Recessed Jaws, What do you think?

[StudyHacks]

Hi

Can you please tell me what I should do to fix my recessed jaws and get enough projection? I'm thinking about getting bimax.

What should I do to get attractive forward-projected mandible and maxilla?

Thank you!

Below are my CEPH results/pictures

https://imgur.com/a/Df5ivXB

[Lefortitude]

Probably bimax.

Its hard for me to say exactly what kind of bimax.  from observation it looks like your occlusional plane is not steep, but it also looks like you have forward heard posture in your ceph.  So you may have a steep occulsional plane, which means you can get the POG point (chin) to an aesthetic neutral position through some combo of rotation and advancement.

[Dogmatix]

Hi

Can you please tell me what I should do to fix my recessed jaws and get enough projection? I'm thinking about getting bimax.

What should I do to get attractive forward-projected mandible and maxilla?

Thank you!

Below are my CEPH results/pictures

https://imgur.com/a/Df5ivXB

Not sure how to respond, you state pretty clear what you want.

fix my recessed jaws and get enough projection

Well. If you consider your jaws recessed, then there's only one remedy, to advance them. The term for a surgery to advance both jaws is bimax, and the "s" after "jaw" indicates that you want both jaws advanced. So if you're looking for the term that describes what you're asking for, then you're right. It's "Bimax", and possibly "genioplasty" to adjust the chin individually.

What should I do to get attractive forward-projected mandible and maxilla?

Again, forward projection translates to advancement. If you want more forward projection, that means to advance the jaws. If I see correctly, you seem to have a class I bite, so it's basically to maintain the oclussion and displace them more forward to your liking, maybe some ccw rotation for projection of the lower face. Have you had any extractions or previous orthodontics?

[StudyHacks]

Not sure how to respond, you state pretty clear what you want.

Well. If you consider your jaws recessed, then there's only one remedy, to advance them. The term for a surgery to advance both jaws is bimax, and the "s" after "jaw" indicates that you want both jaws advanced. So if you're looking for the term that describes what you're asking for, then you're right. It's "Bimax", and possibly "genioplasty" to adjust the chin individually.

Again, forward projection translates to advancement. If you want more forward projection, that means to advance the jaws. If I see correctly, you seem to have a class I bite, so it's basically to maintain the oclussion and displace them more forward to your liking, maybe some ccw rotation for projection of the lower face. Have you had any extractions or previous orthodontics?

Yes, one extraction of the molar on the left side when I was 7-8 years of age.

[Dogmatix]

Yes, one extraction of the molar on the left side when I was 7-8 years of age.

But this is the implant that shows on the x-ray as well? With extractions I mean for orthodontic purpose, where they extract a tooth and close the gap with braces. But it doesn't look like you've had such treatment.

So exactly what do you ask or want to know? Do you want opinions if you "need" surgery? If so, the answear is probably no. You have a good bite, don't look abnormal or deformed and don't mention anything about breathing issues.

So it seems like a pure aesthetic concern. There is some recession, so sure you can have it advanced. It's a risky procedure for everyone. The difference if it's a pure aesthetic procedure is that you can only lose from a medical aspect. But I'm not the one to tell anyone what to do and if this is a real issue for you, it can be as good reason as anything else. I think people with only aesthetic concerns should at least look into implants before getting into jaw surgery.

[Post bimax]

Additionally, it's very possible to end up looking worse after surgery.  Honestly you should stop posting on this forum and go consult with a surgeon.

[Dogmatix]

https://imgur.com/1xzaWfM

You seem to have similar profile as mine, aside from me having bite issues and low FMA as well. If you want to go for a full bimax, I would say probably slight advancement of the maxilla and ccw to swing the mandible forward and also increase the angle of the upper incisors slightly, and additional genioplasty if needed. There's a good chance you don't need preparation in braces.

[kavan]

Not sure how to respond, you state pretty clear what you want.

Well. If you consider your jaws recessed, then there's only one remedy, to advance them. The term for a surgery to advance both jaws is bimax, and the "s" after "jaw" indicates that you want both jaws advanced. So if you're looking for the term that describes what you're asking for, then you're right. It's "Bimax", and possibly "genioplasty" to adjust the chin individually.

Again, forward projection translates to advancement. If you want more forward projection, that means to advance the jaws. If I see correctly, you seem to have a class I bite, so it's basically to maintain the oclussion and displace them more forward to your liking, maybe some ccw rotation for projection of the lower face. Have you had any extractions or previous orthodontics?

Good question.

A quote from the thread: http://jawsurgeryforums.com/index.php/topic,7831.msg71158.html#msg71158

I got biscupids removed, i watched an animation and it showed that the anterior nasal spine doesnt change, if i were to get bimax to move my jaws the 1 cm that i lost, wouldnt my nose be getting moved 1 cm too far? How do we compensate for this? Can you shave the ANS 1cm? Can you move only the teeth?

So, on one thread he tells people he got his bicuspids (pre-molars) removed from his upper jaw  But his answer to your question was that he had ONE extraction to a molar.

[kavan]

Something to maintain the mandibular plane angle which would be a type of genio that moves down and out along the line of the MP. An 'oblique' genio where a bone 'buttress' is placed between the cut sections. A type of genio that moves the red point closer to the green point. No bimax. End of story.

