(BIMAX) How does one know if they need decompensation?

[Deleted member 19766]

Title, u can consult with Ramieri but he almost always tells literally everyone to get braces for 6-12 months & remove premolars. meanwhile "surgery-first"ers like pagnoni and safi will almost never tell you that you need it, maybe they have done it a few times but i haven't heard of it yet.

Is there a surgeon out there who is a bit more "balanced" and can give us a good opinion that's somewhere in the middle? Or do you think EITHER Ramieri aka the "traditionalists" OR Pagnoni/Safi aka "surgery FIRSTers" ARE that good opinion.

 

[12PSLsubhuman]

Title, u can consult with Ramieri but he almost always tells literally everyone to get braces for 6-12 months & remove premolars. meanwhile "surgery-first"ers like pagnoni and safi will almost never tell you that you need it, maybe they have done it a few times but i haven't heard of it yet.

Is there a surgeon out there who is a bit more "balanced" and can give us a good opinion that's somewhere in the middle? Or do you think EITHER Ramieri aka the "traditionalists" OR Pagnoni/Safi aka "surgery FIRSTers" ARE that good opinion.

Traditionalists r the better ones I think. Even if u need decompensation it's just for a few months anyway

 

[Foreverbrad]

Pagnoni told me I’d need decompensation.

Deep bites seem to be a hard no for surgery-first.

I don’t understand the premolars thing at all. Why is that necessary? When is that necessary?

 

[Deleted member 19766]

Pagnoni told me I’d need decompensation.

Deep bites seem to be a hard no for surgery-first.

I don’t understand the premolars thing at all. Why is that necessary? When is that necessary?

That's weird cause doesnt decompensation worsen an overbite? If its making it even worse than how is it bad for surgery first?

I guess Pagnoni might be trustworthy then though

 

[Foreverbrad]

That's weird cause doesnt decompensation worsen an overbite? If its making it even worse than how is it bad for surgery first?

I guess Pagnoni might be trustworthy then though

Not sure, it’s apparently related to an incorrect curve of Spee.

 

[Deleted member 19766]

Not sure, it’s apparently related to an incorrect curve of Spee.

I just asked all the surgeons I'm talking to if I need DECOMPENSATION, they have my scans so they will be able to tell. If most say yes then I'm roping.

 

[bradpittshairline]

That's weird cause doesnt decompensation worsen an overbite? If its making it even worse than how is it bad for surgery first?

I guess Pagnoni might be trustworthy then though

cant they just cut from the wisdom tooth area jfl why take out my perfectly healthy teeth?

 

[bradpittshairline]

I just asked all the surgeons I'm talking to if I need DECOMPENSATION, they have my scans so they will be able to tell. If most say yes then I'm roping.

what scans do i need to consult

 

[Foreverbrad]

what scans do i need to consult

Digital dental scan from an iTero or the like might be enough to answer the decompensation questions.

 

[12PSLsubhuman]

cant they just cut from the wisdom tooth area jfl why take out my perfectly healthy teeth?

They take just the lower wisdoms 95 percent of the time

 

[bradpittshairline]

They take just the lower wisdoms 95 percent of the time

mine already gone

 

[PlagiocephalyTypeIV]

Pagnoni told me I’d need decompensation.

Deep bites seem to be a hard no for surgery-first.

I don’t understand the premolars thing at all. Why is that necessary? When is that necessary?

I have a deep bite and he said my bite is stable to do surgery first

 

[bradpittshairline]

I have a deep bite and he said my bite is stable to do surgery first

proof that u need to talk to doctors instead of retards

 

[Deleted member 19766]

Bump

 

[Deleted member 19766]

Bump

 

[Pakicel]

Old thread. But I think I know why. It depends on the relationship between your lower jaw and upper jaw. If your teeth are class I but your jaws are class II or III, you have some degree of compensation in your bite, either through braces or just naturally. You can't just advance the jaws with a compensated bite as it is quite unstable and it also won't fix the relationship between the upper and lower jaw. So you need to decompensate the bite and fix the skeletal relationship through differential advancements for each jaw.

