Anterior open bite, retreating 20 yrs later, intro and ?

[jfriend33]

Thanks for having this forum. I currently suffer from anterior open bite from tongue thrusting. I have always been told if my mouth and tongue were in shoe sizes my mouth would be a size 11 and my tongue would be a size 13. I had full braces with elastics and chin cap headgear (nighttime) for 2 years as an adolescent. They never addressed my tongue thrusting, no habit appliances, no myofunctional therapy, nothing. Was handed a bag of rubber bands and told to hold one to the roof of my mouth with my tongue. A kid cannot be expected to comply! Done blaming! At least my teeth appeared straight!

My new journey has began to preserve my teeth thru adulthood. As a result of only having a few back molars make contact I've required several fillings and one root canal with a crown. My open bite is only about 2-2.5mms. (it is more closed first thing in the morning than at the end of the day but they all keep telling me it's normal and that teeth extrude in the night).

I completed 12 weeks of myofunctional therapy successfully in June. I relearned how to drink water, eat, swallow, and even breathe. Luckily I don't have nasal congestion like I used to (due to aging my large tonsils have shrank in size considerably). No mouth breathing. (everyone always seems so amazed when I tell them the myo was my idea. It took lots of video watching, reading, etc. Seemed like even those with surgery had relapse if they didn't fix the cause, the tongue!)

To reinforce the therapy and to be totally sure, August I had 2 brackets bonded to the rear of my two front teeth, and 2 more bonded to the left and right rears of my bottom 4 front teeth. My bite actually closed down a full millimeter all on its own!

Then in November I had a transpalatal arch with acrylic button bonded between my two upper molars. It was definitely an adjustment with speaking. My tongue fits just fine and while resting is helping intrude my molars. I was even instructed to actively push up with this thing whenever possible. As a highly motivated adult I have to remember not to go crazy lol its going to take time! If my tongue was a bicep....

Then this month I had upper and lower braces bonded except for my six front upper and lower teeth. All the way to back molars (my first treatment they never bonded anything back there as a kid). They also used a lower lingual holding arch with a few spikes that are just barely visible when smiling. So it's pretty cool. My bite is closing slowly yet when smiling I don't have much treatment visible. They will wait until my bite is more closed to fine tune any adjustments and put braces on up front.

I honestly didn't see the point in taking things so slowly but they really want to be sure my tongue is trained and doesn't go back to old habits. Next month they will increase size of archwires. Then the following month I am getting several TADs. They said I would be getting as many a 8-12 of them but not all at once. I am so excited because I have read nothing but good things about these temp anchorage devices. Cool stuff!

I think their approach is great. They are adamant about me achieving results that last a lifetime instead of just taking my money and running. Sounds good to me.

Anyway. I will post some pics asap (although it doesn't currently give me the option to?). I did have one question. Has anyone had any major issues in moving teeth with crowns and/or root canals? I feel like when I'm resting or pushing up on this acrylic button to intrude my molars that the side with the crown is moving much more slowly. In fact the side without the crown, the molar doesn't even touch the bottom teeth anymore. Yet the side with the crown hasn't budged. And I feel as though when biting I am biting way too much into this crown and I do not want this expensive restored tooth to fail. So any suggestions would be great

Thanks!

[jfriend33]

Why is is that in my 2 posts since last August nobody will reply. Is my story not interesting enough?

When can I be allowed to post pics? I was hoping to post my progress.

I a no longer biting on the crown. And wow my back molars are definitely doing the most moving.

In fact my lower right one has moved about a half mm away from the banded molar in front of it. I have to use a proxabrush in there several times per day because I'm afraid I'll get a cavity.

Anyway I'd really like the ability to post pics just so I can tracking my progress...

[jfriend33]

Who knew. If you actually post you can upload pics! Here they are!

[jfriend33]

TPA with acrylic button for molar intrusion

[Lorianne]

welcome and good luck with your treatment!

[djspeece]

It's possible that there are not many people who are participating in your therapies, as I think they may be a bit controversial. But I am no expert. I can add that I have had no issues with my crowns, save one bracket popping off 3 days in and having had it then replaced with a banded version. Apparently the adhesive doesn't work as well on crowns vs native teeth.
So while I try to say "welcome aboard" to most new members, I sometimes overlook one or two, or don't have time, or am just lazy. My apologies. Best of luck in your journey though!

[jfriend33]

what about my therapies are controversial? you mean not utilized by many? treating anterior open bites is very difficult. and most cases relapse because of poor retention and lack of treating underlying issues.

yes it is harder to bond to crowns. They had to really rough it up but he assured me he'd have no problem in polishing it up afterwards so it was smooth. Honestly I didn't really like how smooth it was to begin with, it almost felt too fake!

well after reading 9 pages of someone with all their horror stories, I have one of my own. One of my wires on the right side connecting the acrylic button to the band on my crown on my TPA broke. Thank god it wasn't the crown. I will hopefully get it fixed tomorrow. Thank goodness for wax.

[mmkay]

what about my therapies are controversial?

It's a myth that tongue thrust causes bite problems, where tongue thrust is defined as the tongue temporarily moving against teeth when swallowing etc. Resting position of the tongue matters - at a guess you had an issue with this, but there is quite a lot of BS from some people with regards to "tongue thrust".

[jfriend33]

Ok.. Bs or not, myofunctional therapy addresses the resting position. So yes it's kinda like they go hand in hand. It's just not labeled correctly.

Anyway my acrylic button on my TPA / Nance was removed today. Since it's hard to fabricate and they were going to use TADs anyway they are going to see how I do without it.

The 23rd I go in to have my ties and archwires changed and have a few TADs placed.

