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General Category => Functional Surgery Questions => Topic started by: thinkingme on January 01, 2016, 03:37:34 AM
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Im not sure what i must go for improve my profile and teeth. I go 2 orthodontist and one of them say my profile normal other say 4 extraction with surgery or 4 extraction without surgery he want extract my 4 premolar anyway. I dont know must i try to find more orthodontist or surgeons? Or what can i do look photos and radiographs
http://imgim.com/img_20151129_180115.jpg side profile
http://imgim.com/img_20151129_185022.jpg teeth
http://imgim.com/img_20151129_184024.jpg teeth
http://imgim.com/img_20151129_180623.jpg front profile i have no issue with front
And maybe u know anb angle difference is if below 0 its class 3, if 0-4 normal, if 4+ its class 2 and mine is 8
NEW i add this photos cuz my teeth photos not good u think i have ultra narrow jaw(maybe i had but not ultra) 09,03,2016
http://imgim.com/snapshot_20160309.jpg adding new teeth photos with light. i just want to see my jaws not so narrow and u can see my 2n molar teeth stay out of line
http://imgim.com/201incix9720402.jpg 2 year ago 2 week at braces. u can see my teeth they are not flared they are just crowded. and i dont have big jaw estetical problems .
2 year ago, 4 month at braces http://imgim.com/img_20140519_210424.jpg when everything perfect but they didnt stop change teeth they change teeth places with elastics(triangle elastic both side top canine to lower canine and lower first premolar) i dont know WHY u can see.
And problems start after elastics. My teeth start come front without a reason. and they get crowded. and i dont know where the space go
(then i learn i just made a big mistake idont know who take my braces is not orthodontist and ididnt search i just trust he say he is ortho then learned he is just dentist).
(http://imgim.com/sefoelet.jpg)
(http://imgim.com/panrom.jpg)
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guyz no one here who did wisdom+ 4 premorlar extraction for surgery or only 4 premolar extraction?
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Visit one or more maxillofacial surgeons before making a decision.
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you have two narrow dental arches, bimaxillary protrusion and a recessed mandible.
you can either:
- yank out 4 premolars with decompensation orthodontics followed by bimax surgery (will take at least 15 - 18 months pre surgery ortho to close the extraction gaps)
- expand both arches surgically followed by decomp ortho (takes longer, more risk, more surgery, most expensive)
- do nothing at all
- have 4 premolars pulled followed by compensation orthodontics (imo worst option since it will shrink dental arches, shrink mouth, leave s**tty profile, expensive)
you could combine options 3 and 4 with a camouflage genioplasty.
best compromise for time and effort is option 1 although people will murder me for advising to pull teeth. option 2 is risky because lower jaw expansion is a difficult and risky surgery.
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Don't do extractions unless decompensating for surgery, ever. That's why half the people on here are, well... on here.
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you have two narrow dental arches, bimaxillary protrusion and a recessed mandible.
you can either:
- yank out 4 premolars with decompensation orthodontics followed by bimax surgery (will take at least 15 - 18 months pre surgery ortho to close the extraction gaps)
- expand both arches surgically followed by decomp ortho (takes longer, more risk, more surgery, most expensive)
- do nothing at all
- have 4 premolars pulled followed by compensation orthodontics (imo worst option since it will shrink dental arches, shrink mouth, leave s**tty profile, expensive)
you could combine options 3 and 4 with a camouflage genioplasty.
best compromise for time and effort is option 1 although people will murder me for advising to pull teeth. option 2 is risky because lower jaw expansion is a difficult and risky surgery.
my ortho said i have protruding teeth which need to come back. another ortho said i have no issue i dont need braces i didnt agree him. And guyz these are not my natural teeth ihave a bad braces journey 1,5 years ago(iwas 17) and 1,5 years ago i have no problem with my jaws and mouth. My teeth are crooked they try straight teeth without pulled or widening arches(they are not ortho i learn it then they are dentist). Only my teeth was protruding but they make all teeth come front. I dont rly want to extract 4 premolar because of internet stories :/.I have no functional problems now. And if i extract teeth i think my palate get narrower my lower jaw get narrower and my smile get narrower to and i will be very sad.
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Then don't do anything.
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Then don't do anything.
But my side profile seems bad i think. I dont know really extraction is really bad all cases. Or its internet legends only.
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Go to a couple of max fac surgeons, not orthos, but surgeons. See what they recommend and why. Then move forward with a plan.
