Question about facial changes

[maxhammer]

Had a second consult with the ortho today (I've talked to two orthos, and my general dentist, who is a master with teeth, so 3 opinions total). Went over complete records with two orthos. Seems they all agree my mouth is small and would benefit from four (1st) bicuspid extractions. What has my concerned is all these comments about "dished in" profiles. I mentioned my concern to the ortho, and he laughed. He said I have an overbite and can go back at least 2mm and be fine. Plus he said I have full lips, and this helps for some reason (?).

Anyway, I guess I have a more "vertical" jaw than the average guy, and he did say because of this the face could possibly elongate after treatment. This has me concerned. A face elongating from braces? That sounds scary. I just want to be myself, yet with straight teeth and a solid bite. I don't want plastic surgery where my face completely changes. Of course, when I said I was concerned, the ortho said not to worry about it. If anything it would be minor, etc.

Can anyone offer some insight on this? I think I would rather have a minor overbite than a long, horse face. How real is this possibility?

Thanks!

PS. If this information helps, I am considering lingual braces on both the top and bottom due to my age/profession (I'm 34).

[Sunny]

Bones don't change after adolescence, unless you have surgery ... so how did ortho explain that this could happen? What did the other ortho say would happen to your profile?

I suggest you continue with your consults, or if you're really unable to trust an ortho, you'd be best not to have treatment, as you'd be 'second guessing' everything that happened.

[maxhammer]

He said something to the effect that my jaw was "vertical", and pushing back the overbite/overjet coupled with the 4 extractions could elongate it. He seemed to think it was highly unlikely and said they'd do everything to prevent it, but he mentioned it. This is a top notch ortho in Santa Barbara ($$) California who has a great reputation. I don't question his knowledge, and I do trust him. I just tend to become paranoid about things like that when I hear them.

[Sunny]

If it's worrying you ... then it is an important issue that needs to be clarifyed before you consider starting treatment.

I have seen a slight change in patients profile due to the teeth being moved back in the existing jaw. The patients are delighted with this, as it removes the overbite and the face is in better balance.

I don't understand how a face can be elongated in any way, when there can be no change in the bone structure.

Keep asking questions and researching. Good luck!

[maxhammer]

Thanks, Sunny.

How do you feel about extractions? It seems to be very controversial. There is an ortho (the same guy) who shows up in every yahoo thread and says that extractions are outdated technology, and any ortho who practices this way is not a good ortho. Well, I've had one (a conservative guy) say extractions are likely, but he'd try to do it without, another ortho said extractions are definitely needed, and my general dentist (who is amazing, a true craftsman with teeth) said he didn't see how it would be possible to get pleasing results without extracting teeth.

Meanwhile, I read about "dished in" faces, people who age 20 years because of bicuspid extractions, etc. I wonder how much of this is real, and how many of these people micro-analyze their faces and/or have body dysmorphia. Any thoughts?

Thanks.

[Sunny]

A good ortho knows when to extract and when not to. A not good ortho is one who believes that extractions are the only way to go ... or the only way not to go!

Some people have teeth that are too wide and when these teeth are placed correctly in their jaw bone, they just wouldn't fit. It isn't difficult to work this out when an ortho is preparing the treatment plan, due to the extensive x-rays that are used and the 'drawings' the ortho does at this stage. The main issue when more space is needed, is how best to get this space. Teeth are different sizes, so the ortho needs to take that into account. The pre-molars appear a good choice for most extractions, due to them not being the smallest or the largest teeth. If only a small gap is required then IPR (shaving small amounts of enamel) will usually provide the space necessary.

If teeth need to be extracted, then that's the only way that a persons treatment can be done correctly. Our jaw bones are finite in size and our teeth are a fixed size (although they can be made a little smaller with some IPR) ... so the maths need to be done and a good ortho will make the right decision.

If a person has what they think is a 'dished in' face, my guess is they're going to want to blame someone ... and the poor ortho is the person who seems to get picked on, whereas genetics may be the real cause ... or maybe poor body image. Teeth incorrectly placed in the jaw due to lack of ortho treatment, or for some people due to teeth movement due to not wearing retainers after orthodontic treatment, may also cause some of these issues.

Good luck with your consults and decision!

[maxhammer]

Thanks, Sunny.

Any opinion on the dished-in face after extractions? Do people get sallow and age?

Also, my ortho wants to do extractions for two reasons:

1. My face is narrow...widening the arch isn't really an option.
2. The teeth that he wants to extract have gum issues. They'll probably need grafting down the line. He thought we could kill two birds with one stone by extracting them: avoid future gum problems and make space for my narrow jaw/crowding.

Does this seem reasonable?

Also, he said not to get crowns done until after braces. I had to go against this as I had a crack and would have lost the tooth. Any idea why this would be his recommendation? If I get a crown, will the teeth still line up properly?

Thanks.

[Sunny]

Aging is a natural process that happens to everyone. If a person looses weight they could appear more shallow ... other than that ... I have no idea.

Sounds totally reasonable!

Crowns can affect the way a tooth moves, but most ortho's can move teeth with crowns on them. Give your ortho a call and discuss this with him.

[WeeC]

Hi Maxhammer, you sound just like me before I got my braces on, but I think it is important to get the right advice and to ask different ortho's!

I have just had my lingual braces taken off after only 1 year 2months!! makes me wonder why it took me so long to get them as I'm now 30! Like you I have a narrow jaw!! and was suffering from a slight over bite! I didn't need extractions, the brace expanded my teeth slightly and it worked so well as my teeth were very crooked due to my over bite and narrow jaw. Did my face change? my mouth area has changed very very slightly, but I knew it was to be expected because my teeth were repositioned and pulled down and in (as I had an overbite and gap) the result is brilliant, and please don't make the thought of your face changing put you off. You will still look like you but you'll have lovely teeth ;o)

Good luck with it all!

[maxhammer]

Hi Maxhammer, you sound just like me before I got my braces on, but I think it is important to get the right advice and to ask different ortho's!

I have just had my lingual braces taken off after only 1 year 2months!! makes me wonder why it took me so long to get them as I'm now 30! Like you I have a narrow jaw!! and was suffering from a slight over bite! I didn't need extractions, the brace expanded my teeth slightly and it worked so well as my teeth were very crooked due to my over bite and narrow jaw. Did my face change? my mouth area has changed very very slightly, but I knew it was to be expected because my teeth were repositioned and pulled down and in (as I had an overbite and gap) the result is brilliant, and please don't make the thought of your face changing put you off. You will still look like you but you'll have lovely teeth ;o)

Good luck with it all!

It sounds like we have the same exact mouth/jaw. Did your jaw narrow or elongate at all? I hear it narrows after extractions, and this is a concern of mine. As of right now (1 week after extractions) I have not noticed any difference, but my canines haven't moved into the extraction space yet. I worry when they do I'll narrow. What causes the jaw to narrow exactly? Anyone know? Sunny, per our conversation above, I believe my ortho meant there would be the illusion of elongation due to potential narrowing...he said he'd do what he could to avoid that, but I'm unsure what that entails.

[maxhammer]

Thank you.