Idea for complete jaw improvement (angle, occlusion, advancement)

[Optimistic]

I've been looking more and more into distraction osteogenesis (DO) lately and it appears as though DO can in fact be used to improve jaw angles.



So would it not be possible to get say a BSSO with ccw rotation and SG, wait for it to heal, then DO for jaw angle? Perhaps even DO on the rami beforehand to improve the gonial angles.

Maybe I'm going insane thinking of ways to achieve my goals without the use of HA paste or implants, but I'm starting to think a combination of DO and traditional surgery could make this very possible.

[Optimistic]

More ideas... some say that DO isn't always accurate and that can be a problem. Well what if DO was used simply as a method of creating the missing bone and surgery followed to fine-tune it?

So if I wanted improved gonial angles, longer ramus, improved jaw angle, well I could get DO on the ramus and to lengthen and widen the mandible. Afterwards a maxfac surgeon could do a BSSO to rotate the mandible into position. Osteotomise the ramus and move it back creating a straight, longer ramus with accuter gonial angles and a sufficiently long mandible.

Forget cost, pain, or any of this. Is this not THE solution we've all been asking for?

[Optimistic]

Ok, so some follow-up questions: Why is DO unstable? What are the drawbacks that I'm missing? How could this be any more risky than standard maxfac surgery? Isn't advancing a mandible advancing a mandible?

At the very least the lengthening of the ramus and widening of the posterior part of the mandible are incredibly appealing. I'll be in contact with Dr Dr Paul Coceancig to get his thoughts on all of this (his work seems to be among the best I've seen).

[Tiny]

@weakjawbrah

What you're looking for is
a) longer ramus
b) more accute gonial angle
c) flatter mandibular planes
d) longer mandible

a) in theory you can achieve via SSRO or DO.  c) and d) you can do via a BSSO with rotation

however, it's b) that's tricky to achieve. DO on the rami will not make an obtuse jaw angle more obtuse.   BSSO with rotation will change the mandibular plane an the wider "angle" but the actual bone structure of the gonial angle will be the same.  Even it it were possible to do this BSSO + DO thing in 2 separate surgeries (and  I don't think it is, because WTF is going to be happening with the teeth in between the surgeries?), you will still need paste UNLESS you do the BSSO cut diagonally though the angle itself, and put a bone graft in the gap.

Just get implants - sure they have some issues but not as many as this route would.

Have you seen the case of the guy with the long jaw but very obtuse angle/steep plane?  He got an inverted-L with a bone graft

[Lazlo]

@weakjawbrah

What you're looking for is
a) longer ramus
b) more accute gonial angle
c) flatter mandibular planes
d) longer mandible

a) in theory you can achieve via SSRO or DO.  c) and d) you can do via a BSSO with rotation

however, it's b) that's tricky to achieve. DO on the rami will not make an obtuse jaw angle more obtuse.   BSSO with rotation will change the mandibular plane an the wider "angle" but the actual bone structure of the gonial angle will be the same.  Even it it were possible to do this BSSO + DO thing in 2 separate surgeries (and  I don't think it is, because WTF is going to be happening with the teeth in between the surgeries?), you will still need paste UNLESS you do the BSSO cut diagonally though the angle itself, and put a bone graft in the gap.

Just get implants - sure they have some issues but not as many as this route would.

Have you seen the case of the guy with the long jaw but very obtuse angle/steep plane?  He got an inverted-L with a bone graft

i mean i thought i knew my s**t, but i think you could out talk a surgeon at this point for sure! Impressive post. I have no idea if you're right, but it's crazy how well you know this stuff.

[Lazlo]

See that's what I figured. I need ccw rotation and mandibular impaction, which would inevitably fall in the realm of a BSSO-type surgery. However, call me crazy I still think DO combined with surgery will provide me the result I'm looking for. Allow me to explain in more detail:

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1. DO of the rami. This would lengthen the rami to essentially give more room to move in surgery, and prove vital for the later stages of my plan (as you shall see).


2. This is where the first big transformation takes place. With the rami lengthened it's now time to improve the gonial and rami angles, as well as to advance the mandible (with rotation and impaction if necessary).



Exactly as shown here however instead of moving the mandible back it would be advancement. This would require some rest for all the bones to properly heal, however once done we are brought to the third and final stage of my master plan...

3. The jaw angles. The gonial angles are near perfect. The occlusion is great. Impacted for facial thirds and your profile is now that of a good-looking human being. Once again we are using DO, this time to widen the mandible. The changes are natural and dramatic.



IMDO jaw distraction surgery explained with 3D radiology before & after
Before & after jaw distraction surgery before braces with IMDO for dental overbite


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Please don't dismiss this as insanity. I want to know hard facts why this is undoable. I'm going to ask some surgeons and orthodontists about this to get their take on it all.

so you're going to have DO, surgery, then another DO? I dunno I mean maybe it's doable, but you have to take into account the pragmatics of all this. Frankly, this is out of my league. If you're that driven talk to Coceancig and a few others. I doubt orthodontists will know much, but do the cocenacig consult (i think it's like 200 bucks). Just go ahead and get on it and come back and tell us what you learned. Maybe it will help us all. THERE IS NO ONE ON THIS BOARD WHO CAN REALLY TELL YOU IF THIS IS DOABLE OR WORKS. ONLY A SURGEON WHO HAS THESE SKILLS AND EXPERIENCE CAN ACTUALLY ADVISE YOU. Let us know what you learn.

