2.5 years of braces on, premolars leaning in

[oceandographer]

Hello everybody,

I am new to the forum here (first post).

I have a question (quick explanation first)

I had braces put on my teeth about 2 and a half years ago, a precurser to upper jaw surgery. They conducted the surgery and installed the RPE, wich added 8mm to the width of the pallet. After that, they used something that looked like an archwire but spring loaded, to close the gap between the front teeth.

After that I went in for lower jaw surgery to have asymetry corrected and to help with the mid line. Once the lower healed, the orthodontis put in elastics to line up the mid line. I have been going in every 6 weeks and now have elastics on in triangles (connected to upper canine and lower canine plus the lower premolar just adjecent to it).

For about a year now, I've been telling my orthodontist that I have a problem with the two premolars on the upper and lower, on the right side of my face. The problem is, they're leaning in toward the tongue too much, so much that the outer point of the lower premolar closest to the canine touches the middle of the corresponding upper to the point that I can't shut my mouth properly. It's like the part of these teeth closest to the tongue are squished in to the gums, making them partialy submerged. It's driving me absolutely crazy!

When I tell the orthodontist about this or ask questions about it, he gets real quiet and tries to change the subject.

My question is, can this problem with the premolars be fixed? Is there a way to put elastics on the other side of the teeth, so that it pulls them together or something? I'm baffled as to why he hasn't checked the bite pattern lately or done anything about this. Please advise.

[ambraced]

It is rather disappointing to feel a problem has been created by what was supposed to fix your problems. My orthodontist does not communicate either and after 2 years 9 months of being patient I exploded. I suggest you try to be calm yet assertive and persist with your question until you get a satisfactory answer.

Could it be that the bracket is not positioned well? I had a similar problem. I had a gap formed between the molar to which the buccal tube is attached and the molar after it. To correct it my orthodontist placed a common bracket on it and applied a powerchain to connect it to the buccal tube. The gap partially closed but the molar turned and I started getting food stuck in the space created as the molar changed position. In my case I think that the offending bracket was bonded a bit too high.

Good luck I hope you get an answer next time.......all the stress of having a brace is enough! None of us need any additional stress from our orthodontists!!

[oceandographer]

Good advice ambraced. I am doing my best to remain calm and am hoping he has a plan for what to do about it. It's hard not to want to help somehow, yet terribly frustrating not knowing what to do. I get the feeling he has so many patients that he's spreading my appointments too far apart (every 6 weeks). I don't know what the norm is. My teeth move very quickly and then they just sit there for like 4 or 5 weeks.

The worst part for me is, after the last surgery, when everything was healed up; he put on the finishing wire and acted like it was just about time to wrap it all up. I can't tell if he was just trying to keep me patient or if he was going to try to finish it all up with a lot of problems left over (I think he thought the surgery would correct everything that was left). Scary because my braces cost me roughly $8000 and two surgeries cost my insurance companies $80,000.00

It's not like they can get the teeth perfect, but for that kind of money they should come close.

[BraceFace2o1o]

I had the exact same problem. My 1st and 2nd premolars on the lower arch tipped in towards the tongue and so did my uppers. My uppers were corrected with a quad helix and my lowers with elastics that were attached to a button on the inside of these teeth. The quad helix did a great job at correcting my uppers and the lower elastics corrected most of the problem but not fully, my teeth were still clashing, I realised the reason this was was because my lower midline was off to the right making my lower teeth on the right side about 2-3mm further back than they should be, so the lowers were in line with the uppers rather than interlocking (lower teeth like the premolars and molars should be slightly more forward than the uppers so the teeth interlock) almost like a class II bite without the overjet. The teeth should interlock so they sit together. Here is a pic of what I mean as I am not the best at explaining

How my teeth were because of the midline not being centered:
]

How they should be:


I am not having my lower midline fully corrected but the elastics I had did help improve my bite and my orthodontist will be doing some filing after braces to hopefully help my teeth meet better. Last year I could not get my back teeth to meet at all on the right side, the only teeth that would touch were my lower 1st and 2nd premolars on my upper premolars just as you described yours are, but since the elastics and some minor movement of the lower left teeth/midline they are now much better and my back teeth touch.

Depending on whether the reason your bite isn't right is just because the teeth are slanted or something else like a midline shift will depend on how it can be fixed.

I totally understand your frustration it is not a nice situation to be in. I knew I had to discuss it with my ortho and I did otherwise my ortho would have had me out of braces without me being able to chew properly. I made a separate appointment purely to discuss my concerns with him. There was never enough time to discuss this with him during my routine appointments and it always felt a bit rushed. He was happy to see me at a separate appointment to discuss my concerns and started to work with me on trying to improve my bite. I knew that I wasn't going to get my braces taken off until the issue was sorted.

I hope you can work with your ortho to get this resolved.

[oceandographer]

Great post, this is very helpful. I have a question for you. The bottom premolars that were leaning were corrected with elastic rubber bands? How did they place them? The elastics I have now are connected to wire ties that form little loops on the outer part of the teeth; so that the upper and lower canines are rubber banded together as well as the lower premolar directly behind the lower canine. So the rubber band forms a triangle. To fix the problem I have with the premolars, I figured they'd do something similar but on the inner part of the teeth. It sounds like they did exactly that to fix the problem you were having with the lower premolars.

Please tell me more how the fixed your lower premolars, I will suggest the fix to my orthodontist : )

[oceandographer]

Anyone else have this problem?

Can the orthodontist place elastics on the part of the upper and lower teeth--closest to the tongue? You'd think they could, so that it pulls the teeth upright.

[plugnickel69]

[quote=Can the orthodontist place elastics on the part of the upper and lower teeth--closest to the tongue? You'd think they could, so that it pulls the teeth upright.[/quote]

Yes, they can place buttons on the lingual side.

[oceandographer]

So they place buttons on the lingual side and then rubber band them together? That makes total sense.