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Surgical Plan

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SV123:
Hi,


Just wanted people's opinions on this surgical plan that I have been given.




I am getting around 4.3mm LF1 with 13mm of total advancement. I have minor case of SFS so am getting anterior down grafting, but more posterior down grafting alongside it so it would be an overall CCWr.

SV123:
The surgeon told me that there is a risk of a posterior gummy smile forming for my case and that I would need another surgery (I believe a soft tissue surgery) to correct. How much of a aesthetic detriment would this be? At this stage I have only minor teeth show when smiling.

kavan:
I think it has to do with the 'sacrifice' (or trade-off) someone with short face and recession needs to make to have the CCW-r posterior down graft  in order to maximize the advancement of the lower jaw. So, sounds like the trade off  posterior part of the down graft will be more gum show in back. The soft tissue surgery would involve removing gum tissue. That would tend to expose the roots of the teeth. Not sure but maybe they put some bonding material over the exposed roots to protect them. Anyway, the surgeon is suggesting gum removal to expose more teeth and suggesting it to OFFSET the aesthetic detriment of too much posterior gum show.

GJ:
Maybe you should get less CCW rotation so you don't have to have your gums removed?

Probably just a little less rotation in the jaw and moving that to the chin would rule out the need to remove your gums (not a good idea). It sounds like a second opinion is in order. Ask another surgeon about this, and they should also be able to tell you if you'll have a posterior gummy smile or not. Even if you go with the current plan and develop a posterior gummy smile - that's probably better than removing your gums. Gum issues are a can of worms that you don't want to open.

SV123:

--- Quote from: kavan on December 09, 2023, 03:29:21 PM ---I think it has to do with the 'sacrifice' (or trade-off) someone with short face and recession needs to make to have the CCW-r posterior down graft  in order to maximize the advancement of the lower jaw. So, sounds like the trade off  posterior part of the down graft will be more gum show in back. The soft tissue surgery would involve removing gum tissue. That would tend to expose the roots of the teeth. Not sure but maybe they put some bonding material over the exposed roots to protect them. Anyway, the surgeon is suggesting gum removal to expose more teeth and suggesting it to OFFSET the aesthetic detriment of too much posterior gum show.

--- End quote ---

Yes I understand this. In your opinion, would having more posterior gumshow be worth it given the maximum advancement of the mandible that CCWr allows? I am not sure if my smile would even worsen with the gum show as at the moment I barely have any teeth show so my smile is already pretty horrendous to be honest.

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