Alveolar ridge impaction/forward movement?

[nvrhrgin]

Hi, I’m interested in a specific and not largely exposed here or anywhere else topic of moving impaction or remodelling specifically alveolar bone.

My case is not very common here while my face looks long due to specifically philtrum area but not a nose area as usual. I think my upper maxilla is fine with high set cheekbones visible in 3/4 and small and straight nose shorter then average (45mm to tip and 50mm to base as tip is upturned) but my lower maxilla looks sunken with philtrum long enough to land the plane on (20mm) further more it’s totally straight neither concave nor convex. My midface ratio is still okay (1.05-1.07 in photos depends on tipping) as the midface overall (nose + philtrum) length is average.
That’s being said due to such coincidence: short nos + upturned tip + elongated philtrum it looks disharmonious and lack of proportion visually even more.
I suppose I have some more rare than usual downward growth with specifically lower maxilla being down grown and chin slightly recessed while lower jaw itself is ok (not great, a little but narrow with I guess slightly obtuse angle but still fine enough) and I guess recessed and kinda downgrown mandible is a consequence of my lower maxilla being downgrown too.

As the first and the most obvious solution here gonna be Lefort1 with CCWR or I guess Lefort 1 Impaction (not sure on this one tbh) ton solve the problem currently I’m interested if there are any alternatives?
I suppose it (remodelling, moving or impaction in less invasive then Lefort 1 way) could be possible as alveolar bone itself is the softest of all other bones in the skull and at least there are different protocols including its moving when treating overbite, underbite, overjet, etc. and I hope it might be possible to make some changes in case of splitting the midpalate sutures (my jaw isn’t that narrow but borderline acceptable with 41mm between last molars (6th teeth) so there is a room for the widening exist).


After some research I found minimum info on the topic and curious if there are users who were also investigating something similar and could give me some more pieces of info, mb some keywords to search for or at least the right direction? Currently I’m digging into the BAMP or TADS as well as face mask with bone anchorage and splitting the suture with mse or fme (which I doubt I could get in the nearest feature so seems like mse only avaliable option). Also, I’m not sure if any of these even valid for me as I’m in my mid 20s and I guess my bones could be to thick for any meaningful remodelings.

Tagging ppl whose post I found somehow connected to the topic before and whose accs still exists at least:
@noprogressno
@retard
@moze
@yorker12

 

[idkmanimao]

Hi, I’m interested in a specific and not largely exposed here or anywhere else topic of moving impaction or remodelling specifically alveolar bone.

My case is not very common here while my face looks long due to specifically philtrum area but not a nose area as usual. I think my upper maxilla is fine with high set cheekbones visible in 3/4 and small and straight nose shorter then average (45mm to tip and 50mm to base as tip is upturned) but my lower maxilla looks sunken with philtrum long enough to land the plane on (20mm) further more it’s totally straight neither concave nor convex. My midface ratio is still okay (1.05-1.07 in photos depends on tipping) as the midface overall (nose + philtrum) length is average.
That’s being said due to such coincidence: short nos + upturned tip + elongated philtrum it looks disharmonious and lack of proportion visually even more.
I suppose I have some more rare than usual downward growth with specifically lower maxilla being down grown and chin slightly recessed while lower jaw itself is ok (not great, a little but narrow with I guess slightly obtuse angle but still fine enough) and I guess recessed and kinda downgrown mandible is a consequence of my lower maxilla being downgrown too.

As the first and the most obvious solution here gonna be Lefort1 with CCWR or I guess Lefort 1 Impaction (not sure on this one tbh) ton solve the problem currently I’m interested if there are any alternatives?
I suppose it (remodelling, moving or impaction in less invasive then Lefort 1 way) could be possible as alveolar bone itself is the softest of all other bones in the skull and at least there are different protocols including its moving when treating overbite, underbite, overjet, etc. and I hope it might be possible to make some changes in case of splitting the midpalate sutures (my jaw isn’t that narrow but borderline acceptable with 41mm between last molars (6th teeth) so there is a room for the widening exist).


After some research I found minimum info on the topic and curious if there are users who were also investigating something similar and could give me some more pieces of info, mb some keywords to search for or at least the right direction? Currently I’m digging into the BAMP or TADS as well as face mask with bone anchorage and splitting the suture with mse or fme (which I doubt I could get in the nearest feature so seems like mse only avaliable option). Also, I’m not sure if any of these even valid for me as I’m in my mid 20s and I guess my bones could be to thick for any meaningful remodelings.

Tagging ppl whose post I found somehow connected to the topic before and whose accs still exists at least:
@noprogressno
@retard
@moze
@yorker12

"Why standard LeFort I (impaction/CCW) is the go-to​

• LeFort I impaction with counter-clockwise rotation (CCWR) is indeed the definitive surgical option. It physically raises the lower maxilla, shortens the philtrum, and brings the mandible/chin forward in tandem.
• It’s powerful because it corrects both skeletal and dental occlusion in one shot.
• Downsides: highly invasive, expensive, and usually requires braces or surgical orthodontics.

---

Alternatives / Less invasive approaches​

Here’s a breakdown of what’s documented outside LeFort I, especially in adults:

Alveolar remodeling approaches​

• Segmental osteotomies (Anterior Maxillary Osteotomy, AMO):
  Instead of moving the entire maxilla, just the alveolar segment (teeth-bearing bone) is repositioned. This can reduce dental show and philtrum length somewhat, but it doesn’t truly raise the skeletal maxilla. It’s less invasive than full LeFort I but more niche and usually done for orthodontic bite correction.
• Corticotomies + bone remodeling (PAOO / Wilckodontics):
  Uses microfractures of alveolar bone + bone grafting + orthodontics to accelerate movement. This is still tooth-centered, not really facial-structure changing, but it does show that alveolar bone can be manipulated in adults.

