Looking for advice (pics)

[faleixo]

Hello all,

I am 22 years old and due to my underbite and facial asymmetry, I am looking to have jaw surgery done. I am missing three of my second premolars due to congenital causes (the teeth you see in the x-ray were baby teeth and I recently had them extracted). My orthodontist has proposed a treatment plan which includes TAD's to pull the molars and close the space left in the place of the second premolars with respective preparation for upper and lower jaw surgery. Optionally, I could also have genioplasty in conjunction with that.

The pictures are below.

http://imgur.com/fkznKte
http://imgur.com/iFdCaku
http://imgur.com/e2Ggtyt
http://imgur.com/p5YN7QN
http://imgur.com/9xOWDtJ

Now, my questions are the following:
-Aesthetically and functionally speaking, do you think there would be a huge difference of pulling the molars to the front, as opposed to have the spaces filled with implants? I am a bit worried about this since I don't have upper third molars and so this could create kind of a narrow arch. I have also read about people who had second molar extractions due to crowding that had their face look more sunken in after the treatment. Do you think the jaw surgery would potentially avoid this sinking effect?
-In your opinion, in my case, would genioplasty be necessary in addition to bimax surgery to achieve an aesthetically pleasing result?

[Kristen]

I would definitely do implants.   Maintains width and space.   Keeps bite the same. Keeps aesthetics full.   

[faleixo]

On second thought, the 2 years time frame my orthodontist gave me was probably both pre and post-op. Puting implants would probably shorten the time of the treatment, but I would also have to wear braces for some time to prepare my bite for surgery. Also, I think it would cost significantly more since I don't have much bone at the extraction sites and would need bone grafts. If aesthetically it doesn't make a huge difference not to have three second pre-molars as long as the space is well filled by the molars, I think it's worth the time on braces to save a few thousand I would spend on implants.

[Kristen]

Get several opinions.....consults are free