Jaw Surgery - how to make space for BSSO?

[Dropdown666]

Hey guys,

I have the following problem: I’m recessed due to class II bite, which has been aligned by camouflage orthodontics as a teen. But for aesthetic reasons I still need a lower jaw advancement.

My problem is that my surgeons have told me that I can only bring the lower jaw forward 4 mm to have normal occlusion by tilting the upper teeth out and the lower teeth in. IMO this is not enough movement for satisfying aesthetic results. My maxilla is not recessed and my occlusal plane is optimal so I only need linear advancement.

What possibilities do I have to make more space for BSSO? I know these:
- premolar extraction
- Bimax with rotation

I already had Sliding Genioplasty.

Thanks!

 

[Nims]

Bumping thread because intrested.

Tbh the only way Ik of making space is extractions for example wisdoms & premolar.
Rotation could definitely work, I have no other idea on other methods tho.

 

[Mongrelcel]

are teeth always extracted during a BSSO?

 

[Oberyn]

are teeth always extracted during a BSSO?

only wisdom. premolar not always

 

[Mongrelcel]

only wisdom. premolar not always

does extracting wisdom teeth have any negative consequences?

 

[ItsOver999]

1) Lower premolar extractions
2) Bimax with CCW
3) This can be comboed with 1 or 2 but un tilting the top teeth and or bottom teeth like the guy said.

These are your only options, which you already stated, also removing wisdom teeth doesnt do anything cuz that doesnt cause your lower incisors/ front teeth to move back.

Also I cant picture how your maxilla isn't recessed and your occlusal plane is flat but your lower jaw is recessed and u think u need more than 4mm. That doesnt even make sense , can u show like xray or side profile?? I think your occlusal plane isnt 0 degrees like youre saying tbh.

 

[Nims]

does extracting wisdom teeth have any negative consequences?

Some people say it can cause a tiny bit of receding of the jaw, as it creates space for your teeth to shift back, and some people say it can cause the bone to degrade a small amount as the bone has no purpose as it doesnt need to hold the removed tooth in place.

Tbh as long as you are an adult with fused plates I doubt there would be any significant change bone wise after you remove wisdoms.

If you are really concerned you could get wisdom implants.
Personally I will probably get wisdom implants myself after I have BSSO.

 

[ItsOver999]

Some people say it can cause a tiny bit of receding of the jaw, as it creates space for your teeth to shift back, and some people say it can cause the bone to degrade a small amount as the bone has no purpose as it doesnt need to hold the removed tooth in place.

Tbh as long as you are an adult with fused plates I doubt there would be any significant change bone wise after you remove wisdoms.

If you are really concerned you could get wisdom implants.
Personally I will probably get wisdom implants myself after I have BSSO.

The only reason theyd remove wisdom teeth for a bsso is because they clash with the upper wisom teeth or molars, you theoretically shouldnt be able to get wisdom teeth implants?? And no wisdom teeth arent always removed during a bsso. Edit; actually nvm, from skimming google there are other reasons to get them removed but its still not always that they do.

 

[Oberyn]

does extracting wisdom teeth have any negative consequences?

it doesn't matter you will get bimax

 

[Dropdown666]

1) Lower premolar extractions
2) Bimax with CCW
3) This can be comboed with 1 or 2 but un tilting the top teeth and or bottom teeth like the guy said.

These are your only options, which you already stated, also removing wisdom teeth doesnt do anything cuz that doesnt cause your lower incisors/ front teeth to move back.

Also I cant picture how your maxilla isn't recessed and your occlusal plane is flat but your lower jaw is recessed and u think u need more than 4mm. That doesnt even make sense , can u show like xray or side profile?? I think your occlusal plane isnt 0 degrees like youre saying tbh.

I’ve sent you my cbct scan.

 

[Dropdown666]

do you guys think premolar extraction is worth it to increase the movement of lower jaw?

 

[Deleted member 8869]

are teeth always extracted during a BSSO?

nah

 

[Mongrelcel]

nah

in what cases can the patient keep all his teeth?

