Class 2 Division 2 Help

[shnk]

Hey guys my ortho recommended i get a 7mm lower jaw advancement 2 years into braces treatment. I have no idea what to do. I've always been self conscious about my side profile as it doesn't look very nice in my opinion. What would give me the best functional and aesthetic results? I do have some self esteem issues. I dont think im good looking at all. Just a straight advancement of 7mm on my lower jaw? Do i have a case for upper and lower jaw surgery? I do seem like i have a skeletal discrepancy and my reclined upper incisors do feel like they set my lower jaw back a bit. I have also been told by other orthos that i do not need surgery to achieve a perfect bite but my side profile wouldn't change. I would need extractions on my lower jaw to create an overbite if i wanted surgery. Will this change my frontal appearance? I already have a very narrow jaw. Not sure who is right. I just need your opinions.

Front and side:
http://imgur.com/a/SibSq

Xray:
http://imgur.com/a/pTg6B

[Lazlo]

Hey guys my ortho recommended i get a 7mm lower jaw advancement 2 years into braces treatment. I have no idea what to do. I've always been self conscious about my side profile as it doesn't look very nice in my opinion. What would give me the best functional and aesthetic results? I do have some self esteem issues. I dont think im good looking at all. Just a straight advancement of 7mm on my lower jaw? Do i have a case for upper and lower jaw surgery? I do seem like i have a skeletal discrepancy and my reclined upper incisors do feel like they set my lower jaw back a bit. I have also been told by other orthos that i do not need surgery to achieve a perfect bite but my side profile wouldn't change. I would need extractions on my lower jaw to create an overbite if i wanted surgery. Will this change my frontal appearance? I already have a very narrow jaw. Not sure who is right. I just need your opinions.

Front and side:
http://imgur.com/a/SibSq

Xray:
http://imgur.com/a/pTg6B

Honestly you look pretty good. You're handsome for sure. I wouldn't go for surgery. And don't get all this overbite to do surgery bulls**t. DON'T GET EXTRACTIONS NO MATTER WHAT. End of story.

[shnk]

Honestly you look pretty good. You're handsome for sure. I wouldn't go for surgery. And don't get all this overbite to do surgery bulls**t. DON'T GET EXTRACTIONS NO MATTER WHAT. End of story.

Thanks man.. i never really liked the idea of surgery. Maybe i should gain some confidence and hit the gym instead? One thing that does worry me tho is the clicking in my jaw. I have to jut my jaw forward to open it fully.

[CCW]

CCW bimax, no extractions or genio.

[Dean_il_greco]

I would suggest a counterclockwise rotation, and a double jaw surgery, with some minimum maxillary advancement and substantial mandibular advancement.
Your profile is your weakness. En face, you look decent, even though your jawline is weak.
Personally, I would go for it, but it's your decision and your face.

[ditterbo]

Ehhh we don't know if your nose is humpback or not.  If it is / you don't like it for it's heft, then bimax looks even more obvious a solution to me. Don't do rhinoplasties if you can avoid it with a one-two punch bimax surgery.  You'll atleast turn more handsome / decent without that massively retruded jaw.  You've already got a decently forward looking jawline (distance from pogonion to neck) before even getting bimax.

[shnk]

CCW bimax, no extractions or genio.

I would suggest a counterclockwise rotation, and a double jaw surgery, with some minimum maxillary advancement and substantial mandibular advancement.
Your profile is your weakness. En face, you look decent, even though your jawline is weak.
Personally, I would go for it, but it's your decision and your face.

Do i need bimax? Will linear advancement just on the lower jaw give me a less optimal aesthetic outcome? Make my face longer? Also i dont have a gummy smile at all so would this mess up my smile? I have the perfect amount teeth show so i dont want to mess that up by messing with my upper jaw.

Ehhh we don't know if your nose is humpback or not.  If it is / you don't like it for it's heft, then bimax looks even more obvious a solution to me. Don't do rhinoplasties if you can avoid it with a one-two punch bimax surgery.  You've got a similar facial setup as me, so I'm going to project a little bit here, but my guess is you can't quite put your finger on what you don't like about your looks.  It comes down to the close-set eyes and narrow/delicate overall facial structure, aka rather having a head transplant.  But yeah you'll atleast turn more handsome / decent without that massively retruded jaw. I could be totally wrong. You've already got a decently forward looking jawline (distance from pogonion to neck) before even getting bimax.

Got a big slightly curved nose but it doesnt bother me that much. Do you suggest CCW bimax aswell? I didn't know i had close set eyes. My jaw is very narrow. I think it just appears like this because of the picture.

[Dean_il_greco]

Do i need bimax? Will linear advancement just on the lower jaw give me a less optimal aesthetic outcome? Make my face longer? Also i dont have a gummy smile at all so would this mess up my smile? I have the perfect amount teeth show so i dont want to mess that up by messing with my upper jaw.

