Author Topic: Do I have a class II bite?  (Read 1783 times)

Nikolai

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Do I have a class II bite?
« on: September 24, 2024, 09:59:05 AM »
Some time ago, I received this treatment plan from a surgeon, who referenced my bite as class II:



This surgeon that diagnosed my bite as class II has since stopped practicing, so it's not like I can go back and ask him, but from looking at my xray, it doesn't really look like I have a class II to me. I'm not trying to say I know better than the surgeon in the slightest, I'm just trying to fill in my own ignorance on the matter with how my occlusion is considered a class II when it doesn't seem to have the classic overbite look. Also I apologize if it takes more than just looking at a side image of an xray to diagnose a class II. Thanks!


kavan

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Re: Do I have a class II bite?
« Reply #1 on: September 25, 2024, 02:10:54 PM »
Basically, you are saying you don't want to second guess the doctor's (angle classification). But when you ask; 'Do I have a class 2 bite?', you're asking others to. What I can tell you is why it's hard to pin point the class either by APPROXIMATING the angle measures or just looking at it visually.

Based on one of the angle (ANB) measures they look at to determine class pattern, it's too close for me to call the class. That's because I approximate the landmarks and hold a handheld protractor to the screen. When it's not actually a ceph that also shows the soft tissue orientation, the error range gets higher. For example, an ANB measure of 2 degrees is within the norm to call class I and an ANB measure more than 4 degrees is within the norm of class 2. So, if I do an angle measure by APPROXIMATING the landmark point for the angle on an X ray that is not really a ceph showing soft tissue orientation and my error range is 3 degrees and I measure an ANB angle on it, the angle I measure needs to exceed my error range to call the class.

Let's say, I approximated an angle measure of 8 degrees on an X ray (someone else's). A 3 degree range of error would kick up 3 possibilities of: 8 degrees, 5 degrees and 11 degrees. In that case, it doesn't matter which one it is to assign the class because all are class 2 ANB angles when the error range is factored in. Also, someone would be able to see the X ray LOOKED LIKE Class 2 even if they didn't measure the angles. So, when the angle measured EXCEEDS the possible range of error and all the possibilities are within the class range, it's more straight forward to call a class 2 and SEE it on the X ray.

So, in your case, you're not seeing a large enough angle that LOOKS LIKE or is an obvious class two. Fair enough, the class 2 isn't obvious in your case when you VISUALLY APPROXIMATE what a class 2 looks like.

In your case, my error range EXCEEDED the ANB angle I measured (approximated). I approximated about a 2 degree angle. But factoring in an error range of 3 deg, the correct angle could range from 2 degrees, 5 degrees and negative 1 degrees. So, if the correct one is 2 degrees, then it's class 1. If the correct one is 5 degrees, then it's class 2 and if the correct one is negative 1 degree, then it's class 3. So, I can't call the class in your case in the way I approximate. However, even though I'm approximating angles, what my error range CONFIRMS is WHY the Class 2 isn't visually obvious on the X ray. So, I understand why it doesn't look like a class 2. There are 3 possibilities and one of them is class 2.

Another GLITCH here in terms of angles is that a ceph gives more information than the X ray here. There's another landmark point; 'S' (sella) that a ceph shows which is needed for angle measures SNA and SNB which is another reason I can't target your class. However the salient focus point here is the doctor's observations of an upper midface deformity and also double jaw recession.

Now, as to the doctor's write up, it is very patient or layperson friendly and explanatory. Furthermore he's proposing to correct a MIDFACE DEFORMITY which is much more important to focus on rather than what the angle classification  is. The fact that he's doing a HIGH Lefort (bringing forward your UNDER EYEBONE area) and also proposing to augment further with with hydroxyapatite ('bone paste')  means he is meaning to correct a pretty salient midface deformity in addition to balancing both jaws and the bite.

Now I have some QUESTIONS to YOU.

1: Were you a MINOR (under 18) when you consulted. Or was approval from a guardian needed even if you were over 18?

2: Were you wanting INSURANCE to pay for the surgery?


Looks to me that he was a GOOD GUY wanting to HELP you with a pretty salient midface deformity and double jaw recession and needing a party other than you to approve and/or pay for it.
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Nikolai

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Re: Do I have a class II bite?
« Reply #2 on: September 26, 2024, 04:50:53 AM »
Hi Kavan, thanks for the rundown and the example to demonstrate it! And as for the questions you had for me:

1. I was not a minor when I consulted.
2. I was looking to get the surgery at least partially covered by insurance since I couldn't afford the full price tag of surgery back then.

Unfortunately, insurance fully denied the coverage request and deemed this as an elective/cosmetic-only procedure, and I was too stupid at the time to realize I had options to get a loan or finance the surgery, so I never went through with it, which I regret as it's 6 years later now and also that doctor has retired. Seems like insurance coverage for me will never be an option, but I've since (somewhat) overcome the financial barrier between myself and these procedures, which is why I'm starting to reinvestigate my situation and try to get some new consultations booked, but I'm also trying to understand the geometric side of all of this myself so I can better understand my current bone jaw/teeth and also the outcome of any treatment plan.

kavan

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Re: Do I have a class II bite?
« Reply #3 on: September 26, 2024, 08:13:38 AM »
 Your answer to #2 confirms what I thought the situation with assigning class had to do with it.

