What's my best option?

[Tetley]

Hello,

This is my first time posting so I hope to not mess this up too badly. I have a question of which route to go with a desired surgery. My bite is good from past orthodontics (twice) , but my upper jaw is too long by 7mm. I was told by the surgeon that my lower jaw is actually the right size but that I have a flat chin. My orthodontist believes the best route to get the desired aesthetic result is to pull two teeth at the bottom to create more of an overbite and move both jaws, lower forward and the upper one up. Not ideal from my perspective just because we would basically be making it worse before better. The surgeon I think is leaning towards just doing the upper jaw and probably doing a sliding genioplasty as well. He believes he could get the lower jaw to rotate forward this way. This sounds better, but I'd hate to do all that and then be disappointed. I just have no idea how either of these things would look, and was hoping to get feedback from people that have a better handle on these things then I do. Any help would be hugely appreciated. I don't know how these pictures are, hopefully they give a decent idea. 

Thanks SO much!

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[Tetley]

Oh, I also have this if it helps.

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[SJay]

It's hard to tell if your facial thirds are in balance as a significant portion of your face is blacked out. From the lat ceph, the mandible, maxilla and the brow bone all seem to roughly align, perhaps your chin is a bit flat and could come forward. Why pull teeth though? If you want a stronger profile, more of an ante face, then why can't both jaws just move forward plus maybe a small genio, as the bite is good and the jaws seem to roughly align already. You also appear to have some lip incompetence, which any surgery should aim to address.

It's hard for me to see the issue with the long upper jaw, but it's not really my area of expertise. All I can really see is that the chin is slightly recessed and that there is lip incompetence, both of which could be fixed with a sliding genioplasty. Or maybe advance both jaws if you like more of the ante face look.

[Tetley]

Thanks for the response. Sorry, I guess I blacked out too much there. I will attach more clear ones. The upper jaw surgery would be to address the lip strain and the gummy smile and to allow the lower jaw to come forward more I was told. I don't know what ante face is? I am not sure why the tooth extraction was recommended, I was just told there wasn't enough room. Are there pictures more helpful? I don't really need a "perfect" appearance but I would like to be able to close my mouth and have a somewhat better profile/ less gum.

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[Tezcatli]

I'd avoid the extractions.

You need double jaw surgery basically. Upper jaw up and a bit forward. Lower jaw forward with ccw rotation. Sliding genioplasty to bring the chin forward.


See this for a similar case
http://m.imgur.com/a/mUclH

[Tetley]

Thanks for getting back to me. If i went that route (double jaw. no extractions ) would that allow my bite to stay pretty much as it is? I'd hate to have it get worse before it gets better. I'll see what my orthodontist says, maybe there is some reason they didn't suggest that

[JimmyTheGent]

The results on that girl are incredible.  Her whole face looks a million times better. Jaw surgery is scary and difficult enough now we have to pick which route the surgeon takes? How the hell should we know which movements are the best for us. Ughhh!

[kjohnt]

There are a couple of ways you could go and different surgeons may give slightly different treatment plans.  But the ideal result would be less gum show and more chin projection.

Based on your ceph and what I've seen before, I think you're looking at a 6mm anterior maxillary impaction resulting in CCW rotation, then BSSO to fit the mandible to the newly-positioned maxilla.  No maxillary advancement, no extractions, no genioplasty. 

I have a good example that I can show but let me get permission from the person first.  I'll follow up.

[Tezcatli]

There are a couple of ways you could go and different surgeons may give slightly different treatment plans.  But the ideal result would be less gum show and more chin projection.

Based on your ceph and what I've seen before, I think you're looking at a 6mm anterior maxillary impaction resulting in CCW rotation, then BSSO to fit the mandible to the newly-positioned maxilla.  No maxillary advancement, no extractions, no genioplasty. 

I have a good example that I can show but let me get permission from the person first.  I'll follow up.

I think she needs maxillary advancement, she looks to be a somewhat young person yet she already has nasolabial folds due to a retracted maxilla. Advancing the maxilla would make her look younger.

Thanks for getting back to me. If i went that route (double jaw. no extractions ) would that allow my bite to stay pretty much as it is? I'd hate to have it get worse before it gets better. I'll see what my orthodontist says, maybe there is some reason they didn't suggest that

You would need dental decompensation, so you would have more of an overbite before the surgery.

The problem with orthodontists is that they are not surgeons and usually only know what they learned about surgery decades ago in college. In the past it was routine to extract teeth to "make room", however that is avoided nowadays because it makes your smile smaller and can even change your entire face for the worse.

If you are dealing with socialized medicine they also want to do the easiest route possible, so they may try to do single jaw surgery instead of double jaw surgery, so he would need to extract teeth in order to get a good forward movement of the lower jaw.

[PloskoPlus]

Get a sleep study.

[Tetley]

Thanks again everyone . I'm in Canada, so it's partially socialized for the actual surgery. But the plan that is being suggested by orthodontist is to do both jaws AND extractions . I would like to avoid extractions. Does anyone have an idea of how long I would need braces before the surgery if I were to do both jaws , no extractions ? Kjohnt, that might be close to what the surgeon suggested (except w. Optional genio) thanks for trying to get example . What does a sleep study do?

[Tezcatli]

Thanks again everyone . I'm in Canada, so it's partially socialized for the actual surgery. But the plan that is being suggested by orthodontist is to do both jaws AND extractions . I would like to avoid extractions. Does anyone have an idea of how long I would need braces before the surgery if I were to do both jaws , no extractions ? Kjohnt, that might be close to what the surgeon suggested (except w. Optional genio) thanks for trying to get example . What does a sleep study do?

About 1 year in braces if self ligating braces are used.
I'd def get a genio too and some max advancement, but yeah, its mostly maxillary impaction and mandibular advancement

[Lazlo]

Thanks again everyone . I'm in Canada, so it's partially socialized for the actual surgery. But the plan that is being suggested by orthodontist is to do both jaws AND extractions . I would like to avoid extractions. Does anyone have an idea of how long I would need braces before the surgery if I were to do both jaws , no extractions ? Kjohnt, that might be close to what the surgeon suggested (except w. Optional genio) thanks for trying to get example . What does a sleep study do?

without any doubt you DO NOT NEED EXTRACTIONS trust me. tell them to make it work with all your teeth.

[Tetley]

When I had braces as a teenager, they pushed my bottom teeth sort of to the farthest point they could forward to get them to match my upper teeth to reduce the over bite. Could this be why he is saying I need extractions? (no room)

[Lazlo]

When I had braces as a teenager, they pushed my bottom teeth sort of to the farthest point they could forward to get them to match my upper teeth to reduce the over bite. Could this be why he is saying I need extractions? (no room)

find a different ortho, preferably one who uses "damon" braces --and I do agree you need double jaw surgery.

I mean you don't NEED it. You're attractive and if you have no sleep apnea issues than who cares, but you know if you want to take a shot at maybe changing your look a bit it might be worthwhile.