Author Topic: Please analyse my pics and xrays in detail (recessed jaws)  (Read 1588 times)

RW14252

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Please analyse my pics and xrays in detail (recessed jaws)
« on: August 25, 2021, 11:23:44 AM »
I'd be very grateful for thoughts and analysis on the aesthetics of my jaws and how to improve it via procedures. During consultation Dr A (Barcelona), he suggested bimax with 15mm overall projection (4mm Lefort, 7mm CCW and 4 mm genioplasty) and would be interested to see if people think this is too conservative.

For context, I have a functionally fine bite as all my back teeth come together correctly (albeit with bimaxillary protrusion) and so I think I have a recessed mandible and maxilla with steep occlusal plane (please contradict me if I'm wrong on this). Hence surgery would be out of pocket and would mainly be for aesthetics. Will be consulting Dr A (California/Moscow) and potentially Dr R (Italy) next. Thanks in advance.
« Last Edit: September 05, 2021, 10:04:40 AM by RW14252 »

GJ

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #1 on: August 25, 2021, 12:37:20 PM »
I think if you go with bimax what makes the most sense to me is move both jaws forward a bit and then CCW rotate them. Their suggestion of 4mm forward seems about right, although the maxilla doesn't look clear to me on that scan. Maybe you could get away with a little less. Their idea of 7mm CCW seems about right, too, just eyeballing these things. Genio of 4 also makes sense. A molar is about 10mm in an adult male, so that can give you a frame of reference.

« Last Edit: August 25, 2021, 08:47:20 PM by GJ »
Millimeters are miles on the face.

RW14252

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #2 on: August 29, 2021, 02:18:44 PM »
GJ - thanks very much for confirming

Would you recommend any particular procedure (e.g. braces, palatal expansion, Anterior Segmental Osteotomy) for my front incisors being slanted forward (and hence my lips protruding) at all? I think this called bimaxillary protrusion/proclination but could be wrong. I’m slightly worried that it will worsen ¨chimp lip¨ if I do the bimax. Included a few more pictures if it helps all.

Apologies if this is off topic from original post, just thought I would be amiss to not ask you this, as you have great replies about bites and teeth that Ive read on other posts.
« Last Edit: September 05, 2021, 10:04:53 AM by RW14252 »

GJ

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #3 on: August 29, 2021, 03:00:38 PM »
It should be easy to retract the incisors with braces.

Do you have a tongue thrust causing the proclination?
Millimeters are miles on the face.

RW14252

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #4 on: August 29, 2021, 03:18:07 PM »
Oh brilliant braces aren't too bad, thanks

Yep it's 100% tongue thrusting, have been doing as long as I can remember really - how come?

GJ

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #5 on: August 29, 2021, 03:31:06 PM »
Yep it's 100% tongue thrusting, have been doing as long as I can remember really - how come?

You'll want to correct that before braces or surgery. Maybe go on YT and watch some videos on how to correct it.
Millimeters are miles on the face.

RW14252

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #6 on: August 29, 2021, 04:01:57 PM »
That's v useful to know thanks

Last question I absolutely promise - my nose is pretty curved/prominent as I'm sure you'd noticed. Would the proposed 4mm advancement cause it to widen? I kind of like the idea of the end being upturned on the side profile with bimax but thought of widening could put me off altogether.

GJ

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #7 on: August 29, 2021, 05:11:45 PM »
Yeah any movement of the upper will cause about 1 to 2mm widening.
An alar stitch can help keep it in check.
Millimeters are miles on the face.

kavan

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #8 on: August 29, 2021, 05:55:48 PM »
Dr.  A's displacement numbers make sense to me. The 15 mm would relate to total advancement of the chin point (pogonian). The 7mm CCW would refer to a posterior downgraft which, I guess for every mm of the down graft the BSSO to advance lower jaw will be able to advance the chin point by an equal amount. So, 7mm advance chin point with BSSO, 4mm extra it can be advanced via the maxilla advancement and 4 mm more via a genio which add up to 15mm overall to the chin point.

