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Moving my mandible forwards and downwards (x-ray attached)

drwnjp
New Member

About me: 23 y/o male

So 2 years or so ago I noticed that I have a weak chin. During this time I realised that if I push my mandible forward to align both my  top and bottom teeth I get a look that I consider ideal. 

So taking measurements from the x-ray, to achieve this look, I would like to move my mandible 2mm forwards and 2mm down.

Surgery does not seem suitable, nor do I want to be that invasive at this current time as I only have a slight overbite of about 2mm as you can see from the x-ray.  Note that my lower teeth are fairly crowded and therefore protrude forward eliminating said overbite. If this was not the case perhaps surgery would have been more suitable as my forward upper teeth would have caused a more prominent overbite. 

In the current position my teeth (front and back), bite and everything feel perfect, I had braces as a teen that fixed my bite. I would still however like to fix this to feel less self-conscious about my profile as my lower jaw is seated slightly too deep in my skull.

Ideally I don't want to advance my maxilla but if it is necessary for the mandible then so be it. Obviously if I advance my mandible but my maxilla doesn't change too then my bite will be messed up.

So what could be my course of action? Would expansion of my lower palate from thumb-pulling cause mandibular growth for example? Mewing? Face pulling?

X-ray Imgur: https://imgur.com/a/mXcXs8G

Thanks

 

 

Quote
Topic starter Posted : 28/02/2020 3:39 am
max iller
Eminent Member

likely your mandible isn't going to change much unless the maxilla moves with it.

Mewing of course will be your friend, if nothing else it's just good posture. Chewing a lot is the best you can do for creating a more robust jaw, form follows function.

You want to expand your top jaw anyway so your wisdoms can come through, pushing the sides of your aveolar ridge and against the incisive papilla to create a forward and sideways expansion will help those teeth come through, and chewing during this slow top expansion should bring the mandible with it, to help with the crowding.

Experiment with your tongue and try to create sensations around the areas you want to improve. You can facepull with your tongue with enough strength.

None of this is easy but with enough time and dedication your jaws will adapt to whatever you put them through, how do you think you ended up here in the first place? 😉

EDIT: the chin is a muscle attached to you lower lip that you can flex to build soft tissue around that area which might be a quicker short term solution while you wait for the mandible to get where you want it.

ReplyQuote
Posted : 28/02/2020 8:01 am
Sergio-OMS
Trusted Member
Posted by: @drwnjp

About me: 23 y/o male

So 2 years or so ago I noticed that I have a weak chin. During this time I realised that if I push my mandible forward to align both my  top and bottom teeth I get a look that I consider ideal. 

So taking measurements from the x-ray, to achieve this look, I would like to move my mandible 2mm forwards and 2mm down.

Surgery does not seem suitable, nor do I want to be that invasive at this current time as I only have a slight overbite of about 2mm as you can see from the x-ray.  Note that my lower teeth are fairly crowded and therefore protrude forward eliminating said overbite. If this was not the case perhaps surgery would have been more suitable as my forward upper teeth would have caused a more prominent overbite. 

In the current position my teeth (front and back), bite and everything feel perfect, I had braces as a teen that fixed my bite. I would still however like to fix this to feel less self-conscious about my profile as my lower jaw is seated slightly too deep in my skull.

Ideally I don't want to advance my maxilla but if it is necessary for the mandible then so be it. Obviously if I advance my mandible but my maxilla doesn't change too then my bite will be messed up.

So what could be my course of action? Would expansion of my lower palate from thumb-pulling cause mandibular growth for example? Mewing? Face pulling?

X-ray Imgur: https://imgur.com/a/mXcXs8G

Thanks

 

 

MSE first then Le Fort 1  to advance the upper jaw + IMDO.  + braces along the process.

But that's surgery... and you don't seem to want that.

ReplyQuote
Posted : 28/02/2020 11:46 am
NeverGiveup
Active Member

bro that's not a weak chin wake up

ReplyQuote
Posted : 28/02/2020 12:16 pm
Elwynn
Estimable Member

@maxiller

the chin is a muscle attached to you lower lip that you can flex to build soft tissue around that area which might be a quicker short term solution while you wait for the mandible to get where you want it.

Is it a good idea to flex the mentalis muscle a lot? Over the past few months I have been working to avoid doing this, and it has helped me develop a better lip seal.

24 years old

ReplyQuote
Posted : 28/02/2020 4:40 pm
gewgerg
Active Member

@nevergiveup

yes it is it's considerably behind the top lip

 

ReplyQuote
Posted : 28/02/2020 7:33 pm
max iller
Eminent Member

@elwynn

It might help get more chin prominence but also need to be careful it doesnt turn into a lower lip bias

It's more about looking better soft tissue wise than actually serving any practical benefit, honestly just a hypothesis though. Thought it was worth mentioning since many people here want a more forward chin.