The doctor was trying to help you to get the insurance coverage in a circumstance where he (also) wanted to correct the recessive upper midface that stays behind with the usual Lefort 1. The high Lefort advancement of bones below eye but above the part of maxilla usually moved in lefort 1 and also addition of bone paste conveyed that.

He knew the area he needed to correct (upper midface recession) was needed to aesthetically blend in with the double jaw surgery lest your upper midface look more recessive after DJS advancement via relative comparison. He also knew that part was basically an 'add on' for aesthetics only because its alteration was not needed to correct the bite.

He may have had some 'wiggle room'--kind of like my example of error range-- for listing as class 2 because that class is one insurance covers for correction. Correction of a class 1 usually isn't. So, he worded his proposal (that included aesthetic corrections to upper midface) to work into a correction of a class 2 deformity. It was to help you get insurance coverage.

His proposal yields some very USEFUL info as to what type of correction to pursue first; a HIGH LEFORT 1 that advances the recession of the upper midface. DJS in range of 7mm or so for both jaws (linear advancement) and bone paste to blend in any residual step-offs to the 'eyebone area' that could arrise for the High Lefort 1. By the way, his proposal of both the Lefort and BSSO being advanced in the SAME/similar range confirms you are close enough to class 1 that both could be advanced equally.

So, mystery solved as to most likely reason for the class 2 assignment rather than the class 1.





Hi Kavan, thanks for the rundown and the example to demonstrate it! And as for the questions you had for me:

1. I was not a minor when I consulted.
2. I was looking to get the surgery at least partially covered by insurance since I couldn't afford the full price tag of surgery back then.

Unfortunately, insurance fully denied the coverage request and deemed this as an elective/cosmetic-only procedure, and I was too stupid at the time to realize I had options to get a loan or finance the surgery, so I never went through with it, which I regret as it's 6 years later now and also that doctor has retired. Seems like insurance coverage for me will never be an option, but I've since (somewhat) overcome the financial barrier between myself and these procedures, which is why I'm starting to reinvestigate my situation and try to get some new consultations booked, but I'm also trying to understand the geometric side of all of this myself so I can better understand my current bone jaw/teeth and also the outcome of any treatment plan.
Please. No PMs for private advice. Board issues only.

Nikolai

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Re: Do I have a class II bite?
« Reply #4 on: September 26, 2024, 02:38:28 PM »
Thanks again Kavan. While I realized I only got that treatment plan documented because of insurance, I really took everything in there at face value, and didn't ever consider the 'wiggle room' scenario for getting insurance to potentially go for it - too bad they still didn't budge. Also thank you for your opinion on his treatment plan overall; I am keeping this original plan in mind as I go seek out a surgeon to work with, and hoping the 'high lefort' is not too much of a rarity outside of his former practice.

kavan

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Re: Do I have a class II bite?
« Reply #5 on: September 27, 2024, 12:35:28 PM »
Thanks again Kavan. While I realized I only got that treatment plan documented because of insurance, I really took everything in there at face value, and didn't ever consider the 'wiggle room' scenario for getting insurance to potentially go for it - too bad they still didn't budge. Also thank you for your opinion on his treatment plan overall; I am keeping this original plan in mind as I go seek out a surgeon to work with, and hoping the 'high lefort' is not too much of a rarity outside of his former practice.

I think a high lefort, which is somewhat of a 'modified' Lefort 1, might also be somewhat of a 'rarity' because it has some similarities with another type of lefort which is also 'modified' to advance forward parts of the upper midface including the bones that support the under eye area (orbital rims) which is hard to find because the doctor known for performing it also retired.

When looking for another surgeon, my advice would be to establish beforehand whether or not the surgeon performs the 'high lefort 1'. If not, than POOF goes the cost of the consult for them to tell you stuff like 'I don't do that because this that and the other thing'. It is not uncommon for doctors to advise against procedures they 'don't do because of this that and the other thing' when the procedure might take more skill and experience they have to do it. So, you need first find out if the doctor does it. If he does, he should advice you on what ever the risks are in his hands/experience.
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Nikolai

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Re: Do I have a class II bite?
« Reply #6 on: September 28, 2024, 06:47:20 AM »
Quote
my advice would be to establish beforehand whether or not the surgeon performs the 'high lefort 1'. If not, than POOF goes the cost of the consult

Solid advice. Thanks Kavan! Somehow, without hearing it here, I probably would have overlooked this and wasted some money on consults that would have been dead-ends.

kavan

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Re: Do I have a class II bite?
« Reply #7 on: September 29, 2024, 10:37:03 AM »
Solid advice. Thanks Kavan! Somehow, without hearing it here, I probably would have overlooked this and wasted some money on consults that would have been dead-ends.

Best of luck to you in finding a replacement surgeon on the same page of the treatment protocol explained in prior plan.
Please. No PMs for private advice. Board issues only.