General Category > Emotional Support
Feeling discouraged about Downgraft
andyyyy37:
I’m getting this down in a few months to increase my incisor display and I wish I never started doing research on the procedure because it’s all pretty discouraging. I see amazing results all over the internet and hear about it even on this forum but when I read studies on it it’s extremely contradictory. Some research papers say that it’s stable with bone graft and rigid fixation but I found this research paper by a graduate student and they basically said that it’s not really possible to Downgraft it. My incisor is RIGHT in line with my lip so I think I really only need like 3-4 mm. I also just read this technique about sliding the maxilla forward and down to maintain bony contact and the stability was really good. Does anyone else know any tactics or ways to Downgraft it stably or does anyone have any anecdotal stories about it? I really don’t care about how it’s done I literally just want incisor show up to my gum line. I think I’m gonna stop doing research on it because it’s just making me feel anxious and depressed.
kavan:
Not sure if anyone here can opine on the research reading you've done as to what within the contents of it is directly applicable to your specific case.
In general fixation is needed after a bone cut used to displace the maxilla whether or not there is a bone graft included. I would not be fretting about how rigid it is. You should leave that up to the surgeon who probably has ample background to make such a determination. The maxilla can be slid forward and down and still make contact with itself if it's present orientation is one where ANS is below the PNS. Why? because forward advancement has 2 vector components; horizontally outwards and vertically downwards. Hence, if the ANS is below the PNS, moving it along it's present line of orientation will involve vector displacements of horizontally outward and vertically downward. If ANS is above the PNS, ANS-PNS; the line of orientation of the maxilla would most likely need to be rotated clockwise for more tooth show and a graft would be needed.
andyyyy37:
Oh thank you so much!! It took me a while but I think I know what you mean by the line of orientation. Is this the only way to increase the length of the lower third? I don’t know much about surgery but I think I read on here that you can rotate your mandible clockwise by lengthening it. Could you lengthen it clockwise without lengthening the maxilla.
--- Quote from: kavan on February 04, 2021, 03:27:36 PM ---Not sure if anyone here can opine on the research reading you've done as to what within the contents of it is directly applicable to your specific case.
In general fixation is needed after a bone cut used to displace the maxilla whether or not there is a bone graft included. I would not be fretting about how rigid it is. You should leave that up to the surgeon who probably has ample background to make such a determination. The maxilla can be slid forward and down and still make contact with itself if it's present orientation is one where ANS is below the PNS. Why? because forward advancement has 2 vector components; horizontally outwards and vertically downwards. Hence, if the ANS is below the PNS, moving it along it's present line of orientation will involve vector displacements of horizontally outward and vertically downward. If ANS is above the PNS, ANS-PNS; the line of orientation of the maxilla would most likely need to be rotated clockwise for more tooth show and a graft would be needed.
--- End quote ---
kavan:
If you don't know much about surgery and don't have under belt elementary concepts in geometry as to relate to things done in maxfax surgery such as rotations and displacements over inclined planes, reading medical papers about max fax won't help. They come with the assumption that the readers already have enough background under belt to understand them.
A clockwise rotation of the maxilla via an anterior downgraft as to give more upper front tooth show, will increase the anterior vertical height of the lower '1/3rd' (base of nose to bottom of chin) of the (frontal) face. It's also possible to do an overall downgraft that spans equally throughout the maxilla to increase overall vertical height of lower 1/3rd.
The maxilla has to be (vertically) 'lengthened' in some way to increase the height of the lower 1/3rd.
All to be done in maxfax resolves to being a function of many relationships to be balanced or optimized; a multi-variable or 'hairy equation' when it comes to all the rotations and displacements to jaws and teeth for any one unique individual.
If you are wanting basic feedback as what could be generally done in your case, you would need to post photos
Sergio-OMS:
--- Quote from: andyyyy37 on February 04, 2021, 11:51:55 AM ---I’m getting this down in a few months to increase my incisor display and I wish I never started doing research on the procedure because it’s all pretty discouraging. I see amazing results all over the internet and hear about it even on this forum but when I read studies on it it’s extremely contradictory. Some research papers say that it’s stable with bone graft and rigid fixation but I found this research paper by a graduate student and they basically said that it’s not really possible to Downgraft it. My incisor is RIGHT in line with my lip so I think I really only need like 3-4 mm. I also just read this technique about sliding the maxilla forward and down to maintain bony contact and the stability was really good. Does anyone else know any tactics or ways to Downgraft it stably or does anyone have any anecdotal stories about it? I really don’t care about how it’s done I literally just want incisor show up to my gum line. I think I’m gonna stop doing research on it because it’s just making me feel anxious and depressed.
--- End quote ---
Good rigid fixation and grafting works and is stable.
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