Hello all (Mods apologies if this is in the wrong section- please feel free to move it if necessary!)

Having been in braces for just over a year (May 23rd, 2011) my ortho has decided that the time has come for the de-bracing, this coming Thursday. It will be a completely new ortho that I see for the de-bracing as the one who I have been with for my whole treatment has recently moved practices.

I'd really like your opinions on whether or not to accept this result or argue it- please could you take a quick look at my pictures and let me know honestly what you think? I've had a word with my ortho (the one who has moved) in the past over things I've not been happy with but they don't seem to have been fixed- maybe I am being unreasonable.

My problem is the alignment of my bottom teeth, and the fact that my top tooth appears twisted- it appears to be pointing inwards and is further forward than my other top tooth. He did try and fix the top tooth, but brought it waaay forward, so then pushed it back into its previous spot and sort of left it. I'm trying to get the best result possible for my braces to allow for any shifting when they come off. He didn't seem to think there was a problem with my lower teeth, or I didn't explain it to him well enough or something. He kind of brushed it all aside and said that a power chain would sort them out, which makes me feel like I am making a bigger deal of this than it should be. I feel like an idiot, so I want your thoughts!

It would be so helpful to me as I'm trying to decide if I am being unreasonable! I know that I may see things that others don't, and I may well be being too nitpicky, but I would really appreciate an honest response from unbiased people Then if I do find I am being nitpicky will just shut up and accept the finished result with a de-braced smile, haha I do think these pictures are surprisingly more flattering than they appear to me in real life (just please don't mind the lighting on those last pictures! ), but again that could just be me seeing all the faults magnified!


Closed bite (for closed bite pictures please bear in mind I've still got a ceramic lump on my molar! I'm told it will be removed along with the braces )


Open bite


Closed bite


Open bite


Closed bite


Open bite


Closed bite


Closed bite


Closed bite

Would you accept the above as a finished result?

I would really appreciate any responses Thank you!!

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I personally would go get another opinion from another place. I wouldnt accept that. For the money you pay, you should have the perfect smile when all is said and done. If your guy is not listening to you, then he is not the right guy for you.

On the bright side, I am sure you will get everything the way you want it in the end. No stress :D

I think your individual teeth themselves are lovely and white and lovely shaped. I'm sure your result could be better - I agree that you should seek another opinion.
What was your initial treatment time estimate?

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1st Feb 2012 - extraction both upper 2nd premolars
Braced 9th March 2012 - lower metal fixed and upper removable plate
5th September 2012 - bite plate gone, upper ceramic fixed fitted
Estimated treatment time 18-24 months

It looks like you are nearly there but just not quite yet? The thing that would concern me most, is the position of your front tooth, the one that he sounds to have had difficulty in positioning properly? The lowers are quite good, but still look like they need a little fine detailing. But I would struggle to accept the position of that top central incisor and would really explore there as to what can be done to make that more aesthetically acceptable for you. The very best of luck to you - hope you get a result you can be really happy with

I personally would not be happy and i would seek another opinion, then stick the previous ortho with the bill. If it is beyond his "skill " level then he should have referred you to someone else. Dont settle for second best you didnt pay 50% of the billl.

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I think you should seek the opinion of another orthodontist at this point to see what they think before they start the process of taking off the braces.

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~KIMMIE



Click here to view my story: viewtopic.php?f=9&t=42578

Thank you so much for your speedy responses- I was sure I wasn't being unreasonable!!

I actually rang up about 6 weeks ago to get the de-bracing pushed back as I wasn't happy (they were in a similar state) and the receptionist cancelled the hygienist and retainer that time, but this time she refused despite me saying I really wasn't happy for them to be taken off on Thursday- it seems so silly to hog a hygienist appointment (that could be used by someone else) when I really do not want them off! She said she wouldn't cancel the hygienist this time in case I did decide I wanted them off, because then I would have no hygienist there to take them off.

I was worried that I'm being really finicky or something and unreasonable over this (but was sure my teeth weren't finished), so am so relieved to hear that others would not be happy with this as a final result also. My initial treatment plan (off the top of my head- I haven't got the paperwork with me at the time of writing) was 9-12 months.