Your occusal plane does not appear too 'steep'. But it is of benefit to become less steep with the CCW-r because the Mandibular plane also becomes less steep with that. But the main benefit of the CCW-r Dr. A is proposing is that it will allow for a significant advancement to the lower jaw and the chin along with that. So, even IF you have bimax protrusion (which does not look like an exaggerated case of bimax protrusion to me) the proposed advancement is going to MASK it. The upshot of that is that you don't have to fret/worry about deciding to get an anterior segmental osteotomy.

You have an overly projected nose base. It is due to a prominent ANS (anterior nasal spine). Dr A has a technique where he can cut a 'V' shaped notch under the prominent ANS so the nose base does not get overly projected with the maxillary advancement. The ANS can also be trimmed down a little if the 'V' notching is not used. The bottom line of that is you don't have to worry about the chimp lip with the maxillary advancement because chimp lip is basically an aesthetic problem when the base of the nose is advanced, particularly when the ANS is ALREADY prominent. The upshot of that is the ANS can be altered in a way that can DE-PROJECT the nose base and avoid the chimp lip and allow the maxillary advancement to AVOID aesthetic problems that could happen when advancing out a nose base that is already projected out too far via the ANS such that it looks better on the face with relation to the bimax surgery.

As to braces (to move the teeth in which ever direction) or any other pre-surgical devices, that is a matter of the ORTHODONTIST working in tandum with Dr. A.

NOTES:

1:  A detailed ceph analysis is done via high tech artificial intelligence programs that do them automatically by being able to find all the points to the bone structure and from there chart out the angles and planes. From there, Dr A incorporates the data to come up with a displacement proposal that corrects what ever deviations you have from optimized aesthetics. People on here don't do that for you. You don't include an actual displacement proposal from Dr. A; something where the a contour diagram of the profile changes proposed can be looked at that also comes with a chart of all the directional displacement vector breakdowns.

DISCLOSURE: The above statements relate to what Dr. A told you and my familiarity of his technique to avoid the chimp lip via being able to avoid problems that could arise from a prominent ANS. I can't speak of same/similar with the other doctors you will be consulting with.
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RW14252

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #9 on: September 01, 2021, 02:05:28 AM »
Holy moly I had no idea that I had a prominent ANS, this is quite an important consideration - thanks very much for your input Kavan

Dr A has a technique where he can cut a 'V' shaped notch under the prominent ANS so the nose base does not get overly projected with the maxillary advancement. The ANS can also be trimmed down a little if the 'V' notching is not used.

That's so interesting, I was wondering how all Dr A's clinical cases on his website have minimal nose changes. Did you find his technique in this paper below by any chance?

https://www.jle.com/fr/revues/odf/e-docs/osteotomie_de_le_fort_1_gerer_les_tissus_mous_pour_controler_les_modifications_du_nez_318029/article.phtml

kavan

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Re: Please analyse my pics and xrays in detail (recessed jaws)
« Reply #10 on: September 01, 2021, 05:40:14 PM »
Holy moly I had no idea that I had a prominent ANS, this is quite an important consideration - thanks very much for your input Kavan

That's so interesting, I was wondering how all Dr A's clinical cases on his website have minimal nose changes. Did you find his technique in this paper below by any chance?

https://www.jle.com/fr/revues/odf/e-docs/osteotomie_de_le_fort_1_gerer_les_tissus_mous_pour_controler_les_modifications_du_nez_318029/article.phtml

Actually, I found the technique by observing a patient's scull model of the proposed displacements and noticed there was a V notch under the (prominent) ANS. Yet the displacement readout noted a large maxilla advancement at the ANS. So, I told the patient/poster what I observed and asked him to ask Dr. A about it. Patient confirmed Dr. A was to move his maxilla but not ANS with it and confirmed what I noticed that must have been so as to the 'V' notch below his ANS in the scull model displacement proposal.
Please. No PMs for private advice. Board issues only.