BiMax without braces

[BlueShark7]

Hey everyone,

I saw a maxfac surgeon today. My primary issues are aesthetics and mild TMJ. I had overbite and overjet correction as a teenager, extensive work to fill a 11mm gap. My teeth fit together now and are straight, but I still feel like my profile is recessed. When the surgeon did my CT scan, he showed me how narrow my airway is because of where my jaw sits. He says I have the option of a lower jaw advancement (6-7mm) that would mean braces and possibly extractions or bimax advancement without braces or extractions.

I didn't realize bimax was ever done without braces, how do they stabilize your bite post surgery? 
Thanks in advance,

EvK.

[nrelax11]

Someone can answer your question in more depth, but without braces they use temporary anchorage devices which are small screws in your gums. I think also have to add some additional appliances according to a picture I saw with a invisalign patient I saw.

[BlueShark7]

Someone can answer your question in more depth, but without braces they use temporary anchorage devices which are small screws in your gums. I think also have to add some additional appliances according to a picture I saw with a invisalign patient I saw.

Thanks for the reply. I'm wondering if they will wire my jaw shut or anything afterwards if I'm without orthodontics at the time of surgery.

[backward lowerjaw]

do not have extractions you will regret it

[BlueShark7]

do not have extractions you will regret it

Thanks for reply. I am very anti-extractions. I'm stuck though because my lower jaw is small, but my teeth meet and my maxilla is normal, so there's nowhere to go. My bottom teeth aren't even slanted forward that much. A sliding genio wouldn't be ideal because my chin shape is fine, it's a bit far back. If my lower jaw only were to move forward to where it would look good, my molars don't touch, so a posterior segment only of the maxilla brought down to close that posterior open bite would be ideal because my top jaw looks fine; but I don't know if they do that. I also don't know if they can crown the molars so they meet instead? It would be like a 2 millimeter distance.

A chin wing would also be perfect, but I live far from Europe.

So I'm kinda realizing quickly I don't have many options because I won't get extractions.

[MrFox]

I was told by someone from my surgeon's clinic, that if my occlusion is ok then I don't need braces for bimax. That was the first time I'd heard of bimax without braces.

I'd want braces at some point because my left lateral incisor is crowded behind the central incisor and if I have braces after surgery then I am scared it could change the profile that the surgeon has created.

Also, my two front teeth are quite flared out and if I leave them like that then I am worried this flare will make the maxilla look more forward then it actually is. Maybe that would influence the surgery, like he may not move the maxilla as far forward.

[Alue]

My occlusion is fine, but both my upper and lower jaws are very recessed thanks to childhood orthodontics.  I was told by a surgeon that I would only need a few months in braces before jaw surgery and the time was more because of scheduling that the time need in braces.   When I asked him if I could get jaw surgery done without braces he told me no. 

[Mark32]

hi, EvK. when the surgeon showed you how narrow your airway is is that because of your maxilla being too far back, if you know what I mean? this is something i'm interested in as it may affect me. I don't fully understand this myself, but by the airway did the surgeon mean the space between the back of your soft palate and the back of your throat - you know, the gap going up into the nasal passage. or have I picked you up wrong and it's the lower jaw causing the restriction?

the other thing too is why are extractions a bad thing? do they cause damage to the gums or something?

...bimax advancement without braces or extractions.

Is it that you can only avoid braces if you are keeping both jaws in their existing alignment and moving them together as one, if you like? I don't suppose braces can be avoided if the jaws are going to be moved in different directions and their alignment will change?

I was told by a surgeon that I would only need a few months in braces before jaw surgery and the time was more because of scheduling that the time need in braces.

hi, Alue, this touches on something I've been wondering about. does the time in braces before surgery vary from case to case? the thing I find off putting is the idea of having to wear braces for up to 18 months beforehand. will your time in braces be so short because both your jaws are being kept in their current alignment and being moved forward together?


bit OT but how do you do a quote with someone's name on it?

