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Jaw Surgery and Dental Implants in Singapore Blog

Bimaxillary protrusion in Singapore & Hong Kong – a tale of two cities

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Bimaxillary protrusion is an ethnic facial feature of most ethnic Chinese and Malays in Singapore. As with all facial features, if the protrusion develops excessively, it will pose an aesthetic challenge. Unlike an underbite, where the lower jaw has grown to be longer than the upper jaw, diagnosis of whether a particular state of jaw protrusion is excessive and warrants surgery is rather grey. Where do we draw the line, where normal degree of protrusion ends and a dentofacial deformity begins?

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Bimaxillary protrusion corrective jaw surgery without orthodontics

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Bimaxillary protrusion is a condition whereby the tooth-bearing parts of both the upper and lower jaws are positioned further forward than the base of the jaws. It is not strictly speaking a deformity unless it is excessively developed. In fact it is within the ethnic norm for Chinese and Malays. Nevertheless, many patients seek treatment for it as the societal norm now is that a straighter profile is considered more aesthetic. For most patients, orthodontic treatment with extraction of premolars will suffice. Those with more pronounced protrusion will require surgery to achieve the results that they want. However, there is a group of patients who do not want to have orthodontics as their jobs do not allow them to have orthodontic brackets bonded to their teeth for two to three years. Can they have corrective jaw surgeryto treat their bimaxillary protrusion without orthodontics?

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Surgical correction of bimaxillary protrusion in Singapore

bigstock-Smiling-Young-Woman-Face-With--46445635.jpgMany years ago, an orthodontic colleague referred a patient to me for extraction of four premolars. His orthodontic plan was to retract the front teeth back. However, when I asked the patient what made her sought orthodontic treatment in the first place, she said that she found her upper front teeth too protruding and that she was unable to close her lips. Looking at her face, even without smiling, most of her upper incisors could be seen. She had difficulty closing her lips, which were pushed outwards due to the protruding jaw bones. I called the orthodontist to share with him my view that this case was best treated with orthognathic surgery rather than braces alone. He agreed with me but thought that the patient would not accept surgery. That day, instead of extracting her four premolars, I explained the option of orthognathic surgery to correct her condition instead. Eventually, after due consideration, she decided to have surgery instead. I referred her back to her orthodontist for pre-surgical orthodontics and she came back after a year for the surgery.

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