Weak and recessed lower jaw-health problems.

[Dutcherhatcher]

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.

I saw 2 other orthos that refused to treat me because I already began treatment.

The end result of the ortho will be 6 mm max. It is simply not enough. Not to mention that we talking here about a year more at least. I am much much more inclined towards CCW now and already mailed about it with the new info from today.

[InvisalignOnly]

Can't they extract a couple of primolars from your lower jaw? It seems an obvious thing to do to be able to create distance between your upper and lower teeth. I can't understand how can they not do more than 6mm - if they really want to - but maybe I'm missing something here. Of course if you prefer bimax surgery anyway, that's another story.

[InvisalignOnly]

Just checked your previous posts and see you're using Invisalign or similar - can they not do IPR / file down some teeth (instead of extractions) to create more space? What I don't get is, if you have a class 2 issue like myself, so your lower jaw is too far back compared to your upper, how can they not create more distance even though two of your lower teeth are missing already. The whole 'point' of class 2 is that there's distance between the two sets of teeth / jaws, right? Or maybe your case is very different from mine.

[Dutcherhatcher]

Although 6mm could be sufficient for improvement, maybe easier to just  REJOICE! a decision dilemma was made easier by ruling out a prior option due to ortho conflicts.

 It's only bad news if you really had your heart set on single jaw only which you didn't. Now that the OPTION of single jaw looks to be ruled out due to ortho not getting up to the goal, that makes the UNCERTAINTY and INDECISION (single vs. double) LESS.

Keep in mind that a maxfax needs to work with an ortho toward goal of type of plan the maxfax wants. So best to narrow down WHICH of the other bimax ones you want.

Ok. So yoy are right. My family said the same thing. Sometimes the hand of fate chooses for you. Although i was already set on the BSSO i guess life shepherds me towards a way.

Right now my PG is around 1.7 cm  behind the upper lip. If i get a 6mm BSSO we are talking about a 1 cm genio.. feels to me like its a "cover up" and that is a best case scenario.

Now, the question is how much can the upper jaw movement be minimzed, and what other effects will rotataion have compared to only lower jaw. Since so far i feel no one really told me or downsized those effects on the upper jaw area.

In case i cannot find a good plan from the doctors i talked to so far, is there anyone else in Europe you think i should look into?

[Dutcherhatcher]

Just checked your previous posts and see you're using Invisalign or similar - can they not do IPR / file down some teeth (instead of extractions) to create more space? What I don't get is, if you have a class 2 issue like myself, so your lower jaw is too far back compared to your upper, how can they not create more distance even though two of your lower teeth are missing already. The whole 'point' of class 2 is that there's distance between the two sets of teeth / jaws, right? Or maybe your case is very different from mine.

Exactly, but i have no idea as to why or how we cannot do more than 6. I really dont want to extract more teeth, escpeilly when i already removed 2 molars. What is the end result? Good jaws but no teeth? I mean that was not the promised i got at the start of my treatment. If that is the case, i just rather do the CCW. Which avoides both the long treatment time and the need to remove more teeth.

Edit: not to blame you of course, but why should i tell my ortho those options? Thats her job!

In my case my body compensated for the week skeletal jaws by jutting the teeth, creating a perfect occlusion. In a case like mine you either create an overjet or do a CCW

[kavan]

Ok. So yoy are right. My family said the same thing. Sometimes the hand of fate chooses for you. Although i was already set on the BSSO i guess life shepherds me towards a way.

Right now my PG is around 1.7 cm  behind the upper lip. If i get a 6mm BSSO we are talking about a 1 cm genio.. feels to me like its a "cover up" and that is a best case scenario.

Now, the question is how much can the upper jaw movement be minimzed, and what other effects will rotataion have compared to only lower jaw. Since so far i feel no one really told me or downsized those effects on the upper jaw area.

In case i cannot find a good plan from the doctors i talked to so far, is there anyone else in Europe you think i should look into?

If you got a 6mm BSSO, it could be followed by a 3-4mm genio. NOT a 1cm genio.  No suggestion for other doctors since that just brings more confusion. Upper jaw displacement=0 for single jaw surgery. Would need more advancement with Italian doctor to give large BSSO and maybe less with. Both CCW.  Read articles in educational section.

[Dutcherhatcher]

If you got a 6mm BSSO, it could be followed by a 3-4mm genio. NOT a 1cm genio.  No suggestion for other doctors since that just brings more confusion. Upper jaw displacement=0 for single jaw surgery. Would need more advancement with Italian doctor to give large BSSO and maybe less with. Both CCW.  Read articles in educational section.

I had no idea BSSO limits the genio.
I meant the upper jaw displacment effect followed by CCW on the face and teeth.
Ok, i will read and make sure to update following my.talk with them.

