Chin Wing after Bi-Max ??

[ODog]

No tooth show could be due to a long upper lip or vertical maxillary deficiency. In the first case, you get a lip lift and then surgery. In the other case you can still have CCW if your occlusal plane is steep - downgraft both at the front and the back of the maxilla, but more at the back to produce ccw rotation.

Yeah that’s what it is, vertical maxillary deficiency at the front, excess in the back. My philthrum is probably on the long side of normal but when I asked my surgeon if long philthrum was the cause he said no it’s normal and measured twice to confirm.

Basically in Canada I’d be shocked if a surgeon would offer CCW via downgrafts purely for aesthetics ( autorotation of mandible) and without there being some clear indication like excess gum show. My jawline is steep but not severely so, so implants or CW could fix that no problem.

I do have sleep apnea hence the bi-max, but again I’m not sure how much CCW would help that.

[ODog]

I feel like improving tooth show is completely doable for CCW in the right hands.

Dr. Arnett in my previous consultation a long time ago when he was still practicing indicated the need for greater tooth show and that he would address that even though he was doing a massive CCW rotation. He also said support for the upper lip would be better.

I’m sure there are ways like Plosko said lip lift or downgrafts but how much would a bi-max with CCW and genio cost with Gunson? Probably 6X what I’m paying here. I don’t know. Maybe it is indeed worth it to save up. Chin wing would solve the issue though.

[ODog]

I feel like improving tooth show is completely doable for CCW in the right hands.

Dr. Arnett in my previous consultation a long time ago when he was still practicing indicated the need for greater tooth show and that he would address that even though he was doing a massive CCW rotation. He also said support for the upper lip would be better.

Lazlo you’ve had double jaw right and are interested in a chin wing? You should get a 3D come beam scan done local to you and email it to Dr. z to see what he says....

[Lazlo]

Lazlo you’ve had double jaw right and are interested in a chin wing? You should get a 3D come beam scan done local to you and email it to Dr. z to see what he says....

Well I will do something like that but I feel the more prudent thing would be to get a CCW revision to my existing jaw surgery I'm not totally happy with.

I can imagine getting a chinwing would be something in the way of getting revision jaw surgery, am I right?

[kavan]

Yeah that’s what it is, vertical maxillary deficiency at the front, excess in the back. My philthrum is probably on the long side of normal but when I asked my surgeon if long philthrum was the cause he said no it’s normal and measured twice to confirm.

Basically in Canada I’d be shocked if a surgeon would offer CCW via downgrafts purely for aesthetics ( autorotation of mandible) and without there being some clear indication like excess gum show. My jawline is steep but not severely so, so implants or CW could fix that no problem.

I do have sleep apnea hence the bi-max, but again I’m not sure how much CCW would help that.

If you have anterior open bite/excess in the back AND a close to 'flat' OP, it's doubtful you will be getting CCW. A wedge from the back would most likely need to be removed (posterior impaction)= CW and more anterior tooth show is a wedge downward which also is CW.

[GJ]

No tooth show could be due to a long upper lip or vertical maxillary deficiency. In the first case, you get a lip lift and then surgery. In the other case you can still have CCW if your occlusal plane is steep - downgraft both at the front and the back of the maxilla, but more at the back to produce ccw rotation.

Yeah that is possible but would require the unstable downgraft, in conjunction with what many feel is already an unstable movement in CCW.
This is why these class II cases are the hardest of all. Underbites look worse, but have it easier at surgery time.

[kavan]

Lazlo you’ve had double jaw right and are interested in a chin wing? You should get a 3D come beam scan done local to you and email it to Dr. z to see what he says....

OR Lazlo could look at the diagram of the different BSSO types, note that type #3 is the Obwegeser dal pont osteotomy and ask his doctor if he had that one--the most common one-- OR he could just e mail the chin wing doctor his post op ceph where it could be seen what type he had. No cone beam scan needed for him to find out if his BSSO precludes him from a chin wing.

[ODog]

If you have anterior open bite/excess in the back AND a close to 'flat' OP, it's doubtful you will be getting CCW. A wedge from the back would most likely need to be removed (posterior impaction)= CW and more anterior tooth show is a wedge downward which also is CW.

Yes that’s my case, anterior open bite with close to flat OP.