Orthopedic / orthodontic protocols​

• BAMP (Bone Anchored Maxillary Protraction):
  Uses TADs/plates in the infrazygomatic crest and mandible with elastics. Works great in growing patients; in adults, results are modest at best unless combined with corticotomy-assisted techniques.
• Face mask with skeletal anchorage:
  Again, much stronger in children/adolescents. In mid-20s, bone is already fused; the sutures don’t separate easily.
• MSE/FME (expansion):
  Miniscrew-assisted expansion can sometimes split the midpalatal suture in adults (especially <25). This changes transverse width, which indirectly alters vertical and sagittal balance, but it won’t directly shorten the philtrum.

Soft tissue–focused options​

• Lip lift:
  Directly shortens philtrum length by excising skin under the nose. Improves harmony when the philtrum is long relative to nose length. Doesn’t move bone, but sometimes gives ~80% of the visual improvement people are after.
• Dermal fillers / fat grafting to paranasal & upper maxilla:
  Can camouflage a “sunken lower maxilla” by creating forward projection under the nose and around the philtrum. Doesn’t address length, but changes depth perception.

---

Age-related limitations​

• At mid-20s, your midpalatal suture is likely fused, so MSE/FME works less predictably. Success depends on bone density and suture morphology — some young adults can still split it, others can’t.
• True skeletal impaction (shortening bone vertically) almost always requires orthognathic surgery past late adolescence.
• Remodeling techniques (PAOO, corticotomies) can enhance tooth/bite movement but won’t move your maxilla up like a LeFort I.

---

Keywords / research directions​

If you want to dig deeper, here are some keywords to look up:

• “Segmental anterior maxillary osteotomy”
• “LeFort I impaction vs anterior maxillary osteotomy”
• “Alveolar corticotomy adult orthodontics” / “PAOO”
• “Miniscrew assisted rapid palatal expansion adult” (MSE in adults)
• “Bone anchored maxillary protraction adults” (BAMP + corticotomy)
• “Upper lip lift philtrum reduction”
• “Paranasal augmentation with implants/fillers”

 

[nvrhrgin]

Man, thank you for opinion from ChatGPT ofc but I’m kinda waiting for responses from more experienced users with some examples, keywords, real cases, names of orthodontist or jaw surgeon, etc.

"Why standard LeFort I (impaction/CCW) is the go-to​

• LeFort I impaction with counter-clockwise rotation (CCWR) is indeed the definitive surgical option. It physically raises the lower maxilla, shortens the philtrum, and brings the mandible/chin forward in tandem.
• It’s powerful because it corrects both skeletal and dental occlusion in one shot.
• Downsides: highly invasive, expensive, and usually requires braces or surgical orthodontics.

---

Alternatives / Less invasive approaches​

Here’s a breakdown of what’s documented outside LeFort I, especially in adults:

Alveolar remodeling approaches​

• Segmental osteotomies (Anterior Maxillary Osteotomy, AMO):
  Instead of moving the entire maxilla, just the alveolar segment (teeth-bearing bone) is repositioned. This can reduce dental show and philtrum length somewhat, but it doesn’t truly raise the skeletal maxilla. It’s less invasive than full LeFort I but more niche and usually done for orthodontic bite correction.
• Corticotomies + bone remodeling (PAOO / Wilckodontics):
  Uses microfractures of alveolar bone + bone grafting + orthodontics to accelerate movement. This is still tooth-centered, not really facial-structure changing, but it does show that alveolar bone can be manipulated in adults.

Orthopedic / orthodontic protocols​

• BAMP (Bone Anchored Maxillary Protraction):
  Uses TADs/plates in the infrazygomatic crest and mandible with elastics. Works great in growing patients; in adults, results are modest at best unless combined with corticotomy-assisted techniques.
• Face mask with skeletal anchorage:
  Again, much stronger in children/adolescents. In mid-20s, bone is already fused; the sutures don’t separate easily.
• MSE/FME (expansion):
  Miniscrew-assisted expansion can sometimes split the midpalatal suture in adults (especially <25). This changes transverse width, which indirectly alters vertical and sagittal balance, but it won’t directly shorten the philtrum.

Soft tissue–focused options​

• Lip lift:
  Directly shortens philtrum length by excising skin under the nose. Improves harmony when the philtrum is long relative to nose length. Doesn’t move bone, but sometimes gives ~80% of the visual improvement people are after.
• Dermal fillers / fat grafting to paranasal & upper maxilla:
  Can camouflage a “sunken lower maxilla” by creating forward projection under the nose and around the philtrum. Doesn’t address length, but changes depth perception.

---

Age-related limitations​

• At mid-20s, your midpalatal suture is likely fused, so MSE/FME works less predictably. Success depends on bone density and suture morphology — some young adults can still split it, others can’t.
• True skeletal impaction (shortening bone vertically) almost always requires orthognathic surgery past late adolescence.
• Remodeling techniques (PAOO, corticotomies) can enhance tooth/bite movement but won’t move your maxilla up like a LeFort I.

---

Keywords / research directions​

If you want to dig deeper, here are some keywords to look up:

• “Segmental anterior maxillary osteotomy”
• “LeFort I impaction vs anterior maxillary osteotomy”
• “Alveolar corticotomy adult orthodontics” / “PAOO”
• “Miniscrew assisted rapid palatal expansion adult” (MSE in adults)
• “Bone anchored maxillary protraction adults” (BAMP + corticotomy)
• “Upper lip lift philtrum reduction”
• “Paranasal augmentation with implants/fillers”