ramieri not doing bonegrafting compared to raffaini

[lurking truecel]

Lets be clear this is not hate, but doing bonegraft helps with not creating step offs and filling in gaps of leforts and bsso obv. Most of the time the gaps will be filled nonetheless to some degree but bone grafts is more of a guarntee. Also alfaro has many patients i have been in contact with where the bone didnt get healed fully because of huge movements and no bonegrafting and only anterior plates, ram does kinda the same except he dont do the same big movements.

And its more important if you do big bsso cuts, genios or maybe the most important one for big downgrafts of the maxilla.

Also some people might say that bonegraft dont show in ct/cbct, it def does

look in the pic below for example at the cuts shown with red circle:

who gets the bsso step off ? @Nahorscend @EverythingMattersCel @Lefor3Laser @LEFORT17 @tweaqo @kisslessvirgin @Jgns @vermicel


more no bonegraft huge genio from ram

huge movements from ram no bone graft

raffaini doing big bonegrafts

follow up thread https://looksmax.org/threads/ramieri-genio-and-technique.1911295/#post-26691809

 

[yussimania]

Bone grafts help but if you break the natural continuity of the mandibular inferior border (from the gonion to the gnathion) via rotation or vertical movements there will be a contour irregularity regardless

 

[lurking truecel]

Bone grafts help but if you break the natural continuity of the mandibular inferior border (from the gonion to the gnathion) via rotation or vertical movements there will be a contour irregularity regardless

not really if it heals correctly and is grafted, but many people get scar tissue around the cuts which is actually what makes irregularities visble. and ofc doing huge ccw will allways leave people with the banana jaw and something that looks like a step off

 

[Nahorscend]

Bone grafts help but if you break the natural continuity of the mandibular inferior border (from the gonion to the gnathion) via rotation or vertical movements there will be a contour irregularity regardless

So then why would a step-off happen even in a case of purely horizontal advancement?

I assume the reason is that since the mandible is not exactly parallel to horizontal, if you translate the cut segment literally just forward you are in fact breaking the continuity. So would the solution be to move it slightly down per unit forward to preserve the mandibular angle?

 

[yussimania]

not really if it heals correctly and is grafted, but many people get scar tissue around the cuts which is actually what makes irregularities visble. and ofc doing huge ccw will allways leave people with the banana jaw and something that looks like a step off

Yeah for people with small degrees of rotation you won't get a step off

But I feel like that Raffiani bone graft one you shared at the end would cause a step off

 

[ccwb]

Hardmax.org

 

[lurking truecel]

View attachment 4715419
View attachment 4715420

Yeah for people with small degrees of rotation you won't get a step off

But I feel like that Raffiani bone graft one you shared at the end would cause a step off

yea but not the inward type

 

[yussimania]

So then why would a step-off happen even in a case of purely horizontal advancement?

I assume the reason is that since the mandible is not exactly parallel to horizontal, if you translate the cut segment literally just forward you are in fact breaking the continuity. So would the solution be to move it slightly down per unit forward to preserve the mandibular angle?

Well it depends on prior anatomy and you need to define what Horizontal means. This guy has a downward growth patterns.

If we advance genioplasty linearly along the inferior border you will end up with a shit result so what they do is they reduce and rotate it. That doesn't automatically mean you get a step off tho there are many variables that I can't think of rn cuz I'm tired

 

[tyler1234]

Show us ur results bro

 

[lurking truecel]

Show us ur results bro

why is it relevant here ?

 

[geenk worg]

Raffaini uses traditional plates while Ramieri uses titanium

 

[tyler1234]

It’s not but u always vouch for rameiri but won’t show results

why is it relevant here ?

 

[lurking truecel]

Raffaini uses traditional plates while Ramieri uses titanium

hmm yea valid point, also custom guides so they sit where the bone is more dense. but i still think bonegrafting diff can be valid

 

[LackEmpathyTherefor]

I got a shit tone of bone grafting on all of my cuts and I think I still got stepoffs. Iam not sure tho.
But when I pulled my skin to make it tighter around the cuts I can see the jaw going down weirdly, like not continuous

 

[lurking truecel]

I got a shit tone of bone grafting on all of my cuts and I think I still got stepoffs. Iam not sure tho.
But when I pulled my skin to make it tighter around the cuts I can see the jaw going down weirdly, like not continuous

yea i mean bonegraft is just too guide the growth, its not really a guarentee, and it will be gone with time either way. also the bone will be somewhat irregular nonetheless when you touch it as its uncommon it grows totally striaght, but not doing bonegraft in big downgrafts or huge bsso makes the risk more likely that you can get less dense bone growth etc

 

[LEFORT17]

I got a shit tone of bone grafting on all of my cuts and I think I still got stepoffs. Iam not sure tho.
But when I pulled my skin to make it tighter around the cuts I can see the jaw going down weirdly, like not continuous

time for gonial implants, rhino, fat grafts

 

[Nahorscend]

but not doing bonegraft in big downgrafts or huge bsso makes the risk more likely that you can get less dense bone growth etc

how many mm is 'huge bsso' and how many mm is a big genio

cause if you make the genio smaller to avoid step off you will have a big bsso right, cant avoid both

 

[tweaqo]

It’s not but u always vouch for rameiri but won’t show results

I’ve seen his results, they were good.

 

[lurking truecel]

how many mm is 'huge bsso' and how many mm is a big genio

cause if you make the genio smaller to avoid step off you will have a big bsso right, cant avoid both

Huge bsso is 10 mm+

 

[Nahorscend]

Huge bsso is 10 mm+

so if you have option between like

9-10 mm bsso + 4-5 mm genio
OR
6-7 mm bsso + 6-7 mm genio

you should pick the first one to avoid step off risk of big genio?

 

[LEFORT17]

so if you have option between like

9-10 mm bsso + 4-5 mm genio
OR
6-7 mm bsso + 6-7 mm genio

you should pick the first one to avoid step off risk of big genio?

yeah 70/30-80/20 jaw/chin movements are ideal

 

[lurking truecel]

so if you have option between like

9-10 mm bsso + 4-5 mm genio
OR
6-7 mm bsso + 6-7 mm genio

you should pick the first one to avoid step off risk of big genio?

Yea bsso allways look better if you get to choose

 

[Foreverbrad]

Ramieri told me in consult he uses bone graft.
This was 18 months ago though.

 

[Ascension75]

Bone grafts help but if you break the natural continuity of the mandibular inferior border (from the gonion to the gnathion) via rotation or vertical movements there will be a contour irregularity regardless

Does this even matter for those that get jaw implants later on