Orthodontics or jaw surgery?

[triple_banker]

Hi, If any of you knowledgeable forum members have the time and interest to come with suggestions I would greatly appreciate any help.

I have a slight open bite. A reputable orthodontist wants to recontour incisors in mandible in order to create space to be able to retract them so the crowding and bite can be closed. This will be accompanied with some slight molar intrusion and if not possible then recontour molars (invisalign will be used).

I also have a retruded chin and weak jaw in general so my goal is to after bite being fixed also look at chin/jaw implants to make the chin wider and more protruding and possibly lower the gonial angle. However, I wonder if I would perhaps be "camouflaging" the problem by this approach. By looking at my pictures, even thogh my lips line up, my lower incisors are protruding and thus creating a deep labiomental fold (which a SG/implant would obviously worsen) - so perhaps a bsso would be a better option? I don't think I have any airway or TMJ or any other functional problems so it's only for aesthetic purpose.

I have attached a ceph, picture of my bite and side profile. Let me know if some information is missing.

https://imgur.com/a/4TVOOr6

Thanks in advance!

[triple_banker]

Sorry for bumping this but I will see my orthodontist soon after the holidays so I will have to make a decision by then.

Anyone have any advice to offer whether braces would be the right treatment for my open bite or if jaw surgery would be a better option?
Would attaching a picture from the front be helpful?

[notrain]

Intruding the molars would result in the mandible coming forward and up (slight counter clockwise movement) which would improve the things you mentioned a bit.

If you were to go for jaw surgery, you'd be most likely looking at a bimax to fix the hyperdivergent growth pattern of your jaws.

[kavan]

Orthodontics EITHER way whether it's ortho only or ortho to prepare for maxfax surgery. However, you would have to make a choice given the direction of the ortho can differ depending on whether it's ortho alone or ortho to prepare for (maxfax/bimax) surgery.

Obviously IF your GOAL is to camouflage via implants, that would resolve to ortho only.
Thing is, ortho only, ESPECIALLY if it involved removing tooth or tooth structure to get the 'bite right', it could come with the negative trade-off of getting something about your face 'wrong' (like a more BACKWARDS push) in which case you would need to MASK something like that with implants OR it would just be a more CHALLENGING thing to correct with bimax surgery.

Your soft tissue profile line up reveals mostly the LOOK of chin recession and under chin convexity. Some masseter muscle strain looks to be there. However, both COULD be from the anterior open bite where the BACK teeth meeting first could put strain on masseter muscle and also the back teeth meeting first can kind of force a lower jaw position to go somewhat down and backwards where you can't really swing it up and out because back teeth don't allow that due to their position. Also, your under lip to chin fold angle is within the norm and does not look like it would 'suffer' much at all if made less obtuse. That is to say, I don't think a SG if included with a bimax surgery would result in an overly acute under lip to chin fold angle.

The common bimax surgical approach for anterior open bite is to remove somewhat of a wedge from the posterior maxilla so that the lower jaw can move up and out without INTERFERENCE from back teeth preventing that. It's called; 'posterior impaction'. So, ya, a BSSO could/would be in picture. But NOT BSSO 'only' deal given it's contingent on also operating on the maxilla.

My advice resolves to consulting with maxfax about SURGERY and do so BEFORE you decide on ortho only.

ETA: Salient thing here is that ortho for ortho ALONE differs from ortho in prep for a surgery. Hence, consulting with a maxfax will yield more information before you lock yourself into an ortho only choice.

[triple_banker]

Thank you both Notrain and Kavan for your elaborate answer.

Thing is, ortho only, ESPECIALLY if it involved removing tooth or tooth structure to get the 'bite right', it could come with the negative trade-off of getting something about your face 'wrong' (like a more BACKWARDS push) in which case you would need to MASK something like that with implants OR it would just be a more CHALLENGING thing to correct with bimax surgery.

With BACKWARDS push – I assume you refer to the mandible being pushed back and not the palate or arch?

Your soft tissue profile line up reveals mostly the LOOK of chin recession and under chin convexity. Some masseter muscle strain looks to be there.

Under chin convexity – do you mean the look of a low hanging hyoid bone?
Regarding the masseter bulge it’s simply because i clench my teeth, and not really a strain

[kavan]

Thank you both Notrain and Kavan for your elaborate answer.

With BACKWARDS push – I assume you refer to the mandible being pushed back and not the palate or arch?

If he's doing for both jaws than could be both. I just to the mandible, then the mandible.

Under chin convexity – do you mean the look of a low hanging hyoid bone?
Regarding the masseter bulge it’s simply because i clench my teeth, and not really a strain

The part I put a blue convex curve under. Clenching is 'easier', even if one does not know they are doing so, when the back teeth touch before the other ones do.

ETA: Can't opine on a hyoid bone I don't see in the ceph. But CAN tell you the contour I pointed out (blue curve) under chin is a common one with situation where back teeth touch first and preclude the other teeth from meeting (anterior open bite).