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But my side profile seems bad i think. I dont know really extraction is really bad all cases. Or its internet legends only.
Where do you live ? Makes a difference in what surgeons may be available to you .
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Where do you live ? Makes a difference in what surgeons may be available to you .
Im from turkey. There is good surgeons and not high values and sometimes goverment help for cost. But my family think i have no issue and they are not supporting i must earn money :(
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you have two narrow dental arches, bimaxillary protrusion and a recessed mandible.
You forgot the exaggerated curve of Spee, looks mostly mandibular. Don't think I've ever seen that before.
- expand both arches surgically followed by decomp ortho (takes longer, more risk, more surgery, most expensive)
They can be lengthened too. Surgical widening of the mandible is not widely practiced, for reasons I can only speculate about.
- do nothing at all
Always an option. Or do something later. However, airway looks small so CPAP may be needed at some point.
you could combine options 3 and 4 with a camouflage genioplasty.
Chin looks normal to me.
best compromise for time and effort is option 1 although people will murder me for advising to pull teeth. option 2 is risky because lower jaw expansion is a difficult and risky surgery.
I don't love pulling teeth either but I'm coming to the conclusion that it makes sense in a lot of cases. Cases like these are good candidates for surgically assisted orthodontics. Very few people know how to do it though, probably not in Turkey. Then extractions can be avoided and surgery is simplier. I really don't love the surgery they'd have to do for those lower incisors though. It looks like it's still unclear to me whether vertical changes are possible with SFO, maybe it could help there too.
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You forgot the exaggerated curve of Spee, looks mostly mandibular. Don't think I've ever seen that before.
They can be lengthened too. Surgical widening of the mandible is not widely practiced, for reasons I can only speculate about.
Always an option. Or do something later. However, airway looks small so CPAP may be needed at some point.
Chin looks normal to me.
I don't love pulling teeth either but I'm coming to the conclusion that it makes sense in a lot of cases. Cases like these are good candidates for surgically assisted orthodontics. Very few people know how to do it though, probably not in Turkey. Then extractions can be avoided and surgery is simplier. I really don't love the surgery they'd have to do for those lower incisors though. It looks like it's still unclear to me whether vertical changes are possible with SFO, maybe it could help there too.
First sorry i dont know what is sfo and surgically asister orthodontics(if its different mean) mean. And exaggerated curve of spee probably cause of my protruding teeths. lower back teeths look inside so much and fronts look frontside. I know widening mandible is possible in turkey i search a same university cases but ithink they did it on very special cases.
I will discuss with plastic surgeons and jaw surgeons that what can they do but for me a ccw rotation of mandible can improve my profile.
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shut the f**k up you moron (op) don't get extractions. Just got to Gunson and Arnett and have them instruct your ortho what to do. You need a plan from them and you need full out bi-max plus genioplasty. If you don't have the money you better start saving now.
YES EXTRACTIONS OF PREMOLARS ARE 19th CENTURY ORTHODONTICS APPLIED TO 21ST CENTURY. IT"S NOT AN "INTERNET LEGEND". ORTHODONTISTS ARE JUST STUPID AND EVIL PEOPLE.
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shut the f**k up you moron (op) don't get extractions. Just got to Gunson and Arnett and have them instruct your ortho what to do. You need a plan from them and you need full out bi-max plus genioplasty. If you don't have the money you better start saving now.
YES EXTRACTIONS OF PREMOLARS ARE 19th CENTURY ORTHODONTICS APPLIED TO 21ST CENTURY. IT"S NOT AN "INTERNET LEGEND". ORTHODONTISTS ARE JUST STUPID AND EVIL PEOPLE.
+1 to the orthodontists are stupid/evil comment. Doesn't change my opinion about extractions for most people, if it were me I'd be seriously looking into all this new age stuff to avoid it, like DO, surgically faciliated orthodontics (SFO), etc. We're not gonna see replacement natural teeth in our lifetimes. Implants are better than no teeth but you don't want them.
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shut the f**k up you moron (op) don't get extractions. Just got to Gunson and Arnett and have them instruct your ortho what to do. You need a plan from them and you need full out bi-max plus genioplasty. If you don't have the money you better start saving now.
