Jaw Surgery for Overbite

[Fix_your_bite]

Hi,

I started orthodontic treatment 4 months ago, which will lead to jaw surgery in about a year and 2 months. I am currently searching for a surgeon. I'm living in Quebec, Canada, so the surgery will be paid by the healthcare system and I don't have the money to do it elsewhere.
What I am looking for is advices on what should be done by the surgeon.

Pictures: https://imgur.com/a/XO2zqMK

This is my functionnal issue:

- Overbite of about 10-13 mm.

This is my aesthetic issues:
-Lips incompetency
-Weak Chin
-(small) jaw assymetry which I doubt I will bother.
-Steep mandibular plane

From what I read on the forum. I should start with a BSSO to fix my overbite. Coupled with a genioplasty to improve my lips incompetency and my weak chin. But my fear is that my mandibular plane is so steep that a BSSO alone will make my face longer. I think a counterclock-wise rotation of the maxillomandibular complexe will fix this issue, but what can be done about my upper jaw.

That's my principal question. I thought about an impaction of the front of my maxilla of about 2mm. I don't have much of a gummy smile, and I'm not a big fan of impaction (overimpaction is quite bad). If I get a slight impaction of the front of my maxilla, and the lower jaw corrected to the new angle, will it flatten my occlusal plane and give me a good aesthetic results? Or the impaction of my maxilla will be a bad move? I'm planned for a consultation with another surgeon in September where I hope I'll get my questions answered.

I already got a consultation with a local maxfax, and he told me I could get a BSSO + genio or he could impact a little bit of the maxilla + BSSO + genio, and it would flatten my mandibular plane because it would take longer for me to close my mouth. (it makes sense to me, I hope it is for you guys!)

This is what I would like to get as result (insert male model /s): https://i.imgur.com/fBqmUP2.jpg
I feel like I have the same pre-op profile as this guy, and he got a really good result. BSSO + genio + ??

Thank-you for your help.





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[PloskoPlus]

You have a big open bite. I don't see how it can be fixed without DJS.

[CCW]

You have a big open bite. I don't see how it can be fixed without DJS.

Yep, this is a textbook CCW MMA case. Since OP has an open bite and a very convex profile, the rotation needs to be done with posterior downgrafting. You don't have a significant gummy smile. If your surgeon says a 2mm impaction is enough to flatten your OP, he's lying because he can't do posterior downgrafting. The OP is flattened with posterior downgrafting and impaction is just used to correct tooth show. If you get a SJS and a genio, it won't improve your profile much. Most of the improvement will result from the genio.

[Fix_your_bite]

Thanks for your inputs guys, I appreciate it.

CCW, by CCW MMA, do you mean you would also advance the upper jaw?

[kavan]

Thanks for your inputs guys, I appreciate it.

CCW, by CCW MMA, do you mean you would also advance the upper jaw?

He's referring to the act of DISPLACING the upper jaw via a posterior downgraft for the counter clockwise rotation needed. Another displacement could be advancing it forward which is just better to do when it's also rotated.

[Fix_your_bite]

Update #1

I had an appointment with an oral surgeon last week. I will go with him for my surgery (still in about a year).

He told me he would do CCW with an anterior impaction of my maxilla (4mm up, 2.5mm forward) + BSSO matching my maxilla (12mm) + sliding genio. The numbers are rough estimate, the surgery plan will not be made until next year. He said I show 2.5 mm of gum, so the slight impaction combined the forward movement of the maxilla would be perfect for tooth show. I asked him about my lips incompetence, he said it would be corrected entirely.

He even noticed my slight jaw asymmetry, before I told him about it. He said he would rotate my lower jaw to the side about 1 degree. I don't really know what that means, but my asymmetry is purely aesthetic, so a jaw implant would work too.

I'm finaly confident with my journey for jaw surgery. Finaly having a surgeon is a relief. I trust both my ortho and my oral surgeon, and my ortho has been doing some good work. My teeth look super straight! I just hope the final result will reflect how confident I am.

Stay positive!