Surgical Plan Review

[eastcoastian1]

Hi all,

Getting closer to pulling the trigger on removal of implants+jaw surgery. My surgeon just sent me his surgical plan. I have a meeting with him in a few weeks to talk it through but in the mean time, wondering if you guys could take a look and give me your thoughts.

I have to say, it seems much more conservative than I thought. He told me the movements mimic my implants, but I see only a 4mm genioplasty and 4mm mandible movement with little to no CCW rotation (the occlusal plane is still very steep?)

https://imgur.com/a/wDuED5Y

[GJ]

I think you could benefit from a little CCW based on those photos.

[kavan]

The 'max bite pitch' is the maxillary occlusal plane. (An asterisk * beside a measure means measure is in DEGREES; an angle). So, the plan conveys the OP is to be changed to a LESSER angle that is within the norm. (9.1 deg. is within a norm of 8 deg with 2 deg standard deviations.). Since decreasing the angle of inclination of the OP is in direction of CCW, CCW is being done.
The plan says the angle change is -2.5 which means decrease of the OP and hence it is CCW.

ANB= SNA-SNB (subtraction of angles). So, the changes of SNA and SNB, together bring you closer to the norm for ANB.

It does look with aim to replace implants as close as possible but also bring you closer to the norm as to angle relationships. Also because some of the GAP changes differ on each side of the mandible, maybe to relieve some stresses to the joint/s or just to even some parts of it out that the BSSO doesn't change. Kind of looks like a 'reverse L' osteotomy is to be done on mandible (part of it shown in green) under section called; 'Mandible Gaps'.

[eastcoastian1]

The 'max bite pitch' is the maxillary occlusal plane. (An asterisk * beside a measure means measure is in DEGREES; an angle). So, the plan conveys the OP is to be changed to a LESSER angle that is within the norm. (9.1 deg. is within a norm of 8 deg with 2 deg standard deviations.). Since decreasing the angle of inclination of the OP is in direction of CCW, CCW is being done.

ANB= SNA-SNB (subtraction of angles). So, the changes of SNA and SNB, together bring you closer to the norm for ANB.

It does look with aim to replace implants as close as possible but also bring you closer to the norm as to angle relationships. Also because some of the GAP changes differ on each side of the mandible, maybe to relieve some stresses to the joint/s or just to even some parts of it out that the BSSO doesn't change. Kind of looks like a 'reverse L' osteotomy is to be done on mandible (part of it shown in green) under section called; 'Mandible Gaps'.

I suppose then I’m just wondering, why would the surgeon not rotate the jaws to be level instead of still having the downward slope. Doing something similar to below:

https://i0.wp.com/entokey.com/wp-content/uploads/2019/06/f057-002-9780323443395.jpg?zoom=3&w=960

[kavan]

I suppose then I’m just wondering, why would the surgeon not rotate the jaws to be level instead of still having the downward slope. Doing something similar to below:

https://i0.wp.com/entokey.com/wp-content/uploads/2019/06/f057-002-9780323443395.jpg?zoom=3&w=960

 Let me get this straight are you actually asking why the surgeon doesn't do something to DECREASE your facial height when your objective is to have the surgery get as close to what the implants did which was to INCREASE your facial height? I mean the OBVIOUS thing to observe in the low angle OP photo was the facial height was decreased.

[eastcoastian1]

Let me get this straight are you actually asking why the surgeon doesn't do something to DECREASE your facial height when your objective is to have the surgery get as close to what the implants did which was to INCREASE your facial height? I mean the OBVIOUS thing to observe in the low angle OP photo was the facial height was decreased.

Right, my face definitely looks shorter without the implants. They absolutely added height to the lower third which was what was needed. I just had thought if you do a CCW rotation with a posterior downgraft, you can both level the occlusal plane while at the same time helping adding some length, which as you mentioned is needed too.

[kavan]

Right, my face definitely looks shorter without the implants. They absolutely added height to the lower third which was what was needed. I just had thought if you do a CCW rotation with a posterior downgraft, you can both level the occlusal plane while at the same time helping adding some length, which as you mentioned is needed too.

That's not how it works. The read-outs tell you that facial height is the distance from N to Me which is distance from nasion to base of chin and or distance from ANS to base of chin which is the facial height you wanted the implants to increase (anterior facial height).

The photo diagram in your link clearly conveys the extent of CCW to make OP almost flat DECREASED anterior facial height.

Conclusion: Something that has the effect of DECREASING the ANTERIOR facial height (significant CCW) is ? :

a: What to do for someone who had implants to INCREASE their anterior facial height
b: What NOT to do for someone who had implants to increase their anterior facial height

[eastcoastian1]

That's not how it works. The read-outs tell you that facial height is the distance from N to Me which is distance from nasion to base of chin and or distance from ANS to base of chin which is the facial height you wanted the implants to increase (anterior facial height).

The photo diagram in your link clearly conveys the extent of CCW to make OP almost flat DECREASED anterior facial height.

Conclusion: Something that has the effect of DECREASING the ANTERIOR facial height (significant CCW) is ? :

a: What to do for someone who had implants to INCREASE their anterior facial height
b: What NOT to do for someone who had implants to increase their anterior facial height

I guess my mind is just a bit blown right now. All these years, I thought for SURE, my steep mandibular/occlusal plane means I needed a CCW rotation to flatten and bring everything level. I just assumed that this could be done without shortening the face overall.

[kavan]

I guess my mind is just a bit blown right now. All these years, I thought for SURE, my steep mandibular/occlusal plane means I needed a CCW rotation to flatten and bring everything level. I just assumed that this could be done without shortening the face overall.

Well see if you can improve your thinking process. That's what I look for when I address questions; did the person learn anything. You didn't answer the simple question I asked in my last post:

 Something that has the effect of DECREASING the ANTERIOR facial height (significant CCW) is ? :

a: What to do for someone who had implants to INCREASE their anterior facial height
b: What NOT to do for someone who had implants to increase their anterior facial height

[eastcoastian1]

Well see if you can improve your thinking process. That's what I look for when I address questions; did the person learn anything. You didn't answer the simple question I asked in my last post:

 Something that has the effect of DECREASING the ANTERIOR facial height (significant CCW) is ? :

a: What to do for someone who had implants to INCREASE their anterior facial height
b: What NOT to do for someone who had implants to increase their anterior facial height

Sorry didn’t know you were legitimately asking.

Well the answer I would think is B then if it’s a given that significant CCW would decrease facial height. I thought this was the case when only doing anterior impaction with the CCW. If you do posterior downgraft and no anterior impaction, the face wouldn’t get shorter.

[kavan]

CCW, either kind, (as a function of the extent of it) can shorten anterior facial height.

[eastcoastian1]

Update!

Braces are on and the journey has officially started. Wish me luck!

Hopefully the movements will suffice enough where I won't need another implant, but worst case, I'll just throw a couple of custom ones back at the angles if needed.

[thedude]

I suppose then I’m just wondering, why would the surgeon not rotate the jaws to be level instead of still having the downward slope.

In general from what I have been able to tell a flat occlusal plane is not the aesthetic ideal. You want a slight downward slope just like you have. You’ll even notice if you study other mammals most of them have a slight downward slope to their jaws.

[eastcoastian1]

After just two months of decompensation, it’s really showing just how bad my jaw really is even WITH my implants. Feeling better and better about my decision to do surgery.

https://imgur.com/a/wzrXbMc

[eastcoastian1]

One month out from surgery guys. Plan is:

- Bimax
- Genio
- Small CCW with posterior downgraft
- NEW angle implants

Starting to get major cold feet though after reading so many people with permanent numbness and nerve damage.