YES EXTRACTIONS OF PREMOLARS ARE 19th CENTURY ORTHODONTICS APPLIED TO 21ST CENTURY. IT"S NOT AN "INTERNET LEGEND". ORTHODONTISTS ARE JUST STUPID AND EVIL PEOPLE.
extraction is not always bad http://ovortho.com/jaw-surgery/ look that. But really i dont know my case this is why im here. Because my ortho said i can fix ur profile with 4 premolar extraction and i didnt agree and start search. My case not normal overbite not normal overjet back teeth fit good but incissors not fit. My front teeth like u shape but lower teeths V shape. And is it possible can i contact with gunson and arnett or better doctors online?
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To Lazlo and anyone else who shuns extractions. Do you truly not believe there is a place for them within surgical treatment?
The OP has a very small lower jaw and, consequently, arch. The teeth are flared to fit. For the lower jaw to be lengthened in relation to upper jaw, the teeth need to be decompensated and the angle normalized.
There would be 3 ways to do this.
1. Expand mandible and move the teeth back. However, I don't really ever see discussion of mandibular widening. It seems few do it and risky. I think distraction (vs. BSSO) is something really only done on children so that is out. Any BSSO without decompensating first would either create an underbite or not be significant if the teeth remain flared.
2. File all teeth to create space for movement. This is really only useful in cases that need a small amount of depcompensation. Many, including OP I'd bet, need too much decompensations for this to be effective.
So... That leaves us with 3. Extraction.
You remove the teeth and are now able to completely decompensate and create proper angle for teeth. This will create more severe bite discrepancy... But it should match jaws now.
The lower jaw can now be moved more significantly in relation to upper jaw... which will give best results.
If creating space was possible without extraction, it'd be fine. So, SARPE is a good example. Unfortunately, for the mandible, that treatment doesn't seem to be used.
I could be wrong. But what do you guys think?
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My lower palate seem narrow but i dont think my mandibula narrow. My lower back teeth's angle look so much inside i dont know its normal or not. 2 year ago i have bad braces journey but they didnt use braces on my 2nd molar and my 2nd molars stay outside of other teethlines. If ican photo them i will add here.
i find a case have same narrow arches like me but with good jaw position. http://www.dentalcompare.com/Featured-Articles/36839-Invisalign-Case-Study-Lower-Crowding-Anterior-Bite/
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I apologize for writing narrow rather than small, which can be defined as either narrow OR short (back to front) or both.
I really was implying that a small mandible, whether narrow, short, or both, goes hand in hand with small arches. For people in your case (as well as my own), the teeth in the lower jaw are angled which gives the illusion of a larger arch. However, if you angled them properly, they would be crowded within your arch.
So, how can you get the room to allow them to be both straight and uncrowded? Well, you need to either 1. make the space for the teeth bigger or 2. accept the space you have and remove teeth.
The issue with #1 is that to enlarge mandible by lengthening it forward, you are limited by the amount of overjet you have (or can be given via upper jaw advancement. This is because, your bite needs to be stable after BSSO to heal properly. Sure, if you could get BSSO with the angled teeth, let that heal as an underbite and then use orthodontics to bring the flared angle back to upright... well that'd be great! Unfortunately, that (to my knowledge) isn't done.
Bottom line, if space isn't there to let teeth decompensate, then space needs to be made... by either expanding arch somehow, removing teeth, shaving teeth, etc.
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I speak one more ortho 2. And he said i dont need surgery. I dont know they are all in my mind or there is a issue. I think there is a problem and i want to fix it. But 3 ortho said i dont have a jaw problem. One of them said upper jaw to nose angle must be 80-84 and mine 85. and lower jaw to nose angle must be 78-80 and mine 77. But he add the difference between them 0-4 is normal mine is 8. Really i dont know what must i do.
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Honestly?
You have clearly have a recessed mandible/chin. Anyone who says otherwise doesn't know what they are talking about or being deceptive. Additionally, teeth are not intended to be flared forward (as yours are) and this is either an intentional compensation by a former orthodontist to camouflage your bite or something caused by a tongue thrust. Either way, it is helpful as it stands because it gives you more tongue space (easier to speak and swallow) and allows you to bite into things better (vs. an extreme overjet or something which makes that difficult).
So, the question becomes...
Does your recessed mandible/chin and the angle of your teeth bother you enough to get jaw surgery?
They could be an issue in a few ways:
1. Aesthetics - if the mandible/chin is brought forward, it brings balance to the face, becomes more masculine, and looks like proper development. This is not to say you look bad. It's up to you to decide what you are comfortable with there.
