Chin Wing after Bi-Max ??

[Post bimax]

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 ?

He can downgraft the anterior maxilla to close the bite without posterior impaction.

[kavan]

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 ?

Posterior impaction is a modality used to help close an open bite. Anterior downgraft is used for more tooth show. Both are CW rotations.

Sorry dude but you don't put all your info together correctly or all in one place. Case in point, Plosko tells you how CCW can work but you don't tell him you have a flat OP and anterior open bite or even show your ceph in this questioning process. You're just engaging people in a GUESSING GAME of what you MIGHT have. 'IF this THEN that'

Now you reveal you're not getting posterior impaction and want people to tell you how your surgeon is going to fix your open bite. I'll leave that to the PSYCHICS who can do 'remote reading' on exactly what your surgical plan says.

[ODog]

Posterior impaction is a modality used to help close an open bite. Anterior downgraft is used for more tooth show. Both are CW rotations.

Sorry dude but you don't put all your info together correctly or all in one place. Case in point, Plosko tells you how CCW can work but you don't tell him you have a flat OP and anterior open bite or even show your ceph in this questioning process. You're just engaging people in a GUESSING GAME of what you MIGHT have. 'IF this THEN that'

Now you reveal you're not getting posterior impaction and want people to tell you how your surgeon is going to fix your open bite. I'll leave that to the PSYCHICS who can do 'remote reading' on exactly what your surgical plan says.

I am going to get clarification with my surgeon and hopefully he can email me his surgical plan. I spoke to my orthodontist and he said my surgeon will likely be impacting the upper posterior segments and leaving the anterior segment about where it is or extruding it - depending on my gum display.

I don’t know what extruding means. Maybe my surgeon just never felt he need to mention the impaction that will be done because it’s a given? Either way, I’ll find out soon. 

[kavan]

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.

Plosko isn't predicting your surgery will be bad. He's probably picking up on some
faulty information processing abilities. I mean it's not as if you demonstrate you understand how things work or even what you are getting. Nor do you convey all in one place what you even have.

He can correct me if I'm wrong. But I take it that he HOPES cheapness is not the main determining factor for your surgery. He's quite correct when he says: 'Bad surgery is worse than no surgery.' If you think he's predicting your surgery WILL be bad, then that demonstrates lack of processing abilities.

Look at one of your statements here where you said (in reference to chin wing):

......The thing is, you can always get an implant later if it truly is a worthless procedure.

I mean what kind of 'conclusion' is that in light that BenfromUK on here relays he had bad chin wing experience AFTER he got it to correct his bad implant experience. I'm wondering even if you understand the difference between a 'worthless procedure' and a BAD SURGERY necessitating much more pain expense, etc. than just slapping implants over it.

[ODog]

Plosko isn't predicting your surgery will be bad. He's probably picking up on some
faulty information processing abilities. I mean it's not as if you demonstrate you understand how things work or even what you are getting. Nor do you convey all in one place what you even have.

He can correct me if I'm wrong. But I take it that he HOPES cheapness is not the main determining factor for your surgery. He's quite correct when he says: 'Bad surgery is worse than no surgery.' If you think he's predicting your surgery WILL be bad, then that demonstrates lack of processing abilities.

Look at one of your statements here where you said (in reference to chin wing):

I mean what kind of 'conclusion' is that in light that BenfromUK on here relays he had bad chin wing experience AFTER he got it to correct his bad implant experience. I'm wondering even if you understand the difference between a 'worthless procedure' and a BAD SURGERY necessitating much more pain expense, etc. than just slapping implants over it.

I’m assuming the bad CW result would be from a sub-par drop-down and/or widening that would be more enhanced with jaw implants. I mean worthless as in not overly noticeable result. I’ve seen b/a’s where that’s the case. There’s improvement but it’s “meh.” You’re right it could also be a bad procedure as in Ben’s case, but it seems to me the surgeon didn’t do what he was supposed to do, so his result isn’t indicative of what a side wing can normally achieve.

[kavan]

I’m assuming the bad CW result would be from a sub-par drop-down and/or widening that would be more enhanced with jaw implants. I mean worthless as in not overly noticeable result. I’ve seen b/a’s where that’s the case. There’s improvement but it’s “meh.” You’re right it could also be a bad procedure as in Ben’s case, but it seems to me the surgeon didn’t do what he was supposed to do, so his result isn’t indicative of what a side wing can normally achieve.

