Questions about jaw surgery if you have a class 1 bite

[LG18]

Hi,

I’m in need of some advice about fixing my recessed jaws with orthogonatic surgery. Here’s a picture of my side profile: https://imgur.com/a/QfIiC0q

Sorry for the quality — it’s the only one I have as I currently have a large beard to hide it. I don’t have any X-rays yet, either, so I know it’s not ideal but hopefully it gives a decent idea.

Up until recently, I’ve been planning to have cosmetic surgery. In identifying my high mandibular plane angle and recessed chin, I was planning to have two procedures. First, a jumping genioplasty to both vertically shorten my chin and project it as much as possible in the horizontal dimension. Then, custom jaw implants which both vertically lengthen the ramus and add some bigonial width.

I’d come across the prospect of bimax surgery before but thought that because of my class 1 bite, it wouldn’t be possible for me. Having researched a little further, I found that people do indeed still have this surgery even if their bite is perfect, and that actually, none of the planned cosmetic procedures I’d planned would actually properly rectify the issue.

Having done some more research, I found that having a high mandibular plane angle probably also means I have a high occlusal plane. Also, given the fact that my jaws themselves are recessed, I came to realise that a maximum genioplasty alone would not solve the issue, and that it in combination with the jaw implants would probably look a bit weird and unnatural.

I came to the conclusion that what I really need is bimax surgery, which, from what I can tell from the research I’ve done so far, would likely consist of a lefort 1 and a count-clockwise rotation BSSO.

The biggest thing confusing me is how I’ve ended up with the recession in the first place, and what the procedure entails considering I have a perfect bite. Both my dad and youngest sister also have the same recession as me, but all of us have had dentists comment on the fact that we have a perfect bite and good teeth.

I’ve come across the concepts of compensation/de-compensation, but I don’t really understand how it might relate to me. It’s said that sometimes dental recession can be naturally compensated by the body over time to form a class 1 bite even though the jaws are recessed, so I don’t know whether this might be the case with me. I’d find it difficult to believe that I and my other two family members have class 2 profiles but somehow our bodies compensated our teeth to form perfect occlusion, and if this is the case, why do most people have overbites that have our profile?

Then I considered that perhaps both jaws are simply recessed to the point where normal occlusion has been created. Presumably in class 2 people, the top jaw is mostly in the right position but the lower jaw is recessed, and vice versa for class 3. So could it be that I just have recession in both jaws?

I’ve seen that it’s common for people’s bites to be camouflaged by previous orthodontic work creating a perfect bite, but obviously then they still present with the recessed skeletal structure of whatever class of recession they have. For them to have jaw surgery, their bite then needs to be decompensated to resemble their natural occlusion before braces to achieve maximum movement. I haven’t had any orthodontic work myself as my bite has never been a problem.

I guess what I’m trying to decipher is whether or not this decompensation stage will be necessary for me, which brings me to two situations. Either somehow I’m class 2 and my bite has naturally compensated to the point that it’s perfect, or both jaws are recessed to the point that my teeth became perfectly occluded. Or perhaps a third option I don’t know about. Maybe regardless, having a perfect bite is a barrier to any substantial advancement and I’d need decompensation anyway. Obviously if I didn’t have decompensation, my jaws could only be moved in tandem by the same amount of assuming linear advancement, but then perhaps counter clockwise rotation could be a solution to that.

Of course, you can surely only de-compensate a bite if there has already been compensation, so I don’t know what would be the solution if both my jaws are recessed and have formed a class 1.

Obviously, I really hope there’s another solution here than making my bite look terrible for over a year before I can get jaw surgery to make me look better. I’m already horribly unhappy with my appearance and that just sounds like a horrendous undertaking mentally.

I’ve seen cases like this: https://imgur.com/a/b9n5opR that have been done for sleep apnea, where they’ve had both jaws rotated while keeping the bite the same. This person didn’t have braces pre or post op because they had a perfect bite, but then perhaps if they did have braces, they might have been able to get a better advancement.

