My elastics ...

[Clo]

Hi Dr. Jernigan,

maybe you remember my case a bit.
If not, I have here the link to the last questions I asked you :

viewtopic.php?t=6444

Now, in order to try to close my bite more, I got the following elastics
configuration :



Now that my molars are closing some (still only one pair touches when I
bite down), I experience that my front teeth open again. And my overjet
is getting worse too. I tried to take some more pictures :





I know this is difficult for you to see if something is wrong. But this is an
ongoing story of closing front bite, closing back bite and again needing to
close front bite ... And this after 19 months in braces, and 13 of them
with elastics. Short question, this is going wrong isn't it ? Some days ago,
there was a question here of Yayme! Her canine (pic 3) is just like mine
was in the beginning. So I guess the attempt to try to create a good bite
for me without extractions or even jaw surgery is ment to be unsuccessful.
At least I begin to think that. Oh my ... sorry about such a complex post !
But I seriously begin to see this ending in a bad way. And I even don't
dare to think about future stability ...

[Chris]

Poor Clo...the Elastic King! How long does it take to get all those elastics in? I bet you don't even want to eat cuz it will take you too long to get them back in again.


From the photos I don't see increased overjet. Can you take a side photo with your teeth together?

All I can say is 18 months is still within normal range of wearing braces, you still have time to get things together. Keep us posted. Wishing you the best outcome!

DOCS, how come it takes longer for some people to get those molars together??? I'm right behind Clo...but I haven't gotten the elastics yet.

[fearthetenor]

Oh my God! Those elastics look horribly painful!

I have elastics right now. Only 1 though. It goes from the inside of one of my bottom teeth to the outside on the top. I still need more kinds of elastics to finish things before I can even dream of getting my braces removed.

Anyway, I hope that all goes well for you. Best of luck!

[Clo]

Thanks fearthetenor and of course once more Chris for your kind words !!!
It was painful the first week. And this combination was only possible
because of a building up scenario where my last configuration was a bit
like this but not as 'heavy'. Having this for first elastics would almost be
impossible I think. Ortho said that too. Chris, after more than one year
wearing elastics, I place and remove them quite quickly. And as I said
in the other post, my ortho prefered I eat with them in ... Sometimes it
works, sometimes they break one after another, depending on what I eat.

I'll try to make an 'overjet pic' one day. I now have about 5 mm of overjet
and 2 mm of anterior open bite. About the 18 months you (Chris) spoke
about. I only mentioned this because at my first consultation, I was
given a treatment time of about 2 years. Now I have braces for 19 months
and my bite has never been worse. So I fear I took some wrong way
somewhere in my journey through braceland ...

Dr. Jernigan, I really wonder about your input on this one. So, if you find
'some time sometime', I would really appreciate this !! Thanks in advance.

[dr.j]

My ideas:

You more than likely have a skeletal openbite pattern. Characterized by a longer lower face (not all of the time but most of the time) and vertical overgrowth of the posterior portion of the upper jaw or maxilla. This overgrowth - termed VME for vertical maxillary excess- has the effect of decreasing the profile of the lower jaw: it rotates down and back during the development of VME.

The most ideal tx for this is treating the cause of the problem:

Braces, then surgery to impact the posterior portion of the maxilla this allows the lower jaw to auto-rotate i.e. close up and foward. Thus, closing the openbite and the overjet and providing great vertical and horizontal facial balance.

Elastics - which we all use on our patients - do not address the skeletal cause but simply drag the teeth and the bone that holds them together. Elastic closure of moderate to severe openbites are tantamount to relapse in a big way. They are tough to retain even with retainers! Toungue posture and muscle adaptation plays a role.

Extractions do help close bites down even when we sometimes don't want them to b/x the teeth tip on the wire and become more vertically upright. Maybe exo of 2 upper premolars could help with overjet and get you some more overbite while correcting the class 2 bite relation at the canines (they fit end to end)

I think you have good alignment but your case is very tough to close down. You should talk to the doc about your future tx months - good luck with those elastics. That is one heck of scheme to close the bite - a great effort on the ortho's part - and yours too!

Better side shot biting pic would be nice to see.

Dr.J

[Chris]

Dr J...Clo has been in braces over 18 months, if he chooses to extract premolars now, how long would it take to close gaps and finish treatment?

[dr.j]

It could easily be another year and possibly a little more.

dr.j

[Clo]

Hi Dr. Jernigan,

Better side shot biting pic would be nice to see.

I tried to take better pics :





I took out my elastics so you can better see my premolars. On both pics
I am biting down completely. Do those pics tell you some more than the
first ones ?

[Chris]

Clo, great shots by the way. Are you saying your back teeth are completely touching and you have that much of a front open bite? ?

I see the overjet..I have the same amount right now.

Dr J...why would bringing the back teeth together create such an open bite as Clo's??? Cant you put elastics on the front teeth to bring them together? How about bringing the bottom teeth forward more?

And what did you mean by "tongue posture and muscle adaptation plays a role?"

Clo...your teeth are so nice and white! I'm jealous.

[dr.j]

1st : uncrowding patients can create openbites, as teeth flare forward and uncrowd they are relatively intruded.

2nd: brining the lower teeth forward opens the bite more, it may help with overjet but creates more of an openbite. Besides, there is only a thin trough of bone for the lower teeth to reside in - they cannot always be brought forward.

3rd: many openbite patients have a tongue thrusting pattern b/c they have to form a seal to create all of the sounds of speech. Say the word "yes" out loud without touching your teeth! This tongue thrust becomes a subconscious habit that can crack an openbite again in retention. As a professor said once "it's hard to unlearn a subconscious habit"

4rd: elastic closure of openbites are tough. Sometimes the arch is like a see-saw. Extruding front teeth open the bite in the back and vice versa. Clo's class 2 elastics for overjet are notorious bite openers.

Class II, semi-crowded (pre-tx) openbites are really tough to treat well non-extraction and non-surgically. They usually have a compromise.

...or they have to agree to renew their passport and move to Equador in retention. The good ole' geographically successful ortho tx!

dr.j

[Clo]

Thanks dr.j for all your time and effort to answer my questions.

I can understand about everything you said. But if I were your patient,
what would you advice I do from now on. I got the impression after I
read what you wrote that I must not expect much improvement anymore.
At least when I follow the path my ortho set out. When I asked her the
last time what would be done, she said some more elastics here and there
and then finishing off. Braces removed within 6 months. With this bite,
this can't be it I think .

[Chris]

Sounds like you solve one problem and create another with adult orthodontics.

I got into this hoping for a better bite, so far, its worse and its been very discouraging. I second guess myself whether I should have gone the extraction route seeing that this "flaring of the front teeth" makes it more difficult to chew but then I was told extractions may create a more sunken look for my profile.





Here is my worst side...he can't move the canine into alignment with the bottom. And I have two missing bottom molars (implants later).



I still have a deep bite but its open in the back. Thats what makes it so difficult to chew. If only he can bring those molars together and keep them there, I'd be much more happy. I have to live with my tongue wanting to push towards the back of my front teeth...it feels so odd. I was so use to my sunken in teeth.

[Clo]

Hi Dr. Jernigan,

not that I am impatient, but I have another adjustment within some days.
So I would have more knowledge if you could anwser my last question I
put here a bit higher. Many thanks in advance and eternal gratitude ...