 

[Pakicel]

Ramieri has made the right call recommending extractions and braces to many users who consulted with him. But for one user who had a class I bite and skeletal relationship, I think he was wrong.

Pagnoni, safi etc have agreed to do surgery-first on dudes with significantly compensated class II bites, which is pretty concerning. Pagnoni did recommend braces in my case though he was willing to do surgery first. I am a skeletal class II with a 4.5 mm overjet and slight compensation of my lower teeth. Never had braces so it's just natural.

 

[hansmoleman]

Title, u can consult with Ramieri but he almost always tells literally everyone to get braces for 6-12 months & remove premolars. meanwhile "surgery-first"ers like pagnoni and safi will almost never tell you that you need it, maybe they have done it a few times but i haven't heard of it yet.

Is there a surgeon out there who is a bit more "balanced" and can give us a good opinion that's somewhere in the middle? Or do you think EITHER Ramieri aka the "traditionalists" OR Pagnoni/Safi aka "surgery FIRSTers" ARE that good opinion.

Respectfully, what you say about Ramieri and Safi is not accurate at all. In the case of Pags it's totally true.

In the borderline cases, it's not easy, and there is no "right" thing, both options can end up good. In the more clear cases, it's quite obvious. The planning software detects your skeletal relation as class 2, while you have a good bite. You look at the lower teeth and they are indeed proclined instead of straight.

 

[Pakicel]

Respectfully, what you say about Ramieri and Safi is not accurate at all. In the case of Pags it's totally true.

In the borderline cases, it's not easy, and there is no "right" thing, both options can end up good. In the more clear cases, it's quite obvious. The planning software detects your skeletal relation as class 2, while you have a good bite. You look at the lower teeth and they are indeed proclined instead of straight.

It seems like I might be a borderline case. I am a mild skeletal class II with a 4.5 mm overjet. It seems like there is a 3-4 mm discrepencacy between my mandible and maxilla. I would need decomp to get my overjet up to 6-7 mm and then an 7 mm BSSO to fix my skeletal issues.

I am not sure if extractions would be required in my case.

 

[Pakicel]

Respectfully, what you say about Ramieri and Safi is not accurate at all. In the case of Pags it's totally true.

In the borderline cases, it's not easy, and there is no "right" thing, both options can end up good. In the more clear cases, it's quite obvious. The planning software detects your skeletal relation as class 2, while you have a good bite. You look at the lower teeth and they are indeed proclined instead of straight.

Pags seems willing to do surgery first on everyone lol. Even people with lots of compensation in their bite.

 

[hansmoleman]

It seems like I might be a borderline case. I am a mild skeletal class II with a 4.5 mm overjet. It seems like there is a 3-4 mm discrepencacy between my mandible and maxilla. I would need decomp to get my overjet up to 6-7 mm and then an 7 mm BSSO to fix my skeletal issues.

I am not sure if extractions would be required in my case.

I'd do decompensation in your case

 

[Pakicel]

I'd do decompensation in your case

Can I send my scan to you?

 

[Pakicel]

I'd do decompensation in your case

Yes. That would def be the correct call. But how much? I only need 3-4 mms more advancement of my mandible for my ANB angle to be ideal. Anymore, would require a big advancement of my maxilla (which would dogmax me) or give me a class III relationship. I can't get lots of CCW as my occlusal plane is like 4 degrees.

So are you saying I should just decompensate like 3mm? Is it even worth it in such a situation since I'd have to extract teeth? Or maybe I could get some IPR?

I never had braces so this compensation is just my teeth adjusting to my jaws.

 

[hansmoleman]

Can I send my scan to you?

I don't know enough to interpret it tbh.

 

[hansmoleman]

Yes. That would def be the correct call. But how much? I only need 3-4 mms more advancement of my mandible for my ANB angle to be ideal. Anymore, would require a big advancement of my maxilla (which would dogmax me) or give me a class III relationship. I can't get lots of CCW as my occlusal plane is like 4 degrees.

So are you saying I should just decompensate like 3mm? Is it even worth it in such a situation since I'd have to extract teeth? Or maybe I could get some IPR?

I never had braces so this compensation is just my teeth adjusting to my jaws.

