Yep none of us will ever have a perfect surgical plan. I think you're doing pretty good if you have black and green and not too much red or blue.
There is usually a method to the madness though. These surgeons who follow Arnett's analysis normally start with setting the upper incisor position first and plan from that. He says in the video the incisor is key to facial planning.
BUT I also re-watched parts further into the video and he said in her case he made the OP completely flat with aggressive CCW to help her joints and airway. Not sure how that helps her joints, but yes what you said is true, it was a trade-off. I never pick up on stuff from the first watch, so that'll be my lesson to re-watch. He said he will even do a negative OP in some cases, but that's when it really affects the smile.
Those numbers on her teeth represent how far away horizontally the tips of her teeth are from the TVL.
You can see how far her teeth were advanced forward by comparing those ones e.g 19-9 = 10mm advancement of her lower teeth, and 11-7 = 4mm advancement of her upper teeth. That matches up with her VSP read outs.
Well, if they need to make the OP flat, it would be to maximize both the airway and the the 'pure' horizontal displacement of the mandible and also to minimize unfavorable changes to the nose base from displacements of the maxilla. Basically, they're looking to maximize the horizontal advancement of a 'forward' displacement and minimize the vertical displacement that is also a component of moving 'forward' along a DIAGONAL line. Diagonals are inclined away from a horizont. The OP is something that has an ANGLE OF INCLINATION away from the horizont and the higher the it's angle of inclination is relative to a horizont the more (unwanted) vertical displacement there will be to achieve the 'pure' horizontal displacement needed. So, a CCW that makes the OP 'flat' allows for only the needed horizontal displacement because the angle of inclination the OP has with the horizont becomes 0 deg (or 180 which is same) in which moving 'FORWARD' becomes a 'pure' horizontal displacement where as moving 'forward' over an INCLINED PLANE (diagonal inclined away from the horizont) has ALSO a VERTICAL component of displacement to achieve the wanted horizontal displacement. So, if any vertical displacement is unwanted with the movement the angle of inclination the OP has with the horizont is minimized.
The whole concept behind CCW is basically to minimize any unwanted vertical displacement that would arise if one moved 'forward' along a diagonal inclined 'too much' away from the horizont. In that way, they can get the horizontal displacement they want and have more control over the vertical displacement that would arise as a function of the angle of inclination the OP has with the horizont.
The easiest way, at least for me, to appreciate that concept is to think in terms of a RIGHT ANGLE triangle where the hypotenuse is the diagonal line ('plane' or 'slope') one moves 'forward' on. 'Forward' movement along that line has BOTH a horizontal element and a VERTICAL. The higher the angle of inclination the diagonal/hypotenuse has with the horizont, the more vertical displacement you will have via the act of moving 'forward' on it to move a horizontal distance. So, if one wanted to totally eliminate any vertical displacement that would arise in the act of moving 'forward' along a diagonal line, 'slope' or PLANE with angle on inclination away from the horizont, one would have to reduce the angle of inclination to 0 (or 180 deg) in which all movement would be 'purely' horizontal with NO vertical component. Hence the concept of FLAT PLANE and the geometrical relationship of REDUCING the angle of inclination the OP has with the horizont. Done to minimize, mitigate or eliminate unwanted VERTICAL displacement that would arise in moving 'forward' along a diagonal line, slope or plane.
As to the numbers (and color coding), I don't get into it in detail from 'worms eye' perspective. But rather from 'birds eye' perspective where I see they relate to what the surgeon can anticipate; such things as some things getting 'bull's eye' on target with 'ideal' and other things being improved but with some deviations from the norm (or ideal). Hence trade-offs.
