Can You Guys Analyze My CTP?

[sushilover2]

Hi everyone,

Had my consultation for jaw surgery with Dr. Gunson recently and strangely, he did NOT recommend jaw surgery, rather an ortho only approach. To be fair, I'm doing this mostly for aesthetic reasons, but was still disappointed he advised not operating.

That said, can you guys take a look at the simulated CTP she give me your thoughts? Should I still push to do it?


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[april]

Looks like we have similar profiles.

What would orth-only possibly do? Did he say?

[sushilover2]

Looks like we have similar profiles.

What would orth-only possibly do? Did he say?

Correct the bite.

[april]

I meant to your profile. I'm no expert but your bite doesnt look too bad, so I assumed it was to change your profile. What was your main concern going in?

Were you wearing a wax bite in for the ceph xray? Is your profile like that usually? I might be completely wrong but one thing I've noticed is that A&G tracings are sometimes slightly more retruded than others'. I think it's to do with being put into centric relation for the records (including xrays) as opposed to a habitual bite. Has anyone else noticed that? Or do all surgeons do a wax bite for xrays at the pre-surgical consult?

And it's a tough call. I'm in a somewhat similar boat. It's great you have a non-surgical option but it really comes down to what your main concern is and if ortho alone can correct it.

[PloskoPlus]

Correct the bite.

Congratulations.  I recently contacted Gunson about revision jaw surgery half-hoping that I will be turned down.  I was told that I am definitely a surgery case.  FWIW, my bite is perfect.

[kjohnt]

So he recommended no surgery even though the tracing clearly shows ccw rotation bimax advancement an a geioplasty?

Also does anybody have a link to a guide or happen to know what all of the numbers mean?

[Lurker25]

Also does anybody have a link to a guide or happen to know what all of the numbers mean?

Start at slide #8: http://www.slideshare.net/meghdubi/steiner-analysis-48319042

[strongjawman]

Good stuff ^

What was his reason for advising against surgery OP?

[sushilover2]

One is that I currently have custom jaw/chin implants in, which are working "ok" but are more of a camouflage approach than treatment for the underlying issue. He just thinks that going all out and doing the braces/surgery, in the end, the result will be a difference of "sunrise and sunset" more than "night and day".

I probably should have asked Dr. Gunson when I had the chance, but according to the CTP, what does it look like the procedures entail? Is this just straight lower/upper jaw advancement or is there CCW and impaction as well? Would this approach elongate my midface or shorten it? It's currently pretty long.

[sushilover2]

Bump

[sushilover2]

Bumping again.

[kjohnt]

This shows CCW rotation by posterior maxillary downgraft.  So the back of your maxilla comes down - no impaction.  See the red part?  That's the result.  The back of your maxilla and your molars move down and forward.  The pivot point is right behind your nose near the number 13 so no advancement there, but upper incisors rotate such that your upper lip will have more support behind it.  Most of the forward movement realized from the CCW rotation is at the chin, and then a genioplasty (small chunk moved forward at chin) helps project it even further.

The vertical length of your face will not change in this scenario.

[kjohnt]

Start at slide #8: http://www.slideshare.net/meghdubi/steiner-analysis-48319042

I know the analyses and points/lines thereof, but what do these numbers mean on the CTP?

[sushilover2]

This shows CCW rotation by posterior maxillary downgraft.  So the back of your maxilla comes down - no impaction.  See the red part?  That's the result.  The back of your maxilla and your molars move down and forward.  The pivot point is right behind your nose near the number 13 so no advancement there, but upper incisors rotate such that your upper lip will have more support behind it.  Most of the forward movement realized from the CCW rotation is at the chin, and then a genioplasty (small chunk moved forward at chin) helps project it even further.

The vertical length of your face will not change in this scenario.

Interesting. I thought CCW always results in a shorter and wider face....

Based on the ceph, can you see this having a major aesthetic benefit?

[Dharma]

Hmmmm.  There are many ways of going about cephalometric analysis. If you have access to a university library or VPN, I would start digging into the literature if I were you--there's a lot too it. Most importantly, your provider should be able to go over this at whatever detail you desire.   

As CCW has been mentioned, here's a free article online about CCW that also explores cephalometrics a great deal. 

https://mail.google.com/_/scs/mail-static/_/js/k=gmail.main.en.cyIFDuqk_Yo.O/m=m_i,t,it/am=PiMeCZj_e38wrjMAaKWPVJj3_vPdkvKzyz3-f2cCROpVwP_N_h_A_8FetIUC/rt=h/d=1/rs=AHGWq9C_yfU-teE3cz5sV3XTnrKiDmNBBg