It depends. When you smile, do you display a few mms (1-2) of your gummies?
If so, a 2-3-mm maxillary advancement and a 2-3mm anterior maxillary impaction should be enough.
If not, then, you are probably right. The impaction may affect your upper teeth show, which means the lower only advancement is recommended.

Ps. Take what others say about your facial features with a pinch of salt. Your eye area is just fine. Ignore c*nts who won't take anything less than a male-model face.

[shnk]

It depends. When you smile, do you display a few mms (1-2) of your gummies?
If so, a 2-3-mm maxillary advancement and a 2-3mm anterior maxillary impaction should be enough.
If not, then, you are probably right. The impaction may affect your upper teeth show, which means the lower only advancement is recommended.

Ps. Take what others say about your facial features with a pinch of salt. Your eye area is just fine. Ignore c*nts who won't take anything less than a male-model face.

My upper teeth seems to be lined up perfectly with my upper lip. Maybe 1mm show of gummies? Not sure. Should i post a picture? And thanks man. I'll try not to obsess over my looks but it happens sometimes.

[Dean_il_greco]

My upper teeth seems to be lined up perfectly with my upper lip. Maybe 1mm show of gummies? Not sure. Should i post a picture? And thanks man. I'll try not to obsess over my looks but it happens sometimes.

Actually, yes, a photo with your smiling would be helpful.

It's 2017. I get it. If we don't look like Nick Bateman, we are all doomed. LOL.
Face-wise, en face you look average. Your profile is a little worse.
A well-planned and -executed ortho would definitely improve your face aesthetically, but you'd not end up looking like Mr. Bateman.
It's completely different trying to look the best you can and trying to look like someone else.
Cheers!

[tdawg]

I personally wouldnt do jaw surgery just for profile aesthetics(unless there was a severe abnormality). How often to judge somebody's attractiveness by their profile? The girl I am crushing on right now, I have no idea what she looks like from the side and I dont really care. People tend not to notice as long as everything is normalish and your standard mild to early moderate class 2 falls into that imo. From the front(which is what matters) you look normal. All that being said it is your face not mine and the fact that you even made this thread indicates it bothers you. You need to do what will bring you peace. Just know that there are risks to the surgery. Do your research and evaluate the risks + cost in money and recovery time vs the potential benefit. Good luck in whatever you decide.

[Dean_il_greco]

I personally wouldnt do jaw surgery just for profile aesthetics(unless there was a severe abnormality). How often to judge somebody's attractiveness by their profile? The girl I am crushing on right now, I have no idea what she looks like from the side and I dont really care. People tend not to notice as long as everything is normalish and your standard mild to early moderate class 2 falls into that imo. From the front(which is what matters) you look normal. All that being said it is your face not mine and the fact that you even made this thread indicates it bothers you. You need to do what will bring you peace.

Well, firstly, a photo can be misleading. We all know that.
Secondly, the lower jaw advancement wouldn't just improve his profile. His jawline is also weak and that's partly because of his recessed mandible.
An 8-10mm advancement would substantially improve his jawline, hands down.
However, as you correctly mentioned, jaw surgery is yet another surgery, which means there are risks involved and you can never predict highly accurately the outcome if it.

[kavan]

Your reclined upper incisors are part of the problem as they act as a 'clasp' to push your mandible backwards. So, they would have to be pushed forward (braces) as part of bringing lower jaw forward. The lower teeth would have to be pushed backwards to maximize the lower jaw advancement and also to MINIMIZE the very deep chin sulcus you have which would tend to look even deeper subsequent to chin advancement that would probably go along with advancing the lower jaw. Since there is NOT enough room to push the lower teeth backwards, THAT is why they need to pluck a pre-molar (one from each side) to maximize the lower advancement and minimize the depth of the deep chin sulcus when they also advance chin. Most likely bimax as opposed to single jaw simply because it's very common to have to make upper jaw adjustments to accommodate displacement of the lower jaw.

I could be in error due to your MARKING UP your ceph in places where I'm looking for the A and B points but it looks like your ANB angle is approx 8 degrees which is 2X the norm and marker for retrusive mandible which 'jives' with your feeling you have a skeletal descrepency and also seeing the soft tissue profile of your lower face is much more backwards than you would like to see it.

You don't need surgery to 'get the bite right'. But you might instead want it to balance the jaws as to correct the skeletal deficiency. Bringing a narrow lower face more forward in this process will make it look less narrow because you're bringing it forward and well enough to compensate for plucking the pre-molars in this process. Pre-molar plucking is bad when they do it JUST TO get the bite right because it's often done to the upper jaw to push the upper teeth backwards to accommodate a retrusive lower jaw. So, it depends on why they are plucking them.

Features:

Eyes:

Except for some minor ptosis (or maybe it's just micro blinking for the photo?), your eyes are good. Nice horizontally 'long' palpebral fissue (distance from inner to outer canthus) and distance of'one eye' between the eyes.

Ears: Would look better pinned back. Sticking out exaggerates any narrowness to face.

