Author Topic: Dr Antipov orthognathic surgery lecture  (Read 6972 times)

april

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Dr Antipov orthognathic surgery lecture
« on: April 27, 2019, 08:08:43 PM »
" Dr. Antipov covers the steps of the procedure in his lecture.  Starting from diagnosis, 2d planning, 3d planning, surgery and recovery. "

https://youtu.be/4vIrUQXvy8M

april

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Re: Dr Antipov orthognathic surgery lecture
« Reply #1 on: April 27, 2019, 08:58:35 PM »
He discusses this girl's case and planning. He seems to follow the AG style of dealing with TMJ cases

I think her tooth show got destroyed. Too much impaction/rotation?




GJ

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Re: Dr Antipov orthognathic surgery lecture
« Reply #2 on: April 27, 2019, 09:52:33 PM »
She looks great.
Millimeters are miles on the face.

PloskoPlus

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Re: Dr Antipov orthognathic surgery lecture
« Reply #3 on: April 27, 2019, 10:04:02 PM »
She looks great.
Yeah, but the tooth show is terrible.

april

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Re: Dr Antipov orthognathic surgery lecture
« Reply #4 on: April 27, 2019, 10:06:31 PM »
There's no doubt she looks better overall.

But I'm just honing in on the tooth show, and I'm wondering if making her OP completely flat like he said he did, has resulted in more lower teeth showing and less of her upper teeth and gums.

kavan

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Re: Dr Antipov orthognathic surgery lecture
« Reply #5 on: April 28, 2019, 07:35:59 AM »
There's no doubt she looks better overall.

But I'm just honing in on the tooth show, and I'm wondering if making her OP completely flat like he said he did, has resulted in more lower teeth showing and less of her upper teeth and gums.

Didn't watch the whole video. Just skipped through it. But even if the lower tooth show was a function of making the OP flat, maximizing the airway and maximizing the advancement which did result in GREAT overall AESTHETIC improvement was ALSO a function of the choice to flatten the OP. So, some lower tooth show (and less upper show) could be considered a MINOR trade-off of the OVERALL improvement.

To the best of my knowledge, the VSP, (since they do PLAN all this stuff out) will show, in the read outs numerical data of the parts that will be 'on target' with desired aesthetics and things that will deviate somewhat. It will have numbers to that regard and color coding of such.

Aside from something going 'wrong' in the surgery or some unexpected unfavorable consequence (eg. a risk associated with surgery), for the most part, they look at the VSP predictions of all the things that will change as a result of their plan where they see the highly favorable ones along with what would be considered 'trade-offs'; deviations from either the norm or deviations from 'highly favorable' (and here, perhaps the tooth show). So, they probably can anticipate them. But they are considered 'trade-offs' because the data tells them they are things that can't be changed to 'highly favorable' without altering the other very SALIENT highly favorable changes.

Honing in on the tooth show:

Actually, the tooth show can be anticipated via the ceph displacement plan. If you look closely at the displacement diagrams, ( photo of ceph tracing called 2D plan) and ZERO IN on the teeth, you can see that the lower tooth does not show through the mouth in the before. Now, if you look at the 'after' plan and zero in on the lower tooth, you can see that it's going to show through the mouth and it shows kind of high. You can do the same with the upper too.

So, that does look to be something that they anticipate as happening. Afterall, even if one can't understand what the numbers and color coding of them mean, how the teeth are going to show through the mouth can be seen via the 2D plan vs the before just by LOOKING at the relative position of the TRACING of them relative to the lips. Hence, it's something that shows as PART of the PLAN and something they accept as a trade-off in exchange for the other over all improvements involved with the entire plan.
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kavan

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Re: Dr Antipov orthognathic surgery lecture
« Reply #6 on: April 28, 2019, 07:36:58 AM »
Yeah, but the tooth show is terrible.

Trade-off for overall improvement.
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GJ

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Re: Dr Antipov orthognathic surgery lecture
« Reply #7 on: April 28, 2019, 10:03:48 AM »
Yeah, but the tooth show is terrible.

Really? It looked excessive before, and now it looks within the realm of normal. I mean maybe another half mm, but to expect that kind of precision is unrealistic.

Unless robots do the surgery. Hopefully they will soon.
Millimeters are miles on the face.

april

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Re: Dr Antipov orthognathic surgery lecture
« Reply #8 on: April 28, 2019, 10:58:12 AM »
Didn't watch the whole video. Just skipped through it. But even if the lower tooth show was a function of making the OP flat, maximizing the airway and maximizing the advancement which did result in GREAT overall AESTHETIC improvement was ALSO a function of the choice to flatten the OP. So, some lower tooth show (and less upper show) could be considered a MINOR trade-off of the OVERALL improvement.