 

[Deleted member 8869]

in what cases can the patient keep all his teeth?

it depends on the surgeon there is almost always a way in my case for example it was possible to keep all teeth

 

[Mongrelcel]

it depends on the surgeon there is almost always a way in my case for example it was possible to keep all teeth

I was under the impression that teeth need to be pulled out so that a cut through the bone can be made

can you please elaborate? thanks

 

[Deleted member 8869]

I was under the impression that teeth need to be pulled out so that a cut through the bone can be made

can you please elaborate? thanks

yes in extreme cases but keep in mind max possible movement isnt the best option most of the time especially with orthognatic surgery offered to us (bimax with lf1 and bsso) since your lower jaw will be extremely portruded while your midface lacks projection. in most cases around 7 to 11mm are enough

 

[Deleted member 20631]

I was under the impression that teeth need to be pulled out so that a cut through the bone can be made

can you please elaborate? thanks

Teeth are usually taken out to set the lower jaw back for larger mandible movements not so the cut through the bone is made. There are ways to get jaw surgery without getting teeth taken out like a very large maxilla advancement with CCW but you have to be careful with that because you’ll look chimp-faced with an overly forward lower maxilla

 

[Deleted member 20631]

yes in extreme cases but keep in mind max possible movement isnt the best option most of the time especially with orthognatic surgery offered to us (bimax with lf1 and bsso) since your lower jaw will be extremely portruded while your midface lacks projection. in most cases around 7 to 11mm are enough

Ideal surgery would be MLF3 + BIMAX, but I’m struggling to find a surgeon who will perform MFL3 for less then 20k.

 

[Mongrelcel]

yes in extreme cases but keep in mind max possible movement isnt the best option most of the time especially with orthognatic surgery offered to us (bimax with lf1 and bsso) since your lower jaw will be extremely portruded while your midface lacks projection. in most cases around 7 to 11mm are enough

ah, so that's the reason

lifefuel for me then, I was never planning on a large movement, my lower jaw is not too recessed as it is, it's just that it's a bit recessed compared to the maxilla

 

[Mongrelcel]

Ideal surgery would be MLF3 + BIMAX, but I’m struggling to find a surgeon who will perform MFL3 for less then 20k.

why is MLF3 better than just LF1?

what kind of a patient needs MLF3 compared to a patient who needs LF1?

 

[Deleted member 8869]

ah, so that's the reason

lifefuel for me then, I was never planning on a large movement, my lower jaw is not too recessed as it is, it's just that it's a bit recessed compared to the maxilla

Yeah then you could even go with the surgery first approach if your occlusion is normal 7 to 11mm is a huge difference

 

[Deleted member 8869]

why is MLF3 better than just LF1?

what kind of a patient needs MLF3 compared to a patient who needs LF1?

i guess everybody here would get mlf instead of lf1 since it advances the whole midface.

 

[Deleted member 8869]

Ideal surgery would be MLF3 + BIMAX, but I’m struggling to find a surgeon who will perform MFL3 for less then 20k.

what surgeons did perform it in general?

 

[Deleted member 20631]

what surgeons did perform it in general?

2019-2020 Dr Sinn performed the surgery for I think 14k-27k but he’s old as fuck now. I ideally want the surgery June/July so it doesn’t get in the way of my school when I find a surgeon and have a quote and everything set up I’ll pm you.

Who does modified LeFort 3?

Modified LeFort3 is a good procedure that has been done on non-deformed people to fix their midface projection, especially by Dr. Sinn. Dude has retired now, so I wonder who still does it?

looksmax.org

 

[Mongrelcel]

Yeah then you could even go with the surgery first approach if your occlusion is normal 7 to 11mm is a huge difference

surgery first approach?

i guess everybody here would get mlf instead of lf1 since it advances the whole midface.

well not everybody needs more forward growth that desperate
I'd rather stay with what I have, than undergo such a brutal and invasive surgery
good enough for me

 

[Deleted member 8869]

2019-2020 Dr Sinn performed the surgery for I think 14k-27k but he’s old as fuck now. I ideally want the surgery June/July so it doesn’t get in the way of my school when I find a surgeon and have a quote and everything set up I’ll pm you.

Who does modified LeFort 3?

Modified LeFort3 is a good procedure that has been done on non-deformed people to fix their midface projection, especially by Dr. Sinn. Dude has retired now, so I wonder who still does it?

looksmax.org

shit so no other surgeon?

 

[Deleted member 8869]

surgery first approach?


well not everybody needs more forward growth that desperate
I'd rather stay with what I have, than undergo such a brutal and invasive surgery
good enough for me

you get surgery first and then orthodontic treatment if necessary

 

[Mongrelcel]

you get surgery first and then orthodontic treatment if necessary

my plan as of now is to get SARPE with a palate extender (MSE or Power expander), then fix teeth with litigating braces and only then start consulting for a surgery

do you think I should consult for a surgery sooner?