2. Airway - not everyone with a recessed mandible has airway issues. So, maybe you still have a large enough airway and perhaps even if you gain weight or lose some sort of muscle tone as you age... you might still have a good airway. Maybe not though. Regardless, jaw surgery will improve your airway. Whether or not you think the current airway is good enough can only be determined by imaging and getting the opinion of doctors. And, finally, what you want. Even if your airway wasn't great and you develop sleep apnea, there are ways to help without jaw surgery.
3. Jaw pain - you might or might not have jaw pain now or in the future. Your bite being as it is, which is functionally okay, but not "correct" (i.e. your lower jaw is too small and you have angled teeth to camouflage the issue) could cause problems. If it is causing issues... jaw surgery could correct it.
4. Tooth issues - maybe your bite could cause premature wear on some teeth, it might not be stable so you could need to wear a retainer to maintain a "proper" bite. You might have gum issues due the angle of the teeth (it causes gum recession).
So, are you a candidate for jaw surgery? In my mind, there is no doubt. Any orthodontist, dentist, surgeon, etc. who says otherwise is either ill informed or deceptive. I suppose if you have seen none of the negative consequences of recessed mandible/chin (other than impact aesthetically) then it becomes perhaps less "necessary" in that you aren't trying to cure sleep apnea or jaw pain. Still, I think orthodontist's need to tell their patients the truth. You do have a recessed mandible and a discrepancy outside the normal range. Disregard those numbers you quoted about angles. They are useless because your soft tissue is being propped up by your incorrect angled teeth. If they were at the proper angle (i.e. decompensated) then you would have numbers further from average it'd be clear jaw surgery would help.
I wish you luck. Jaw surgery isn't an easy decision to make. It can be expensive. It takes a toll. It can have permanent side effects (partial numbness in lower lip/chin being common). It can also help alleviate the issues I outline above...
It's up to you to decide but I think anyone who says you aren't a clear candidate is either lacks knowledge or is misleading you for some reason.
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Guyz i think i need surgery i talk my family decide it and go orthos to start and to inform my parents. But they say me '' oh rly u dont need surgery'' and my family say look u dont need surgery wtf I go istanbul 6 months later for talk with good maxfax surgeons and orthos.
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you need surgery without extractns
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i have chubby and fat cheeks(im not fat). its because of my recessed mandible with big maxilla? Will it be change with surgery?
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you need surgery without extractns
I'm honestly curious... How would he be able to get jaw surgery without extractions?
I am in a similar boat and have heard more than once extractions are necessary on mandible to reduce tooth flare and create overjet to correct via surgery. Without extractions, his teeth have nowhere to move to be decompensated. What techniques do surgeons and ortho use to correct jaws without extracting.
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I'm honestly curious... How would he be able to get jaw surgery without extractions?
I am in a similar boat and have heard more than once extractions are necessary on mandible to reduce tooth flare and create overjet to correct via surgery. Without extractions, his teeth have nowhere to move to be decompensated. What techniques do surgeons and ortho use to correct jaws without extracting.
if there is a normal way to go surgery without extractions i can go for it. but if surgeons say u need extraction i will go for extractions. but im afraid hope surgeons dont think i dont need surgery
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I'm honestly curious... How would he be able to get jaw surgery without extractions?
I am in a similar boat and have heard more than once extractions are necessary on mandible to reduce tooth flare and create overjet to correct via surgery. Without extractions, his teeth have nowhere to move to be decompensated. What techniques do surgeons and ortho use to correct jaws without extracting.
If he got palatal expansion, it would create more room for the teeth and the incisors could be uprighted within the arches without the need for extractions. This would be the most aesthetically pleasing option from frontal view as well, as his arches are very narrow.
As somebody else mentioned, this is the most costly and time-consuming option.
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i think that ican get palatal expansion but mandible is hard. i have 16 teeth (with wisdoms) on maxilla 15(one wisdom missing from evolution) at mandible. But im stil thinking my molar teeth angle look inward of my palate. And it seems narrow.
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Some points to clear up:
- No one does surgical expansion of the mandible. Lots of people have tried it. No one likes to publish their failures. That's begging for a lawsuit. I'm sure it gets discussed quietly at conferences. On top of it, surgical expansion of both arches is technically challenging because the uncertainly is now doubled. Getting both to relapse the same, predictable amount is hard. If you want to expand the mandible, then there is only one decent option on the market right now and that's surgically facilitated orthodontics. There's maybe a dozen people on the planet with enough experience to do this right now, extra surgery, unpredictable relapse rates, and it's limited to about 5mm. DO to lengthen the mandible is also very rarely done, even in children. And it's the wrong movement, usually they need to be widened.
