Will surgeon's base plan significantly improve my profile(x-ray provided)

[FranAK]

Hello everyone,

I have a weak chin and a genuinely unattractive side profile with a 5mm overbite, and have been consulting with Kaiser OMFS norcal for Jaw Surgery. Now it seems that Kaiser's primary goal is to fix the bite, with improved aesthetics being a bonus. My  my surgeon also indicated that I would only need an upper jaw widening and a lower jaw advancement, with no mention of rotational movements.

I was able to look at my x-ray for the first time today and it seems that I have a steep occlusal plane and I do have a long face, so I'm worried that an advancement without rotation would only make a minor improvement in my profile. What do you guys think? Should I ask my surgeon what his specific plan is before I enter orthodontic treatment?  I have attached my ceph below.

Thanks

[GJ]

It looks like your lower jaw can be moved pretty substantially, linearly, due to a large dental overjet. You might be able to get away with a few mm there, and then another few mm rotating the chin with a genio.

Is that your wisdom teeth? Do they plan to remove them first?
 
Kaiser has a bad reputation, so maybe get another opinion. Who is doing the surgery there? Upper jaw widening is a three piece, and it's not the easiest surgery. Regarding rotation, I don't think your angle looks super steep. Maybe borderline CCW case. That's why I'd ask around, in addition to the risk of segmenting the upper by a Kaiser doctor.

[kavan]

The surgeon is conveying that you don't need your maxilla advanced. He's looking at an angle relationship associated with maxilla position (SNA) and he's seeing that advancing the maxilla would be beyond what would be considered a good aesthetic for it. He's also looking at an angle relationship associated with the mandibular position (SNB) and seeing the angle relationship is deficient and would be within the norm (aesthetic benefit) for the mandible to come forward.

For the mandible to come forward without the maxilla coming forward with it, the maxillary arch needs to be expanded for the TEETH of both jaws to 'mesh'. Otherwise the teeth in the lower arch would be too wide set for those in the upper arch.

He's also looking at other angles that would not require rotational displacements such as the occlusal plane angle (OP) and probably also seeing that any increase in the mandibular plane angle (MPA) from advancing your mandible along it's OWN present MPA could be offset with a sliding genio for the 'look' of a CCW rotation.

[FranAK]

It looks like your lower jaw can be moved pretty substantially, linearly, due to a large dental overjet. You might be able to get away with a few mm there, and then another few mm rotating the chin with a genio.

Is that your wisdom teeth? Do they plan to remove them first?
 
Kaiser has a bad reputation, so maybe get another opinion. Who is doing the surgery there? Upper jaw widening is a three piece, and it's not the easiest surgery. Regarding rotation, I don't think your angle looks super steep. Maybe borderline CCW case. That's why I'd ask around, in addition to the risk of segmenting the upper by a Kaiser doctor.

Do you think a linear advancement of my lower jaw will provide a decent aesthetic benefit? Also yes, that is my wisdom tooth, and my surgeon did mention I would need to remove it (them) prior to surgery. My surgeon is Dr. Desai at Kaiser. Have you heard of him?

 I would love to ask around, but I am limited to Kaiser since they cover everything. If you know any good surgeons within Kaiser in California (north or south), please let me know.

[FranAK]

The surgeon is conveying that you don't need your maxilla advanced. He's looking at an angle relationship associated with maxilla position (SNA) and he's seeing that advancing the maxilla would be beyond what would be considered a good aesthetic for it. He's also looking at an angle relationship associated with the mandibular position (SNB) and seeing the angle relationship is deficient and would be within the norm (aesthetic benefit) for the mandible to come forward.

For the mandible to come forward without the maxilla coming forward with it, the maxillary arch needs to be expanded for the TEETH of both jaws to 'mesh'. Otherwise the teeth in the lower arch would be too wide set for those in the upper arch.

He's also looking at other angles that would not require rotational displacements such as the occlusal plane angle (OP) and probably also seeing that any increase in the mandibular plane angle (MPA) from advancing your mandible along it's OWN present MPA could be offset with a sliding genio for the 'look' of a CCW rotation.

Hi Kavan, thanks for the reply.

Assuming your interpretation of my surgeons' analysis is correct, would you also personally agree that this analysis would provide me with significant aesthetic benefit? Do you think I could get by with just an LJS and arch expansion?

[kavan]

Hi Kavan, thanks for the reply.

Assuming your interpretation of my surgeons' analysis is correct, would you also personally agree that this analysis would provide me with significant aesthetic benefit? Do you think I could get by with just an LJS and arch expansion?

The information conveyed is consistent with better aesthetic balance

The basic information the doctor conveyed to you is consistent with his stated goal of aesthetic improvement, better aesthetic balance along with making the bite right.

There's no need for me to think in terms of level of of 'significant' or how 'significant' as a follow up to my interpretation of what he was conveying. There's no information for me to opine on how 'significant' the aesthetic improvement would be to you. Those types of questions usually translate to: 'Will I love what I see in the mirror?' whether or not the person uses those exact words. Not to mention you need an 'answer' to that in the absence of a visual (as in ceph displacement proposal).

Instead of engaging as to 'how significant' this will be and so engaging in the absence of a visual (ceph displacement proposal from the doctor) and expecting people to some how know how significant this would be to you, consider getting a displacement visual from the doctor to show here OR try thinking in terms of whether or not you would be satisfied with better aesthetic balance than you have already. All that can be concluded here by me is that the goal includes better aesthetic balance which is something relative to a maxfax identifying deviations from the norm (imbalances) and corrections aimed at bringing to norm and/or closer. No conclusion can be made as to the level of 'significance'.