CBCT scan , Best movement for a blackpilled trimax result with Ramieri?

[CookedCope]

Had a 3D scan done for surgical planning (attached). It was taken with a bite block, so the jaw looks open.

Main issues I see:

• High mandibular plane angle
• Obtuse gonial angle

Ramieri’s data center or whatever was down during the consult so we couldn’t run any simulations — now I’m stuck doing this over email. What’s the most blackpilled way to phrase “give me the best possible outcome” without sounding like a clueless normie?

Looking for feedback from people who’ve studied/undergone CCW or trimax. Serious input appreciated , need to get the max out of this surgery.

Plan was Implate+Trimax but my occlusion kinda good ngl , wonder if Jaw angle implants+genio might give decent enough ROI too?

 

[muragoat]

Implate+Trimax will fix it.
just let him know you want a radical change and he will plan it.

 

[lurking truecel]

I would skip implate and just go with trimax. You got a good wide chin. Its just needs to come forward. Dont overotate, high angle isnt that much of a problem and can look better from front either way

 

[CookedCope]

I would skip implate and just go with trimax. You got a good wide chin. Its just needs to come forward. Dont overotate, high angle isnt that much of a problem and can look better from front either way

He offered something like this. Maybe I can ask for a bit more forward movement from the maxilla.

 

[CookedCope]

I would skip implate and just go with trimax. You got a good wide chin. Its just needs to come forward. Dont overotate, high angle isnt that much of a problem and can look better from front either way

Also I dont think implate is for the chin but to gonials. I have <0.8 Zygos to Gonials if im calculating correctly (on bone). Maybe in real life it looks bigger due to masseter hypertrophy

 

[LEFORT17]

He offered something like this. Maybe I can ask for a bit more forward movement from the maxilla.

nah you dont need more on the upper jaw. plan looks good, occlusion plane almost flat maybe 2-4 degrees which is completly fine. go for it lil bro

 

[CookedCope]

nah you dont need more on the upper jaw. plan looks good, occlusion plane almost flat maybe 2-4 degrees which is completly fine. go for it lil bro

Tnx big dawg , any opinion on implate?

 

[LEFORT17]

Tnx big dawg , any opinion on implate?

nahh i dont see a reason why you need it

 

[lurking truecel]

He offered something like this. Maybe I can ask for a bit more forward movement from the maxilla.

Dont do the genio like that, and dont impact anteriorly. Even if it gives a slightly longer face. Its better to stretch soft tissues. Then to make your face shorter like the plan from impaction and very vertically short chin

 

[LEFORT17]

Dont do the genio like that, and dont impact anteriorly. Even if it gives a slightly longer face. Its better to stretch soft tissues. Then to make your face shorter like the plan from impaction and very vertically short chin

theres a slight downward rotation to maintain height, the genio is fine

 

[lurking truecel]

theres a slight downward rotation to maintain height, the genio is fine

The genio is the worst part, it will look extremly point also when its not a high cut genio. This is for real a trade mark from what i have seen that ram is kinda bad at genios. And yes hmits not much impaction but the shortening od the face and the advancement dont go good together. He should do more forward advancement. And less genio

ideally he should do gga

 

[lurking truecel]

theres a slight downward rotation to maintain height, the genio is fine

In worst case with this extreme vertical lowering of the chin ot will be this kind of step off. This is a ram result btw

 

[LEFORT17]

View attachment 4341340
In worst case with this extreme vertical lowering of the chin ot will be this kind of step off. This is a ram result btw

what about small genio movements with vertical shortening, like 2mm forward 2mm up

 

[LEFORT17]

The genio is the worst part, it will look extremly point also when its not a high cut genio. This is for real a trade mark from what i have seen that ram is kinda bad at genios. And yes hmits not much impaction but the shortening od the face and the advancement dont go good together. He should do more forward advancement. And less genio View attachment 4341329 ideally he should do gga

yeah probably right about more jaw/less chin. i like raffaini style with 80/20 jaw/chin movements

 

[lurking truecel]

what about small genio movements with vertical shortening, like 2mm forward 2mm up

Depend on the width and height of the vertical cut, this one is extremly small in height which has bigger risk

 

[lurking truecel]

yeah probably right about more jaw/less chin. i like raffaini style with 80/20 jaw/chin movements

Yea 100% why do bimax if you need a big genio. Its prob because that you ddint decomp then. This dude would need pre molars removed to get overbite. Maybe thats what he is getting.

 

[CookedCope]

"it is very hard to give and established plan with the scan you provided that is very low quality and with a limited field of view. I could evaluate that you will need preparation braces as already underlined. The movements that I foresee are CCW of the maxillo-mandibular complex and genioplasty.

I'm attaching a very superficial and ballpark estimation of the possible skeletal outcomes. "

That was his words , so movements are not "final"

 

[CookedCope]

You guys are to high iq , ngl im lost
Am i getting botched ? Im starting decomp next week. Only wisdom teeth extraction has been done

 

[LEFORT17]

You guys are to high iq , ngl im lost
Am i getting botched ? Im starting decomp next week. Only wisdom teeth extraction has been done

did he say anything about lower premolars extraction with the braces

 

[CookedCope]

did he say anything about lower premolars extraction with the braces

No , asked only for wisdom teeth extraction

 

[CookedCope]

did he say anything about lower premolars extraction with the braces

What is the reason for premolar extraction ?

 

[LEFORT17]

What is the reason for premolar extraction ?

to get an (worse) overbite for bigger lower jaw movements