Weak and recessed lower jaw-health problems.

[april]

It sounds like A was touching on smth slightly similar about the overjet, no? Altho he was working to a 8-10 advancement, not 12mm.

(bolding my own)

The first to only move the lower if the braces will allow it. Which he said is ideal and what i should strive for.
The second is to do a CCW if there wont be enough space. He made sure to comment that the CCW will only be used if there is not enough space for my lower jaw to come forward and ideally i would avoid from the upper jaw. Since less is better.

You don't want to be edge-to-edge. At a very minimum you need to end up with a 1-2mm overjet afterwards (although 3mm is the ideal post surg overjet according to Arnett/Gunson).

So you will need close to 9-10mm overjet, in order to get a 8mm bsso and be left with a 1-2mm overjet post surg. What is your overjet now?

Its true they can't just procline teeth in/out as much as they want. There are limits. I think the point is to have the teeth in a healthy position in the bone, so the results are stable long term. I think they do some sort of angle measurements of the incisors to figure some of this out.

[april]

Just saw in your cephx reports your overjet is around 4mm now.

Sorry if you already mentioned it, but what's happening with that extraction space according to these docs? Are they retracting the front teeth back, or protracting the back teeth forward?

[kavan]

 retract the lower teeth backwards. He's got the space from the missing molar to do that.

[april]

I just saw in the first post he said his local guy only wants to move his jaw forward 6mm. Then in other posts says 8mm forward. Which one, dutcherhatcher?

For 6mm advancement you will need 7-8mm overjet, which would be more attainable than a 9-10mm overjet needed for an 8mm advancement.

Dutcher, can you clarify if all these advancement numbers from these surgeons are including or not including genio?

He currently thinks our best course of action is to decompress my bite, create an overjet and move only the lower jaw 6 mm forward and add genio if needed

[Dutcherhatcher]

I'm saying a BSSO of 8 (contingent on X+Y=8; an over jet of 8mm) with a genio of 4, still gives an overall advancement of 12 and resolves to SINGLE jaw surgery. Your chin is also somewhat recessive and chin advancement also helps with apnea. Also, your maxilla is NOT recessive. Your SNA angle is somewhat higher than normal. Hence, I'm NOT finding much to justify R's surgery proposal to do the lefort as to advance SO HE can make the BSSO as 12.

Ok. gotcha.

It sounds like A was touching on smth slightly similar about the overjet, no? Altho he was working to a 8-10 advancement, not 12mm.

(bolding my own)
You don't want to be edge-to-edge. At a very minimum you need to end up with a 1-2mm overjet afterwards (although 3mm is the ideal post surg overjet according to Arnett/Gunson).

So you will need close to 9-10mm overjet, in order to get a 8mm bsso and be left with a 1-2mm overjet post surg. What is your overjet now?

Its true they can't just procline teeth in/out as much as they want. There are limits. I think the point is to have the teeth in a healthy position in the bone, so the results are stable long term. I think they do some sort of angle measurements of the incisors to figure some of this out.

We are talking about going from normal perfect class 1 occlusion to an overjet that needs 8mm correction to go back to being perfect. Perfect is a 3mm overjet as you said.

I just saw in the first post he said his local guy only wants to move his jaw forward 6mm. Then in other posts says 8mm forward. Which one, dutcherhatcher?

For 6mm advancement you will need 7-8mm overjet, which would be more attainable than a 9-10mm overjet needed for an 8mm advancement.

Dutcher, can you clarify if all these advancement numbers from these surgeons are including or not including genio?

We are suppose to advance it at 8, sorry it was a typo. And Kavan already answered to your other question.

And they dont include genio

[kavan]

Lower incisors are proclined forward (protruded). They are using the empty space from the missing tooth to push them backwards. That would create most of the over jet. How much exactly, I don't know. If the empty tooth space were totally or mostly closed up, that part of the over jet would be close to the mm measure of the empty tooth space.

Elsewhere, April mentioned the size of a pre-molar was about 7mm-8mm wide. A molar (as you have lost) would tend to be wider.

Ref=http://jawsurgeryforums.com/index.php/topic,7831.msg71158.html#msg71158 (reply #6)

I don't know all the minutia--not within 2mm--of such things as your molar width SPACE or whether or not it gets closed completely by pushing back the lower front teeth. But IF let's say, they got a push back (part of overjet) of 6, the PUSH OUT to the front UPPER teeth would need to be 3-4 for total overjet of 9 to 10. That could allow the 8mm BSSO with a 1 to 2mm 'clearance' overjet. Your front uppers look to be straight down or maybe a tad retroclined (Class 2 is common for retroclined). So, I don't know why some (R and some other recent doctor) are telling you close to 'impossible' to get the OJ needed for an 8mm BSSO. I mean I've seen cases of class2 in brace prep for surgery where they create a significant overjet by bucking out front uppers and pushing backwards the front lowers (after a space is made by extraction to lower jaw).

