Suggested plan by Dr Ramieri Italy

[strongjawman]

Visually speaking, what do you think?

I noticed that it looks decent from the profile view but from the 3/4 it appears that I almost have an underbite..? Has changed the ogee curve relationship. Wondering if the software is not giving an accurate representation.

Plan is CCW, posterior downgraft of ~4mm, maxillary advancement of 3mm and it appears almost 12mm at the longest point of mandibular advancement. This seems like too much for my taste but he advised that the 3d soft imaging usually appears 20% more advanced than it would be in reality...

From the front the slight maxillary cant is corrected and the left mandible is advanced slightly more than right in order to correct incisor midline. The ramus on each side was also suggested to be widened about 4mm on each side, which he said would give a similar appearance to having implants.

All of this is done prior to any orthodontic work. In contrast, Dr Alfaro in Spain suggested I would need orthodontic treatment first however after a series of questions on my part regarding the treatment, he told me he didnt think I needed surgery.

Dr Ramieri on the other hand essentially lets you play around with the 3D planning/cuts with how you want it to be and then gives his opinion which I actually liked.

Here are the images from Dr Ramieri in Rome: https://imgur.com/a/ow9XnNN

Here are a couple of photoshopped pre planning images Dr Aflaro gave me: https://imgur.com/a/gJjySUO and https://imgur.com/MD3WoIV

[kavan]

As to 3/4 view:

The head pose (to the right) should be turned somewhat more to the left for the full 3/4 view and visa versa.

When I used to morph people to show improved contour changes, my requirement was that the 3/4 view for the ogee curve was to pose without the nose getting in the way and for both eyes to show. Basically, the head pose needed to conform with the artistic principles of how to draw a human head in 3/4 view. If not, the person's actual ogee curve is not completely in the field it needs to be viewed in and subsequently alter it. Your pose has the eye area blacked out and the nose in the way.

I see what you mean by the curve contour below the nose making it look somewhat like an underbite. It could be an artifact (type of hiccup in soft ware program). But just to say, it's a problematic perspective to view the true 3/4 perspective and also to morph it from. See if you have the option for him to show you from a true 3/4 perspective. If not, show him what you're seeing and ask if that particular perspective kicked up a 'hiccup'.

Anyway, the SALIENT perspective to look for an underbite contour is the PROFILE perspective. A maxfax guy is usually going to make sure the profile posture of the head is right (correct) for that one and software predictive programs have an easier time with those.

As to Alfaro, I think he's 'straight out' with it in the sense that you really don't 'need' surgery. Like you could 'survive aesthetically' if you didn't have any. He's also straight out with it to say on the morph proposal that it depicts the direction he's going in.

I think Ramieri might be a better choice for you especially IF he let's you play with the design program to show what you like. But I think the profile and frontal perspectives are the better ones to base your decision on rather than the 3/4 perspective which is not exactly a 'true' 3/4 pose.

[strongjawman]

Hi Kavan, thank you for the reply.

Thank you for the insight regarding the 3/4 view - I will ask Dr Ramieri to send other images at a better angle in order to assess it better.

From the side profile view, do you think it looks like a substantial improvement in your opinion?

Dr Alfaro was sure he could do surgery and advised me to get scans done of my teeth and a plan done with and without surgery which cost me 500 euro. After I asked a few questions he seemed to change his mind, maybe he thought I was annoying or pedantic. He also didn't seem to notice the asymmetry to the same degree Ramieri did.

I will update following my next consult! Cheers

[kavan]

Hi Kavan, thank you for the reply.

Thank you for the insight regarding the 3/4 view - I will ask Dr Ramieri to send other images at a better angle in order to assess it better.

From the side profile view, do you think it looks like a substantial improvement in your opinion?

Dr Alfaro was sure he could do surgery and advised me to get scans done of my teeth and a plan done with and without surgery which cost me 500 euro. After I asked a few questions he seemed to change his mind, maybe he thought I was annoying or pedantic. He also didn't seem to notice the asymmetry to the same degree Ramieri did.

I will update following my next consult! Cheers

Well, you don't really need a 'substantial' improvement. However, it does show an improvement.