[ODog]

https://imgur.com/1xzaWfM

You seem to have similar profile as mine, aside from me having bite issues and low FMA as well. If you want to go for a full bimax, I would say probably slight advancement of the maxilla and ccw to swing the mandible forward and also increase the angle of the upper incisors slightly, and additional genioplasty if needed. There's a good chance you don't need preparation in braces.

How do you think CCW-r would be done without knowing what his gum show is like? On that note, aren’t there only a handful of surgeons in the US who do CCW-r via downgrafting if tooth/ gum show is already good?

I’m just wondering if it’s obvious a surgeon would do CCW-r with a flat occlusal plane. I’m not even sure the top surgeons will do this if the OP is flat. Am I wrong ?

[Post bimax]

How do you think CCW-r would be done without knowing what his gum show is like? On that note, aren’t there only a handful of surgeons in the US who do CCW-r via downgrafting if tooth/ gum show is already good?

I’m just wondering if it’s obvious a surgeon would do CCW-r with a flat occlusal plane. I’m not even sure the top surgeons will do this if the OP is flat. Am I wrong ?

It’s not clear whether his OP is flat due to his head posture

[kavan]

https://imgur.com/1xzaWfM

You seem to have similar profile as mine, aside from me having bite issues and low FMA as well. If you want to go for a full bimax, I would say probably slight advancement of the maxilla and ccw to swing the mandible forward and also increase the angle of the upper incisors slightly, and additional genioplasty if needed. There's a good chance you don't need preparation in braces.

  You rotated his photo 7 degrees (downward) in CW to suggest CCW to him?

[Dogmatix]

How do you think CCW-r would be done without knowing what his gum show is like? On that note, aren’t there only a handful of surgeons in the US who do CCW-r via downgrafting if tooth/ gum show is already good?

I’m just wondering if it’s obvious a surgeon would do CCW-r with a flat occlusal plane. I’m not even sure the top surgeons will do this if the OP is flat. Am I wrong ?

Not sure if I understand the questions. There are many variables in a displacement diagram. Ccw rotation only tells the direction of the rotation, gum show is addressed either by anterior impaction or downgrafting depending on what to achieve. Rotation by posterior down grating have less impact on tooth show and with a combination of anterior and posterior adjustments you can control the tooth show.

I don't know what fraction of surgeons that do posterior down grafting. I thought 3 part lefort was uncommon as well, but after looking into a Facebook group it seems like every other patient is having it. I can say like this, going in for a bimax surgery with only aesthetic in mind, I would pick surgeon very carefully. It's high stakes and the expectations are high.

No, nothing is obvious, and different surgeons may suggest different procedures. The bite is solid as it is, which would resolve to Kavans "Dont touch it". There are always tradeoffs any way you handle it.

The chin is more retruded than the maxilla, and the upper incisors could benefit from being tipped out a bit and it would also support the upper lip a bit to meet the subnasal TVL. A ccw rotation would address this. I'm not sure how to measure the OP, but after rotating the ceph in FH orientation, it's not horizontal. I think this is the most common way to rotate the skull when planning, some surgeons even rotate it a bit further. The displacement diagrams I've seen normally seem to allow ccw rotation until the OP I horizontal in FH orientation, which would allow ccw rotation in this case.

I've been cautious in my own case about rotation as I have an excessive curve of speed and to me it seems hard to not get the OP over rotated with ccw rotation. But as I have multiple opinions supporting it, it seems legit. And also it's always a trade. Do you want the chin projected in a way ccw rotation allow, or less rotation of the OP? You can't have both. The thread is very vague with no real question, so we're basically guessing. But it seems clear that advancement is the priority to the aesthetic concerns.

[Dogmatix]

You rotated his photo 7 degrees (downward) in CW to suggest CCW to him?

Yes, just as all surgeons I've consulted and cephx have done to my ceph before lining out the TVL and suggesting movements. I believe rotating the ceph to FH orientation is standard procedure.

[kavan]

Yes, just as all surgeons I've consulted and cephx have done to my ceph before lining out the TVL and suggesting movements. I believe rotating the ceph to FH orientation is standard procedure.

It might be a standard procedure. BUT it's one that depends on finding the EXACT 'Po' point and I'm not too sure you found it. I'm not too sure because it's perfectly normal for someone to have their S-N line 7 degrees away from a pure horizont and his was so.

You rotated his ceph about 7 degrees down. His S-N line was 7 degrees away from a pure horizont which is NORMAL. Your rotation made his S-N line a pure horizont. The cephalostat in the ceph also got rotated 7 deg away from the true vertical. It's perfectly normal for someone to have what is referred to as a 'horizontal' plane eg. S-N or Frankfort horizontal, NOT to have a pure horizont.

Also, he ALREADY HAD a pure horizont that could be drawn from the 'Or' point to a point that could have been the Po point (blue dot) for the Frankfurt horizont. You used a point BELOW that, which happened to be about 7 degrees away from his Or point, found his 'Or' point wasn't horizontal with it and then rotated his ceph 7 degrees  downward in CW.
So, what makes you so sure you found the correct Po point associated with the Frankfurt horizont? It's a hard point to find on a ceph. Although I'm not so sure mine is the exact Po point either, I know it's in that vicinity but is hard to find. In fact it's difficult enough to find in a ceph that Steiner came up with his method of using the S-N line INSTEAD which is easy to spot. So I wouldn't be rotating anyone's ceph unless I was damned well sure I found the EXACT Po point.