I was 12 years. But more updates: went to the orthodontist yesterday and she didn't advice me to get implants because she doesn't think I need them and why would I risk my healthy tissue and bone. Implants don't last a lifetime as well. But she agreed with bringing the teeth forward. So what do you guys think? Are implants a good idea?

https://ibb.co/bE4A7c
https://ibb.co/gX3L7c
https://ibb.co/e2aYSc
https://ibb.co/eJZ4YH

[Miss01Herself]

I have also attached two recent photos ( slightly profile and forward) because the others were a bit older and some of you didn't see the long face I mentioned but here you can see it better.

https://ibb.co/hFOv7c
https://ibb.co/gVrRDH

[kavan]

Firstly, I would suggest that photo presentations be organized into ONE link. IMGUR is a good place to do that. Otherwise, it's tedious to click on a bunch of separate links to cross compare.

Secondly, I'm eliminating Dr. Z from the picture. Enough already with 'chin wings for everyone'. So, I shall focus on Dr. D's plan.

From what I see on the Pan X ray, you are indeed missing 2 lateral incisors  to the upper jaw. Very well could be congenital simply because it's the pre-molars that are commonly extracted for ortho work. Also, wisdom teeth but that's not issue with jaw surgery.

Although, info is limited as to Dr. D's full plan and your choice of showing your smile in oblique view instead of FRONTAL view does not help either in terms seeing what your smile looks like in frontal view, I would tend to think that making the upper jaw wider to accommodate missing teeth would be a good plan for starters.

[haven]

Its hard to tell but your airway appears to be small on the x-ray. I also have bad eyes so that doesnt help.

[CCW]

Its hard to tell but your airway appears to be small on the x-ray. I also have bad eyes so that doesnt help.

For sure, it looks tiny. I'm surprised Dr. Z didn't mention anything about it and just recommended chin wing. Her OP also looks somewhat steep and profile is convex. Since she doesn't have an excessive overjet or a huge gummy smile, that'd indicate she needs CCW bimax with posterior downgrafting. I don't think Dr. D's plan is right either, so I'd get a fourth and a fifth opinion (Raffaini and Alfaro, for example).

[Miss01Herself]

what’s wrong with chin-wings? When I visited dr. Z he showed me his cases and alot of his patiënts who had a chin-wing procedure looked very good afterwards, to me it kinda looked similar to patiënts  who had a CCW..  Alright, i finally received my Cone-Beam Scan results: https://imgur.com/gallery/DfRGK

It’s quite a difference to the previous scan I shared lol.

[girl]

Wow, what a difference to the other scans!

I can only really comment on the aesthetic side of things. Firstly, it looks like you have really small teeth and would benefit from veneers and gum contouring after jaw surgery (if you get it).

Your actual palate doesn't look narrow i.e. high arched to me. However, sounds like widening would be the thing for missing teeth.

To be honest, your biggest "issue" when smiling in particular is the fact you have some excess facial fat. I still think your jaws and face are balanced, and that you are pretty. Your occlusion looks good and symmetric, and your OP looks good here too.

[Miss01Herself]

I’m still not sure about these scans aswell tho, because she had to make them twice and I had to look up alot! I normally can’t/ don’t hold my head in that position for long.

[Miss01Herself]

I’m still not sure about these scans aswell tho, because she had to make them twice and I had to look up alot! I normally can’t/ don’t hold my head in that position for long.

Sigh, I will probably have to make another at the orthodontist , third time’s a charm they say haha(i’m crying).

[kavan]

They're not for everyone and this guy is a 'chin wings for everyone' guy. You would still have option of having a chin wing after a max fax surgery even if it included a BSSO. But I'm not to sure a doc doing a BSSO would want to do it after a chin wing.

As to air way, I can't really 'read' airway space. I would defer to CCW saying it's small if he sees that. Also with suggestion to consult with the 2 docs he suggested. However, I have nothing to say to actually dissuade you from Dr. D's suggestions.
As to what 'girl' said regarding the fat to the face, that could be a matter of the soft tissue POOLING on the face because it's not spread out enough due to the LACK of space you would tend to have to the upper jaw given congenital absence of the teeth. Hence, expanding the area would tend to open up more space to support the soft tissue pooling due to lack of space.

what’s wrong with chin-wings? When I visited dr. Z he showed me his cases and alot of his patiënts who had a chin-wing procedure looked very good afterwards, to me it kinda looked similar to patiënts  who had a CCW..  Alright, i finally received my Cone-Beam Scan results: https://imgur.com/gallery/DfRGK

It’s quite a difference to the previous scan I shared lol.