- You don't have to extract teeth but if you don't, there won't be enough room in the arches for them. So your orthodontist will expand the arches. And the teeth will sit near or even outside the margins of the bone. 60% of people have teeth like this but don't realize it and at all ages. When that happens, the teeth are unstable (likely to crowd again), roots get blunted, and gums tend to recede. It gets compounded by age, as the face shrinks and bones decalcify, esposing at risk teeth. These problems take decades to appear! I've already got recession on two teeth because they're tipped lingually. It's a s**tty choice to make but, objectively, removing 4 teeth to protect 24 other teeth down the line makes a lot of sense. Dr Posnick writes the same in his textbook.
- Airways get worse with age and most of us will get sleep apnea at some point. What differs largely is when we get it. Many won't get it until 80-90, some at 50, and some, like me, before the age of 5. Diagnosis rates are low because the symptoms are vague and come on gradually. The kinds of problems sleep apnea causes are multi-factorial and the other factors are often caused by sleep apnea. High blood pressure and heart disease get blamed for sudden death mid-age, even though sleep apnea underlies the cause of both conditions. If your arches are small, then assume this is a condition which you are already afflicted by. Your older self may not have the option of a surgical fix when it becomes apparent that you need it. CPAP and newer technologies are always options. I don't know your specifics but, you can get it without notable risk up until about age 60. You'll want to be proactive about catching it, get a sleep study every 5 years.
- Jaw joint issues... surgery can prevent them. If you have a high angle occlusion, significant crossbite, or nocturnal bruxism then you should consider surgery sooner than later. I don't know about two decades from now but at this point, TMJ problems are essentially unfixable. An ounce of prevention is worth a pound of cure.
- Same goes for the midface/cheeks. There are no good long term solutions for this problem IMO. And I think that's why most oral surgeons don't want to touch them in conjunction with jaw surgery. We're all really hoping that changes in 10-20 years! And just pray that in the mean time, your starting point is good enough that you can fix your functional problems without uglying yourself too much because that's really what it comes down to more than surgeon skill.
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http://imgim.com/snapshot_20160309.jpg adding new teeth photos with light. i just want to see my jaws not so narrow and u can see my 2n molar teeth stay out of line
http://imgim.com/201incix9720402.jpg 2 year ago 2 week at braces. u can see my teeth they are not flared they are just crowded. and i dont have big jaw estetical problems .
2 year ago, 4 month at braces http://imgim.com/img_20140519_210424.jpg when everything perfect but they didnt stop change teeth they change teeth places with elastics(triangle elastic both side top canine to lower canine and lower first premolar) i dont know WHY u can see.
And problems start after elastics. My teeth start come front without a reason. and they get crowded. and i dont know where the space go
(then i learn i just made a big mistake idont know who take my braces is not orthodontist and ididnt search i just trust he say he is ortho then learned he is just dentist).
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Guyz i think i need surgery i talk my family decide it and go orthos to start and to inform my parents. But they say me '' oh rly u dont need surgery'' and my family say look u dont need surgery wtf I go istanbul 6 months later for talk with good maxfax surgeons and orthos.
thinkingme family specially sisters, mother, women in general are always against improvements, trust me (its like cheating nature for them), for you its more health, more high self esteem. if you need surgery and you do, start saving and follow your head.
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i want to improve but how. it seems imposibble. im not normal class 2 or overbite and overjet. my teeth are different like my jaw. if i get forward my jaw a little i will get long face and underbite. i talk this problem with a family they feel guilty a little. cuz in my child pictures i have crooked teeth and in child i have dentofobia i didnt want to go dentist. and when we go braces its wrong adres and its their fault too. Now i want fix something but i feel so desperate. When i try forgot these jaw problems i get more problems everything get worse. and i dont want to extract 4 premolar.
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i search and speak a lot of people who get jaw surgery in my country. Some of them expand both palates with expand appliances without surgery and they success at age 20s. Is it possible expand arches without surgery. And i have one root treatment teeth with screw. u can see first premolar right maxilla http://imgim.com/panrom.jpg. Is it possible move this teeth?
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my ortho said i have protruding teeth which need to come back. another ortho said i have no issue i dont need braces i didnt agree him. And guyz these are not my natural teeth ihave a bad braces journey 1,5 years ago(iwas 17) and 1,5 years ago i have no problem with my jaws and mouth. My teeth are crooked they try straight teeth without pulled or widening arches(they are not ortho i learn it then they are dentist). Only my teeth was protruding but they make all teeth come front. I dont rly want to extract 4 premolar because of internet stories :/.I have no functional problems now. And if i extract teeth i think my palate get narrower my lower jaw get narrower and my smile get narrower to and i will be very sad.