A better assumption to make would be that Ben assumed a chin wing would be great for him based on SJ's content.

[ODog]

A better assumption to make would be that Ben assumed a chin wing would be great for him based on SJ's content.

No we need to be clear about what went wrong in Ben’s case. As far as I understand from what Ben has told me (maybe I’m wrong or new information has been learned)) he communicated clearly to his surgeon he wanted a drop down in the back, the surgeon then went against this supposed plan and made the cut 3/4 way down his jaw and dropped down the front part of his jaw and chin, lengthening the wrong part of his face, making it look longer, squarish, and blunting the angles - when the problem as stated by him was at the BACK of his jaw, I.e his jaw angles. In other words, nothing was done at all to enhance his jaw angles.

His follow-up surgeon explained that the cut “should have been” from the back to about mid-way, dropping and widening the jaw angles and filling it with hip-grafts, leaving the chin area untouched. This was not done in Ben’s case. It seems to me he got a traditional chin wing for people who lack vertical hieight in the chin area, and NOT a side wing which is for those who have a high jaw angle. 

So how can we conclude anything about the effects of a Side Wing from Ben’s case when it wasn’t it performed correctly ?

[kavan]

No we need to be clear about what went wrong in Ben’s case. As far as I understand from what Ben has told me (maybe I’m wrong or new information has been learned)) he communicated clearly to his surgeon he wanted a drop down in the back, the surgeon then went against this supposed plan and made the cut 3/4 way down his jaw and dropped down the front part of his jaw and chin, lengthening the wrong part of his face, making it look longer, squarish, and blunting the angles - when the problem as stated by him was at the BACK of his jaw, I.e his jaw angles. In other words, nothing was done at all to enhance his jaw angles.

His follow-up surgeon explained that the cut “should have been” from the back to about mid-way, dropping and widening the jaw angles and filling it with hip-grafts, leaving the chin area untouched. This was not done in Ben’s case. It seems to me he got a traditional chin wing for people who lack vertical hieight in the chin area, and NOT a side wing which is for those who have a high jaw angle. 

So how can we conclude anything about the effects of a Side Wing from Ben’s case when it wasn’t it performed correctly ?

Sorry dude but regarding BOTH SJ and Optimistic who you often cite for the chin wings it seems hard for you to conclude that BOTH got the chin wing FIRST and THEN the side wing.  That is to say, both KNEW--and no problem understanding why-- one does a chin wing FIRST to CCW rotate the (back of )mandible downwards as to decrease the MP angle and THEN one does the side wing to 'pry out' the back part for the angles from the front effect. You seem to think that someone with a near high MP can just get ONLY a side wing which is not the case. Asking for it with a near high MP angle is like asking the doctor to have jaw angle sticking out right below your ears.

One makes the right conclusions by obtaining the right information and having the ability to process it which is what Optimistic did who had the ability to read and 'digest' med journal articles about the wings and also the ability to apply that info to himself. SJ being a fast learner, using same/similar information was able to do the same.

Now as to Ben, there is really no way for you to cross reference his case with cephs, before afters as to SEE the problem. What's clear to me is that he assumed a chin wing would work out well for him and assumed so via SJ's content and promotions of them.

Even Dr. Z is trying to spare you from making the wrong decision and you still don't get it. Maybe Ben's doctor will do it for you.

[ODog]

Now as to Ben, there is really no way for you to cross reference his case with cephs, before afters as to SEE the problem. What's clear to me is that he assumed a chin wing would work out well for him and assumed so via SJ's content and promotions of them.

Even Dr. Z is trying to spare you from making the wrong decision and you still don't get it. Maybe Ben's doctor will do it for you.

Lol I already told you what the problem was. There is nothing more to see. Ben went to another surgeon who took Cephs and pinpointed why the surgery gave a bad result. There is no need to be vague and say we have no way of knowing. That’s already been figured out. He assumed a chin wing would work out well for him given that the drop down would be at the back, not the front. SJ obviously got a drop down at the back, same with Optimisitc, Ben did not.

Is it not clear to you that the problem has less to do with SJs promotion of the CW or Optimisitc’s awesome information processing abilities and more to do with the fact that Ben’s surgeon messed up? That’s the point I am trying to convey here.

