General Category > Aesthetics
Failed CCW rotation
dailydave:
It looks like my jaw is just at steep as before, if not even more, despite ccw rotation. What’s the issue here? My jawline has actually gotten worse after surgery and I still have a class II profile. Based on measurements I got around 11-13mm advancement at lower jaw + 6mm genioplasty and then a second round of genioplasty with +4mm and it still looks bad. When the Xray was takem I was still swollen from 2nd genio so recession is not that visible.
Before: https://ibb.co/4FJHYjT
After: https://ibb.co/23PwjrD
kavan:
With reference to the after cephs, I don't see any aesthetic 'failure' in the outcome. I see an improvement. The Mandibular plane angle (MPA) in the after from where it is measured (with reference to the horizont) has decreased and the profile line up (with reference to a vertical) has improved and is within an aesthetic norm.
With reference to what people have in their 'mind's eye' that they want to see in the mirror, that is beyond me to measure/compare with points, angles and planes, and not something I can opine on. What I can say here is that the after ceph shows an improvement that is within the aesthetic norms of aesthtic balance
The main failure I noticed here is that the before ceph is (CCW) rotated away from the horizontal and vertical planes as if a PHOTO of the before ceph was chosen for this presentation. The after ceph is aligned with the vertical and horizontal planes. That is to say, the ceph stat in the after is aligned with the vertical plane of the after photo but the ceph stat in the before is rotated in CCW direction away from the vertical plane. None the less, when this was compensated for, the MPA was REDUCED by about 4 degrees.
The after ceph seems to show that the look of CCW-r was achieved mainly via somewhat of a CCW 'twist' of the mandible itself and a sliding genio (outward horizontally and upward vertically which is a technique they can use to give more of the look of CCW especially in a case where the CCW-r is ANTERIOR IMPACTION and there is only so much anterior impaction that can be done without the upper teeth disappearing. Basically CCW-r to the maxilla, ANY KIND, will only reduce the MPA by the same amount, NOT MORE than that. So, if the MPA is excessively steep and that steepness exceeds the the CCW-r done to the maxilla, CCW-r to the maxilla won't reduce all of it. Geometrically impossible.
So, what's the issue here? You are using cephs to talk about things you see in the MIRROR that you don't like which are not seen in the cephs. The after ceph shows an improvement with reference to your starting anatomy. I would not suggest or encourage any more revisions.
GJ:
The position does look objectively better after.
dailydave:
--- Quote from: kavan on November 22, 2023, 12:14:08 PM ---With reference to the after cephs, I don't see any aesthetic 'failure' in the outcome. I see an improvement. The Mandibular plane angle (MPA) in the after from where it is measured (with reference to the horizont) has decreased and the profile line up (with reference to a vertical) has improved and is within an aesthetic norm.
With reference to what people have in their 'mind's eye' that they want to see in the mirror, that is beyond me to measure/compare with points, angles and planes, and not something I can opine on. What I can say here is that the after ceph shows an improvement that is within the aesthetic norms of aesthtic balance
The main failure I noticed here is that the before ceph is (CCW) rotated away from the horizontal and vertical planes as if a PHOTO of the before ceph was chosen for this presentation. The after ceph is aligned with the vertical and horizontal planes. That is to say, the ceph stat in the after is aligned with the vertical plane of the after photo but the ceph stat in the before is rotated in CCW direction away from the vertical plane. None the less, when this was compensated for, the MPA was REDUCED by about 4 degrees.
The after ceph seems to show that the look of CCW-r was achieved mainly via somewhat of a CCW 'twist' of the mandible itself and a sliding genio (outward horizontally and upward vertically which is a technique they can use to give more of the look of CCW especially in a case where the CCW-r is ANTERIOR IMPACTION and there is only so much anterior impaction that can be done without the upper teeth disappearing. Basically CCW-r to the maxilla, ANY KIND, will only reduce the MPA by the same amount, NOT MORE than that. So, if the MPA is excessively steep and that steepness exceeds the the CCW-r done to the maxilla, CCW-r to the maxilla won't reduce all of it. Geometrically impossible.
So, what's the issue here? You are using cephs to talk about things you see in the MIRROR that you don't like which are not seen in the cephs. The after ceph shows an improvement with reference to your starting anatomy. I would not suggest or encourage any more revisions.
--- End quote ---
Thank you for your answer!
The reason why I thought this was a failed ccw is mainly because right after surgery my ceph looked like this:
https://imgur.com/a/8F4OFVO
It seems like the lower jaw didn’t rotate entirely with the upper one.This open bite (which I never had before surgery) was resolved later with elastics, however the part of the mandible which was moved seemed to remain in that steep, open bite position.
This is how I look now 1 year post op and genio revision:
https://imgur.com/a/Tt41CVR
I think, objectively, this would be still classified as a Class II appearence.
kavan:
--- Quote from: dailydave on December 03, 2023, 09:29:32 AM ---Thank you for your answer!
The reason why I thought this was a failed ccw is mainly because right after surgery my ceph looked like this:
https://imgur.com/a/8F4OFVO
It seems like the lower jaw didn’t rotate entirely with the upper one.This open bite (which I never had before surgery) was resolved later with elastics, however the part of the mandible which was moved seemed to remain in that steep, open bite position.
This is how I look now 1 year post op and genio revision:
https://imgur.com/a/Tt41CVR
I think, objectively, this would be still classified as a Class II appearence.
--- End quote ---
I think your result looks well within normative and/or good aesthetics. The BSSO advancement on the scan looks significant and the chin is vertically up and horizontally outward for CCW look. Although larger BSSO advancements are possible with the posterior downgraft CCW and the the more rotation, the more they can decrease the Mandibular plane angle (MPA). But when the CCW-r is via impaction only, the MPA decrease can only be proportional to the extent of the impaction. When I looked, you got in venue of about 4 degrees decrease in MPA.
So, ya, 4 degrees is less than reduction of MPA and less advancement than a 15 degree posterior downgraft. But not everyone is a candidate for that just because it's mentioned a lot on here. The fact that you got somewhat of an anterior open bite (AOB) afterwards tells me that you would have much MORE of one if you got a large rotation via CCW-r posterior downgraft which would mean the doctor worked within the LIMITATIONS of what could be done and you were not a candidate for a large CCW-r posterior downgraft. So, not being a candidate for a large rotation via CCW-posterior downgraft does not make it a 'failed CCW'.
Class 2 appearance is overly convex profile. You don't have that. Your appearance is ORTHOGNATIC as in jaws in good balance. 'Orthognatic' does not always mean prominent lower jaw or low side of spectrum of MPA.
Navigation
[0] Message Index
[#] Next page
Go to full version