Education > Educational Material
Esthetic-Treatment-Planning-for-Orthognathic-Surgery
kavan:
Esthetic-Treatment-Planning-for-Orthognathic-Surgery Arnett/Gunson
https://static1.squarespace.com/static/540a2db7e4b0d0f5498571f1/t/590cffd55016e187a5feda0f/1494024150982/9-2010-JCO-1-Interview-Esthetic-Treatment-Planning-for-Orthognathic-Surgery+%281%29.pdf-
Post bimax:
--- Quote ---The mandibular incisors are ideally placed from 61-68° to the
mandibular occlusal plane and the maxillary incisors at 54-60° to the maxillary occlusal plane.
Attempting orthodontic overjet correction and then
resorting to surgery without decompensating the
incisors produces extremely poor facial results
--- End quote ---
--- Quote --- treating a skeletal mandibular retrusion
with maxillary first premolar extractions, headgear, and Class II elastics will cause the maxillary
incisors to upright and the mandibular incisors to
flare. If surgery is then performed with these dental compensations present, the nasal base may be
too prominent and the chin too recessive.
--- End quote ---
I think this is part of my issue. My upper incisors appear upright and the mandibular incisors are flared out to meet them. My nasal base protrudes and my lower jaw still looks somewhat recessed despite 10mm BSSO and small genio.
I didn't notice any change in my bite during pre-op orthodontics and at the time I didn't know the right questions to ask about what was actually being done. All I knew was that my teeth were 'getting ready' for surgery. There was no change in the size of my open bite or noticeable decompensation, at least from my uninformed perspective.
april:
Clockwise rotation probably made all that worse for you too.
--- Quote --- The mandibular incisors are ideally placed from 61-68° to the
mandibular occlusal plane and the maxillary incisors at 54-60° to the maxillary occlusal plane.
Attempting orthodontic overjet correction and then
resorting to surgery without decompensating the
incisors produces extremely poor facial results
--- End quote ---
--- Quote ---The best recommendation for buccal segment
control is to keep the teeth and roots in the alveo-
lar bone without dental expansion or labial crown
torque. Segmental maxillary surgery can manage
archform and arch-width issues without the risk of
dental relapse or periodontal decline associated
with orthodontic expansion of the maxillary pos-
terior segments. Excessive orthodontic buccal
crown torque, in particular, can lead to complica-
tions in orthognathic surgery
--- End quote ---
I haven't had surgery, but it's like a checklist of everything that's been done wrong with my pre-surgical ortho tbh. Gunson pointed all of this out too. I had a bunch of compensations (and still do have some). Ortho was 'correcting' tooth show and cants etc dentally. My overjet reduced from 9mm to 4mm at one stage. My mandibular incisor angles are still 75°, so I guess that means they are not in the bone correctly? I've also been dentally expanded, with the hanging cusps. It's a big ol' mess. I'm not sure how some orthodontists can get it so wrong
Lefortitude:
--- Quote from: april on November 08, 2019, 07:19:31 AM ---I'm not sure how some orthodontists can get it so wrong
--- End quote ---
I've seen more incompetent orthodontists than I can count. To the point I've been thinking about going to school in SoCal so i can have my surgical prep ortho there.
Post bimax:
--- Quote from: Lefortitude on November 08, 2019, 07:55:14 AM ---I've seen more incompetent orthodontists than I can count. To the point I've been thinking about going to school in SoCal so i can have my surgical prep ortho there.
--- End quote ---
I don't understand how this is possible. You have to go through SO MUCH SCHOOL to become an orthodontist. How can you learn that much and still miss information that is so essential to aesthetics.
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