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General Category => Functional Surgery Questions => Topic started by: Eroica on June 24, 2012, 01:54:33 PM

Title: Clockwise Rotation
Post by: Eroica on June 24, 2012, 01:54:33 PM
Anyone have any good pics or articles on clockwise rotation? This is what I'll be having done to correct my flattened occlusal plane, shortened lower face and incisor show deficiency.

This dude underwent clockwise rotation/advancement for the same reasons. I have a similar facial pattern though my jaw/chin are more recessed.

http://4.bp.blogspot.com/-NrDZc0rflG8/TgWEj-6vQKI/AAAAAAAAAGc/Gv5aS88YiKM/s1600/PICT0017.jpg
http://3.bp.blogspot.com/-v86QQJw3Lbg/T9EKTRsnGOI/AAAAAAAAASg/d4kemFYPofE/s1600/Foto+am+07.06.12+um+22.03+%234.jpg
Title: Re: Clockwise Rotation
Post by: x on July 13, 2013, 06:09:02 PM
bump

anyone have any articles or before/afters for this? there's scant info in comparison to CCW rotation
Title: Re: Clockwise Rotation
Post by: x on July 15, 2013, 02:04:53 PM
actually I think clockwise rotation can refer to two different things, which both result in a steeper occlusal plane:

1.)vertically shortening the posterior maxilla w/ impaction

2.)vertically lengthening the anterior maxilla

1 would apply to open bites, 2 to short face
Title: Re: Clockwise Rotation
Post by: pekay on July 15, 2013, 02:15:32 PM
actually I think clockwise rotation can refer to two different things, which both result in a steeper occlusal plane:

1.)vertically shortening the posterior maxilla w/ impaction

2.)vertically lengthening the anterior maxilla

1 would apply to open bites, 2 to short face

were you told that you need CW? or just linear advancement?
Title: Re: Clockwise Rotation
Post by: x on July 15, 2013, 02:24:52 PM
were you told that you need CW? or just linear advancement?
a surgeon only said impaction, didn't go into specifics on degree & location. my maloclussion is more complex than just a retruded maxilla.

I don't think linear advancement can allow for any meaningful amount of upward mandible rotation
Title: Re: Clockwise Rotation
Post by: Tiny on July 21, 2013, 06:02:12 PM
I've got the opposite problem - deep bite at the front, 1mm open bite at the back.....but still a short face, from the nose downwards!!  Retruded mandible and extruded maxilla but no gummy smile - which I would probably have if my face was longer.   So I need extrusion of the posterior teeth not impaction, or to lengthen the posterior maxilla via le fort + rotation and make the plane flatter (opposite to what is shown below) 

OP, have you considered segmental osteotomy?  I am considering it as an alternative to a le fort 1 + rotation as double jaw surgery scares be a bit.  It would open my bite and lengthen my face but not fix my upper lip position
Title: Re: Clockwise Rotation
Post by: Tiny on July 25, 2013, 10:44:46 AM
a surgeon only said impaction, didn't go into specifics on degree & location. my maloclussion is more complex than just a retruded maxilla.

I don't think linear advancement can allow for any meaningful amount of upward mandible rotation

Why?  Surely it can if it's done far back?  (at least, I am hoping it can be done, otherwise I will need double surgery)
Title: Re: Clockwise Rotation
Post by: x on July 25, 2013, 09:25:08 PM
Why?  Surely it can if it's done far back?  (at least, I am hoping it can be done, otherwise I will need double surgery)
what's your class and surgical plan?

a Lefort alone can allow the mandible to autorotate up
Title: Re: Clockwise Rotation
Post by: Tiny on July 26, 2013, 04:39:26 AM
Class 2, 80% deep bite but small overjet.  However, very small chin/lower jaw.

I'm not sure what the best option is right now.   My lip discrepancy is at least 1cm and the lower jaw significantly retruded.   I really need the lower jaw brought forward but I don't have that much overjet so would probably need more extractions so the teeth could be brought back - however, I already had large adult molars removed as a teen and don't want to take out any more teeth! :( 

The deep bite could be closed by extrusion of the posterior molars, but this isn't stable in adults and my molars are pretty much fully extruded.  The way I see it, I will need to rotate the mandible up or the back of the maxilla down, or get a segmental subapical osteotomy of the posterior molars.