You don't need SARPE, you may need a cone shaped split of the maxilla to widen the space between the left and right upper jaw molars. That is what I got, 4mm wider upper jaw in the back, no widening in the front.
This really does intrigue me. I’m not sure if it’d be applicable to my case though, as my bite is perfect right now so I think I’d need to widen the mandible too so the dental arches would match. I’ll mention it to the next surgeon I speak to though!
It has in part to do with the teeth no longer meshing with their natural counterparts. The unavoidable problem however occurs because your lower incisors are now excessively proclined which makes 1st premolar extractions mandatory in order to place them in a normal upright (90°) position. This however will cause the incisors to lengthen as the ortho uprights them which will in turn give you a huge bilateral open bite immediately after surgery (doesn't matter if you get bimax, bsso, ccw or no ccw). This open bite has to be closed with post op orthodontics via means of extrusion of the lower jaw molars and premolars. This extrusion usually relapses partly after the braces are removed. My bite was actually very good right after ortho and after 12 months the extrusion relapsed by about 1mm. Not a huge deal, but my bite before surgery was better (my looks were way worse).
Ah, that
completely makes sense about the teeth rotating, thanks for clarifying. When you point it out, it almost seems obvious, but despite knowing this is a game of millimeters I still sometimes find myself failing to recognize how each miniscule movement and rotation can have such a profound effect like that. As I was writing this response, I just remembered one of the most interesting things Gunson said to me, which is actually relevant to this. He said that the teeth are supposed to mimic the level of the jaw, but then pointed out that my teeth don’t; my flat occlusal plane doesn’t match my steep mandibular plane, with my lower front incisors being higher than they should be (either from my previous orthodontic work pushing them up to artificially close my open bite, or just due to my mentalis muscle strain pushing them up) and he said I should talk to my current orthodontist about the possibility of pushing these teeth back down into the mandible. So I may be able to do that instead of extruding the lower molars and premolars.
I had surgery by a completely unkown German surgeon. I'll gladly PM you the name if you want, but seeing as you are from Canada, I'd say it is pointless. A linear BSSO is a simple surgery, even if it is a large advancement. Almost any jaw surgeon should be able to execute this surgery properly for you. You need specialists if you are a high angle patient who needs a large rotational advancement, but you are not a candidate for this (be glad, it is expensive).No problem, that's what we're all here for.
Interesting, I thought you may’ve gone to a “big-name” surgeon with a more complex plan like that. But yes, in that case I think you are right about it not being necessary, as I still have several more surgeons to talk to on this continent! (Well, and Alfaro as an exception.)
No problem, that's what we're all here for.
Well I’m immensely thankful for your generosity, as well as the generosity of everyone else here.
Well, I see neither of you answered the simple geometry concept relating to ANGLES.
You took the last few days researching this? The question was asking for a simple geometric concept. People lacking simple geometry concepts are going to have a real hard time with a lot of what's going on with max fax and will be confusing themselves and over complicating things.
HINT:
SNA, SNB are ANGLES. Angles alone don't tell you anything about the SIZE of something.
If I have 2 equilateral triangles, the fact that their angles are the same tells me NOTHING about the distance of the lines making up the triangle and hence the SIZE of the triangles. One triangle can be a different size than the other. One can be BIGGER than the other.
So, Sanjay's statement of: ["Im curious how are both his jaws underdeveloped if his sna is way above the norm?"] reveals he doesn't understand why an angle does not tell you anything about the SIZE of something. He might as well be curious as to how 2 equilateral triangles, similar in shape are different sizes if they both have the same angles.
Basically, someone with grammer school geometry would have known angle relationships alone don't tell you anything about the SIZE of something and would not have asked that question.
BOTH jaws CAN be undeveloped whether or not SNA exceeds the norm because angles don't tell you about the SIZE of something.
I won’t speak for Sanj87, but my curiosity and confusion about SNA doesn’t stem from a misunderstanding of basic geometry, but what seems to be a fundamental misunderstanding of the application of cephalometric values, or at least SNA in particular. I originally thought SNA
directly indicated maxillary protrusion/retrusion, as some of the (admittedly introductory) resources I read seemed to state as such without elaborating further (“>85° - protrusive or prognathic maxilla, <79° - deficient or retrognathic maxilla”). I know the difference between angle and size, but my confusion led me to assume that perhaps maxfac’s had some method of converting the SNA angle (and I guess every other individual angle and value for that matter) into some directly applicable measurement for determining size of movement. I basically thought that each of these values (SNA, SNB, etc.) could, with the use of some other hypothetical function, very precisely indicated how much something should be moved.
When Sanj87 asked, “How are the jaws underdeveloped if SNA is way above the norm?” due to my misunderstanding I translated it as, “How are the jaws underdeveloped if
the clinical measurement which directly determines jaw development says otherwise?”
At the time, this seemed like a good question, as for a total layman, when you see that you possess a value that deviates from the norm, it can seem like a cause for alarm. Really I was just trying to determine if an abnormally high SNA is something to be concerned about.
Perhaps, as you say, I’m overcomplicating things, and these cephalometric values hold less importance/determinacy than I originally thought, and they are simply used as an approximate assessment and not for directly applicable use, or perhaps they really are serious warning signs for aesthetic repercussions. I'll keep researching into this.
Anyway, I’m sorry my misunderstanding got in the way of meaningful discussion. All I can do is keep trying to learn, and I will do my best to continue doing so.
