Thoughts on this BiMax?

[valhalar]

Are you sure about this part? Moving the lower teeth back, particularly the molars, is next to impossible. The alveolar bone in the lower jaw is less malleable and the lower teeth are constantly pushed forward by the upper teeth through mesial drift.

I may be wrong but I thought lower jaw surgery alone was possible in class I cases where they can buck out the upper teeth and pull back the lowers? Perhaps this is only really possible in a Class II because the overbite needs to be bad enough already. I understand they usually recommend  a double jaw surgery if the bite is Class I.

[Abdulrahman]

I may be wrong but I thought lower jaw surgery alone was possible in class I cases where they can buck out the upper teeth and pull back the lowers? Perhaps this is only really possible in a Class II because the overbite needs to be bad enough already. I understand they usually recommend  a double jaw surgery if the bite is Class I.

Paul Coceancig did mention a procedure where the lower teeth are pulled backward to make space for the incisors to be torqued back and improve the mentolabial angle.

Another orthodontist also mentioned a similar procedure using a skeletal anchorage system such as mini screws. I think it's called distal movement. Maybe that is the same process you were referring to and maybe it does work. If anchorage points are placed in the skeletal part of the mandible and the teeth moved very slowly maybe it can work.

[PloskoPlus]

Extract 2 lower teeth, close the gaps, advance the mandible. Alternatively, if you have a steep occlusal plane, CCW rotation of the maxilla will create a bigger overjet. The maxilla can also be advanced to allow the mandible to be advanced.

[korvitz]

Slightly old thread but although I've never consulted him I'll post what I know about him that nobody else here knows:

My orthodontist used to work with him closely & even co-developed IMDO with Coceancig (surprise surprise Coceancig wasn't alone despite what it seems, orthos of course usually aren't capable of doing surgery but he had some experience in maxfax so thats that) but stopped working with him due to some kind of disagreement on the surgical results Coceancig produced, eventually the relationship got bad enough that there were accusations of defamation & legal threats. Not sure what happened since I didn't ask for an indepth explanation but the but I was told that Coceancig "travels overseas on conference tours but only 1 in 10 of his results are good" or when I expressed fear about overcorrection by advancing the jaws too much "the only surgeon I know that overcorrects is Coceancig in the hopes that the patients will relapse, I told him no don't do this but the patients didn't end up relapsing & that's why I stopped working with him". Now he doesn't want to work with Coceancig anymore so much that I was almost refused treatment by my ortho since he thought I wanted surgery with Coceancig!
I wont name my ortho directly (I don't want to land him in legal hot water or have you guys annoy him with emails about IMDO) but if you look hard enough on the internet of orthos that have collaborated with Coceancig (HINT: PUBLISHED PAPERS) you will eventually find his name.


BTW for anyone in Australia considering IMDO there are actually surgeons other than Coceancig in NSW who perform it, it's just that Coceancig has an huge presence on the internet compared to these other surgeons & he seems to travel to alot of conferences to promote himself (He even managed to land a seat next to A&G in BSCOSO 2015 conference) that you don't hear about other IMDO surgeons (dunno how good these other surgeons are though). Someone on this forum who consulted Coceancig told me via DM "He does come off as car salesman" but nonethless hes does seem to be still well above average compared to average the Australian surgeon skillwise despite what my ortho warned.

Does anybody know if he does CCW with posterior downgrafting?

[korvitz]

Well he isn't kidding about being serious with the term "super-bimax"

https://www.ijoms.com/article/S0901-5027(19)30614-9/abstract

[ben from UK]

Can't believe people are tricked by pictures where they only show profile view. I don't know how many times it has to be repeated that the FRONT is the most important. Same thing with nosejobs and implants. Sometimes they show great profile results and then the front happens to be s**t. Unless your only problem is profile, I would always ask front views as well.

[april]

or when I expressed fear about overcorrection by advancing the jaws too much "the only surgeon I know that overcorrects is Coceancig in the hopes that the patients will relapse, I told him no don't do this but the patients didn't end up relapsing & that's why I stopped working with him".

Well not sure what your ortho is talking about specifically, but as far as regular JS goes some surgeons have told me it's common to slightly overcorrect because a bit of relapse is normal/anticipated.

About the over-advanced look - from watching some of his vsp planning on youtube, I think he advances the maxilla until the upper central incisors line up with the most forward bit of the nose bone (not sure what that points called). I'm not sure how that compares to other surgeons such as Gunson, Alfaro etc.

[GJ]

He used to post here (I think he was "OrthodonticExpert"). Total asshole who didn't disclose he was a surgeon, told people they needed surgery, then made threats when I banned him/called him out on it.

[Lazlo]

Yeah but what I don't understand is whether IMDO can even be done in adults? If not, then f**k this huckster!!!!

[april]

Korvitz can your ortho confirm/deny?

I think it might, cause in one of his vids he suggests it to a really recessed 30 yr old to break up the distance (like 10mm IMDO, 10mm BSSO).

I read regular DO takes longer in adults vs kids cause the bone turnover is slower.

[korvitz]

Korvitz can your ortho confirm/deny?

I think it might, cause in one of his vids he suggests it to a really recessed 30 yr old to break up the distance (like 10mm IMDO, 10mm BSSO).

I read regular DO takes longer in adults vs kids cause the bone turnover is slower.

I'll ask him when I meet him again but that's next year in Febuary so wait till then. There might be an limitation to the maximum distraction length for IMDO due to the physical design of the IMDO distractor devices but I dont know if this is indeed the case for IMDO? I will post an answer in this thread when I get the chance

But if you watch https://youtu.be/zoQi3ao1Osw?t=538  at 8:58 you will see an 17mm mandibular distraction in an adult case & I've seen a young adult girl who I was told had 14mm so large D.O. advancements in adults is possible (with an different distractor device in this case) so why not with IMDO??

Réflechir, rechercher, innover en chirurgie maxillo-faciale. Entretien avec Albino Triaca https://sci-hub.tw/10.1051/orthodfr/2016021

"Chez le jeune, la distraction osseuse sagittale est plutôt bien supportée. Ce n’est pas forcément le cas chez l’adulte mais elle présente de nombreux avantages : avancements importants, reconstruction osseuse, absence de risque d’altération condylienne (Figs. 16 à 18). Lorsqu’un patient a présenté des phénomènes de résorptions condyliennes, mais que les condyles sont corticalisés, il est nettement préférable, selon moi, d’envisager une distraction plutôt qu’une ostéotomie sagittale.."

Kids in general heal better than adults & it even goes for genioplasties
https://www.angle.org/doi/pdf/10.2319/030414-152.1
"Better bone apposition and remodeling is observed in younger patient compared with adults."