lurking truecel
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Bimax is the most talked about lookmax method on this forum and elsewhere when it comes to the more invasive surgery options there are to pick from.
but many people still don't know some basics which should be understood before doing the surgery.
DECOMP
lets first look a decmomp, thats when you put the teeth in the position more aligned to your true. skeletal structure rather then having them either camouflaged by other ortho or your body itself adapted a bite that makes the bite works but isnt compensated and not true to your skeletal structure
down below is 2 example of protruded teeth that isnt aligned with the bone and then 3 others which has decomped teeth, or teeth true to their bone structure making it fair for bimax. hope you understand the concept
What happens if you dont decomp teeth properly, yea then you loose out on some good advancement of the actual bone and just push the protruded teeth forward like below. ( but this guy prob couldnt decomp more because of space)
Optimum the teeth should be straight with bone like below, many cant decomp to that because of crowded teeth and to small bone
EXTRACTION AND DECOMP
Many people hate on extraction for bimax but for asians with their often protruded faces it can look better, this is a example of a woman who did just that. This def made the end result better atleast from the side view.
She did just what did pic also shows, a protruded look to a more straight look with properly decomped teeth with makes the lips less protruded and it looks more harmonious
The most important risk factor for relapse is CONDYLES
When it comes to bimax and how much advancement you can get, apart from the bone itself you also need to take inconsideration the cut and tmj.
and esp the condyles as shown below, more anteriorly projected condyles make it more reliable to make big bssos without tmjs risks, obv its kinda unfair since those with most risk often need the biggest advancement since they often have posteriorly projected condyles
BSSO CUT and its impact on stability and relapse
another thing that makes relapse less likely or tmj issues and overall stability is to make the cut more anterior( more further forward on the mandible body)
why is because of simple physics, less bone overhang and less loose bone so to speech
as seen below this cut is kinda far back, making it more insatiable, obv the ramus osterotomies that some people suggest to lengthen the ramus is the most unstable and risky.
this is a more safe cut since it doesnt put pressure on the condyles and also less on the overall plates too since its a smaller part of the mandible. but obv its less aesthetic. btw this was the reason why pag had so many botches, because his cuts were to far back making it unstable and the plates failed.
MOVEMENTS - three diffrent ones apart from forward only( CCW; IMPACTION, DOWNGRAFT)
Lets look at clear visual representation of what people mean when they talk about impaction, downgraft and ccw rotation.
lets start with the most common ccw rotation, below you can see the pre op green and the post op on top. as you can see the mandible and chin was rotated upwards. there are impaction in this case too. which is usually the case for ccw cases
lets now show a case that only got impacted with no rotation at all making the surgery very simple apparenlty, it was from bell.
And lastly a case that was down graft, this famous one
GENIO - lets look at the diffrent ones
when it comes to genios, every genio is not created equal. a normal sliding genio plasty is usually very low cut and risk mentolabial folding as a consequence if you advance too much.
below you can see a normal genio cut planned by ramieri
vs a more based genioglossus cut which extends more up on the mentolabial area reducing the risk of a mentolabial fold
ideally you want a genioglossus advancement that also raises the muscle in the submental region making it more aesthetic
this is another example of a more high cut genio then the standard one, and also a comparison with the standard sliding genio
HOW FAR SHOULD YOU ADVANCE?
firstly there are some different lines that are used as reference for bimax as we can see below, some surgeons have had lines that has been a lot more forward like coceancigs line, the normal line is the barcelona line.
The general line that works the best in my opinion is too have the incisors slightly forward of the nasion in the ct scan, this is more like the barcelona line
but these lines are very case specific, and sometimes you can go more and some you might go less depending on other soft tissue related issues or for optimization.
Here are some good result from bimax i wanted to share aswell as i havent seen them here:
lets end it with some horrendous ones when you go to much forward
but many people still don't know some basics which should be understood before doing the surgery.
DECOMP
lets first look a decmomp, thats when you put the teeth in the position more aligned to your true. skeletal structure rather then having them either camouflaged by other ortho or your body itself adapted a bite that makes the bite works but isnt compensated and not true to your skeletal structure
down below is 2 example of protruded teeth that isnt aligned with the bone and then 3 others which has decomped teeth, or teeth true to their bone structure making it fair for bimax. hope you understand the concept
What happens if you dont decomp teeth properly, yea then you loose out on some good advancement of the actual bone and just push the protruded teeth forward like below. ( but this guy prob couldnt decomp more because of space)
Optimum the teeth should be straight with bone like below, many cant decomp to that because of crowded teeth and to small bone
EXTRACTION AND DECOMP
Many people hate on extraction for bimax but for asians with their often protruded faces it can look better, this is a example of a woman who did just that. This def made the end result better atleast from the side view.
She did just what did pic also shows, a protruded look to a more straight look with properly decomped teeth with makes the lips less protruded and it looks more harmonious
The most important risk factor for relapse is CONDYLES
When it comes to bimax and how much advancement you can get, apart from the bone itself you also need to take inconsideration the cut and tmj.
and esp the condyles as shown below, more anteriorly projected condyles make it more reliable to make big bssos without tmjs risks, obv its kinda unfair since those with most risk often need the biggest advancement since they often have posteriorly projected condyles
BSSO CUT and its impact on stability and relapse
another thing that makes relapse less likely or tmj issues and overall stability is to make the cut more anterior( more further forward on the mandible body)
why is because of simple physics, less bone overhang and less loose bone so to speech
as seen below this cut is kinda far back, making it more insatiable, obv the ramus osterotomies that some people suggest to lengthen the ramus is the most unstable and risky.
this is a more safe cut since it doesnt put pressure on the condyles and also less on the overall plates too since its a smaller part of the mandible. but obv its less aesthetic. btw this was the reason why pag had so many botches, because his cuts were to far back making it unstable and the plates failed.
MOVEMENTS - three diffrent ones apart from forward only( CCW; IMPACTION, DOWNGRAFT)
Lets look at clear visual representation of what people mean when they talk about impaction, downgraft and ccw rotation.
lets start with the most common ccw rotation, below you can see the pre op green and the post op on top. as you can see the mandible and chin was rotated upwards. there are impaction in this case too. which is usually the case for ccw cases
lets now show a case that only got impacted with no rotation at all making the surgery very simple apparenlty, it was from bell.
And lastly a case that was down graft, this famous one
GENIO - lets look at the diffrent ones
when it comes to genios, every genio is not created equal. a normal sliding genio plasty is usually very low cut and risk mentolabial folding as a consequence if you advance too much.
below you can see a normal genio cut planned by ramieri
vs a more based genioglossus cut which extends more up on the mentolabial area reducing the risk of a mentolabial fold
ideally you want a genioglossus advancement that also raises the muscle in the submental region making it more aesthetic
this is another example of a more high cut genio then the standard one, and also a comparison with the standard sliding genio
HOW FAR SHOULD YOU ADVANCE?
firstly there are some different lines that are used as reference for bimax as we can see below, some surgeons have had lines that has been a lot more forward like coceancigs line, the normal line is the barcelona line.
The general line that works the best in my opinion is too have the incisors slightly forward of the nasion in the ct scan, this is more like the barcelona line
but these lines are very case specific, and sometimes you can go more and some you might go less depending on other soft tissue related issues or for optimization.
Here are some good result from bimax i wanted to share aswell as i havent seen them here:
lets end it with some horrendous ones when you go to much forward
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