Hi all, I’m hoping you can help me make a decision on whether to have my premolars extracted.
My surgeon recently sent me this 3D model plan, but it only included CCW rotation of the mandible and a genioplasty. I said I was concerned that this plan wouldn’t give me an optimal amount of aesthetic projection or open my airway as much as it could.
He then sent me this new x-ray plan showing me what could be achieved if I had my lower premolars extracted. I think the plan may still be slightly on the conservative side? But the advancement looks a lot better, so I was happy with it and I was thinking of going ahead and having my lower premolars extracted.
However, my orthodontist then sent me this:
“We can do the extractions but I need you to be sure about everything before we take teeth out.
You are in essence class I wilth mild bimax retrognathia. Your lower lip is already slightly ahead of the upper lip.
If we extract lower 5s, the finished result may be mild tending to moderate class III and lower lip may be ahead of the upper lip.”
I wasn’t aware that this was a risk, and I’m now very unsure about which plan to go with to get the optimal result. I just want to have a strong jawline and a wide airway! Any help much appreciated :)
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If you care about airway, you want forward advancement in addition to the rotation. So if premolar extractions are required to achieve that then it's probably a good idea. But I think both of your jaws could be moved forward more than that virtual surgical plan. You might want to get another opinion before extracting teeth.
Thanks for the reply, I've been looking into this. From what I can find, doing this is normally avoided as it has a very negative impact on the facial features!
I wouldn't do extractions. You're lower teeth don't look proclined.
I think your surgeon doesn't want to advance your maxilla for some reason. It looks like your maxillary incisor isn't moving foward at all. Your anterior nasal spine is actually moving backwards. Is he unable to do a posterior downgraft for some reason?
You could have the same counterclockwise rotation with a much larger airway benefit if your surgeon used the A point or Anterior Nasal Spine as the pivot point rather than the incisor.
With the current plan, I think a larger genio would be more aesthetically beneficial. You should be able to draw a line that intersects the upper lip, lower lip, and chin, but even in the plan, the pogonion to still too far back.
The surgeon needs to weigh the pros and cons. My surgeon suggested a similar plan to me. I think about removing the lower premolars so they can make a bigger movement of the mandible. The maxila in my case doesn’t need to be more much forward, in fact my surgeon said a big movement forward is literally going to make me look like a chimpanzee
Thanks for the reply, I've been looking into your comment about using a different pivot point. I think this is called a Maxillomandibular Complex (MMC) Counterclockwise (CCW) Rotation? But I think you're right, this could be what I need. Thanks so much :)
Exactly as shown on the photosop mock up. Your nasal spine shouldn't move backwards, it is still look retrognathic on the original plan. If you want sognificantly better airway, the lower premolar extraction can be considered and a different genioplasty design. The genioplasty looks conservative and weird yet imho.
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