Ben got the majority of his money back. I may be wrong but is that even possible to do if the CORRECT procedure was performed and the patient just happened to be dissatisfied? That’s probably only going to happen if the surgeon admits he did something extraneous, wrong, out of the ordinary, unexpected etc. So that is proof that there is more to the story here.

You seem to want to muddy my point in an effort to dismiss the CW procedure altogether.

[kavan]

Lol I already told you what the problem was. There is nothing more to see. Ben went to another surgeon who took Cephs and pinpointed why the surgery gave a bad result. There is no need to be vague and say we have no way of knowing. That’s already been figured out. He assumed a chin wing would work out well for him given that the drop down would be at the back, not the front. SJ obviously got a drop down at the back, same with Optimisitc, Ben did not.

Is it not clear to you that the problem has less to do with SJs promotion of the CW or Optimisitc’s awesome information processing abilities and more to do with the fact that Ben’s surgeon messed up? That’s the point I am trying to convey here.

Ben got the majority of his money back. I may be wrong but is that even possible to do if the CORRECT procedure was performed and the patient just happened to be dissatisfied? That’s probably only going to happen if the surgeon admits he did something extraneous, wrong, out of the ordinary, unexpected etc. So that is proof that there is more to the story here.

You seem to want to muddy my point in an effort to dismiss the CW procedure altogether.

 You muddy your own points. Some examples of your other conclusions:

Some of your other conclusions:

That may be true but consider that he underwent a side wing that vertically dropped his ramus for the sole purpose of squaring his jaw,

No, it's the chin wing that vertically drops the BORDER of the mandible and in his (SJ's) case to make LESS the MP. The side wing, AFTER THAT is used to square out the jaw.

...... My jawline is steep but not severely so, so implants or CW could fix that no problem.

This after you're told having a standard BSSO cut IS a problem with a chin wing?

..... I actually don’t even want a CW but a side wing.

Same as saying you only want the second step of something that's contingent on the first step being done. For a side wing not to stick up close to the ears in someone who is NOT a LOW MP angle patient, one FIRST needs the CW to rotate and drop down the border of the mandible.

Visually speaking I’m not sure why a BSSO would make a side wing harder, chin wing yeah I can understand because  you’re cutting further down where the BSSO cut was made, which is probably what he means by “the border is destroyed with BSSO,” but with SW the cut is at the back only, I.e there’s no sliding forward movement or anterior mandible dropdown needed in my case as that will be accomplished with my genio and BSSO. I just want a wider, squarer jaw at the back

So, exercise in futility to provide visuals. A cut from the front needs to be done to get to the back.

I guess the next thing to determine is why some BSSO cuts are preferred to others and why. Is it arbitrary? Does it depend on the surgeon?

Dr. Z told you why and ample visual info was provided on the board to this regard.

This was Dr. Z’s explanation.....

“if the distance after conventional BSSO from the lower border to the nerve is too small Side Wing or Chin Wing are not possible anymore. And: Small segment (makes for ?) difficult fixation, higher risk of resorption, possible step in Jaw Line.”

The latter part I think was in response to me asking if he could segment only a small part of the back jaw for the side wing. So it seems the real issue is the distance from lower border to nerve? But isn’t that the case even if you don’t get a BSSO? I’m confused.

Only a small segment can be moved in either chin wing or side wing if the lower border of the mandible is too close to the nerve. But to do a side wing on a near high angle patient, one needs the chin wing first to lower the angle and then the side wing. No small segments even with no BSSO.

You got ruined goinal angles because the surgeon segmented the wrong section of your mandible. Hard to believe, but he messed up. CW is going to blunt your angels but a side wing should not. How could it ?

CW only blunts the angles if the angles have to be brought forward in the act of advancing the chin. If the movement is just a downward drop with CCW rotation to the back of the mandible, there is no blunting. If there is blunting of the angles when the whole chin wing segment is advanced forward to include chin advancment, a SECOND operation is done to move the part of the angle back, pry it outward for a side wing and also put a bone BUTRESS between the GAP doing that makes. It is not a thing of 'just getting a side wing ONLY'.

There is a user here, Optimistic, that apparently had great results with a side wing.

