Bimax Setback plus CCW and Gum/Tooth Show

[Post bimax]

Hey guys,

I'm just trying to think about the aesthetic effects of what I anticipate Gunson would offer me as a revision if he offered me anything.  Since my problem is convex/prominent upper lip due to large advancement, I'd expect a bimax setback to help the lip and nose angles, plus CCW-r to improve the neck/jaw angle and maintain projection.  If he offered a bimax setback without CCW, I would just reject it so I'm going to operate under the assumption of CCW.

I'm curious about what you guys would expect in terms of changes to teeth/gum show.  My tooth show was essentially unchanged (it's good) despite 10mm advancement and likely slight anterior downgraft.  Would a setback likely reduce tooth show? What effect would CCW (achieved via posterior downgraft- I don't think I'd do a lip lift and anterior impaction) have on this?

Feel free to leave thoughts on other possible changes to nose, lips etc.

Thanks guys

[PloskoPlus]

Can have differential downgraft - a little at the front, more at the back. The net effect is still CCW. Remember, the osteotomy line can take a whole mm away all by itself.

[kavan]

Set back would tent towards puting your teeth more in the background. They might show similar as they do now relative to how downward they are (tooth show). But you might lose the 'pop' to the smile one has when the teeth are closer to the lips and not receeding into the background.

[GJ]

If the teeth are proclined (CCW of the teeth) beyond normal (i.e. straight relative to the bone) you should prepare mentally for gum recession, too.

[april]

I would guess you need your ANS area set/tilted back more than the actual incisor edge. So maybe they can keep the incisor edge in the current position in your face as is for tooth show, and still angle the maxilla back with CCW.

My tooth show was essentially unchanged (it's good) despite 10mm advancement and likely slight anterior downgraft. 

So there wasn't an increase? Don't they say that for every 3mm forward you gain 1mm or something like that?

[Post bimax]

Thanks for the responses. Good to keep the gum recession in mind.

I would guess you need your ANS area set/tilted back more than the actual incisor edge. So maybe they can keep the incisor edge in the current position in your face as is for tooth show, and still angle the maxilla back with CCW.

So there wasn't an increase? Don't they say that for every 3mm forward you gain 1mm or something like that?

I agree but I’m not sure whether there’s enough degrees of CCW available to really fix it without a setback. It could just have to do with the structure of my ANS and soft tissues. I’m still cautiously hopeful ANS re-contouring could solve it, but my issue isn’t quite the same as the typical candidate for that.

As to your question I actually thought the same and asked Posnick about it pre-op because I thought maybe I should get impaction. He basically said not to worry about it and he was actually right about that. I gained maybe 1mm of gum show at full smile at the most.