SARPE + Bimax Questions (X-Rays provided)

[beyondconfusedtbh]

Hi all,

I'll be getting SARPE pretty soon which is all well and good, but i'm concerned about formulating a plan for the bimax.
I'd love to get some of your opinions on this.

Up until now I thought the best thing for me would be some sort of maxillary advancement plus posterior downgrafting to achieve CCW.

Is this a good plan? I've just been reading up on a few cases on here & found some incredibly helpful material as usual, so i'll put it below just for reference. Thanks everyone

It could be that the steep occlusal plane is what's making your face look longish and the downgrafted posterior maxilla will actually make your face appear shorter since the CCW rotation would be achieved, because what you see is the front of your face, and the convex profile is part of what gives people "long faces."  Also note that as I mentioned in my previous post, maxillary advancement will add to tooth show (gumminess) because you are stretching the soft tissues, so impaction would be performed to offset this.

If you think about a face from profile view and create three vertical sections: back, middle and front... the middle would then be lengthened but the front would be shortened... like a maxillary teeter-totter.  And when you talk about a long face, you're talking about the front.

This is how I understand it anyway.  

[kavan]

What's going on in your x ray...are those white globs impacted teeth?

[beyondconfusedtbh]

sadly yeah. the plan is to remove one of the wisdom teeth so that there's an even amount.

I know my upper jaw is completely screwed up but I do have a somewhat steep occlusal plane right? Ignoring the fact that the teeth are lower at the back of my maxilla on the profile.

[beyondconfusedtbh]

Wow is my xray that bad, f**k

[Fix_your_bite]

From what I understand, if your head is not tilted up in your profile xrays, then your occlusal plane would be flat and you mandibular plane, steep. If you did CCW, your occlusal plane would be going up, which would be weird. I am not a pro tho.

Whar are your reasons to getting bimax?

[jawguy123]

I know my upper jaw is completely screwed up but I do have a somewhat steep occlusal plane right? Ignoring the fact that the teeth are lower at the back of my maxilla on the profile.

The steepness of the occlusal plane is literally defined as how much higher (or lower) the the teeth at the back of your maxilla are than the teeth at the front. "Ignoring the fact that the teeth are lower at the back of my maxilla" would be like asking "Does my jaw lack forward growth? Please ignore how far forward my jaw is."

Also, if that x-ray is natural head posture, your occlusal plane is anything but steep. Why do you think you need CCW (other than that everyone throws around the terms like it's some godly solution to all cephalometric imbalances)? If anything, you'd need CW (assuming NHP).

[PloskoPlus]

Your profile looks normal.

[beyondconfusedtbh]

Yeah my heads tilted. Thats just how they had me rest my head on the machine. I have the classic convex profile going on so I guess hopefully the angle of the occlusal plane on the x-rays is where i'll be at.

My bad, certainly should've thought about that and put it in my original post.

Now with that out of the way, anyone want to give advice on my current plan of action?

[beyondconfusedtbh]

oh yeah, about this posterior downgrafting thing.

read that its kind of like tilting your head back on another post. 'kind of' does not mean 'the same as' in this case, does it?

[Fix_your_bite]

What do you want to achieve? Why do you want bimax? Weren't you considering lf3? With just the xrays man, your profile seems normal to me.

[april]

If you were that tilted in the scan, you're going to need to post a photo in your NHP... none of these members can really help you otherwise.

[beyondconfusedtbh]

What do you want to achieve? Why do you want bimax? Weren't you considering lf3? With just the xrays man, your profile seems normal to me.

I guess my main goal is to compensate for a lack of development during my teens. More specifically, a shorter midface & more forward growth. Thanks though, although like i said I'm fairly certain my head was tilted a bit. Thats just how they had me sat for the CT.

Regarding MLFIII, I have a couple threads on that but i'll sum it up real quick (TLDR):

Face grew down rather than out (to some degree at least, maybe not quite as severe as other cases) resulting in hypoplasia of mid-face. Together the lack of forward growth of my jaws coupled with the lack of development of orbital area etc look 'okay' on an x-ray I guess, but thats just because they're both lacking.

And perhaps most glaringly of all, it's still not taking into account the fact that my head is tilted (my fault but if you rotate the profile slightly you'll understand).

Thanks everyone for the help so far, sorry for causing this confusion

[kavan]

Your jaw is rather robust and makes about a 20 degree angle from the horizont. So it is NOT 'too steep'. Would not be considered steep at all.


I don't see aesthetic need for double jaw advancement. Your face looks pretty forward. You don't have 'convex' profile.

I would be more concerned about increasing the risk of a fracture when getting the wisdom (impacted lower) teeth removed during the same surgery as a BSSO.

[beyondconfusedtbh]

Your jaw is rather robust and makes about a 20 degree angle from the horizont. So it is NOT 'too steep'. Would not be considered steep at all.

Heads tilted back :/

It's possible I walk around like this but I have forward head posture or whatever its called, been working on bad posture habits from years of sitting etc I have all the usual bad habits.

Don't worry about the impacted lowers, I think the Dr. was considering removing them during the SARPE surgery.

[kavan]

Heads tilted back :/

It's possible I walk around like this but I have forward head posture or whatever its called, been working on bad posture habits from years of sitting etc I have all the usual bad habits.

Don't worry about the impacted lowers, I think the Dr. was considering removing them during the SARPE surgery.

Head tilt here is not significant. Salient point is your mandibular plane angle is NOT steep.


I understand that you are confused about things. But when speaking of a 'plan' in the same mention where you are getting surgery, what precludes you from clarifying what is actually PLANNED for the surgery you are getting?

If the doctor will be removing the impacted lower wisdom teeth during a SARPE surgery (which is fine), why did you toss a BSSO and everything else into the mix?

Establish WHAT the surgical plan actually is for the surgery you are booked for.