True, it could be a minor issue for her considering everything else. She looks happy. I think I am projecting my own issues and worries about tooth show on to this case; it was the first thing that stood out to me. She might also still be recovering and have muscle weakness etc going on which makes her unable to show more of her upper teeth.

Quote
Actually, the tooth show can be anticipated via the ceph displacement plan. If you look closely at the displacement diagrams, ( photo of ceph tracing called 2D plan) and ZERO IN on the teeth, you can see that the lower tooth does not show through the mouth in the before. Now, if you look at the 'after' plan and zero in on the lower tooth, you can see that it's going to show through the mouth and it shows kind of high. You can do the same with the upper too.

So, that does look to be something that they anticipate as happening. Afterall, even if one can't understand what the numbers and color coding of them mean, how the teeth are going to show through the mouth can be seen via the 2D plan vs the before just by LOOKING at the relative position of the TRACING of them relative to the lips. Hence, it's something that shows as PART of the PLAN and something they accept as a trade-off in exchange for the other over all improvements involved with the entire plan.

I see it, yes, thanks. You often hear upset patients who've been over-impacted by various surgeons, and had no warning it would happen. So it's at least good this was visible on her tracings.

I've sort of learned how to read these 2D plans. I'm over-analyzing, but the number that I am pretty sure represents upper tooth show actually look a bit off when you compare it to the tracing of the teeth under the lip.  Like the number does not correspond with the position of the teeth.

https://i.imgur.com/q0uN90T.jpg

She started with 5mm of upper mx incisor show at rest (as seen by the green 5), and the projected plan says 3 (in black). But it really doesn't look like 3mm of her upper teeth are sitting below her upper lip in the drawing, more like 1mm or 2mm.

april

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Re: Dr Antipov orthognathic surgery lecture
« Reply #9 on: April 28, 2019, 11:21:21 AM »
Really? It looked excessive before, and now it looks within the realm of normal. I mean maybe another half mm, but to expect that kind of precision is unrealistic.

Unless robots do the surgery. Hopefully they will soon.

I always thought you were supposed to show about 1mm of gum at full smile. Even more important if you're young like she is, as it gets worse with age. But I might be overreacting and she may still be recovering her lip mobility after surgery. Or it might just be the agreed trade-off.

Anyway, I didn't mean my observation to take away from the vid itself. There's some good info in there.

GJ

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Re: Dr Antipov orthognathic surgery lecture
« Reply #10 on: April 28, 2019, 01:39:04 PM »
I'd have to see more photos of her, but plenty of people show less than 1mm of gum and look normal/great.
Millimeters are miles on the face.

kavan

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Re: Dr Antipov orthognathic surgery lecture
« Reply #11 on: April 28, 2019, 02:34:22 PM »
True, it could be a minor issue for her considering everything else. She looks happy. I think I am projecting my own issues and worries about tooth show on to this case; it was the first thing that stood out to me. She might also still be recovering and have muscle weakness etc going on which makes her unable to show more of her upper teeth.

I see it, yes, thanks. You often hear upset patients who've been over-impacted by various surgeons, and had no warning it would happen. So it's at least good this was visible on her tracings.

I've sort of learned how to read these 2D plans. I'm over-analyzing, but the number that I am pretty sure represents upper tooth show actually look a bit off when you compare it to the tracing of the teeth under the lip.  Like the number does not correspond with the position of the teeth.

https://i.imgur.com/q0uN90T.jpg


She started with 5mm of upper mx incisor show at rest (as seen by the green 5), and the projected plan says 3 (in black). But it really doesn't look like 3mm of her upper teeth are sitting below her upper lip in the drawing, more like 1mm or 2mm.

Well, she's got a RED 19 for the lower tooth on the before and a green 9(?) on the after and a black -11 for the upper tooth show on the before and green 7 for upper tooth show in the after. So, the colors green and numbers with them seem to indicate within norms.
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kavan

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Re: Dr Antipov orthognathic surgery lecture
« Reply #12 on: April 28, 2019, 02:41:25 PM »
It's all basically a multi-variable/factorial optimization equation where they 'balance' the numbers/factors to fit into a desired visual paradigm. But they can't make each and every one of the displacements associated with the numbers 'perfect'. One would have to be extremely lucky to have NO deviations from the ideal visual paradigm.
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Dogmatix

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Re: Dr Antipov orthognathic surgery lecture
« Reply #13 on: April 28, 2019, 03:25:23 PM »
It's all basically a multi-variable/factorial optimization equation where they 'balance' the numbers/factors to fit into a desired visual paradigm. But they can't make each and every one of the displacements associated with the numbers 'perfect'. One would have to be extremely lucky to have NO deviations from the ideal visual paradigm.

Just wait until someone starts doing multipiece lefort III  :).

kavan

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Re: Dr Antipov orthognathic surgery lecture
« Reply #14 on: April 28, 2019, 03:36:22 PM »
Just wait until someone starts doing multipiece lefort III  :).

Indeed.

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