Weak and recessed lower jaw-health problems.

[Dutcherhatcher]

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.

Right now i think i have around 2mm. So that might put me closer to the ideal of 6mm according to the paper.

A few more questions if it is okay. Does the upper jaw have to be advanced?
As long as there is no advancment almost no changes will occur, allowing for a smooth advancment of the lower jaw?

[Post bimax]

Right now i think i have around 2mm. So that might put me closer to the ideal of 6mm according to the paper.

A few more questions if it is okay. Does the upper jaw have to be advanced?
As long as there is no advancment almost no changes will occur, allowing for a smooth advancment of the lower jaw?

You don't have to advance the upper jaw.  The jaws can be rotated CCW around the incisor tip or the ANS without physically lengthening the bone.  There's a limit to the amount of pogonion differential that can be achieved via rotation alone, and that will largely depend on your starting occlusal plane.  I wouldn't worry about the effects of a maxillary advancement of 3mm or less though if you really need the extra advancement to achieve your goal.

[Dutcherhatcher]

You don't have to advance the upper jaw.  The jaws can be rotated CCW around the incisor tip or the ANS without physically lengthening the bone.  There's a limit to the amount of pogonion differential that can be achieved via rotation alone, and that will largely depend on your starting occlusal plane.  I wouldn't worry about the effects of a maxillary advancement of 3mm or less though if you really need the extra advancement to achieve your goal.

All surgeons agreed i will need 2 mm Upper jaw advancment. Which i guess is good.

Noe just making sure i understand, the bigger the rotation the more my lower jaw will come forward.

You can however add a bsso ontop of the rotation, in which case you will need to renove the wisdom teeth and a make a cut there, or avoid a BSSO and a cut at the wisdom teeth, and simply make the rotation larger.

This might be the reason why Alfaro wanted me to wait and create an overjet, so the rotation will be smaller and the BSSO larger.

[Dutcherhatcher]

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.

I think my orthodontist simply overreached

[Post bimax]

All surgeons agreed i will need 2 mm Upper jaw advancment. Which i guess is good.

Noe just making sure i understand, the bigger the rotation the more my lower jaw will come forward.

You can however add a bsso ontop of the rotation, in which case you will need to renove the wisdom teeth and a make a cut there, or avoid a BSSO and a cut at the wisdom teeth, and simply make the rotation larger.

This might be the reason why Alfaro wanted me to wait and create an overjet, so the rotation will be smaller and the BSSO larger.

Bigger rotation = more advancement (to a point, obviously).

The BSSO osteotomy is naturally more stable than the CCW movement, so that could be a factor.  The size of a movement correlates with instability.

[Dutcherhatcher]

Bigger rotation = more advancement (to a point, obviously).

The BSSO osteotomy is naturally more stable than the CCW movement, so that could be a factor.  The size of a movement correlates with instability.

Ok gotcha. Where does 12mm jaw advancement falls as far advancements go

[Post bimax]

Ok gotcha. Where does 12mm jaw advancement falls as far advancements go

That's larger than the average advancement but well within the realm of manageability.  I wouldn't be concerned about that.  Especially if part of the advancement is from rotation and the other part BSSO mandibular lengthening.  FWIW my own procedure was 10mm straight MMA (both jaws) and it has been perfectly stable.

[Dutcherhatcher]

That's larger than the average advancement but well within the realm of manageability.  I wouldn't be concerned about that.  Especially if part of the advancement is from rotation and the other part BSSO mandibular lengthening.  FWIW my own procedure was 10mm straight MMA (both jaws) and it has been perfectly stable.

It comes only from the CCW.
It was offered by Raffaini. He believes it will be stable

I have 2 options. Either wait a year+ and create an overjet of around 5 mm and complete the rest with CCW
Or do the CCW now without any BSSO at all ( if I understood everything correctly)
I understand this might get pretty technical at this point, but I would still like to hear what you think.
Of course I rather do the surgery now than wait an entire year

[Post bimax]

It comes only from the CCW.
It was offered by Raffaini. He believes it will be stable

I have 2 options. Either wait a year+ and create an overjet of around 5 mm and complete the rest with CCW
Or do the CCW now without any BSSO at all ( if I understood everything correctly)
I understand this might get pretty technical at this point, but I would still like to hear what you think.
Of course I rather do the surgery now than wait an entire year

Sounds to me like you should get the bimax now.

[Dutcherhatcher]

Sounds to me like you should get the bimax now.

I would like to hear your opinion as to why. The questions is how much effect the 5 mm BSSO will have.

Thank you very much for taking the time. And explaining it to me. You helped me so so much

[Post bimax]

I would like to hear your opinion as to why. The questions is how much effect the 5 mm BSSO will have.