I can't say the exact amount you need. I'm not an expert and we are talking about mm (!) here. But the case you described doesn't seem as a "borderline" case to me. Like you mentioned 6-7mm, I've heard of people needing to decompensate way less than that.

 

[Pakicel]

I can't say the exact amount you need. I'm not an expert and we are talking about mm (!) here. But the case you described doesn't seem as a "borderline" case to me. Like you mentioned 6-7mm, I've heard of people needing to decompensate way less than that.

No. I wouldn't be decompensating 6-7 mm lol. I already have a 4.5 mm overjet, with slight compensation of lower incisors. So to make enough room for an 8 mm BSSO I would need 3 mm of decomp to create an 8 mm overjet. It's a borderline case because what's the point of decompensating for an extra 3 mm on the mandible, especially if I get extractions? And if I want a larger decompensation to like an 11.5 m overjet to enable a 13 m BSSO, I would end up with a class III relationship, which is def not right. Maybe, I could get something like IPR or have my lower wisdoms removed tbh.

Most people with my kind of bite likely got braces to get rid of their overjet and need 6-7 mm like you said. But I never did so I still have a significant overjet.

 

[Deleted member 19766]

Respectfully, what you say about Ramieri and Safi is not accurate at all. In the case of Pags it's totally true.

In the borderline cases, it's not easy, and there is no "right" thing, both options can end up good. In the more clear cases, it's quite obvious. The planning software detects your skeletal relation as class 2, while you have a good bite. You look at the lower teeth and they are indeed proclined instead of straight.

So u think safi is trustworthy in terms of determining whether one needs extractions/DECOMPENSATION or not?

 

[hansmoleman]

So u think safi is trustworthy in terms of determining whether one needs extractions/DECOMPENSATION or not?

I'll consult with him but haven't met yet. From what I've heard and investigated, my best guess is that he'd definitely say that you need decompensation if you really need it. All surgeons will have their own biases and some might tend to over-recommend the omission of orthodontics, but in the case of Safi, from what I've seen, I wouldn't say he'll ignore your need for orthodontics if you really need it.

 

[Deleted member 38639]

Pagnoni told me I’d need decompensation.

Deep bites seem to be a hard no for surgery-first.

I don’t understand the premolars thing at all. Why is that necessary? When is that necessary?

Interesting. I have a deep bite and that wasn't the case for me with Pagnoni/Ramieri/Coceancig.

 

[Deleted member 38639]

I have a deep bite and he said my bite is stable to do surgery first

same

 

[Pakicel]

Interesting. I have a deep bite and that wasn't the case for me with Pagnoni/Ramieri/Coceancig.

how bad is it?

 

[Deleted member 19766]

how bad is it?

Interesting. I have a deep bite and that wasn't the case for me with Pagnoni/Ramieri/Coceancig.

will a posterior downgraft during jaw surgery fix a deepbite?

 

[Pakicel]

will a posterior downgraft during jaw surgery fix a deepbite?

Nah. It won't. Molars won't touch if you try to advance your jaws to fix the occlusion without orthodontics.

 

[Deleted member 38639]

how bad is it?

not terrible, but def recessed

 

[Deleted member 46986]

.

 

[Pakicel]

not terrible, but def recessed

Then a @MTNAscension2 HTN might be possible.

 

[Deleted member 38639]

Then a @MTNAscension2 HTN might be possible.

That's pretty much what every surgeon (Coceancig, Safi, Ramieri, Pagnoni, and Celal) including Giant told me

 

[Deleted member 19957]

Decompensation means need to decompensate (who would've thought) the previous alveolar orthodontic compensation you had at one point.

 

[Pakicel]

That's pretty much what every surgeon (Coceancig, Safi, Ramieri, Pagnoni, and Celal) including Giant told me

Yeah. @MTNAscension2 Chadlite or chad is probably impossible.

 

[Deleted member 38639]

Yeah. @MTNAscension2 Chadlite or chad is probably impossible.

I'm fine with that tbh. Fixing my objective failos will ascend me regardless. Plus I've already had LTRs with HTBs and even a stacylite (dumped both for personal reasons), so it can only get better from here