That user got both the chin wing and the side wing as the second operation and he had NO BSSO. I attribute his success to his having a good ability to PROCESS INFORMATION (he's smart) and having the ability to apply it to himself correctly to make the right decision. He was able to FIGURE OUT all of the above with little help from others and did it without confusion and faulty conclusions.

If after all that you still don't understand why you just can't have a 'side wing', I  GIVE up and I shall leave you to your own devices to figure out for yourself what will work for you and what won't.

Be my guest and conclude as you like about Ben and disregard SJ's stuff factored into to his being attracted to getting a chin wing. I'm NOT 'dismissing' the CW procedure altogether. I just think that people who actually UNDERSTAND how it works are the best candidates for it.

[ODog]

Ok I was misusing the term side wing. I thought a chin wing was to advance the chin and/or vertically lower it, and a side wing dropped down the jaw angles. If a side wing only widens the angles, I may not even need that. What I need most importantly is to drop the angles, achieved with a chin wing.

I’ve been avoiding the term “chin wing” because I thought that would be what Ben had done which dropped the chin and middle jaw, hence my wrong usage of side wing. I wanted to differentiate between dropping down the front part of jaw and the back.

Optimisitc was ecstatic with his results from the first chin wing BEFORE he went for the side wing... so in his case dropping the jaw angles alone gave a great improvement.

[ODog]

Look at the attached image. There are users who have contacted Dr. Z who told them himself that a side wing is a procedure to lengthen and widen the jaw angles without touching the chin. That’s exactly how I was using the term.

So take it easy there Kavan, you didn’t have to go full blown autism on me because I may - or may not - have been misusing terms.

[kavan]

Look at the attached image. There are users who have contacted Dr. Z who told them himself that a side wing is a procedure to lengthen and widen the jaw angles without touching the chin. That’s exactly how I was using the term.

So take it easy there Kavan, you didn’t have to go full blown autism on me because I may - or may not - have been misusing terms.

Congratulations. You found one of SJ's aliases.

[kavan]

Ok I was misusing the term side wing. I thought a chin wing was to advance the chin and/or vertically lower it, and a side wing dropped down the jaw angles. If a side wing only widens the angles, I may not even need that. What I need most importantly is to drop the angles, achieved with a chin wing.

I’ve been avoiding the term “chin wing” because I thought that would be what Ben had done which dropped the chin and middle jaw, hence my wrong usage of side wing. I wanted to differentiate between dropping down the front part of jaw and the back.

Optimistic was ecstatic with his results from the first chin wing BEFORE he went for the side wing... so in his case dropping the jaw angles alone gave a great improvement.

Both Optimistic and SJ had the chin wing first and then the side wing. One to drop down. The other to wing outwards so the angles show from the front. There are different variations of how they can move parts of the lower border of the mandible. A 'chin wing' just refers to the act of being able to cut along the border of the mandible and move things in different directions without doing a BSSO. You have to study diagrams to visualize the different ways.

Well, if Optimistic was ecstatic with his results BEFORE he went for the side wing, it should follow that he got the chin wing FIRST.

[ODog]

Both Optimistic and SJ had the chin wing first and then the side wing. One to drop down. The other to wing outwards so the angles show from the front. There are different variations of how they can move parts of the lower border of the mandible. A 'chin wing' just refers to the act of being able to cut along the border of the mandible and move things in different directions without doing a BSSO. You have to study diagrams to visualize the different ways.

Well, if Optimistic was ecstatic with his results BEFORE he went for the side wing, it should follow that he got the chin wing FIRST.

Yes the confusion here is that you thought I wanted the side wing (flared angles) first without dropping them vertically - obviously that would be a disaster.

I propose that the term ‘wing’ refers to the cutting along the border, where “chin wing” means dropping or advancing the chin, as in class II patients who want camaflouge work instead of JS, “Side Wing” where the jaw angles are flared laterally, and “jaw wing” or “back wing” where the jaw angles are lengthened vertically, because everyone has a different interpretation of chin wing.

I mean can you imagine if Ben’s surgeon dropped his chin and middle jaw area simply because Ben asked for a chin wing, meanwhile Ben thought a chin wing meant dropping the back jaw? Just horrendous, unacceptable miscommunication if that’s the case. This is why I’m paranoid about not using “chin wing”