I'm also worried because I was told I had short roots on my front teeth at the beginning of treatment so I'm particularly worried about moving the front one back and forth so much! But maybe that's just me being a worrywart! It's so frustrating because who am I to argue with the professionals?! I don't even know how to argue with them. It's a reputable practice as well, so I can't understand this. It's part of the reason why I was worried that it's just me being fussy!!!

As I'll be seeing a new ortho on Thursday I don't know whether or not to just wait until then (but am terrified I'll let myself be talked into having the braces off as the hygienist will be booked) but I also hate causing fuss (although there wouldn't be any fuss if my teeth looked right!) and I already feel awkward enough over this whole thing as it is. But I just know that if my braces are taken off like this it will feel like the whole time/travel/money/inconvenience that we all know braces cause(! ) was for nothing- I look like someone who needs braces!! I feel like crying- I've always felt so self conscious over my teeth before braces, so it would be my worst nightmare to get them taken off in a different crooked state!

I'm hoping that the new ortho on Thursday will be reasonable and won't try and insist that I get them taken off there and then. I am debating about ringing another ortho in the area and trying to get an appointment before Thursday (short notice) but their initial appointment costs- which I'm guessing would be the equivalent cost of asking for a second opinion appointment- are very steep, £75-£80, which is really far out of my price range.

I feel better knowing it's not just me who sees a problem with my teeth as the matter stands- it's nice to have other opinions backing me up so I know it's not just me being unreasonable!!

Thanks for your opinions, I appreciate it.

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I would not be satisfied and would seek out another ortho w/o debracing. Im the type of person if I'm paying "x" amount of money I should have the desired end result. Would I argue with a reputable professional? Yes I would. Good luck and keep us posted.

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If this ortho being refered from the current one you had?

If so, try also going to another completely different one with no connection to the original one.

I would not only be unhappy about that top arch, I would be having a serious case of the ...uh... I would be very angry. Refuse to finish the job? Fine. You can reach me through my attorney when you get the bill from my new orthodontist.

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Are you going to have an implant in the upper gap?

I can see why my ortho wouldn't let me have ceramic brackets on the bottom, those things look big.

I think the bottom arch is not top bad but I would definitely not be happy with my central upper teeth. Get another opinion do not let them push you around, take a friend or family member with you for confidence if it helps.

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Brace Date: 14th April 2011
Estimated Debrace Date: 14th April 2013

4 extractions, upper ceramic brackets and lower metal to fix overjet and overcrowding.

There are a number of factors at play here:

1. Due to preexisting root resorption, the doctor may not want to stay in treatment too long.
2. The space in the upper arch makes the case look much worse than it might otherwise appear.
3. There is severe wear on the upper right central incisor that makes it shorter than the other one. It looks like your doctor has tried to match up the gumline rather than the incisal edge. This is a good strategy if you show your gumline when you smile. Your choices would be to restore the tooth longer or trim the other one shorter.

That being said, there may be some changes that can be made with the tip and rotation of the incisors. Above all, it may be helpful to show your orthodontist exactly what is bothering you, figure out if it can be done or needs to be done, and then go from there. You will feel better with an explanation. See if you can book a short consultation for some time with the doctor, letting them know that this amount of time may help them save needing a hygienist there if you don't get your braces off. Visiting another orthodontist at this point is probably not required.

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Dr. Jason K. Tam
Certified Markham and Stouffville Orthodontist
Elite Preferred Invisalign Provider
2012 Invisalign Case Shootout Final Four

Toronto Invisalign, Invisalign Teen, Incognito / iBraces

http://www.mcosmiles.com
http://www.markhamortho.blogspot.com
http://twitter.com/markhambraces

Learn all about Invisalign at http://www.torontobraces.ca. See before and after images, Invisalign procedures, and compare Invisalign vs braces.

A couple of questions:

1) What are your restorative plans? Jason is correct in that there is wear on the upper right incisor - are you having a bridge for the missing tooth, which would also retore the edge of your upper right front tooth, or are you planning on an implant? It's certainly affecting your esthetics and is understandably what most of the responses so far have keyed in on. Shaving the tooth next to it to even things up is probably not a great idea; it would make your incisors too short. So you either need to restore the edge of the upper right central incisor (via bridge or veneer) -which is almost certainly what your doctor is planning on - or bring it down more orthodontically to make things look more ideal.

