Why is ccw so much "better"?

[beautyislife]

I have been doing a lot more research and reading so that I don't bog down everyone with dumb questions.
One thing I continue to see is "get ccw" in nearly all cases and I can't seem to find why ccw is recommended so often here.

Could someone expand or point me to resources?

I have a short face and have gotten mixed opinions from surgeons. From my understanding it seems like ccw helps with:
-getting the occlusal plane flatter
-offers more movement for the lower jaw
-offers more support for the upper lip
-fuller midface?

But that's simply based off what I've seen so far / making assumptions and I could be wrong.

[Dogmatix]

CCW is short for counter clockwise. The alternative is an advancement that is not rotational.
A counter clockwise rotation gives the posibility to have the chin advanced without advancing the maxilla as much as would be needed else. So if you have a retruded chin, but your maxilla is not, or only slightly retruded, you can swing the chin forward and have more degree of freedome on what maxilla/mandible advancement ratio you want.
CCW rotation is not always the answear.

[Lefortitude]

Its not. It varies greatly from case to case.  The type of deformity that requires CCW to correct is more common which is why you hear about it alot.  Clockwise rotation is indicated if the face is scrunched up and short vertically, mandible plane is flat or tilting up etc.

[ben from UK]

Its not. It varies greatly from case to case.  The type of deformity that requires CCW to correct is more common which is why you hear about it alot.  Clockwise rotation is indicated if the face is scrunched up and short vertically, mandible plane is flat or tilting up etc.

This. It was popular here for a while because of stupidjaws. It's mainly hype. It can work for some.

[kavan]

This. It was popular here for a while because of stupidjaws. It's mainly hype. It can work for some.

Stupid Jaws popularized the chin wing. Are you sure he popularized CCW?

[PloskoPlus]

Stupid Jaws popularized the chin wing. Are you sure he popularized CCW?

No. He did have CCW with impaction only from a big name Italian surgeon. I didn't see his post-ccw photos, only "post everything". His bite looks no good, so the surgery was not great. I think he got insufficient rotation and the maxilla was overadvanced.

When appropriate, CCW does produce the most natural looking results. One can have a non-gummy class I bite and still look off because of a steep occlusal plane. People can go overboard with genioplasty, implants, chin wings, etc.  But only CCW surgery to normalise the occlusal plane can fix their aesthetic issue.

[Lefortitude]

Heres a great example of a unique case where CCW is NOT indicated and would infact make the deformity worse. Note the entire maxilla is downgrafted with a larger portion in the anterior.

"2 years post op
Maxilla: 8mm downgraft and 10mm advancement measured at upper incisor. Mandible: 8.7mm advancement at pogonion.
Cheekbone grafts." (Gunson, 2019)

[kavan]

No. He did have CCW with impaction only from a big name Italian surgeon. I didn't see his post-ccw photos, only "post everything". His bite looks no good, so the surgery was not great. I think he got insufficient rotation and the maxilla was overadvanced.

When appropriate, CCW does produce the most natural looking results. One can have a non-gummy class I bite and still look off because of a steep occlusal plane. People can go overboard with genioplasty, implants, chin wings, etc.  But only CCW surgery to normalise the occlusal plane can fix their aesthetic issue.

Well, I know he had the bimax after mishaps with getting rhino and chin implant first and the bimax used CCW which I THINK was the anterior impaction.

I'm just saying I don't recall him popularizing CCW. To the best of my recollection the popularization of CCW was from people saying; 'Go to Gunson (or Wolford)'.

CCW usually referred to here (on board in general) is the posterior down graft. Most to all maxfax docs do the anterior impaction CCW for gummy smile. I don't think he got the posterior downgraft CCW. Later he got 2 chin wings to compensate for what the maxfax surgery he go did not do to the back of the jaw line.

[kavan]

Heres a great example of a unique case where CCW is NOT indicated and would infact make the deformity worse. Note the entire maxilla is downgrafted with a larger portion in the anterior.

"2 years post op
Maxilla: 8mm downgraft and 10mm advancement measured at upper incisor. Mandible: 8.7mm advancement at pogonion.
Cheekbone grafts." (Gunson, 2019)

Good example of what CCW is not indicated for; someone with a SHORT CHIN/short lower '1/3rd' as seen in the patient there.

[cjQ]

excuse me, why got his lips THAT full afterwards?

[Post bimax]

Heres a great example of a unique case where CCW is NOT indicated and would infact make the deformity worse. Note the entire maxilla is downgrafted with a larger portion in the anterior.

"2 years post op
Maxilla: 8mm downgraft and 10mm advancement measured at upper incisor. Mandible: 8.7mm advancement at pogonion.
Cheekbone grafts." (Gunson, 2019)

Oh my god what an amazing result. Wow..

[PloskoPlus]

Well, I know he had the bimax after mishaps with getting rhino and chin implant first and the bimax used CCW which I THINK was the anterior impaction.

I'm just saying I don't recall him popularizing CCW. To the best of my recollection the popularization of CCW was from people saying; 'Go to Gunson (or Wolford)'.

CCW usually referred to here (on board in general) is the posterior down graft. Most to all maxfax docs do the anterior impaction CCW for gummy smile. I don't think he got the posterior downgraft CCW. Later he got 2 chin wings to compensate for what the maxfax surgery he go did not do to the back of the jaw line.

You're correct on all counts. Except the fact that most don't really understand what posterior downgraft CCW is and the fact that it's applicable in not only class ii cases. Most think CCW is just anterior impaction. Hell, that's what I thought for a long time as well.

[kavan]

You're correct on all counts. Except the fact that most don't really understand what posterior downgraft CCW is and the fact that it's applicable in not only class ii cases. Most think CCW is just anterior impaction. Hell, that's what I thought for a long time as well.

Ya, most don't understand that most suggestions here to get CCW refer to the posterior downgraft or seek out someone doing hefty downgrafts. One hardly has to say; 'get CCW' when it refers to anterior impaction simply because most maxfax docs will do that if someone has the gummy smile.

[kavan]

excuse me, why got his lips THAT full afterwards?

Because the forward advancement of both jaws gave the lips more support and put them more into the foreground where as prior they didn't have much support and receded into the background.