[InvisalignOnly]

why should i tell my ortho those options? Thats her job!

You're absolutely right, but after some bad experiences, I honestly got to the point that I'll only ever get orthodontic treatment again from an orthodontist that actually listens to me and / or to a surgeon selected by me. Having had braces before and consulted several orthodontists in the past as well as recently, I got the impression many of them don't see the big picture (in terms of what's best for the patient's face, aesthetically speaking), and simply ignore the fact that wearing braces for years has serious consequences for the patient's quality of life. They do not even try to find ways to shorten the treatment, make it less visible or more convenient or faster etc. This does not apply to all of them but the majority I spoke to seemed to be like this. One says, 'xyz cannot be done' (full confidence - it's a 'fact'), then next day you go to another one and they say 'xyz should be done' (again, full confidence, it's a fact etc.). The same applies to surgeons to an extent but I find it's even much more so with orthodontists.

[Dutcherhatcher]

You're absolutely right, but after some bad experiences, I honestly got to the point that I'll only ever get orthodontic treatment again from an orthodontist that actually listens to me and / or to a surgeon selected by me. Having had braces before and consulted several orthodontists in the past as well as recently, I got the impression many of them don't see the big picture (in terms of what's best for the patient's face, aesthetically speaking), and simply ignore the fact that wearing braces for years has serious consequences for the patient's quality of life. They do not even try to find ways to shorten the treatment, make it less visible or more convenient or faster etc. This does not apply to all of them but the majority I spoke to seemed to be like this. One says, 'xyz cannot be done' (full confidence - it's a 'fact'), then next day you go to another one and they say 'xyz should be done' (again, full confidence, it's a fact etc.). The same applies to surgeons to an extent but I find it's even much more so with orthodontists.

The good thing about my current ortho is that she said she is ready to be 100% commited tk any surgeon plan i bring her. Including working with surgeons from Europe. But i am just sad the plan failed

[InvisalignOnly]

I see, so what exactly happened? Did you have a plan / clincheck that showed more than 6mm overjet as the end result, and your teeth stopped tracking, or? I thought one of the advantages of Invisalign was that you can see in the beginning what result are you going to get at the end (unless teeth does not move as planned). I'm asking because I'm also planning to use Invisalign to set my teeth up for surgery.

[kavan]

I had no idea BSSO limits the genio.
I meant the upper jaw displacment effect followed by CCW on the face and teeth.
Ok, i will read and make sure to update following my.talk with them.

I was meaning that a single jaw 6mm BSSO + a 4mm genio, TOGETHER  are a total 10mm advance at pogonian.  I had no idea where you got the movement of 1CM (10mm) for the chin.

[Dutcherhatcher]

I was meaning that a single jaw 6mm BSSO + a 4mm genio, TOGETHER  are a total 10mm advance at pogonian.  I had no idea where you got the movement of 1CM (10mm) for the chin.

I meant that the 1 cm genio is what i will still need in order to bring the pog to a good position. But as far as i understand if i get the 6 mm bsso i will be limited to a 4mm genio.

Also the CCW i need is posterior downgrafting right? There is no effect other than the mandible coming forward due to the rotation effect.

Anterior impaction is for people with long faces and steep occlsuopm that need to shorten the face right?

[Post bimax]

I meant that the 1 cm genio is what i will still need in order to bring the pog to a good position. But as far as i understand if i get the 6 mm bsso i will be limited to a 4mm genio.

Also the CCW i need is posterior downgrafting right? There is no effect other than the mandible coming forward due to the rotation effect.

Anterior impaction is for people with long faces and steep occlsuopm that need to shorten the face right?

Anterior impaction is to correct a gummy smile.  If your gum and tooth show is fine, it's a bad option.  The only other way to achieve CCW is posterior downgraft, which does swing the mandible forward.  Posterior downgraft does not preclude BSSO advancement nor a genio.

[Dutcherhatcher]

Anterior impaction is to correct a gummy smile.  If your gum and tooth show is fine, it's a bad option.  The only other way to achieve CCW is posterior downgraft, which does swing the mandible forward.  Posterior downgraft does not preclude BSSO advancement nor a genio.

My gum show is perfect. That means that if i go with posterior downgraft, should i expect any other effect beside the lower jaw coming forward? As far as teeth goes,nose etc

[Post bimax]

My gum show is perfect. That means that if i go with posterior downgraft, should i expect any other effect beside the lower jaw coming forward? As far as teeth goes,nose etc

Posterior downgraft will tend to increase your posterior gum show.  I'm not sure exactly what the effect would be in your case, but it could be worth the tradeoff (if it occurs). 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909438/

This is what I'm referring to

Nose changes are minimized by CCW because the maxillary advancement is minimized, but changes are still possible.  CCW alone with no advancement should have virtually no impact on the nose.