Wait a second. I thought that bringing teeth "backward" to solve an overbite was the worst thing that can be done???? This is what I had as a kid and now because my genius orthodontist moved my teeth so far back I have a recessed lower jaw, narrow arches, and worst of all sleep apnea. If you move the teeth backwards you make your airway narrow. Is what I'm saying true???
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Wait a second. I thought that bringing teeth "backward" to solve an overbite was the worst thing that can be done???? This is what I had as a kid and now because my genius orthodontist moved my teeth so far back I have a recessed lower jaw, narrow arches, and worst of all sleep apnea. If you move the teeth backwards you make your airway narrow. Is what I'm saying true???
Its not only overbite. i have everything slight but totally combo
in a facebook group john mew said in my post'
'you are right your skull pattern is unusual and that means you need to be careful to select an experienced surgeon. You have a "Bimaxilary Protrusion" but this is a misnomer as your jaws are actually many millimetres too far back not forward and it is your teeth that are too far forward relative to the bone.''and added
''The extraction of your premolars should lead to a nice alignment of the teeth but there is a strong tendency for the teeth to relapse afterwards. This is because Bimaxillary Protrusion is associated with leaving the lips apart about ten millimetres and pushing forward with the tongue when you swallow. Although I was a surgion myself, I prefer to avoid both extractions and surgery. You can have muscle training to teach you to swallow correctly but this is difficult. Also the extractions tend to lengthen the face which can spoil your appearance.
Ideally you should have been treated at the age or around 8 to take your facial bones forward but it is too late for that now. Read up about the Tropic Premise which advises that your lips should be closed at rest with your tongue resting on your palate when you swallow. This would slowly improve most of your problems but is very difficult to achieve constantly. Best of luck Prof John Mew.''
He just want to say u have problem but dont go surgery or extraction and my methods dont work for adults dramatically. And at age 8 my f**king dentist extract one lower one upper premolar because tooth decay and like 4 year there is no teeth and gap was closed. Than i get ultra crowded teeth.
also i have an appointment tomorrow with one of 3 ortho which i can go with surgery(3 of them have experience surgery with class). Hope he wont say u dont need surgery. In appointments i generally ask what is ur plan for me. Then if ortho didnt mention surgery i ask i feel my lower jaw far back which need surgery. everyone in this thread can see jaw problem in my ceph but which prodecure and moves give me good appearance i dont know. I search this issue for 8 month and active at forums for 6 months and still no idea what surgeons do me or what must i do. I never find a similar face skull problems as mine.
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Wait a second. I thought that bringing teeth "backward" to solve an overbite was the worst thing that can be done???? This is what I had as a kid and now because my genius orthodontist moved my teeth so far back I have a recessed lower jaw, narrow arches, and worst of all sleep apnea. If you move the teeth backwards you make your airway narrow. Is what I'm saying true???
It depends on the starting point. If teeth sitting correctly within the arches and then being excessively retroclined to compensate for jaw discrepancy, you are correct. But in thinkingme's case of overly-proclined teeth due to tongue thrust, they need to come back a bit.
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thinkingme - you're likely going to have to get the extractions as part of a surgical plan. It's not the end of the world. Your arches aren't large enough to hold your teeth and, as has been covered within this thread, expansion options aren't really options at all at this point. When John Mew pointed out that it may make the face look longer, I believe he means when not coupled with surgery, because with surgery, this shouldn't be the case.
To summarize: Incisors are overly proclined to fit because arches are under-projected. Premolar extractions are needed so the teeth will then fit within the arches properly. After that point, bimaxillary advancement to bring both the mandible and maxilla forward horizontally. The anterior-posterior is the simple part.
The more difficult part is addressing your jaws vertically. Your curve of spee looks exaggerated but may be fine once the teeth are positioned correctly, i.e. it's possibly just a dental issue. To be honest I'm not sure. The issue I see with which I'm unfamiliar is it appears your lower incisors' tips will sit higher than the rest of your lower teeth once properly uprighted.
Also, it appears you have a very flat occlusal plane when compared to Frankfurt plane but I think you head posture is bad in your ceph in that you're leaning back, because your Frankfurt plane is not horizontal, so I think it's fine. I don't have a protractor on hand to measure.