Nose: Well, I can see you don't want people to comment on that (blacking it out and cutting the ceph. But just to say, that's what people in 'real life' will notice first on your face. But it would look relatively less 'out there' when the mandible and chin are brought forward.

[shnk]

Well, firstly, a photo can be misleading. We all know that.
Secondly, the lower jaw advancement wouldn't just improve his profile. His jawline is also weak and that's partly because of his recessed mandible.
An 8-10mm advancement would substantially improve his jawline, hands down.
However, as you correctly mentioned, jaw surgery is yet another surgery, which means there are risks involved and you can never predict highly accurately the outcome if it.

imgur.com/a/Cv2u0

I personally wouldnt do jaw surgery just for profile aesthetics(unless there was a severe abnormality). How often to judge somebody's attractiveness by their profile? The girl I am crushing on right now, I have no idea what she looks like from the side and I dont really care. People tend not to notice as long as everything is normalish and your standard mild to early moderate class 2 falls into that imo. From the front(which is what matters) you look normal. All that being said it is your face not mine and the fact that you even made this thread indicates it bothers you. You need to do what will bring you peace. Just know that there are risks to the surgery. Do your research and evaluate the risks + cost in money and recovery time vs the potential benefit. Good luck in whatever you decide.

Yeah thats true. I'm still looking around before i make a decision. Thank you.

Your reclined upper incisors are part of the problem as they act as a 'clasp' to push your mandible backwards. So, they would have to be pushed forward (braces) as part of bringing lower jaw forward. The lower teeth would have to be pushed backwards to maximize the lower jaw advancement and also to MINIMIZE the very deep chin sulcus you have which would tend to look even deeper subsequent to chin advancement that would probably go along with advancing the lower jaw. Since there is NOT enough room to push the lower teeth backwards, THAT is why they need to pluck a pre-molar (one from each side) to maximize the lower advancement and minimize the depth of the deep chin sulcus when they also advance chin. Most likely bimax as opposed to single jaw simply because it's very common to have to make upper jaw adjustments to accommodate displacement of the lower jaw.

I could be in error due to your MARKING UP your ceph in places where I'm looking for the A and B points but it looks like your ANB angle is approx 8 degrees which is 2X the norm and marker for retrusive mandible which 'jives' with your feeling you have a skeletal descrepency and also seeing the soft tissue profile of your lower face is much more backwards than you would like to see it.

You don't need surgery to 'get the bite right'. But you might instead want it to balance the jaws as to correct the skeletal deficiency. Bringing a narrow lower face more forward in this process will make it look less narrow because you're bringing it forward and well enough to compensate for plucking the pre-molars in this process. Pre-molar plucking is bad when they do it JUST TO get the bite right because it's often done to the upper jaw to push the upper teeth backwards to accommodate a retrusive lower jaw. So, it depends on why they are plucking them.

Features:

Eyes:

Except for some minor ptosis (or maybe it's just micro blinking for the photo?), your eyes are good. Nice horizontally 'long' palpebral fissue (distance from inner to outer canthus) and distance of'one eye' between the eyes.

Ears: Would look better pinned back. Sticking out exaggerates any narrowness to face.

Nose: Well, I can see you don't want people to comment on that (blacking it out and cutting the ceph. But just to say, that's what people in 'real life' will notice first on your face. But it would look relatively less 'out there' when the mandible and chin are brought forward.

Wouldn't getting a ccw rotation eliminate the need to get extractions? Do you recommend i get a ccw rotation aswell because of my steep angle? Would a linear advancement look bad? And you also recommend a chin advancement?? Thank you for your criticism.

[kavan]

imgur.com/a/Cv2u0

Yeah thats true. I'm still looking around before i make a decision. Thank you.


Wouldn't getting a ccw rotation eliminate the need to get extractions? Do you recommend i get a ccw rotation aswell because of my steep angle? Would a linear advancement look bad? And you also recommend a chin advancement?? Thank you for your criticism.

I'm not so sure about CCW in your case. Keep in mind that a rotation of the maxilla is with the aim of getting the occlusal plane closer to the horizontal (but not totally flat). In turn, ANS-PNS (maxilla) also gets closer to the horizont.

Here is example:

The OP is taking on a big downward diagonal (negative slope). So is ANS-PNS of maxilla. The rotation is CCW and both the OP and ANS-PNS are more aligned with the horizont.

In this example:

The OP is too close to the horizont. ANS-PNS is taking on more of an upward diagonal (positive slope). The rotation is CLOCKWISE.

In your case, ANS-PNS is aligned away from the horizont via more of an upward diagonal. So, it would be clockwise rotation that would align it closer. Not CCW--OR something where it's just left to 'linear' advancement with little rotation. So, I don't think it's a question of CCW in your case. But check with your maxfax.

It looks to me like they probably want to MINIMIZE moving the maxilla forward for the above reason where your only option is to move the lower teeth backwards and pluck out the premolars in X-change for MAXIMIZING lower jaw and chin advancement.