The initial  plan with my first surgeon was posterior impaction but they never explained how that  would translate to CCW. As far as I knew that would mean CW as you’re saying now, Kavan? My orthodontist said it would “shorten my face.”

The anterior tooth show will apparently be fixed with forward advancement. My upper lip is very flat... 90 degrees to base of nose so that could be contributing as well.

[ODog]

OR Lazlo could look at the diagram of the different BSSO types, note that type #3 is the Obwegeser dal pont osteotomy and ask his doctor if he had that one--the most common one-- OR he could just e mail the chin wing doctor his post op ceph where it could be seen what type he had. No cone beam scan needed for him to find out if his BSSO precludes him from a chin wing.

Get on that Lazlo. Kidding lol... that’s what I’ll do after I get the Ceph from my surgery.

[Post bimax]

Yes that’s my case, anterior open bite with close to flat OP.

The initial  plan with my first surgeon was posterior impaction but they never explained how that  would translate to CCW. As far as I knew that would mean CW as you’re saying now, Kavan? My orthodontist said it would “shorten my face.”

The anterior tooth show will apparently be fixed with forward advancement. My upper lip is very flat... 90 degrees to base of nose so that could be contributing as well.

Posterior impaction could “shorten” your face by allowing your mandible to swing closer to “flat” when your mouth is closed.

[kavan]

Yes that’s my case, anterior open bite with close to flat OP.

The initial  plan with my first surgeon was posterior impaction but they never explained how that  would translate to CCW. As far as I knew that would mean CW as you’re saying now, Kavan? My orthodontist said it would “shorten my face.”

The anterior tooth show will apparently be fixed with forward advancement. My upper lip is very flat... 90 degrees to base of nose so that could be contributing as well.

Yes a CW rotation would be needed via posterior impaction and some CW probably to anterior maxilla to rotate down and make the OP less flat. Well, a NET clockwise rotation does not change into CCW.  You only get a net CCW with for example a posterior down graft that is larger in the back than the anterior downgraft they put to the front for more tooth show. You'r NOT gettting a posterior downgraft. Not done with vertically long posterior maxilla. Posterior impaction is CW but it does allow your jaw to swing upward to CLOSE the bite because it's the BACK teeth forcing the back of the lower jaw downward. That is what the ortho means by it will 'shorten'.

[Lazlo]

OR Lazlo could look at the diagram of the different BSSO types, note that type #3 is the Obwegeser dal pont osteotomy and ask his doctor if he had that one--the most common one-- OR he could just e mail the chin wing doctor his post op ceph where it could be seen what type he had. No cone beam scan needed for him to find out if his BSSO precludes him from a chin wing.

haha thanks Kavan, makes my life easier. What did I say on the other thread: ASK KAVAN!!!

[PloskoPlus]

My surgery is March 18 and most of it is covered by insurance so I’m going forward with it. I’m also getting bi-max advancement which would be more than 30k + in the US. Besides, I have no tooth show so wouldn’t CCW make that worse? No surgeon has been able to satisfactorily explain if I’m a CCW case or not.

I hope you don't decide to have surgery because it's cheap. A bad surgery is worse than no surgery.

[ODog]

Yes a CW rotation would be needed via posterior impaction and some CW probably to anterior maxilla to rotate down and make the OP less flat. Well, a NET clockwise rotation does not change into CCW.  You only get a net CCW with for example a posterior down graft that is larger in the back than the anterior downgraft they put to the front for more tooth show. You'r NOT gettting a posterior downgraft. Not done with vertically long posterior maxilla. Posterior impaction is CW but it does allow your jaw to swing upward to CLOSE the bite because it's the BACK teeth forcing the back of the lower jaw downward. That is what the ortho means by it will 'shorten'.

Right so it would be beneficial fixing the open bite with posterior impaction. But then how is my new surgeon planning on bypassing the posterior impaction ?? He’ll fix the open bite with just forward advancement ?

[ODog]

I hope you don't decide to have surgery because it's cheap. A bad surgery is worse than no surgery.

Why do you think my surgery will be bad? Now I’m doubting it. I don’t think my open bite is significant, so my new surgeon didn’t think it was an issue. I believe the impaction would be quite small if it was done.