I don't think anyone can predict 'exactly' within 1 or 2mm if they can get 8-9mm for the overjet.  It just looks pretty LIKELY to me, you would get close enough to the 8mm BSSO from the single jaw proposal. Would still be improvement if 7 or 6 and then just ADD the genio given you chin is recessed anyway.

The only way to know for sure how much 'exactly' your overjet is going to be is to be in the braces. If it's the amount needed for it to be for your local guy to do the single 8mm BSSO (have him do the chin also), then go with him (providing he also does the chin). If it's less than that and/or he won't do the chin, then choose one of the other docs.

[april]

I do get a bit too stuck in the minutia of things! But this sounds like good advice! You won't know until they attempt it.

The only way to know for sure how much 'exactly' your overjet is going to be is to be in the braces. If it's the amount needed for it to be for your local guy to do the single 8mm BSSO (have him do the chin also), then go with him (providing he also does the chin). If it's less than that and/or he won't do the chin, then choose one of the other docs.

It's just weird R didn't think you could even get more than 5mm overjet safely. 
All I can think is that he wasn't thinking of retracting the front bottom teeth back all the way to close that extraction space IDK.

[kavan]

I do get a bit too stuck in the minutia of things! But this sounds like good advice! You won't know until they attempt it.

It's just weird R didn't think you could even get more than 5mm overjet safely. 
All I can think is that he wasn't thinking of retracting the front bottom teeth back all the way to close that extraction space IDK.

Hi April,

I must have missed this post. Anyway, minutia is OK and true what you mentioned about approx 2mm clearance space (residual over jet) being needed. It's just that I go with the main concept. So, easy enough to factor in the 2mm with it.

I too found it very weird--let's say 'off'or even 'suspect'-- R said the OJ needed (for his 8mm BSSO) could not be had safely. Not to mention the selection of a 12mm BSSO, which to me harked of a number where one would HAVE TO DO a Lefort1 to get the BSSO for 12mm BSSO. Add suggestion of septo/rhino and breathing scare.

[Dutcherhatcher]

Hi April,

I must have missed this post. Anyway, minutia is OK and true what you mentioned about approx 2mm clearance space (residual over jet) being needed. It's just that I go with the main concept. So, easy enough to factor in the 2mm with it.

I too found it very weird--let's say 'off'or even 'suspect'-- said the OJ needed (for his 8mm BSSO) could not be had safely. Not to mention the selection of a 12mm BSSO, which to me harked of a number where one would HAVE TO DO a Lefort1 to get the BSSO for 12mm BSSO. Add suggestion of septo/rhino and breathing scare.

Hey Kevan; the last couple of days I thought about the subject non stop and here are my thoughts.

Currently I suffer from health problems and aesthetic problems. Of course I want to max both solutions.

On the one hand, we have my local doctor, who is considered a no name compared to some of the guys here. I already managed to confirm my self he does not do CCW and is more newer in the scene.

On the other hand, we have someone who trained with Gunson and Wolford, is one of the best in the world and who have written huge books about aesthetic. If he say something should be done, should I not listen to him? Why should I trust my local guy who is only a decade or 2 in the business? I mean trained under the guy who invented jaw surgery! I just find it hard to believe he would try to oversell something or be a sellman. I fear that but the time I finish my local surgery I will regret not going with him.

What if the overjet soultion is the more simple one, but would not max the best outcome since the upperjaw is not touched? What if prof saw that solution first and is why he does not want to touch my upper jaw?  When i asked him he directly on advancing the upper jaw, he had one clear answer NO

I am confused since I feel my upper jaw can be better, and got even more confused when I read threads here about Ante face vs monkey lips. Some say it’s bad, some say it’s good. I mean my SNA is slightly under average, my mind is telling me slightly above average is the best measurement, but then how do you avoid the monkey mouth?

I feel like I have a 50/50 chance here to make the right call and I only have one time, and if i will make the wrong call I will live with it for the rest of my life. Currently I have no idea who to choose. The world famous surgeon who might try to oversell me or the local surgeon with 5% of the expirence

[april]

I'm not Kavan, but I just want to say that I don't think you need to worry about getting a 'monkey mouth' from ANY of these surgeons  Some will just do lower jaw surgery, so there's no risk at all there because your upper jaw won't be touched.

I also think the 'ante face' and monkey mouth/chimp lip are two different things.

[kavan]

Hey Kevan; the last couple of days I thought about the subject non stop and here are my thoughts.