Thank you very much for taking the time. And explaining it to me. You helped me so so much

A few reasons:

1) Life is short and being in braces sucks.  Another year+ in braces is not an exciting prospect.

2) You have personally perceived 5-6mm is not enough mandibular advancement for your case.  In my opinion, CCW rotation gives a more natural and aesthetic result than a BSSO that is compensated with a genioplasty.  Your best option to achieve 12mm pogonion advancement would therefore be to rotate the jaws.

3) Extreme proclination of the upper incisors can have deleterious effects on the gums.  It sounds like a bimax now will mitigate the amount of incisor proclination relative to trying to create a huge overjet and then meeting the bite with a BSSO.

[Dutcherhatcher]

A few reasons:

1) Life is short and being in braces sucks.  Another year+ in braces is not an exciting prospect.

2) You have personally perceived 5-6mm is not enough mandibular advancement for your case.  In my opinion, CCW rotation gives a more natural and aesthetic result than a BSSO that is compensated with a genioplasty.  Your best option to achieve 12mm pogonion advancement would therefore be to rotate the jaws.

3) Extreme proclination of the upper incisors can have deleterious effects on the gums.  It sounds like a bimax now will mitigate the amount of incisor proclination relative to trying to create a huge overjet and then meeting the bite with a BSSO.

The BSSO will be part of the CCW so i guess the second point is moot? But the rest are dead on and excellent.

I guess the downsides will be less stable result and maybe unwanted effects on the face due to bigger rotation.

Both options are good i guesa and offered by both Raffaini and Alfaro. But i am much much more inclined towards the CCW only like you said. I just hope i wont have a relapse horroe story

[kavan]

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?

I'm sorry BUT I have no idea where your basis of 'understanding' is coming from with regard to your bringing in a genio of 10mm advancement and now my brain is being scrambled.

Let's just FORGET the option of a single jaw advancement since that was RULED OUT.

As to understanding relationships having to do with rotations of the maxilla, it relates to the construct of a TRIANGLE. You would need to ALREADY HAVE grounding in elementary geometry as a BASIS to understand how rotating the maxillary mandibular complex RELATES to the construct of a TRIANGLE and what would happen with rotation of it around a selected FIXED point. Confusion follows when people lack the that type of basis.

Enclosed is a diagram of a triangle that has been rotated x degrees CCW around a FIXED point. You would need to 'relate' to what is happening there to relate it BACK to what's happening with a rotation at the maxilla around a FIXED point.

VISIT the educational section for material.  Link to diagrams on rotation: http://jawsurgeryforums.com/index.php/topic,7883.msg72313.html#msg72313

[kavan]

It comes only from the CCW.
It was offered by Raffaini. He believes it will be stable

I have 2 options. Either wait a year+ and create an overjet of around 5 mm and complete the rest with CCW
Or do the CCW now without any BSSO at all ( if I understood everything correctly)
I understand this might get pretty technical at this point, but I would still like to hear what you think.
Of course I rather do the surgery now than wait an entire year

NO. You have ONE option and that is to revisit concepts in elementary geometry because if you don't understand the very fundamental relationship of rotating a TRIANGLE and how the parts of it displace as a function of the direction of the rotation and a fixed rotation point you will have NO BASIS to relate anything they do in maxfax. Nor will I address questions that reflect a a lack of that type of basis.  Your questions reflect you lack this fundamental basis.

'Post bimax's' answers reflect he has good grounding in basic geometry which is what you need for things to be more self explanatory.

[Dutcherhatcher]

I'm sorry BUT I have no idea where your basis of 'understanding' is coming from with regard to your bringing in a genio of 10mm advancement and now my brain is being scrambled.

Let's just FORGET the option of a single jaw advancement since that was RULED OUT.

As to understanding relationships having to do with rotations of the maxilla, it relates to the construct of a TRIANGLE. You would need to ALREADY HAVE grounding in elementary geometry as a BASIS to understand how rotating the maxillary mandibular complex RELATES to the construct of a TRIANGLE and what would happen with rotation of it around a selected FIXED point. Confusion follows when people lack the that type of basis.

Enclosed is a diagram of a triangle that has been rotated x degrees CCW around a FIXED point. You would need to 'relate' to what is happening there to relate it BACK to what's happening with a rotation at the maxilla around a FIXED point.

VISIT the educational section for material.  Link to diagrams on rotation: http://jawsurgeryforums.com/index.php/topic,7883.msg72313.html#msg72313

Hey Kevan. The 1.5 cm advancement comes from the fact that my Pog is 1.5cm behind the lip line. Which means i need to advance it by that much. If we only get 6 mm at the jaw, the rest needs to come from somewhere else.

Regarding the rotation, let me dwell on it a bit more to make sure I have full understanding.

I also found this info guide https://pocketdentistry.com/rotation-of-the-occlusal-plane/