Hi guys again,
My surgery is in a few weeks. I have a class 3 bite, small upper jaw in all 3 dimensions, VMD posteriorly causing a slight anterior open bite; nothing major. My lower jaw is not retrognathic but it’s rather small and not forward enough, and the MP angle is steep. Since I have no upper tooth show at rest, CCW is only possible via posterior downgrafting, which is what I want to ask today about. But first...
I will be getting both jaws advanced about 6 mm and a 5 mm genio, along with maxilla widening and posterior impaction. This should shorten my LAFH a bit, but won’t change my MP.
I think my surgery will give good results. I have a very flat/ recessed face. My upper lip-nose angle is 90 degrees. So moderate Bi-max advancement will bring good aesthetic improvement. Yes the chimp look is possible but I believe my advancement is not huge and bringing the lower jaw forward will offset the upper jaw advancement.
My question is regarding my options for addressing the steep MP angle, which is a big aesthetic problem for me. What are the criteria for posterior downgrafting? I believe Kavan in another thread said the OP needs to be steep and can’t be flat to do CCW via posterior downgrafts. Can someone elaborate on this?.
Here is my x-ray,
https://imgur.com/a/CM9vXbk.... is my OP flat or steep? Would I be able to get just CCW in a second surgery at a later date? If not, I guess my only options are Chin Wing (likely can’t get this after BSSO) or jaw angle implants to addresss the vertical deficiency?