General Category > Functional Surgery Questions

Class two surgery or genio+ryno?

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GJ:
Ideal candidate...that is severe class 2.

You need advancement and CCW rotation.

Frastolo:
Thank you, let's wait the first appointment with the surgeon...he is a big name in my country after that i also have scheduled a check with Raffaini.

kavan:
Although I can't tell you for sure, you might be more of a candidate for the conventional approach which involves the braces before hand rather than the Surgery First method. Of course, being in EUROPE, even though your selected doctor doing the SF approach would be different, to the best of my knowledge, the candidacy for it does not differ a whole lot amoung the doctors who do the SF method.


From one of Alfaro's paper's regarding candidates for the Surgery First method:

http://www.institutomaxilofacial.com/wp-content/uploads/2016/05/Surgery-What-have-we.pdf

[There is a restriction of the SF method to those not needing too much pre-surgical alignment
and decompensation. [In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered.]


[[Despite the evident advantages of an SF approach, it
is unquestionable that careful patient selection, detailed
treatment planning, and constant communication between
the surgeon and the orthodontist are absolutely
indispensable.5 According to the authors’ protocol, patients
with TMJ symptoms or uncontrolled periodontal
disease are automatically excluded from an SF approach
based on an unstable postoperative occlusion or demanding
orthodontic movements, respectively. Regarding
the type of dentofacial anomaly, Liou et al8,10
restricted their indications to cases that did not need
too much presurgical orthodontic alignment and
decompensation; in other words, cases with well
aligned to mildly crowded anterior teeth, flat to mild
curve of Spee, and normal to mildly proclined or
retroclined incisors. In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered. Moreover,
cases requiring SARPE to achieve an adequate
transverse maxillary dimension or severe asymmetries
with 3D dental compensations are currently excluded
from the SF protocol. In the authors’ opinion, these
scenarios seem to be too complex and inaccurate to
anticipate the final occlusion accurately. Moreover,
3D dental compensations can significantly impair
immediate postsurgical stability. The authors prefer
a conventional approach for cases managed by an
orthodontist with limited experience in orthognathic
surgery. Although the current exclusion criteria may
seem rather extensive, the authors expect to gradually
broaden the indications for the SF approach as their
experience increases and current limitations become
reasonably controlled.]

Frastolo:

--- Quote from: kavan on October 29, 2017, 09:56:10 AM ---Although I can't tell you for sure, you might be more of a candidate for the conventional approach which involves the braces before hand rather than the Surgery First method. Of course, being in EUROPE, even though your selected doctor doing the SF approach would be different, to the best of my knowledge, the candidacy for it does not differ a whole lot amoung the doctors who do the SF method.


From one of Alfaro's paper's regarding candidates for the Surgery First method:

http://www.institutomaxilofacial.com/wp-content/uploads/2016/05/Surgery-What-have-we.pdf

[There is a restriction of the SF method to those not needing too much pre-surgical alignment
and decompensation. [In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered.]


[[Despite the evident advantages of an SF approach, it
is unquestionable that careful patient selection, detailed
treatment planning, and constant communication between
the surgeon and the orthodontist are absolutely
indispensable.5 According to the authors’ protocol, patients
with TMJ symptoms or uncontrolled periodontal
disease are automatically excluded from an SF approach
based on an unstable postoperative occlusion or demanding
orthodontic movements, respectively. Regarding
the type of dentofacial anomaly, Liou et al8,10
restricted their indications to cases that did not need
too much presurgical orthodontic alignment and
decompensation; in other words, cases with well
aligned to mildly crowded anterior teeth, flat to mild
curve of Spee, and normal to mildly proclined or
retroclined incisors. In agreement with Liou et al, the
present protocol excludes patients with severe
crowding requiring extractions and cases of Class II
Division 2 malocclusion with overbite, that is, cases in
which the curve of Spee is severely altered. Moreover,
cases requiring SARPE to achieve an adequate
transverse maxillary dimension or severe asymmetries
with 3D dental compensations are currently excluded
from the SF protocol. In the authors’ opinion, these
scenarios seem to be too complex and inaccurate to
anticipate the final occlusion accurately. Moreover,
3D dental compensations can significantly impair
immediate postsurgical stability. The authors prefer
a conventional approach for cases managed by an
orthodontist with limited experience in orthognathic
surgery. Although the current exclusion criteria may
seem rather extensive, the authors expect to gradually
broaden the indications for the SF approach as their
experience increases and current limitations become
reasonably controlled.]

--- End quote ---

The extractions that you are speaking about are on the upper jaw? Every dentist told me to extract them but i think that it's only a way to provide an ulterior camufflage...

XXRyanXXL:
I agree with the opinions rendered here, CCW rotation and advancement. Your inability to wait is of no concern to any surgeon you see, you must be fully decompensated as it gives room for the surgeon to make the movements necessary and provide long term stability of the class II surgical correction.  Many surgeons dislike surgery first approach. I anticipate you will have a difficult time isolating those surgeons. The braces, also, provide rigid fixation after surgery, many surgeons prefer you be in braces and not arch bars, as these will tear up the gums and also straighten the teeth prior to surgery.

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