Can i get away with only LJS?

[kanko]

Hello guys, i have been reading for a while and have some doubts about my case, can i get away with a LJS only?

I believe my mandibular plane(21 degrees)  and oclusal plane(i dont know how to acurately measure) are not really steep in a way i could get away with only LJS to fix my recessed mandible.

My current overjet is a tiny bit over 5mm, my IMPA is arround 106 degrees. My idea is to retrocline my lower incisors to arround 88 degrees (thus increasing the overjet to 7mm), and also procline the upper incisors (u1 to FH= 106) arround 15 degrees, so the final overjet would be 9mm. In that way i could get away with a 7mm BSSO and arround 5 mm genio.

I know by doing that i would still be a little bit away from the arnett  gunson 100% perfect result, as my upper lip would still be 1-2mm away from its ideal place. Right now it sits right under the Sn point from the FH and by proclining my teeth i believe it would increase arround 1mm. But would the result be good? Or is it too small of an advancement for my case? Im scared of doing something on the maxilla just for a small rotation  in a way that i would not like the end result(mess with nose and lips). im also not sure if those tooth movements are even possible/ can be done to increase overjet

Thanks a lot!
 This is my lateral ceph
https://imgur.com/a/DR3Mhix

[kanko]

Just to be clear on the oclusal plane is im not sure because my head is tilted as in i believe the right side is a little bit lower than the left, also my upper and lower molars overlap a little when i bite so that makes me unsure about where they start to accurately measure

[kavan]

It looks like what you have going on is somewhat in the venue of what another poster had which is prominent ANS (anterior nasal spine). You have an overly obtuse nose to lip angle and it looks like you would benefit from a deprojection rhino to address the nose base upper lip connection which kicks up the protrusive look to the upper jaw area RELATIVE to the lower jaw.

Now, since you are mentioning Gunson, my GUESS is what he would want to do would be to do CCW around the incisor point which would tend to bring the ANS backwards for a betternose to lip angle and of course, maximize how much he could advance the lower jaw.

As for single jaw only, that would involve 'bucking out' your upper teeth which would only exaggerate the problematic ANS area of base of nose upper lip connection. It would also involve extraction of lower pre-molars to make room to push the lower teeth backwards in order to create the overjet. So, I don't see that combo as looking good and does not seem like it would be something Gunson would accommodate.

My suggestion would be deprojection rhino and chin augmentation.

Here is a tutorial of what I'm talking about when it looks to me that someone has a prominent ANS which is a base of nose and upper lip area that needs to be brought in CLOSER to the face.

http://www.facialsurgery.com/ClkoffTPgt3_2011_09_01mh.html

[GJ]

Hello guys, i have been reading for a while and have some doubts about my case, can i get away with a LJS only?

I believe my mandibular plane(21 degrees)  and oclusal plane(i dont know how to acurately measure) are not really steep in a way i could get away with only LJS to fix my recessed mandible.

My current overjet is a tiny bit over 5mm, my IMPA is arround 106 degrees. My idea is to retrocline my lower incisors to arround 88 degrees (thus increasing the overjet to 7mm), and also procline the upper incisors (u1 to FH= 106) arround 15 degrees, so the final overjet would be 9mm. In that way i could get away with a 7mm BSSO and arround 5 mm genio.

I know by doing that i would still be a little bit away from the arnett  gunson 100% perfect result, as my upper lip would still be 1-2mm away from its ideal place. Right now it sits right under the Sn point from the FH and by proclining my teeth i believe it would increase arround 1mm. But would the result be good? Or is it too small of an advancement for my case? Im scared of doing something on the maxilla just for a small rotation  in a way that i would not like the end result(mess with nose and lips). im also not sure if those tooth movements are even possible/ can be done to increase overjet

Thanks a lot!
 This is my lateral ceph
https://imgur.com/a/DR3Mhix

The idea of single jaw + chin isn't a bad one, and 12mm is a lot. Maybe consult with a few more surgeons. I think that would produce a good result. I wouldn't consider a nose job, personally.

[kanko]

Update.

So i have consulted with a orto and by the looks of it i could probably get away with the initial plan by torquing the teeth, she said i could probably increase my oberjet by arround 4 mm. Note: the orto didnt do any actual measurements and just said that by looking. Also said she would have to do some teeth shaving.

I tried pressing on a teeth extraction protocol to make a bigger overjet to see her opinion and her acessment was that it would not be benefitial as it would increase the overjet more than what wouldd be needed, increase the time spent on braces etc. she said correcting teeth + extractions would increase the overjet by 10mm. I could not find literature on orto treatments to verify the claim and tbh i would end up losing a lot more time reserching and from my latest studies i am considering giving up altogether as it is looking grim.

I say that because at the orto consult i asked to make a mandible CT to view my nerve pathway. On the horizontal portion my nerve looks to be as far away from the mandible as possible which is good. But on the vertical portion my mandible is extremely thin, the canal is as close to the outer portion as possible, there is no bone marrow in between, and you can actually see on the outer part of the mandible a bump that the canal made on the bone by pushing out.

This has made me extremely uncomfortable in folowing surgery as from what i see, nerve damage is extremely looked over upon, and is more common than surgeons care to admit, even with the piezoeletric devices.

Of course big mandibles with a lot of space in the canal can get away with it as if the surgeon splits the mandible and the nerve isnt visible you are probably not getting any nerve damage.