[Tiny]

, my molars don't touch, so a posterior segment only of the maxilla brought down to close that posterior open bite would be ideal because my top jaw looks fine; but I don't know if they do that. I also don't know if they can crown the molars so they meet instead? It would be like a 2 millimeter distance.

Yes, this can be done - it's called CCW.  I have a posterior open bite too as my maxilla is vertically deficient (short face). The advantage of doing in this in your case is that it should allow a bit of additional lower advancement because upper incisors end up tilting outward slightly
Sometimes it needs bone grafts but that depends on the amount them move it, I think it's more commonly required when they downgraft the entire maxilla


Now I've written this I realise this is on old thread.......

[BlueShark7]

Yes, this can be done - it's called CCW.  I have a posterior open bite too as my maxilla is vertically deficient (short face). The advantage of doing in this in your case is that it should allow a bit of additional lower advancement because upper incisors end up tilting outward slightly
Sometimes it needs bone grafts but that depends on the amount them move it, I think it's more commonly required when they downgraft the entire maxilla


Now I've written this I realise this is on old thread.......

Thanks Tiny, this is really helpful. Are you referring to standard CCW where the whole maxilla is rotated in one piece? Or just a posterior segment moved?

[BlueShark7]

hi, EvK. when the surgeon showed you how narrow your airway is is that because of your maxilla being too far back, if you know what I mean? this is something i'm interested in as it may affect me. I don't fully understand this myself, but by the airway did the surgeon mean the space between the back of your soft palate and the back of your throat - you know, the gap going up into the nasal passage. or have I picked you up wrong and it's the lower jaw causing the restriction?

the other thing too is why are extractions a bad thing? do they cause damage to the gums or something?
Is it that you can only avoid braces if you are keeping both jaws in their existing alignment and moving them together as one, if you like? I don't suppose braces can be avoided if the jaws are going to be moved in different directions and their alignment will change?
hi, Alue, this touches on something I've been wondering about. does the time in braces before surgery vary from case to case? the thing I find off putting is the idea of having to wear braces for up to 18 months beforehand. will your time in braces be so short because both your jaws are being kept in their current alignment and being moved forward together?


bit OT but how do you do a quote with someone's name on it?

Hi Mark, I don't fully understand the cause of small airway in my case, but the surgeon's letter says the airway is narrow from soft palate to epiglottis, so I guess that means both jaws?

As for extractions, everyone has their own reasons for/against. I'm just against losing healthy teeth if it can be avoided, nothing more than that.

[Tiny]

Thanks Tiny, this is really helpful. Are you referring to standard CCW where the whole maxilla is rotated in one piece? Or just a posterior segment moved?

I'm referring to the entire maxilla.  However, segmental osteotomy that moves just some of the teeth is possible, but rarely done

[Mark32]

I'm referring to the entire maxilla.  However, segmental osteotomy that moves just some of the teeth is possible, but rarely done

hi Tiny

can this - ccw? - be done to close a bite at the front. I think that my maxilla may be recessive and might need advancement but also you can only see about half of my upper front teeth when I smile. I have an edge to edge incisor relationship but my posterior teeth meet so if my maxilla was just moved forwards horizontally i'd still be left with no vertical overlap of my incisors. Plus i'd still have a mostly hidden smile, if you know what I mean.

or do they advance the maxilla along a plane parallel to your bite plane (don't know if that makes any sense) so that your upper front teeth would slide down into view?

Hi Mark, I don't fully understand the cause of small airway in my case, but the surgeon's letter says the airway is narrow from soft palate to epiglottis, so I guess that means both jaws?

As for extractions, everyone has their own reasons for/against. I'm just against losing healthy teeth if it can be avoided, nothing more than that.

i'm not sure about the small airway thing either. I looked up epiglottis on Wikipedia and a diagram shows it to be level with the lower jaw so I suppose that means your airway must be narrow at the pinch points behind both jaws. when I lie down at night I find breathing through my nose too restrictive and i'm wondering if this might be something to do with my upper jaw being possibly too far back.