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.

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.

[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]

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.

Good rigid fixation and grafting works and is stable.

[andyyyy37]

Oh okay thank you!! Is this something that you do regularly? I don’t see a lot of examples for it online. What about it makes it unstable without rigid fixation or a graft? Do you think that after I get it done I should be extra careful to not grind and eat only soft foods for a few months? And after the graft heals would you say that I’m “out of the woods” and it’s just as strong as my other bones ?

Good rigid fixation and grafting works and is stable.

[andyyyy37]

is there a way to downgraft the maxilla in the anterior for more incisor display without stretching the musculature. Would a clockwise rotation of the mandible help as to not have to stretch my facial muscles so much? or what would be the appropriate way to accomplish that? thanks for your input and help by the way! (:

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

[andyyyy37]

my incisors seem to be RIGHT in line with my lip and they can be seen when I'm laughing and talking. Ortho and surgeon says it's not really that big of a discrepancy. In virtual consult one proposed a 5mm downgraft but they didn't take any measurements. I feel like this would give me 5mm of tooth show at rest and isn't that too much for a guy? A surgeon who consulted me in person recommended me like 2-3 mm downgraft but i feel like that's not enough/worth it to do that for 2-3mm so do you think i could just lengthen my teeth with veneers for 2-3mm? Also is your face supposed to get slightly shorter when your teeth are in occlusion? I think i have like 3-4 mm of freeway space is that normal?

[kavan]

is there a way to downgraft the maxilla in the anterior for more incisor display without stretching the musculature. Would a clockwise rotation of the mandible help as to not have to stretch my facial muscles so much? or what would be the appropriate way to accomplish that? thanks for your input and help by the way! (:

I'm sorry, but your questions reveal you lack the very basic foundation to build on to address questions as you ask them. This is not a matter of lack of information. It's a matter of not being able to use the information you already have or have been given. It's like building a house on sand or over a sink hole.  You are too confused to un-confuse and any info you get won't go anywhere other than into a CONFUSION GENERATOR. I don't think there is any clarity anyone here can give you that you won't use as a spring board to confuse yourself more or generate more anxiety for yourself.

There's really no way to answer questions that arise from a person who wants to lengthen his face BUT doesn't want to lengthen their face. Dude, if you lack the foundation to know the difference between WANTING to lengthen your face and NOT wanting to lengthen it, then you are too confused to be un-confused by any answer you get from any of your questions.
 
Some examples:

Here you state you WANT to LENGTHEN your face.

I see it’s more common to want to shorten a long face but I wanna do the opposite. I’m getting a Downgraft soon due to lack of tooth show. Does this make the face longer? The surgeon says he will do about 6-7 mm down but that sounds like such a small amount to me. He is also going to do a genioplasty, can a genioplasty lengthen your face and by how much? Also what can I do to lengthen my face? Is lengthening possible through jaw surgery?

Here you DON'T want to lengthen your face.

this is what i'm wondering as well. I just want to increase incisor display without making my face longer and without stretching my muscles.

Another example:

Sergio gives you a very STRAIGHT FORWARD answer which should mitigate confusion about rigid fixation and grafting being stable. That info went right into a sink hole. All you did with it was to use as a spring board to ask more spin off questions having little or nothing to do with his clarification that rigid fixation and grafting were stable.

Next comes your question to me AFTER I CLARIFY a prior question. I'm not answering it. Why? Because your questions don't arise from any clarity on your part about anything and there is no demonstration any  clarity given to you based on addressing a prior questions has resulted in clarifying things for you. The simple 'answer' to someone asking questions about surgery who is wanting a longer face but also NOT wanting a longer face is NOT to have surgery.


I will give you 3 TIDBITS of info than can be used for you to answer your OWN questions. But will not be addressing any more 'spin off' mechanizations you generate subsequent to being given this info. If it isn't ample for you to un-confuse YOURSELF, I doubt anyone here can un-confuse you FOR you.

1: Muscles move with bone.
2: An alternative to rigid fixation is having your jaws WIRED SHUT for 6 weeks and being on a liquid/soft NO CHEWING diet (consuming food through a straw).
3: The alternative to no fixation at all and/or no graft for more tooth show for a person WANTING a longer face who also DOES NOT WANT a longer face is veneers to make the teeth longer.