From the research i saw, if the nerve is close to the outer border of the ramus you are probably guaranteed to get some sort of nerve damage.

So im currently giving up/ considering researching genioplasty/ chin wing

Here is the scan if anyone wants to look at it and give an opinion, i included one of the canal
At the second molar too
https://imgur.com/a/P6oh0He

Here is the 3d view of
The skull, if anyone wants to give an opinion on that
https://imgur.com/a/vQuQZdU

[kanko]

It looks like what you have going on is somewhat in the venue of what another poster had which is prominent ANS (anterior nasal spine). You have an overly obtuse nose to lip angle and it looks like you would benefit from a deprojection rhino to address the nose base upper lip connection which kicks up the protrusive look to the upper jaw area RELATIVE to the lower jaw.

Now, since you are mentioning Gunson, my GUESS is what he would want to do would be to do CCW around the incisor point which would tend to bring the ANS backwards for a betternose to lip angle and of course, maximize how much he could advance the lower jaw.

As for single jaw only, that would involve 'bucking out' your upper teeth which would only exaggerate the problematic ANS area of base of nose upper lip connection. It would also involve extraction of lower pre-molars to make room to push the lower teeth backwards in order to create the overjet. So, I don't see that combo as looking good and does not seem like it would be something Gunson would accommodate.

My suggestion would be deprojection rhino and chin augmentation.

Here is a tutorial of what I'm talking about when it looks to me that someone has a prominent ANS which is a base of nose and upper lip area that needs to be brought in CLOSER to the face.

http://www.facialsurgery.com/ClkoffTPgt3_2011_09_01mh.html

I have read on your suggestions and of course only a chin augmentation would be an amazing choice. What you are recommending is only a genio? I did not consider initially because since i need a lot of advancement i.e about 9mm of soft tissue, i am afraid it would give me a big chin and small gonion look, i imagine it would look kinda like tinothee chalamet chin, am i correct? Like a big protuberance on the chin. Kinda like a witch chin.

 I have seen a girl that ended up with this kinda of big protuberance on the chin by means of a big genio, i wont post her face because i dont want to expose her even though the photo is public, but that is my concern about it.

Or are you recommending a chin wing? From my perspective it sounds better as it involves advancing the whole mandible forward, but i havent researched much about it so im not sure about pros/cons. What i would be worring initially would be about step offs, if they are common/ visible.

The other question i have is regarding balance, from my CEPH above its my whole lower jaw that needs to move forward. I know the B spot can be advanced by bone graft but regarding the lower lip, if i advance only the chin will the lower lip stay put? From my research the lower lip would have to advance 2-3mm from where it is now (comparing to the current position of upper lip) to achieve balance. Wouldnt advancing only the chin still not fix this and still have me with the recessed look?

[kanko]

The idea of single jaw + chin isn't a bad one, and 12mm is a lot. Maybe consult with a few more surgeons. I think that would produce a good result. I wouldn't consider a nose job, personally.

Id love your opinion on my update too GJ…

[kavan]

I'm not good at interpreting those kind of scans for nerve placement. So, all I have to add here is a suggestion to cross reference your interpretation as to your personal risk with the BSSO (sagittal split) with the surgeon. Fragility or thinness of the bone is a factor in what they call a 'bad split'. So, I think, nerve damage would fall under that type of risk. In short, you want to inquire as to whether or not you are at a high risk for a bad split and if you think you are at risk for that sort of thing (or nerve damage), it's best to explore your assumptions further with surgeon/s who would/could be performing your surgery.

[GJ]

Id love your opinion on my update too GJ…

My opinion is to see a surgeon and ask them. Any generic ortho is likely going to have different goals than you or a surgeon. But, they're right extractions would increase time in braces.

Regarding the nerve, I don't know how to read that on a scan or if that's even possible, but in talking with surgeons the general idea is they try not to cut the nerve but will "sacrifice" it if need be. I had piezo, and I feel it helped (I lost zero sensation). It could be coincidence, but it's known to do that, and it seemed to work for me. In talking with surgeons they seem to agree it does help.

[kavan]

I'm not recommending a chin wing for you because it looks like the nerve could be too close to a chin wing cut. In my prior post, I suggested a genio. If you can get LJS only, than that could work. A genio could be added.

[TheGerman]

It looks like what you have going on is somewhat in the venue of what another poster had which is prominent ANS (anterior nasal spine). You have an overly obtuse nose to lip angle and it looks like you would benefit from a deprojection rhino to address the nose base upper lip connection which kicks up the protrusive look to the upper jaw area RELATIVE to the lower jaw.

Now, since you are mentioning Gunson, my GUESS is what he would want to do would be to do CCW around the incisor point which would tend to bring the ANS backwards for a betternose to lip angle and of course, maximize how much he could advance the lower jaw.

As for single jaw only, that would involve 'bucking out' your upper teeth which would only exaggerate the problematic ANS area of base of nose upper lip connection. It would also involve extraction of lower pre-molars to make room to push the lower teeth backwards in order to create the overjet. So, I don't see that combo as looking good and does not seem like it would be something Gunson would accommodate.

My suggestion would be deprojection rhino and chin augmentation.

Here is a tutorial of what I'm talking about when it looks to me that someone has a prominent ANS which is a base of nose and upper lip area that needs to be brought in CLOSER to the face.

http://www.facialsurgery.com/ClkoffTPgt3_2011_09_01mh.html

Good tutorial really helps with understanding the issue. I just pray my bimax solves this