Closing gaps - suggestions needed, please!

[CLB26]

I currently have large gaps in my teeth - one on each side, right between my canines and my first pre-molars. It's a long back story, but these teeth were extracted as a child and the gaps were closed with an appliance. I had a different "ortho" (was just a dentist but doing orthodontics) try to open up the spaces again to replace the teeth to fix my TMJ issues. Well, that was just a disaster and I ended up worse off than I was in the first place. So now I've been back in braces for the past 8 months or so.

So now I am getting to a point where I want to close those spaces again. My new ortho is pushing me towards just replacing the teeth with bridges. The spaces are smaller now than they were, but they are still pretty big. Leaving the spaces open is not an option because I look like a hillbilly but I had bridges before and I HATED HATED HATED them and don't want them back (I just have crowns now which I am fine with).

The reason my ortho is pushing me towards bridges is that he said he can move my back teeth forward to fill in the gaps by using TADs (temporary anchorage devices), but he has never used this method before and doesn't want to make me a guinea pig because 1) I've been through so much crap already he doesn't want to put me through more than necessary and 2) He doesn't have any experience using TADs yet and doesn't want to try it for the first time when the gaps are so large. So what I'm wondering (and forgot to ask him ... I don't go back now until February so have to wait to ask him) - what other alternative methods are there to closing these gaps (i.e., to bringing the back teeth forward)? Obviously, since my ortho has been in practice for 20 some years he has moved back teeth forward on other people in the past, so there must be another way. I don't understand why we can't just use the "old" method rather than having to do the TADs.

Power chains? Would those work? Has anybody else had back teeth brought forward to close gaps? Any other ideas?

[ArchWired28]

Hey CLB26
I have read your story the other day. You indeed have been through a lot.
Getting back to your question, TADs are used as an anchorage in the most complicated cases - when any other anchorage cannot produce enough forces to achieve the movement. They are metal pins inserted in the roof of the mouth or any other place in the jaw so that the chain can be attached and your skeleton can be used to pull those teeth. I am assuming since he offered you TADs to do the job, he does not believe that conventional methods (powerchains, elastics etc) can close the gaps. By the way, have you tried anything of those? Any success?

If your ortho is offering you TADs, he must have had special training to use them. Now, being his 1st patient on TADs is probably a little risky since it is a surgical procedure, albeit an easy one. But with him being 20 years in business, maybe worth giving it a shot. If it was my mouth, nothing else was working and I really wanted the gaps closed, perhaps I would have given it a shot - especially if he's not charging extra for TADs (it is an expensive procedure). The worst that could happen is they won't close the gaps. If anything goes wrong during the process, I think your rotho is experienced enough to see that and take action, especially given that he would be extra careful anyway

I also wanted to note that knowing your story, I understand why you hate bridges. I would too (in fact, I am in braces because of a bridge as well ). But since your teeth that surroung the gaps will be crowned, why not make them a little thicker to cosmetically fill the gap? Can the gap be closed or almost closed by cosmetically thickening the crowns' walls?
How is your TMJ pain, is it better? if it is, this might be another argument in favor of leaving the gaps there. Since if your gaps are fully closed, you may be in pain again. Just a thought.
Best of luck to you and please keep us updated on your progress!

[CLB26]

Hi ArchWired,

Thank you for your response and for taking the time to read my full story!

I haven't yet tried anything to close the gaps, we've been trying to accomplish some other things first. I never thought about him suggesting TADs only because something else might not work. I will check with him next time and see if he thinks anything else would work. If not, I think I'm going to push for the TADs. I really want these gaps closed and, like I said, can't stand the bridgework! Unfortunately, since he doesn't have any experience with the TADs, it might be a long process . I like your idea about making the crowns a little bigger and, if the gaps close enough, that might be an option. Right now, though, the gaps are too big, unfortunately.

My TMJ is much much better, thank you. I see your point about the potential effects of closing the gaps. My gut feeling is that it would be okay, though, and it's a risk I think I'm willing to take at this point.

[ArchWired28]

CLB26
I am glad that you are not in pain! This is so-so good, I know what the TMJ pain is and God forbid I have to live with it till the rest of my life! Maybe it won't be back, let's at least hope for that. As you have pointed out, at least something was done right during that unfortunate treatment!

Yes, ask him what is his rationale for suggesting TADs. This is usually the last resort in case nothing else is thought to do the job. I have read that TADs help the patients who otherwise would have required surgery, so it is quite a drastic measure. Think about it as something in between orthodontia and surgery. So it is a little surprising to me that he did not try anything conventional first, especially knowing that those gaps were created recently and did not exist before that. It is also surprising that he pushes you for bridges, knowing that you are in his office because of bridges in the first place.

If it were me, I would have suggested to try powerchains and elastics first. Maybe they won't close the gaps completely but maybe they can make them small enough to be taken care of cosmetically (crown thickness). In any case, before you commit to TADs (or decide in favor of bridges), be sure to have all those questions addressed, if necessary, by somebody else. Good luck!

[sirwired]

ArchWired, TAD's are not a "last resort" or particularly invasive. They are used to provide forces that cannot be provided by anchors on teeth. This can be because of the direction of force needed or the desire not to disrupt the position of other teeth. In this case I suspect they are being suggested so as to make sure the other teeth remain upright while this one is being scooted around.

They generally do not require incisions, take virtually no time to insert (a YouTube video of the procedure is all of 3:15 long), and require no anesthetics beyond a routine local nerve block; same as a filling, graft, etc. They are made of biocompatiable titanium and are removed when no longer needed. I don't think they are any more expensive than any other orthodontic part that is already being used.

I don't think they are particularly expensive either.

[ArchWired28]

sirwired
maybe I overestated their invasiveness, but they are certainly more invasive compared to virtually any other orthodontic technique.
There are so may gaps being closed during orthodontic treatments, and yet TADs are seldomly used. Why were TADs selected as a treatment of choice in this case? I understand that he might want to keep her other teeth upright, but isn't there a similar need to keep the teeth upright in any other case where space closure is required?

The situation is further complicated by the fact that the ortho is not experienced with TADs (and yet presents them as the only treatment choice). He further pushes for bridgework instead of space closure, knowing that the patient had great problems with bridges in the past. All this seems a little odd to me. Just stating my opinion.