ReplyQuote
Posted : 29/02/2020 4:40 pm
Elwynn liked
drwnjp
New Member

@sergio-oms

 

Hi Sergio,

 

I have been learning much about orthognathic surgery and so forth since I created this post and I have realised that my original 2mm amount is nonsense...

 

Because of this I have seriously begun to consider surgery.

 

I have also seen some posts of yours in relation to IMDO on other forums etc. and I would like to utilise your expertise to address a few questions and queries.

 

I realise actually although I have a chin it is actually my entire jaw that is far too small and narrow...My jaw shape I have realised is quite peculiar, I have now looked at hundreds of x-rays and not many are similar to my own. It is however most similar to people with overbites/overjet and low occlusal planes.

My crowded lower front teeth that protrude forward and narrow mandible and maxilla actually gives me a class I bite despite my entire lower face being 'squashed' into a small space due to the bimaxillary protrusion and poor mandible growth. my ramus and the body of the lower jaw is also very short and thin for a male.

 

I wanted to ask you a few key things:

1) Why do you recommend MSE over SARPE/SARME?

2) My upper teeth and lower teeth mesh just about perfectly together at the moment yet my jaw is very underdeveloped. If I expanded the maxilla then my lower teeth would not match as my mandible is too small to match the expanded upper teeth. Does BSSO or IMDO address this? I know that IMDO expands the jaw 3 dimensionally but can BSSO on the mandible alone match a widened maxilla. I am a little hesitant about IMDO despite still being quite young as I have heard must controversy surrounding it on these forums.

3) Is it more challenging to do orthognathic surgery on someone with a smaller jaw? my ramus and mandible as a whole is very small I have found. Far smaller than average when I have compared myself to many different x-rays of other people. By small I mean not just short but also width and vertically speaking. furthermore there is little space between the rear molars and the ramus, some of my wisdom teeth also have not erupted, does the lack of space/small size cause issues with lefort, bsso etc.? I have heard as passing remarks multiple times that having more 'delicate' features makes surgery more tricky.

4) IMDO/DO lengthens and widens the mandible. Is there any way to increase the vertical height of the mandible? Or is this usually achieved only via palatal expansion->le fort I (downwards movement)

5) I live in Syd, Aus and I believe that I will have a consultation with Paul C in the near future whom I believe you know. IMDO however worries me as I have heard some older people have done it yet the bone did not grow and everything had to be reversed. Do you know if Paul C has done IMDO on many adult patients and when he does it, does he usually combine it with BSSO or is IMDO alone enough. Any examples over the recent year etc. My mandible at this time (if my mandibular teeth were not protruding outwards) would have an overjet of ~10mm. 

6) If I did not do Le fort I/maxilla expansion and just changed my mandible via extraction of pre molars + BSSO would this be a bad idea?..

7) At this time I have issues with TMJ. I can only open my mouth to slightly more than 2 fingers width. If I continue to open (such as when I yawn) my mandibular condyles feel like they unhinge out of their sockets. I think I have done this to myself as over the past 2 years I have been sticking my jaw out to make it look less recessed. I have recently stopped doing this as forcefully as I have in the past yet somehow the tightness/unhinging feeling when I yawn has gotten worse ever since I have stopped. Have I permanently damaged the joint area by sticking my jaw out? Would jaw surgery help me in opening my mouth wider in a more natural manner where I do not get this unhinging feeling?

 

Thanks,

 

 

ReplyQuote
Topic starter Posted : 30/03/2020 9:20 am
Sergio-OMS
Trusted Member
Posted by: @drwnjp

@sergio-oms

 

Hi Sergio,

 

I have been learning much about orthognathic surgery and so forth since I created this post and I have realised that my original 2mm amount is nonsense...

 

Because of this I have seriously begun to consider surgery.

 

I have also seen some posts of yours in relation to IMDO on other forums etc. and I would like to utilise your expertise to address a few questions and queries.

 

I realise actually although I have a chin it is actually my entire jaw that is far too small and narrow...My jaw shape I have realised is quite peculiar, I have now looked at hundreds of x-rays and not many are similar to my own. It is however most similar to people with overbites/overjet and low occlusal planes.

My crowded lower front teeth that protrude forward and narrow mandible and maxilla actually gives me a class I bite despite my entire lower face being 'squashed' into a small space due to the bimaxillary protrusion and poor mandible growth. my ramus and the body of the lower jaw is also very short and thin for a male.

