There is no actual surgical plan describing the exact multitude of displacements to opine on here. The CT conebeam OBSERVATIONS (I'll copy and paste those further down in my post) say: "The orthognathic surgery planning will be performed by Maxfac Surgeons using dedicated third party software." The observations also tell you that you have arthritis/bone spurs to the Jaw JOINTS (condyles).
'Wanting maximum advancement'
Some of your questions resolve to whether or not you can pick and choose what you want from the surgery. The general answer is 'no'. That's because the surgical plan will take into consideration some limitations as to what you are STARTING with and that will take priority over picking and choosing what you wish to get out of it. For example, placement of the condyles (jaw joints) would factor in as to how much stress to put on them via 'rotation' of upper jaw and advancement of lower jaw. Assuming the 'rotation' you are asking about is probably CCW-r (posterior downgraft) often used to maximize lower jaw advancement, it isn't something you can pick and choose as to how much to have because how much of that someone can have depends on what kind of stress it could put on jaw joints and condition of your jaw joints would be factored into any plan they make.
'3-D surgical plan'
Although not found here, it doesn't matter. What matters is you should be in the capacity to OBSERVE a visual plan, even if it's just a profile contour change diagram or a skull model showing the change from before to proposed after. A visual provides enough information for someone to answer to themselves whether the proposed plan is to their liking as far as an improvement goes. In other words, if the surgeon shows you a visual plan, you should be in the capacity to LIKE it or NOT like it and if you don't, you should be in capacity to ask doctor on the SPOT whether or not 'this or that' can be changed (and accept the answer).
Question #2: It isn't clear where the assumption comes from that your molars would not touch and why you should have implants for that 'reason'. So, no advice can be rendered based on 'who knows where' the assumption behind it came from.
Question #3: Gum recession is what you START with. Not having any or not having more of it after the surgery, I don't think is something you can pick and choose for the surgery to accommodate prevention of it, especially so if more of it arises as part of the process (a trade-off) for improving the position of the jaws (eg, advancement).
Question #4: Chin wings have nothing to do with the surgery you are getting. So, not part of the discussion with your doctor. In addition, the type of cut they do in (modern, standard) BSSOs (lower jaw advancement) interferes with the type of cut they make with a chin wing and can often preclude having a chin wing later down the line.
Question #5: I think you need to disband with any assumption that the surgery you are getting (which will most likely IMPROVE your profile AND help your apnea) is meant to also accommodate a request for a perfect 'crisp' jaw line or maximum jaw line enhancement. Although there are procedures in the type of venue of further improvement, for example jaw implants and/or face/neck lifting, those type of things are outside of the venue of the surgery you are getting and the requests you can make as to what the surgery should do to meet expectations of MAXIMUM improvement.
Question #6. The main thing I would suggest asking about is what effect the arthritis to the jaw joints will have on what kind of aesthetic requests you can make with reference to the type of improvements you are asking about here.
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Enclosed: Text of CT observations.
30/03/2023, 12:46, CT Cone Beam Other
CASE HISTORY:
Site: Bilateral
Infection Risk: Unknown
Clinical Details: for 3d planning of bimaxillary advancement for sleep apnoea patient needs to be
biting into wax jig for condyle placement
Specific Que
30/03/2023, 12:46, CT Cone Beam Other
CASE HISTORY:
Site: Bilateral
Infection Risk: Unknown
Clinical Details: for 3d planning of bimaxillary advancement for sleep apnoea patient needs to be
biting into wax jig for condyle placement
Specific Question to be answered: skeletal assesmsent for bimax adv
Confirm previous imaging: On KCH Romexis
. CBCT request will be rejected if all relevant previous imaging is not available for justification.
Any relevant external radiographs must be added on King's Romexis or King's PACS
Inpatient/Outpatient: Outpatient
Bleep / Contact no: 37740
. Cone Beam CT Scan (CBCT) is to be performed by the Dental Radiology Department at
Dental Hospital
Requested By: Francine Ryba
Consultant: Sukhraj Grewal
REPORT TEXT:
A 23x 17cm iCAT CBCT scan of face with the patient biting on wax bite was performed on
30.03.2023.
The orthognathic surgery planning will be performed by Maxfac Surgeons using dedicated third
party software.
Caries cannot be diagnosed due to streak and beam hardening artefacts from fixed orthodontic
appliances.
There are no obvious apical radiolucencies. It is not clear whether UL1 has mild widening of the
apical periodontal ligament spaces so please check for pulp vitality and symptoms.
There appears to be mild to moderate periodontal bone loss in some teeth.
Both mandibular condyles demonstrate marked osteophytes, subcortical radiolucencies and
sclerosis and the features are in keeping with osteo-arthritis.
The paranasal sinuses are clear. The nasal septum is deviated to the right side and has a bony
spur.
Degenerative changes are also noted in the cervical spine image.
There is no obvious bony abnormality.
CBCT scan has poor soft tissue resolution, hence cannot be used for soft tissue assessment.
Dr Batchu, Bhagy, Consultant Dental and Maxillofacial Radiologist, GDC no - 109467
Reported: 09/05/2023, 11:30
Reported by BATCHU Bhagyalakshmi and BATCHU Bhagyalakshmi o
