Rudimentary Advice on Jaw Surgery and CCW Rotation (pics)

[implseeker]

Hey guys, I've attached three pictures of my front view, and I believe I'm a candidate for jaw surgery. I am going soon to get a CT scan because I'm in the process of getting jaw implants, that I realized I have some structural asymmetry that might not be possible to resolve with just implants alone.

I think I need CCW rotation of my mandible and maxilla and not any advancement.

Now I'm a heavy teeth grinder and grind teeth on my right side and I can feel the masseter is much larger on that side. Is it possible that the asymmetry could be musculature in nature and be solved with some botox to the right masseter?

I would like to avoid jaw surgery if possible

https://imgur.com/a/c7WLHje

[kavan]

Let me first get some things out of the way:

I have no comments on your thoughts that you 'need CCW' other than to point out CCW is part of jaw surgery which you say you don't want and also CCW inherently involves advancing the mandible via the BSSO subsequent to the lefort to the maxilla to perform the rotation.

My comments are limited to your front photos and what you mention is a problem you have.

The sticks reveal you have a CANT (a 'slanted' bite). The problem you mention is teeth grinding. So, it is possible the CANT is from wearing down the teeth on the right side and of course, a masseter more bulky on that side would be seen.

Some people have a CANT from part of maxilla being longer on one side and for them, jaw surgery is option to address uneven bone discrepancies which are seen via such things as bone scans. So, all that can be said at this point in time, from frontal photos alone, is that your CANT looks consistent with what you say is a problem you have: grinding down one side of the teeth which could be shorter due to that. But one would only know if there is inherent discrepancy in bone 'unevenness'via such things as scans, doctor looking at them and telling you whether or not that is problem or part of it.

As to your wanting to avoid jaw surgery, a maxfax surgeon might also want to avoid doing surgery on you if the problem with the CANT is found to be directly attributed to bruxism. So, moot point to address thoughts on what type of jaw surgery you think you need other than to point out the type of jaw surgery you 'think you need' actually involves lower jaw advancement which you say you don't want. So, a jaw surgeon might ALSO might want to avoid doing surgery on you. Jaw surgery isn't the first line approach to 'fix' bruxism anyway.

I'm including a LINK about varied approaches to address bruxism. Approach depends on the cause of it. But just to say, it looks like you need to focus on getting treatment for bruxism.
https://www.mayoclinic.org/diseases-conditions/bruxism/diagnosis-treatment/drc-20356100

Jaw implants can even out and define the contours of the lower face as you probably know already. But I think you also probably realize that they won't make LEVEL the lines you show as SLANTED when you bite on the Popsicle sticks.

[GJ]

Hey guys, I've attached three pictures of my front view, and I believe I'm a candidate for jaw surgery. I am going soon to get a CT scan because I'm in the process of getting jaw implants, that I realized I have some structural asymmetry that might not be possible to resolve with just implants alone.

I think I need CCW rotation of my mandible and maxilla and not any advancement.

Now I'm a heavy teeth grinder and grind teeth on my right side and I can feel the masseter is much larger on that side. Is it possible that the asymmetry could be musculature in nature and be solved with some botox to the right masseter?

I view your cant as minor and don't think it's a jaw surgery case based on what you posted.

You could get a thin splint or retainer for the bruxism. You could even try botox as you mentioned, but I've done that for an overactive muscle and you run into the opposite problem where it atrophies. I'd never have it injected again, personally. But it might be worth a try.

My lady has pretty much perfect bone structure, and she still has a cant. Pretty much everyone has some discrepancy. Yours looks within normal.

Without better records I have no thoughts on whether you need CCW as you stated. Objectively, you look very normal.

[implseeker]

Thank you for those great responses.

I will do more research on bruxism and in the mean time make plans to get ct scans done soon.