2) Have you had a recent panoramic radiograph? If you're planning on an implant for the missing lateral incisor the roots of the adjacent teeth can't impinge on the implant space. Your upper right front tooth looks like it could be slightly tipped towards the midline, which would put the root closer to the implant than it needs to be and could make placement more difficult. Take what I say with a "grain of salt"! Because of the wear on the tooth, it's not possible to determine this unless you do an x-ray, and I'm just looking at a picture. I'm assuming your orthodontist has checked this and it's just the wear on the tooth making it look tipped (which is very common) but it never hurts to be sure!

3) You said you had concerns about your lower teeth. Your lower right central incisor may be a SMIDGE behind the others (tough to tell from pictures, especially with some worn edges), but overall alignment looks pretty good. Again, a pan would let you check root angulation, and assuming the roots are in a good spot some gentle contouring of the edges (very common on adults) can make things look dramatically better.

You have every right to discuss your concerns with your orthodontist before removal. Most orthodontists charge more for adults. While some of this is because adults are not growing and treatment CAN be more challenging (though it's often not), most of it is because adults take more chair time due to their desire to be more interactive in their treatment. Every orthodontist wants (or SHOULD want!) you to be a "raving fan", it's in both of your best interests. I agree with Jason that you need to express that you have some concerns and make sure you have enough time (ex short consult) to review things, possibly with the aid of pictures.

Thank you all so much for the responses, special thanks for the professional input, really appreciate that.

I haven't had a recent x-ray, and my plan is to get an implant. I think this is what I'll see if I can request tomorrow. I'm quite nervous about it, but have just taken more pictures of my teeth on my phone to show the new ortho, and it's really not a result I'm happy to finish with. Not like this, anyway, but as pointed out, the missing tooth may make things look much worse than it is. If the roots are straight then it could just be the shape of the tooth, which I expect can be sorted out somehow by my dentist or a cosmetic dentist. And hopefully there will be some sort of explanation for my bottom teeth.

I will ask for an explanation and take it from there. I really hope the new ortho will be understanding

(In terms of the length of my central incisors, the larger one was actually shaved down a little by my ortho before. The two front teeth did used to measure up at some point during my braces journey, and were straight together, so he shaved the bigger one just to make them look more equal. I was quite upset that my longer one was shaved down, as I already think my teeth are too small as it is!!! Never mind though so long as my finished product is good I'll be happy)

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THANK YOU all so much for your honest responses and input!!

Just got back in from the ortho, and I'm so happy!! My new ortho is LOVELY, and the first thing she asked was if I was happy. I showed her some photos of my teeth and pointed out what I was not happy with. (I didn't mention that I had posted online for advice)

She said that she thought the bottom teeth were near as perfect as they were going to get, but she would sort out the top one. I was so happy when she said the best thing to do would be to get an x-ray to check the angulation of the roots so that an implant could eventually be done without being too close to the root (DrBill ). She kept talking about implants and roots and said that she thinks the best thing to do is to speak to someone who does implants to get their opinion on the distance between my roots before the braces come off.

She repositioned my brackets, which was a first for me. She repositioned the one on the offending top tooth, and three on my bottom row (the one with the dot on it, and the two front teeth next to it). She said as I'm staying in braces longer it would be worth seeing if there is any more that we can get out of my bottom teeth, but she does think that they're nearly there, but we will still see. OMG it hurt getting the top bracket off!!! It felt like my whole tooth was going to come out of my mouth or split or something!! The bottom ones were a cinch, but that top one... OW. I'm convinced my teeth are already looking better after this appointment though, maybe that's just wishful thinking!

I get my next appointment and an x-ray in three weeks time. She said she wants someone else to be available that day, so I wonder if this person has got more in depth knowledge/experience re. implant root distances or if she will just be wanting another opinion on something.

THANK YOU ALL SO MUCH for your honest responses and again very special thanks for the professional input. I'm so happy this new ortho took me seriously, and I'm so happy to have been backed up on here before I went.

Thank you again!!!!

(Pic from after appointment- check out my new brackets, haha)

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