Hi,

I am new to this forum and have come here looking for some opinions on an analysis I received from an initial consultation with a local orthodontist. I know nothing about orthodontists in great detail, so wanted to run this analysis by the team here to get their opinion on it, mainly to get some reassurance that it all "generally" checks out. I am a 26 year old, healthy male, who lives in the UK. Okay, bare with me on this as I am having to type it all out from a letter I received in the post.

Thank you in advance to everyone who replies. I look forward to reading your thoughts and opinions

The Problem
You have what we describe as a class two, division one malocclusion with an overjet, which is a prominence of your upper front teeth of up to 1cm on the left central incisor. The overbite which is the vertical overlap is normal at 2mm, but is incomplete and your side tooth relationship is out of phase by a whole premolar width, with upper definition being forwards of the lowers, although as you rightly note, it is really the case of your lower dentition being set back.

You have slight rotations of some of the anterior teeth, but these are minor and your upper and lower centre lines are displaced 2mm to the right. The arches are mildly crowded, but with the proclination of your lower anterior teeth, it may be necessary to consider taking out two premolars to decompensate them if the madible is just to be brought forwards through surgery. I feel this deicison is best made once initial alignment has been carried out and a new x-ray taken to assess the position of the lower anterior teeth.

I have sent your file over to the jaw surgeon and asked him to assess whether he feels it would be just a case of bringing the lower jaw forwards through surgery (or a bone implant), or whether he feels a dropping down at the back of the mandible would also be necessary. If it is just a forward displacement, the extraction of the premolars becomes more likely than less.

The Solution
Your orthodontic treatment would involve upper and lower fixed appliances, preferably metal brackets on all teeth, but it should be possible to use ceramic brackets on the upper four incisors, as these will not be so essential as part of the locking together at surgery. Pre-surgery treatment time is likely to be between one year and fifteen months in braces and it may be necessary to refer you back when we need to decide whether to extract lower teeth (hopefully done before nine months if necessary).

You will then go for a surgical evaluation and this would be accompanied by study models, which will require you to have impressions again later on. Once the surgery is planned, I will need to place heavy wires in and traction hooks so they can lock the two arches together. I will use smaller stainless steel brackets on the side teeth and lower anterior teeth, which will carry a slot which will allow us the placement of a hook so without making lots of barbed wires on large fat stainless steel wires. I can keep it fairly neat and tidy, but still have the heavy wires in to support the surgical correction. After surgery, there is likely to be a six month period of post-surgery treatment settling in order to establish the final inter-digitation and locking together of the dentition. In the long term you will need to have retainers and if the lower incisors are allowed to drop back and teeth are taken out, it is very unlikely that there will be much indication for them wanting to move post-treatment. The upper arch normally behaves very well, so I recommend that you have removeable retainers for no less than a year, but there is the possibility of resorting to fixed retainers if the teeth for some reason do not stabilise. However, this would be unusual.

My Thoughts
Although fixed braces will straighten teeth to a very high standard and retainers usually keep all teeth straight, some tooth movement will occur after the end of retention. Some of this tooth movement is natural and favourable, but unfortunately in some cases, it can be unfavourable and this is called a relapse. Wherever possible, tooth movement is carried out to an excess during active treatment so that the teeth settle in a normal relationship during the post-treat settling phase. However, in some instances, tooth movement cannot be over-corrected and tooth movement occuring after retention cannot be predicted. In these cases, secondary treatment may be necessary and in my experience, this happens to approx 3% of patients. If this happens during the year od retention, this will be covered in your initial treatment charge. If it occurs after retention or as a result of not wearing your retainers, a seperate charge will be necessary.

There are some drawbacks to orthodontic treatment that I would like to make you aware of...
He goes on to discuss "loss of root length" and the "untimely death of teeth" due to orthodontic treatment, but finishes by saying that the vast majority of people pass through orthodontic treatment without any problems.

Costs
Charges for a full course of fixed appliance treatment using full upper and lower metal attachments currently start at £3,000 and this includes all appliances, adjustments and maintenance throughout treatment. However, in your case, because of the prolonged nature of this treatment and the possible use of ceramic brackets on the upper four incisors, the fee for treatment will be £4,500, inclusive of all procedures except fixed retainers, which command an additional charge of £250 per arch if they prove to be necessary.