[Optimistic]

@weakjawbrah

What you're looking for is
a) longer ramus
b) more accute gonial angle
c) flatter mandibular planes
d) longer mandible

a) in theory you can achieve via SSRO or DO.  c) and d) you can do via a BSSO with rotation

however, it's b) that's tricky to achieve. DO on the rami will not make an obtuse jaw angle more obtuse.   BSSO with rotation will change the mandibular plane an the wider "angle" but the actual bone structure of the gonial angle will be the same.  Even it it were possible to do this BSSO + DO thing in 2 separate surgeries (and  I don't think it is, because WTF is going to be happening with the teeth in between the surgeries?), you will still need paste UNLESS you do the BSSO cut diagonally though the angle itself, and put a bone graft in the gap.

Just get implants - sure they have some issues but not as many as this route would.

Have you seen the case of the guy with the long jaw but very obtuse angle/steep plane?  He got an inverted-L with a bone graft

Do you have a link to that case? Inverted-L you mean an IVRO? I hear that can improve gonial angles quite nicely as well as jaw angle.

In the beginning I placed a lot of faith in HA paste, since then this forum has beaten that down a lot. I'm almost willing to just try and go for as flat a mandibular plane as possible and get an implant if need be.

[Lazlo]

Do you have a link to that case? Inverted-L you mean an IVRO? I hear that can improve gonial angles quite nicely as well as jaw angle.

In the beginning I placed a lot of faith in HA paste, since then this forum has beaten that down a lot. I'm almost willing to just try and go for as flat a mandibular plane as possible and get an implant if need be.

Dude, you got to do the coceancig consult. On this board we've now altogether consulted with every major surgeon in north america for sure. I even flew to the bloody mayo clinic for a few days to consult. I've shared all my results with everyone. We need a coceancig consult --he may be a game changer--i doubt it but i want to know. Do the consult with him asap (if you're not in australia it will be over skype or something). Let see what he says....

[Optimistic]

Dude, you got to do the coceancig consult. On this board we've now altogether consulted with every major surgeon in north america for sure. I even flew to the bloody mayo clinic for a few days to consult. I've shared all my results with everyone. We need a coceancig consult --he may be a game changer--i doubt it but i want to know. Do the consult with him asap (if you're not in australia it will be over skype or something). Let see what he says....

I'll see what I can do.

[Tiny]

Do you have a link to that case? Inverted-L you mean an IVRO? I hear that can improve gonial angles quite nicely as well as jaw angle.

In the beginning I placed a lot of faith in HA paste, since then this forum has beaten that down a lot. I'm almost willing to just try and go for as flat a mandibular plane as possible and get an implant if need be.

Euphoria posted it...it's in here somewhere.  Insanely steep occlusional angle and open bite (I think)  They guy had trimax

If you elongate the ramus in the vertical dimension then you will move the teeth apart, vertically.  Rotating the mandible will move the back teeth down even more.  However you look at it it will be tricky. 

No matter what you do, even if you get DO + BSSO, you will still need paste to smooth things over.  There is a Dr Y case where someone got implants because their jawline wasn't smooth after jaw surgery

I think it's all going to depend on the actual shape of the gonial angle and the the occlusional plane

Consider this schematic

In the first row, you have the 'ideal' jaw shape and the 'downward growth' shape where everything is very steep, but not short.  The guy who got the trimax with IVRO was like this.

In the 2nd row, the pic on the right has short ramus and mandible, obtuse gonial angle.  Even if you do this DO + BSSO thing, the gonial angle is still the same shape and there is going to be a discrepancy after rotation that you will need paste or an implant to cover.  That's why you might be better doing the cut in the angle itself, and fill it with a graft

In the 3rd row, the plane and angle are good, but the ramus and the mandible is short.  In this case you would get a good improvement

The 4th case, which I didnt draw, would be were the angle is OK, but the upper and lower planes are steep.  In this case you could do a lefort with rotation and rotational, lengthening SSRO (it it was stable)

[Optimistic]

Ok, so my case is probably more like the third row. What would you suggest for that then?

[Tiny]

If you can get DO, make it stable, and make it work with the teeth, then it should give you a good cosmetic outcome.   You know though that often there isn't room in the mouth for the equipment?  If it could only be done with external would you still do it?  It would leave scars

If you can't get DO then I guess all you can do is try an SSRO and try and stabilise it - don't know how one would go about that

Or get implants


There isn't really a good solution, unfortunately

[overbiter]

If you can get DO, make it stable, and make it work with the teeth, then it should give you a good cosmetic outcome.   You know though that often there isn't room in the mouth for the equipment?

Who told you that? A lot of teenagers get they surgery done and they should have slightly smaller mouths than adults. Even new born babies get DO done if they are born with a facial abnormality. I can't believe there is an adult alive that has a mouth smaller than a new born baby.

[Tiny]

Who told you that? A lot of teenagers get they surgery done and they should have slightly smaller mouths than adults. Even new born babies get DO done if they are born with a facial abnormality. I can't believe there is an adult alive that has a mouth smaller than a new born baby.

I read it somewhere...can't remember exactly but it was reasonably reputable.  Could have even been MMs website?

Don't for some of these kids, they put the DO equipment on the outside of the face?

[overbiter]

Don't for some of these kids, they put the DO equipment on the outside of the face?

Yeah, maybe they do for the babies actually.