Starting ortho treatment in 2 weeks

[pearlywhites]

hi guys am new on here
after two kids and numerous photos i have decided to pluck up the courage and ask my dentist about correcting my teeth.
i was 14 when i was last told about orthos having to break my jaw and wire it into place and then get metals fixed for two years alas i was going through exams so my mother didnt alllow it to happen.
now though 15 years later my bite has become more noticable and teeth more apparent especially in photos. i didnt know about adults getting braces but have since learned that we can so asked about it. pleased to know i can have them corrected but a bit apprehensive about the pain ill go through. dentist has told me the orthos might want to pull a couple off teeth out instead of breaking my jaw to align them better. so lets see and ill keep posting. is any one the same age as me getting tis treatment done and does it work?

[mikeg]

I am always "skeptical" when an orthodontist or dentist says the only way to fix a person's teeth is to break the jaw.

I went through the same thing as a kid, and then when I was an adult late 20's I found an ortho who knew his sh** and fixed my bite alone with braces and elastics.

Pulling teeth is a lot better than having jaw surgery, especially if it is not needed!

Start your blog and we'll be able to give you advice going forward. Good luck and kuddos to you for getting this done now. Adults with braces is VERY common.

[Zoso]

I am less skeptical than you, Mike. There are a lot of things to consider when options such as surgery or extractions are presented. It's not just about whether you can get to a good bite and/or a pretty smile (and sometimes one of these results is achieved without the other) without them, but it's also about the stability of the results, and also other considerations around facial aesthetics. It might sometimes be possible to get there without surgery and/or extractions, and the results might sometimes be both good and stable, but this is not always going to be the case.

I'll give a few examples.

Perhaps a person has a very recessed chin and a significant excessive overjet. The ortho might be able to get a decent looking smile (but probably still with an imperfect bite) without surgery, but the only way to give her the profile she wanted might be by advancing the lower jaw - and this way she might have got a perfect bite too, rather than one that just looks good.

Perhaps a patient with a smilar case is offered either surgery or extractions to correct it. She chooses extractions, but is unhappy with her profile at the end of treatment, because the entire lower third of her face seems small.

Perhaps a person is advised to get extractions, but refuses. At the end of the treatment, her bite is great, but she is unhappy because she feels that her mouth is too protruberant, and she has trouble closing her lips together completely - she has bimaxillary protrusion, and would have been better off having premolar extractions.

Consider an adult who is advised by multiple orthodontists to have surgically assisted expansion, but eventually finds one who will treat her with an expander alone. Her smile looks great at the end of treatment, but in truth the bite has been achieved not by expanding the palate, but by tipping the teeth so that they only meet by the upper teeth leaning out at an angle. Looks good, but ultimately this is not the best bite, because it doesn't direct the forces of chewing along the length of the roots, and poses a heightened risk to the long-term health of those teeth.

Or maybe the problem is an open bite that is being caused by a skeletal discrepancy. The ortho manages to correct it and all looks well, but over the next few years the bite just opens right up again and she ends up back in treatment, this time opting for surgery to get a result that is good looking and functional, but also stable. (This one isn't hypothetical - I know someone who went through this scenario)

The thing I am trying to say is that we need to ask a lot of questions, and make sure that we are confident that we are doing the very best thing for ourselves. We need to understand all aspects of the quality of the results we should expect from a particular treatment plan - not only whether the smile will look nice, but also whether the bite will be good, how the facial aesthetcis will be impacted, and how stable those results are expected to be. Then we need to weigh our options in terms of the quality of the results versus what we would have to go through to get to them, and which considerations are the most important to us as individuals - for someone who really really really wants rid of that recessed chin as well as the overjet, but doesn't want surgery, surgery may still be the right choice, but for someone who wants rid of the recessed chin and overjet but really really really doesn't want surgery, then looking for some sort of compromise treatment plan, and accepting that the profile would not be corrected would probably be the way to go.

Edited to add: I strongly disagree that extractions are better than/preferable to surgery. They are less traumatic, perhaps (although for many people orthognathic surgery proves not to be a big trauma either) but they are not always appropriate. Each case has to be considered individually, and though extractions might sometimes give absolutely fantastic results and be by far the best approach to a particular case, they can also sometimes give dismal results from an aesthetic standpoint (when the case is one that was poorly suited to this approach).

[Zoso]

hi guys am new on here
after two kids and numerous photos i have decided to pluck up the courage and ask my dentist about correcting my teeth.
i was 14 when i was last told about orthos having to break my jaw and wire it into place and then get metals fixed for two years alas i was going through exams so my mother didnt alllow it to happen.
now though 15 years later my bite has become more noticable and teeth more apparent especially in photos. i didnt know about adults getting braces but have since learned that we can so asked about it. pleased to know i can have them corrected but a bit apprehensive about the pain ill go through. dentist has told me the orthos might want to pull a couple off teeth out instead of breaking my jaw to align them better. so lets see and ill keep posting. is any one the same age as me getting tis treatment done and does it work?

For me the best option was surgery (my orthodontist felt that in my case extractions would lead to poor facial aesthetics). And I'll tell you that I was reluctant! But it turned out so well - so much better than I ever could have hoped. My smile looks great, and more importantly I have a really good bite now.

