Confused about Lower Jaw Advancement! Scans

[anand1528]

Hello Guys,

I'm really scared about getting a lower jaw advancement done, especially because I've consulted over 10 max fac surgeons and everyone has a distinct opinion about the amount of lower jaw advancement that I need. To begin with, I've got a skeletal deformity - Class II Division I, And an overjet of 7mm. However, my molars are in an edge to edge relationship despite the class II malocclusion.

The surgeon that I prefer is saying that he'll go with the surgery first orthodontic approach (SFOA) and then an ortho treatment for over a year. He said that he'll advance up to 9.5mm and create a class III. He's primarily doing this for aesthetics and I seem to agree with him.

The other surgeon that I cite with said he'll advance up to 6-7mm create a class I followed up with a short ortho treatment, makes the aesthetic improvement a little less pronounced but adds a bit of vertical height(2mm) to my face.

Here's what I think - if I go into the reverse overjet territory(9mm advance) then I'm scared it'll make my face shorter because of the CCW rotation and I don't know If I truly want that when there's an alternative available.  I genuinely don't know who to choose. Therefore I request you guys to help me with this dilemma that I'm puzzled in. What will be the repercussions when I get too much of an advancement aka an overcorrection or perhaps the contrary to that?

Also, Both of them said that I don't need genio and the first surgeon said that he can handle the wisdom tooth removal at the time of the surgery.

[april]

I'm not following. Why would you want a -2.5mm reverse overjet?

[kavan]

The first X ray almost looks like anterior open bite. But then again it's a weird looking X ray/ceph. Does not show soft tissue profile.

It's safer to get wisdom teeth extracted BEFORE a surgery. Lowers risk of 'bad break'.

You mention a CCW rotation but nothing about the maxilla being moved. CCW rotation would refer to a rotation at the maxilla. But you only mention advancements that refer to lower jaw.

The photo on your IMGUR link is called 'Predicted Result'.  Who predicted that, you by morphing something or the doctor? You say it's a photo of you holding your jaw forward. But I can tell it's a morph.

Sorry. Can't narrow down for you which one to choose. Maybe choose the one who predicted the result you show and call it a photo of your holding your jaw 9mm forward if you like that.

[InvisalignOnly]

What I don't understand is, why is it not an option to 'normalize' your bite (try to achieve class I) plus a genioplasty? You say the doctors said you don't 'need' a genioplasty. Nobody 'needs' a genioplasty, but would that not make you look better, without the 'reverse overjet' thing you mention?

[InvisalignOnly]

My other two cents... Does this first doctor you mention not sound a bit reckless to you? 'He can handle' the wisdom tooth removal at the time of the surgery - probably so can other doctors but they might not want to because it's not the best option, plus he wants to create a class III (?), surgery first, etc. You say you've spoken to more than 10 doctors, how did you narrow the options down to these two? Did all the others say genio was not a good choice?

[anand1528]

I actually posted the wrong file on Imgur sorry. This is the one I'm talking about (imgur.com/a/Zn3kRjg). And about the CCW rotation, I actually have little to no info about that specific area that was something that my local doctor told me. Also, you're right about the anterior open bite

A lot of doctors said +/- genio(On table decision). And I cited with that reckless surgeon because he sounded the most confident in his approach and assured me that I don't need a genioplasty.

[anand1528]

There's also another doctor who mentioned the thing you're sayin, he said that he'll leave 1-2mm of overjet with the BSSO and also perform a genio along with it, but he said that he'll remove the wisdom tooth before. The thing is, I am confused as to which one should I pick and what is the right treatment for me. Will a genio be beneficial for me or just advancing the mandible will suffice?

[kavan]

I actually posted the wrong file on Imgur sorry. This is the one I'm talking about (imgur.com/a/Zn3kRjg). And about the CCW rotation, I actually have little to no info about that specific area that was something that my local doctor told me. Also, you're right about the anterior open bite

A lot of doctors said +/- genio(On table decision). And I cited with that reckless surgeon because he sounded the most confident in his approach and assured me that I don't need a genioplasty.

Poor presentation, no answer as to WHO did MORPHS, yet assertion it was photo of jaw being held forward, posting wrong file, no info on CCW which is movement to maxilla (bi max surgery). Your confusion is to extent you can't collect and organize information. Not the type that can be used as basis to choose which doctor FOR you. No idea. 6 of 1 or 1/2 dozen of the other.

Learn to use the QUOTE function, if you're responding to a specific post.

[anand1528]

Poor presentation, no answer as to WHO did MORPHS, yet assertion it was photo of jaw being held forward, posting wrong file, no info on CCW which is movement to maxilla (bi max surgery). Your confusion is to extent you can't collect and organize information. Not the type that can be used as basis to choose which doctor FOR you. No idea. 6 of 1 or 1/2 dozen of the other.

Learn to use the QUOTE function, if you're responding to a specific post.

I was just exposed to this max fac thing 2 months ago and that shows clearly but I'm keen to learn more about it from you. No one in my family understands a thing about jaw surgeries that leaves me to make the final call. Also, I morphed the photo and posted it by accident sorry about that.

You're right I should've been a lot more specific with my query I screwed up anyways thanks for the constructive criticism!

[kavan]

You're probably better off getting advancement that is CLOSE to your overjet which would be the 6-7mm lower jaw to leave you in class 1 relationship and the REST of that via the approx 2mm CHIN augment to be close to a 9.5mm amount total. Also get wisdom extracted BEFORE any surgery.

That's a less bad option than getting 9.5mm lower jaw total that leaves with class 3 and takes a years worth of braces AFTERWARDS which sounds TOO LONG for surgery first post brace option.

Your presentation itself is just too confusing to read anymore. So, that's all I'll say here about the choices.