I’ve also seen some people that have a perfect bite go the ‘surgery first’ approach and then have orthodontic refinements after. So undergoing surgery without the decompensation period is clearly possible, but from what I’ve read, surgeons are either dead against that or all for it. One of the best results I’ve seen online was this girl: https://imgur.com/a/mnynazV

She was a class 2 with overbite, but has a very similar profile to me. She had a 4mm upper and 30mm lower advancement as well as a geniplasty and did the surgery first approach, which seems like a huge advancement. Obviously something like this would be fantastic, and genioplasty is certainly going o be necessary for me alongside the jaw advancement.

Of course, to properly learn more about my situation I’ll need to have a few consultations and X-rays taken, but before I begin that process I just wanted to decipher things a little better on my own first. Any thoughts would be much appreciated — what are my options here?

Many thanks!

[snapdresser]

Hi there! Sorry it took someone so long to respond. I was in the same boat in that I already had a perfect bite before my bimax and SG. I’m not a doctor, but I think it’s unlikely that you would need any “decompensation” prior to surgery. Definitely consult with a surgeon, but I think you could probably jump right to surgery with archbars, and probably wouldn’t even need braces afterwards unless they screw up your bite. I would recommend finding a doc that uses Virtual Surgical Planning to ensure a perfect bite afterwards. On a more personal note, I think you would have excellent cosmetic results if you decide to proceed, but of course YMMV. Some nerve damage is common, and likely will last forever if you’re over about 20 years old (though it’s usually not too bad), but seeing a different face in the mirror really messes with your head. That’s the most problematic side effect IMO. MANY people hate their new face, even if it objectively looks better (closer to the 50th percentile face, which is typically what’s considered “attractive”). Subconsciously, different = bad. Keep us posted on what you decide!

[LG18]

snapdresser wrote:
> Hi there! Sorry it took someone so long to respond. I was in the same boat
> in that I already had a perfect bite before my bimax and SG. I’m not a
> doctor, but I think it’s unlikely that you would need any “decompensation”
> prior to surgery. Definitely consult with a surgeon, but I think you could
> probably jump right to surgery with archbars, and probably wouldn’t even
> need braces afterwards unless they screw up your bite. I would recommend
> finding a doc that uses Virtual Surgical Planning to ensure a perfect bite
> afterwards. On a more personal note, I think you would have excellent
> cosmetic results if you decide to proceed, but of course YMMV. Some nerve
> damage is common, and likely will last forever if you’re over about 20
> years old (though it’s usually not too bad), but seeing a different face in
> the mirror really messes with your head. That’s the most problematic side
> effect IMO. MANY people hate their new face, even if it objectively looks
> better (closer to the 50th percentile face, which is typically what’s
> considered “attractive”). Subconsciously, different = bad. Keep us posted
> on what you decide!

Actually, I was hoping you’d reply! Having browsed the forum for similar posts I came across your case and noted it was similar to mine. There’s a doctor here in the U.K. that I’m considering, and then there’s Dr. Alfaro in Spain who seems to be really good. I’m planning to get a CBCT scan done and then consult with those two.

Who did you go with? I suppose my biggest point of confusion at the moment is why my profile is recessed in the first place if I have a normal bite. Are cases like ours basically indicative of both jaws being recessed? That was the reason I mentioned compensation; I thought that maybe my teeth had naturally compensated into a normal bite when in actual fact, I should be class 2.

It’s interesting what you say about not recognising yourself in the mirror: I hadn’t really considered that, but it makes a lot of sense that it can cause some psychological distress.

Thanks!

[snapdresser]

I am in the US, so my surgeon probably isn’t one you would consider. In fact, she isn’t even particularly well known in my area of the US, but she was covered by my insurance plan and she did a great job. I’m not familiar with any doctors in Europe, unfortunately, so I can’t give my input on that.

Our cases are either both jaws are recessed or the mandible is recessed and the maxilla is rotated clockwise to match it. Either way, they can do an advancement and/or CCW rotation to fix that without requiring braces, but everyone’s case is a little different and you should consult with a surgeon to see what’s appropriate for yours.

It took me years to get used to my face in the mirror and in pictures, I’ve been much more critical of other aspects of my face after the surgery, and I’ve been extremely critical of my results (should I have been advanced a millimeter more? Impacted a millimeter less? Etc.). Some people have a difficult time accepting their results, and therapy is indicated. Surgeons should warn patients about that risk, but all they seem to talk about is numbness.