 

I wanted to ask you a few key things:

1) Why do you recommend MSE over SARPE/SARME?

2) My upper teeth and lower teeth mesh just about perfectly together at the moment yet my jaw is very underdeveloped. If I expanded the maxilla then my lower teeth would not match as my mandible is too small to match the expanded upper teeth. Does BSSO or IMDO address this? I know that IMDO expands the jaw 3 dimensionally but can BSSO on the mandible alone match a widened maxilla. I am a little hesitant about IMDO despite still being quite young as I have heard must controversy surrounding it on these forums.

3) Is it more challenging to do orthognathic surgery on someone with a smaller jaw? my ramus and mandible as a whole is very small I have found. Far smaller than average when I have compared myself to many different x-rays of other people. By small I mean not just short but also width and vertically speaking. furthermore there is little space between the rear molars and the ramus, some of my wisdom teeth also have not erupted, does the lack of space/small size cause issues with lefort, bsso etc.? I have heard as passing remarks multiple times that having more 'delicate' features makes surgery more tricky.

4) IMDO/DO lengthens and widens the mandible. Is there any way to increase the vertical height of the mandible? Or is this usually achieved only via palatal expansion->le fort I (downwards movement)

5) I live in Syd, Aus and I believe that I will have a consultation with Paul C in the near future whom I believe you know. IMDO however worries me as I have heard some older people have done it yet the bone did not grow and everything had to be reversed. Do you know if Paul C has done IMDO on many adult patients and when he does it, does he usually combine it with BSSO or is IMDO alone enough. Any examples over the recent year etc. My mandible at this time (if my mandibular teeth were not protruding outwards) would have an overjet of ~10mm. 

6) If I did not do Le fort I/maxilla expansion and just changed my mandible via extraction of pre molars + BSSO would this be a bad idea?..

7) At this time I have issues with TMJ. I can only open my mouth to slightly more than 2 fingers width. If I continue to open (such as when I yawn) my mandibular condyles feel like they unhinge out of their sockets. I think I have done this to myself as over the past 2 years I have been sticking my jaw out to make it look less recessed. I have recently stopped doing this as forcefully as I have in the past yet somehow the tightness/unhinging feeling when I yawn has gotten worse ever since I have stopped. Have I permanently damaged the joint area by sticking my jaw out? Would jaw surgery help me in opening my mouth wider in a more natural manner where I do not get this unhinging feeling?

 

Thanks,

 

 

I prefer to try a MSE or, much more predictable, a minimally invasive SARME (MSE + midline osteotomy ± horizontal osteotomy). This is done under local. It's cheaper and faster. If the horizontal osteotomy isn't done it widens the nasal passage much more.

IMDO would be like the best option for widening the lower jaw and to get a mandibular contour, but in an adult (over 20-25) the postop isn't easy. Maybe a bimax would be a better option, although the results wouldn't be as good in terms of breathing and aesthetics.

Extractions aren't a good choice, in my humble opinion. They reduce the space for the tongue and narrow the smile.

It would be better for you to heal your TMJ issues with conservative treatments: splint therapy + physiotherapy + oromiofunctional therapy before doing any of these other skeletal treatments.

Paul might disagree with me in some of these points...

ReplyQuote
Posted : 10/04/2020 3:53 am
drwnjp
New Member

@sergio-oms

Ok I will definitely discuss MSE with him then.

I really like the idea of IMDO as my mandible is really quite small and narrow. I don't want a crazy masculine jaw but just normal...my jaw looks very similar to the ones in his videos and website, both adult and children (no or little CCW rotation required just forward growth of the jaw being the main concern). I am really hoping that Paul recommends it for me as I think I am willing to try IMDO if he is willing to provide the service. 

One key issue is I do not have an overbite/overjet so my teeth will need to be pulled back I believe to create an overjet before the IMDO procedure. However, there is very little room to do this in my undersized jaw, hence I suggest the extraction of pre-molars of the mandible. If we did extractions, as I understand it can take 1-2 years to close the extraction gap, delaying the IMDO procedure until I am 26-27 y/o...Perhaps there is a smarter way to work around this. Would it be unorthodox to do IMDO first before any orthodontics?

 

ReplyQuote
Topic starter Posted : 10/04/2020 4:13 am
Sergio-OMS
Trusted Member

The idea would be do do MSE first, braces, and then IMDO + Le Fort 1 (this way you would have the necessary overjet), as I said in my first post in reply to yours.

ReplyQuote
Posted : 10/04/2020 5:10 am