Discuss your options, and understand what sort of results to expect. You should probably consider having more than one consultation, if you can, since it sounds like it is possible different orthodontists may have different ideas about the best way to treat your case. Don't be shy to ask questions - don't be shy to ask a doctor who recommends extractions why he thinks this is best, and whether/how your profile might be impacted; don't be shy to ask a doc who suggests surgery (if any do) why he feels this is the right way to go rather than extractions. Heck, if you find one who would lean either way, ask what he'd recommend were you his sister!

[mikeg]

Great point about the Stability. I have seen many cases, where braces alone fixed a bite issue and then a relapse slowly occured, even with the use of retainers 24/7. The people that I have talked, would of preferred to have actually just got through with the surgery in the first place, than to have braces on multiple times and never really correct the issue.

I guess my point with pulling teeth is kind of null too... I agree with your point there too.

Thanks

[pearlywhites]

Thanks guys for your info!!!
funny you say different dentists and orthodontics seem to say different. when i was 14 the ortho i seen was in England were i lived before and that was how they said the relationship between teeth was off, surgery was the way forward with metal braces but that was back in '94 Now however i have moved to scotland and my dentist says extracting teeth may be a solution. I guess ill need to see what they say i have every single one of my teeth and would hate to lose them but if its going to help so be it. if it does turn out that i need surgery i will need to think about it cos ave got young kids to consider if im gonna be in pain. ill keep posting!! 11 days to go!

[Zoso]

There's a few factors at play, Pearly. With ongoing research, like any medical treatment, orthodontia is an ever-evolving field. In the past, "four on the floor" - extraction of four premolarteeth - was an extremely common approach, but it is being used a lot less today; and there are also newer techniques being brought to bear, such as the use of TADs - temporary anchorage devices, which are actually little screws that are attached to the bone, against which the braces can pull. Etc., etc. And, I feel there are also some differences in treatment depending where - in which country - you are located; for example, four on the floor remains more common in some countries than others, or I have noticed the use of removable braces such as Inman Aligners seems to be more common in the UK.

But then there is also the fact that there are multiple considerations in determining the best course of treatment. I've mentioned the expected stability of the results, of course. But there is also the interplay of facial aesthetics and both the function and the aesthetics of the bite itself. And, on top of this, there is the question of what a patient would be willing to tolerate (I suspect some docs shy away from surgery just because they feel patients would consider it too extreme) and also the doctor's experience - quite simply, some are less experienced with surgery, and tend to shy away from it in part because of that. So these are all areas that can lead two doctors who have had broadly the same training to offer different opinions.

My first piece of advice I will add here is not to listen to your general dentist - he can give you some guidance, and might be a good source for a discussion if you find yourself puzzling over your options. But, at the end of the day, he is someone with minimal training and minimal to no experience in moving teeth.

Since you are in the UK, my advice is particularly to seek out someone who is a "Specialist Orthodontist" - in the UK any qualified dentist who provides orthodontic treatment can call himself an “Orthodontist” regardless of whether he has had additional formal training in orthodontia. "Specialist Orthodontists" are docs who hold the Membership in Orthodontics of one of the Royal Colleges of Surgeons (MOrth), which would require extra training. The web site of the British Orthodontic Society has a page where you can search for providers who are local to you (Find an orthodontist - Introduction) and the results clearly indicate which are Specialist Orthodontists. And these will usually be the docs who have the best combination of formal training and experience in moving teeth so as to achieve a good, stable bite, and good facial aesthetics.

[pearlywhites]

Had my appointment and they gave me a full mouth mot and xrays, I was there for 2 hours solid. So yes the dentist was just giving me guidance, and i did feel hopeful but as you pointed out there is a lot of asthetics that go hand in hand. my facial profile is very small and my lower jaw is set back and my teeth have a 10mm gap between them. before i found out the results of my xrays the orthodontist had said it would be a combination of both full metal appiances and surgery, so basically the same when i was told it as a teen. My profile is in line apart from my bottom jaw line and because i have small proportions of facial bones my profile will look more in line after my jaw is moved forward.
The x-rays came back and it confirmed the same so i have decided to go with it and get them sorted now. Has vanyone else had jaw sugery for an overbite because i really need to know how you got on ?
Thanks guys for the feedback

[Zoso]

Surgery sounds pretty scary, but for most people it turns out not to be anywhere near as bad as they imagine. In fact for some people it turns out to be pretty easy.

I'll not sugar-coat it though - there are certain risks to bear in mind. But, as is evidenced by how many people make this choice, for many many folks, the risks are far outweighed by the benefits. The biggest risk you will have will be lingering numbness in the chin and perhaps in the lower lip; but if this happens, the extent - the amount of tissue affected - is usually small.

Good luck!

[mikeg]

How severe is your overbite?

[pearlywhites]

Hi mikeg

My over bite with my teeth together is 10mm distance from bottom to top, they refer it as aclass 2 overbite with protrusion of top front teeth and lower front teeth. i have a smallish facial structure, but my bottom jaw hasnt grown to meet my top jaw its stayed back. as i get older it is becoming more noticable especially on photos and videos. since then ive had two more appointments and the last one has me in shock because there might be cause for both top and bottom jaw surgery.
once the ortho has re alined my top teeth they might swing round to the left, and my bottom will not match in symetry once it comes forward . so pardon the expression am crapping me self . has enyone else had the same?