Currently I suffer from health problems and aesthetic problems. Of course I want to max both solutions.

On the one hand, we have my local doctor, who is considered a no name compared to some of the guys here. I already managed to confirm my self he does not do CCW and is more newer in the scene.

On the other hand, we have someone like who trained with Gunson and Wolford, is one of the best in the world and who have written huge books about aesthetic. If he say something should be done, should I not listen to him? Why should I trust my local guy who is only a decade or 2 in the business? I mean trained under the guy who invented jaw surgery! I just find it hard to believe he would try to oversell something or be a sellman. I fear that but the time I finish my local surgery I will regret not going with him.

What if the overjet soultion is the more simple one, but would not max the best outcome since the upperjaw is not touched? What if prof saw that solution first and is why he does not want to touch my upper jaw?  When i asked him he directly on advancing the upper jaw, he had one clear answer NO

I am confused since I feel my upper jaw can be better, and got even more confused when I read threads here about Ante face vs monkey lips. Some say it’s bad, some say it’s good. I mean my SNA is slightly under average, my mind is telling me slightly above average is the best measurement, but then how do you avoid the monkey mouth?

I feel like I have a 50/50 chance here to make the right call and I only have one time, and if i will make the wrong call I will live with it for the rest of my life. Currently I have no idea who to choose. The world famous surgeon who might try to oversell me or the local surgeon with 5% of the expirence

I gave my thoughts and reasoning on the matter via direct observation of your situation and putting into perspective what the other surgeons told you before confused you or otherwise, in your mind, invalidated the other perspectives that basically confirmed the suggestion of single jaw surgery that your home town doctor had.

His name gets bandied about here and 'recycled' by others who hear it bandied about. Your interpretation of 'being highly esteemed by the board' or 'best in the world' or that 'most people' think his results are best in Europe is your own. It's not mine. You are entitled to have that interpretation/opinion or act on the opinions of others. But I'm not obliged to remove it from you.

I did my best to add some clarity. You are confused because HE confused you. Not my task at this point to un-confuse due to that. Nor one to choose your doctor FOR you. You went on enough consults to make a choice.

CCW is moot point IF someone is candidate for single (lower) jaw surgery only.

Your SNA is within the norm.

Your very questions, statements, interpretations about him, discounting the others, belie you want what is selling you on. So, I think you're in the capacity to un-confuse yourself as to whom to choose.

[Dutcherhatcher]

I gave my thoughts and reasoning on the matter via direct observation of your situation and putting into perspective what the other surgeons told you before confused you or otherwise, in your mind, invalidated the other perspectives that basically confirmed the suggestion of single jaw surgery that your home town doctor had.

His name gets bandied about here and 'recycled' by others who hear it bandied about. Your interpretation of 'being highly esteemed by the board' or 'best in the world' or that 'most people' think his results are best in Europe is your own. It's not mine. You are entitled to have that interpretation/opinion or act on the opinions of others. But I'm not obliged to remove it from you.

I did my best to add some clarity. You are confused because HE confused you. Not my task at this point to un-confuse due to that. Nor one to choose your doctor FOR you. You went on enough consults to make a choice.

CCW is moot point IF someone is candidate for single (lower) jaw surgery only.

Your SNA is within the norm.

Your very questions, statements, interpretations about him, discounting the others, belie you want what is selling you on. So, I think you're in the capacity to un-confuse yourself as to whom to choose.

Would it be ok, if i were to ask you who you think is "the best" in Europe, or is it 100% moot at this point as you are certain i should go with the local guy? I still think the 3d planning software is a huge advantage which my local guy does not offer. I Still think about going with A since he offers both options and i think that may be the best. But i am still not sure.

Also April, thank you very much

[kavan]

Would it be ok, if i were to ask you who you think is "the best" in Europe, or is it 100% moot at this point as you are certain i should go with the local guy? I still think the 3d planning software is a huge advantage which my local guy does not offer. I Still think about going with A since he offers both options and i think that may be the best. But i am still not sure.

Also April, thank you very much

I have no answer to 'who is best in Europe?'. I'm not going to choose your doctor FOR you other than to say 'A' with both options where he's BRACED to do the CCW if it looks like single jaw can't get approx 6-8mm seems to be a reasonable option.

[Dutcherhatcher]

Hey guys. I have a bad update.

Just left my ortho, according to her, due to new estimates we are loking at least another year in braces (good case scenario) and maximum teeth movment of 5-6 mm instead of 8.
I have no idea what to do now. 6 mm is no where near enough for me, and another year and a year and a half of braces is an insane amount. What should i do??

[kavan]

All does depend on end result of the ortho. I said that in a prior post. Get second opinion. Besides, since you were wanting veering toward double jaw, you have that option and have consulted with about already.