Could jaw surgery help?

[ben from UK]

There doesn't seem to be a (very high) golonial angle from profile. From the front, there seems to be a high golonial angle. If you decide to do a vertical drop down, you may get a trade off: a better front but a 90 degree jawangle from profile, which isn't ideal, unless you lengthen your chin as well. But with PS, the least you change to get maximum effect, the better.

Also, consider the fact that the front is always more important than profile (profile isn't thát important). So a 90 degree jawangle or close to 90 degree won't be a disaster. It will still be aestethic. Maybe with a chin procedure as well, you'll get the ideal profile too. I think your profile isn't bad right now. It still looks kind of aestethic, despite the chin deficiency.

A final note is that your left jawangle is steeper than your right jawangle, which is causing asymmetry. You'll probably need more vertical dropdown st the left side than at the right side.

If you take a wrap around implant, you might think you need alot, but I think you just need a couple of millimeters here and there at the jawangles. Bad surgeons aren't able to calculate the right dimensions. Good surgeons are able to calculate the right dimensions. One or two millimeters too much or too little, and you may get a botched job, a bloated face or almost no change. The dimensions are very very important. If you take a chinwing, you need to go to the best as well. Thing is: do you have enough bone under the nerve or is it too small to make a cut?

[Breakingbad]

There doesn't seem to be a (very high) golonial angle from profile. From the front, there seems to be a high golonial angle. If you decide to do a vertical drop down, you may get a trade off: a better front but a 90 degree jawangle from profile, which isn't ideal, unless you lengthen your chin as well.

Do you know what an ideal range would be for the gonial angle? I think mine is about 140 degrees right now but I'm not sure if I've measured correctly.

Also, you suggested a vertical drop down. However, I also noticed that my jaw angles are of a width apart that makes them not visible from the front. What I mean by that is that if I placed my index fingers right on my jaw angles and looked straight ahead, you would not be able to see them because the line of sight to them would be obscured by soft tissue which in a way 'hangs' past the jaw angles. They seem to be set about 1 cm narrower on each side than the widest point of soft tissue at the same horizontal line as the angles. Sorry if that's confusing - it's a bit hard to explain. Anyway, do you think that for that reason it would be useful to widen the angles as well. Do you know if adding height vertically at the angles gives a different effect on soft tissue vs widening?

If you take a chinwing, you need to go to the best as well. Thing is: do you have enough bone under the nerve or is it too small to make a cut?

Is there something about my jaw structure that makes you think there may not be enough room? I'm attaching a ceph xray in the next post - I'm not sure if that can give any indication.

[Breakingbad]

Hello all,

I just had an orthodontic consultation to get an opinion on how my bite looked like. I had a ceph x-ray taken there which I've attached below. They positioned my head for the x-ray using some tabs on the machine that go in the ears and on the top of the nose. I guess that means that the ceph should be properly oriented but I'm not sure.

The doctor told me that I had "Super Class I" occlusion. From what I understand this means that the lower first molar is actually further forward than it should be compared to the upper first molar. Despite this, I still have a bit of overbite and overjet.

I have 3 mm of overjet.

Based on the ceph, does anyone know if I look like a jaw surgery candidate and what kind of movements might be appropriate? Also, does it seem from the ceph like my aesthetic issues could be related to my jaw positioning?

[ArtVandelay]

What a terrible xray machine, that ceph is low quality since you can't make out your individual teeth. Though it does appear you have an accentuated curve of spee (draw a line passing through the top of your teeth). At least US surgeons like to treat that with a segmental lefort. Meaning if you do go the bimax route you might be looking at the more hard core variant.

That being said, your airway appears fine. I agree with the earlier posters, try to get by with a SG or maybe chin wing.

[Breakingbad]

What a terrible xray machine, that ceph is low quality since you can't make out your individual teeth. Though it does appear you have an accentuated curve of spee (draw a line passing through the top of your teeth). At least US surgeons like to treat that with a segmental lefort. Meaning if you do go the bimax route you might be looking at the more hard core variant.

That being said, your airway appears fine. I agree with the earlier posters, try to get by with a SG or maybe chin wing.

I tried to look up "curve of spee" and I think I understand what it is. I'm wondering if it could just be appearing that way on the ceph because of my wisdom tooth on the side that the xray was taken from being wierdly positioned? My wisdom tooth on that side has been growing with the crown angled outward for a few years now and I guess that could make it appear higher up than the other teeth. It's just a thought - please correct me if that's totally wrong.

That's good to hear that my airway looks fine - makes me wonder why I mouth breathe so much.

[kavan]

I don't see anything in your ceph that would justify the bimax surgery.

What you have is mostly chin RECESSION. An upward sliding genio would bring your chin closer to the red vertical, shorten the chin that looks long from the front, make the jaw angles look RELATIVELY lower (they look high because the chin from front casts LONG even though it's recessed) and decrease the overly obtuse lower lip to chin angle.

Although there are different solutions for addressing BOTH the chin and doing such things as lowering the jaw angles and flaring them out, it's important to see what the obvious and straight forward problem mainly is which is chin recession.

[ArtVandelay]

That's good to hear that my airway looks fine - makes me wonder why I mouth breathe so much.

You mouth breath because you have to strain your lips to close your mouth

[kavan]

You mouth breath because you have to strain your lips to close your mouth

lip strain from a recessive chin.

[Breakingbad]

You mouth breath because you have to strain your lips to close your mouth

lip strain from a recessive chin.

I think that's totally true. I've been noticing when my mouth is closed, there are little dimples in my chin from my mentalis muscle having to flex for my mouth to stay closed. They disappear when my mouth is open.

[notrain]

The doctor told me that I had "Super Class I" occlusion.

Are you sure you did not misunderstand him? Because what you have is a supra class 1 occlusion on a class 2 skeleton.
This means that your lower jaw incisors are a bit "above" the occlusal plane of the lower jaw side teeth.

Anyway, that is not really important. Your treatment plan for jaw surgery would likely entail extraction of 2 lower jaw premolars, retraction of the front teeth and levelling of the lower jaw (make that supra occlusion go away by intruding the incisors while retracting them) and lower jaw surgery afterwards.