 

[Deleted member 20631]

i guess everybody here would get mlf instead of lf1 since it advances the whole midface.

Yeah ideal would be MLF3 for mid face projection and then a LF1 with CCW for forward grown maxilla. For mandible ideal would be DO on Ramus + IMDO + Geniopaully + normal genioplasty. All together these surgeries cost 35k at the cheapest and up to 60k depending on how how jewish the surgeons want to be.
You could throw in palate expansion with EASE + RPD if you really need it but the aesthetic benefits aren’t very visible (except for smile), it’s more of a functional surgery anyways.

 

[Deleted member 20631]

my plan as of now is to get SARPE with a palate extender (MSE or Power expander), then fix teeth with litigating braces and only then start consulting for a surgery

do you think I should consult for a surgery sooner?

Make sure to get power expander, MSE is half bone half tooth expansion and it has the chance of expanding skeletally more on one side giving you unfixable asymmetry.

 

[Deleted member 20631]

shit so no other surgeon?

The procedure itself is low risk and any surgeon who can perform a Lefort 2/3 should be able to perform a MLF3. Look at the post I linked, you just have to ask a lot of surgeons and find one willing to perform it. If I find a surgeon I’ll pm you

 

[WagedandReady]

Bumping cuz similar dilemma

 

[coolguy1]

Extracting the teeth is definitely worth it. I'm going to get all my wisdom teeth and 2 premolars on upper jaw and 2 on lower jaw extracted. If ur an adult it won't change shit probably. And even if it does, ur end result will still be positive since ur getting bimax, and the recession that the extractions would cause (which they probably won't) will never be bigger than the advancements of the bimax.

 

[coolguy1]

Yeah ideal would be MLF3 for mid face projection and then a LF1 with CCW for forward grown maxilla. For mandible ideal would be DO on Ramus + IMDO + Geniopaully + normal genioplasty. All together these surgeries cost 35k at the cheapest and up to 60k depending on how how jewish the surgeons want to be.
You could throw in palate expansion with EASE + RPD if you really need it but the aesthetic benefits aren’t very visible (except for smile), it’s more of a functional surgery anyways.

Just stfu bro

 

[Deleted member 8869]

The procedure itself is low risk and any surgeon who can perform a Lefort 2/3 should be able to perform a MLF3. Look at the post I linked, you just have to ask a lot of surgeons and find one willing to perform it. If I find a surgeon I’ll pm you

thanks man im counting on you, and yeah mlf3 is not risky lf2 and 3 are

 

[Deleted member 8869]

Yeah ideal would be MLF3 for mid face projection and then a LF1 with CCW for forward grown maxilla. For mandible ideal would be DO on Ramus + IMDO + Geniopaully + normal genioplasty. All together these surgeries cost 35k at the cheapest and up to 60k depending on how how jewish the surgeons want to be.
You could throw in palate expansion with EASE + RPD if you really need it but the aesthetic benefits aren’t very visible (except for smile), it’s more of a functional surgery anyways.

honestly the more attainable version for hardmaxxers these days would be: high cut lf1 + zso then a BSSO with ramus widening on top a chin wing for lower third height and then a genio after the chin wing implants wise you could try paranasal implants or custom midface masks combined with thin saddle inframalar implants to alter orbit shape

 

[Dropdown666]

Extracting the teeth is definitely worth it. I'm going to get all my wisdom teeth and 2 premolars on upper jaw and 2 on lower jaw extracted. If ur an adult it won't change shit probably. And even if it does, ur end result will still be positive since ur getting bimax, and the recession that the extractions would cause (which they probably won't) will never be bigger than the advancements of the bimax.

Do you know how long it takes for teeth to move back and close the space after extractions?

 

[ChristianChad]

Extracting the teeth is definitely worth it. I'm going to get all my wisdom teeth and 2 premolars on upper jaw and 2 on lower jaw extracted. If ur an adult it won't change shit probably. And even if it does, ur end result will still be positive since ur getting bimax, and the recession that the extractions would cause (which they probably won't) will never be bigger than the advancements of the bimax.

Consider expansion to change pre surgery teeth position, that will definitely fuck your face