[ditterbo]

For sure, it looks tiny. I'm surprised Dr. Z didn't mention anything about it and just recommended chin wing. Her OP also looks somewhat steep and profile is convex. Since she doesn't have an excessive overjet or a huge gummy smile, that'd indicate she needs CCW bimax with posterior downgrafting. I don't think Dr. D's plan is right either, so I'd get a fourth and a fifth opinion (Raffaini and Alfaro, for example).

Assuming we're looking at the same images for judging this, imo she's maaaybe got a smaller than average airway, but it's clinically insignificant, as in she probably has mild to no sleep apnea. I'm comparing my imaging to hers, where mine looks narrower (comparing side view and looking overhead)  and my obstructive index was like 11 (5-15 is considered mild, 20+ is health detrimental according to my sleep doc...you'd guess right if you think she DIDN'T recommend I get DJS). If she does entertain djs though, better safe than sorry to get a sleep test done. Too many factors and types of apnea to make a conclusion here.

[Miss01Herself]

Assuming we're looking at the same images for judging this, imo she's maaaybe got a smaller than average airway, but it's clinically insignificant, as in she probably has mild to no sleep apnea. I'm comparing my imaging to hers, where mine looks narrower (comparing side view and looking overhead)  and my obstructive index was like 11 (5-15 is considered mild, 20+ is health detrimental according to my sleep doc...you'd guess right if you think she DIDN'T recommend I get DJS). If she does entertain djs though, better safe than sorry to get a sleep test done. Too many factors and types of apnea to make a conclusion here.

The first thing dr. D recommended me was a sleep test. Did get one and the outcome was a mild sleep apnea. Anyhow I’m still insecure about lateral incisor implants in the upperjaw..especially on my age and 2 out 3 professionals I asked didn’t think I needed it. Will it have an impact on my TMJ issue? Because if it would kinda relieve me from the constant pressure I feel on my joints I will probably go for it.

[kavan]

The first thing dr. D recommended me was a sleep test. Did get one and the outcome was a mild sleep apnea. Anyhow I’m still insecure about lateral incisor implants in the upperjaw..especially on my age and 2 out 3 professionals I asked didn’t think I needed it. Will it have an impact on my TMJ issue? Because if it would kinda relieve me from the constant pressure I feel on my joints I will probably go for it.

 Keep in mind, his wanting to expand the maxilla area seems to be for better aesthetics. Like you would tend to have better support for your face with that as to kind of spread out the tissue more so it doesn't look like fat. to that regard, he would have to add the teeth. I can't predict how it will impact your TMJ. Good question to grill the doctor on though.

[CCW]

Assuming we're looking at the same images for judging this, imo she's maaaybe got a smaller than average airway, but it's clinically insignificant, as in she probably has mild to no sleep apnea. I'm comparing my imaging to hers, where mine looks narrower (comparing side view and looking overhead)  and my obstructive index was like 11 (5-15 is considered mild, 20+ is health detrimental according to my sleep doc...you'd guess right if you think she DIDN'T recommend I get DJS). If she does entertain djs though, better safe than sorry to get a sleep test done. Too many factors and types of apnea to make a conclusion here.

I was looking at this picture. The CBCT scans look quite different indeed.

[Miss01Herself]

Alright, it's been a while but I am in need of advice once again. So far I had orthodontic treatment for more than a year. We achieved the gap precisely for the upcoming incisive implants. But before the implants, I'm scheduled for jaw surgery. That will be in December. The past week I had a consultation with dr. Nadjmi whom will perform the surgery. The initial plan was a Lefort I, BSSO with genioplasty but his advice is changed into a BSSO and optional genioplasty. Lefort I due to small teeth is not expedient in my case he said. Genioplasty will give me a better aesthetic. He explained that we could make the chin a bit pointier or just only reduce it a bit vertically. I have a strong chin. What do you guys think about Nadjmi's plan?

PS: this is how I look after a year of orthodontics and casually mewing:
https://imgur.com/a/d71FUkW