[sara2280]

I am sort of in a similar situation as you. I had braces as a kid, closed my open bite, etc. Never had any appliances or head gear or anything the first time around. Just vertical elastics. So here I am 20 years later wearing full braces again because my anterior open bite was back and causing excessive wear on my molars. I am over a year in braces (was supposed to be 12 months total) and in the process of getting a lower tongue guard added to hopefully keep my tongue back where it is supposed to be so my bite can finally close. I have been trying to look up info on a lower tongue guard but can't really find anything on them. How has your experience been with the lower tongue guard you have? Was it hard to adjust to? Did you have difficulty speaking or eating? I get mine on next week so I am a little nervous. I asked how long I would need it for and they said as long as I felt I needed it. They said when I felt my tongue thrust symptoms were no longer there then it could be removed. They said I would be the best judge of that. How long have you had yours and how much longer will you have it in? Do you feel it works?

Good luck! Excited to see your progress!

[jfriend33]

I am sort of in a similar situation as you. I had braces as a kid, closed my open bite, etc. Never had any appliances or head gear or anything the first time around. Just vertical elastics. So here I am 20 years later wearing full braces again because my anterior open bite was back and causing excessive wear on my molars. I am over a year in braces (was supposed to be 12 months total) and in the process of getting a lower tongue guard added to hopefully keep my tongue back where it is supposed to be so my bite can finally close. I have been trying to look up info on a lower tongue guard but can't really find anything on them. How has your experience been with the lower tongue guard you have? Was it hard to adjust to? Did you have difficulty speaking or eating? I get mine on next week so I am a little nervous. I asked how long I would need it for and they said as long as I felt I needed it. They said when I felt my tongue thrust symptoms were no longer there then it could be removed. They said I would be the best judge of that. How long have you had yours and how much longer will you have it in? Do you feel it works?

Good luck! Excited to see your progress!

Thanks for your reply.

My tongue guard is kinda pointless for me. Also have two plain brackets behind my two upper front teeth. It is essentially a failsafe to make sure my myofunctional therapy was successful.

Basically people can get appliances and tongue tamers. You end up torturing yourself and sometimes you learn to stop. But as mentioned previously the resting posture is what's important. I would request a referral immediately for myofunctional so that you can get this fixed now. Otherwise there's a chance your bite could relapse.

It's not a cure my any means. I know I sound biased. But in my personal experience before I even had braces my bite closed down an additional 1.5mm all on its own.

I would imagine had I still had the bad posture and thrusting I would have been very annoyed! It is barely visible though and honestly I never touch the thing.

The reason I have this also is to have a lower lingual holding arch. They will be eventually intruding my molars with TADs attached to the loop by my molars. It's to keep my teeth straight and balance the movement. At least that's how it was explained to me. In fact the upper tongue guard that gets bonded to your molars can actually force your molars forward and cause more harm than good.

I was told that in my situation and being an adult, using vertical elastics specifically to close my bite without the use of TADs would cause my front teeth to appear longer than they already are. I hope they are aware of molar intrusion and are really educated in treating you.

What do they think about using tongue tamers bonded to the rear of your front teeth?

Hands down what's the number one priority for all of us? Retention. A dentist once said in comparing all of his patients, the ones with straight nearly perfect teeth always said they'd never had any orthodontic treatment. Coincidentally almost all of the ones with malocclusion said they had received orthodontic treatment previously!

Open bites are tricky as they can be genetic or caused by many different things. I say tackle it from as many angles as possible. Get evaluated from an ENT, to see if you need help breathing through your nose. See a chiropractor if you have poor posture. Treat the poor tongue resting posture with myofunctional therapy. Use retainers that work best on a case by case basis. Some people have great luck with essix however they can wear down easily. Some require a tongue block on a hawley style retainer. And a few require permanent TADs and use of elastics combined with permanent fixed/bonded upper and lower retainers.

Anyway, whatever your case may be, I'm sure you'll adjust quickly. Just be sure to go over everything. It's crucial to be an educated patient. I chose to be treated at a university so I would have multiple opinions, options, and the latest approach.

Good luck to you and I will try to look for your progress thread if you have one.

[jfriend33]

Today I had new stainless steel archwires, before they were NiTi. I also had my molar bands removed up top. What a horrible experience. My crown felt like it was going to pop off. The smell was so bad. I've been selling and toasting that for the last two weeks. My dds says nothing is wrong it's just the braces. At I the only one shocked that band removal is brutal? Lol.

Anyway. Spacers back in, they are making a new transpalatal arch, without the acrylic button, to hook on to a TAD on the roof.

Had two TADs put in on the outside lower between my molars as pictured.

Pretty painless. Just kinda nauseating when my heads so low and all the blood is rushing to it. But apparently the top ones are significantly easier to do.

The farthest back molars that touch keep my bite open. Hopefully with the bigger archs these back molars will move faster.


Why is the file size so annoying? Every time I want to post a pic I have to male my back camera go down to like 1 megapix and crop the heck out of it... So annoying

[sara2280]

Wow that is a lot of tads. I have seen those a lot on here but have not heard anything about them locally where I am from. I had an appointment yesterday too and had spacers removed. Those were not painful just a pain the butt. I kept biting on them. Had the lower tongue guard installed and he also changed my elastic configuration. Instead of doing just a vertical elastic canine to canine I now have a zig zag elastic that goes across 4 teeth on the right side. Pretty much makes it impossible to open my mouth at all. It's a rough one but I will say my open bite is finally almost closed. I'm just not sure I can stand to keep this elastic in all day. Had no problems adjusting to the tongue guard though, I was very glad about that! Also, my bite pulls closed more with the elastic in but opens up more without it. Hoping for some bite stability soon!

It was nice to see an update! Good luck! Enjoy having no palatal arch for a little bit!

[jfriend33]

Today had two more TADs placed up top by my molars outside. Also spacers removed molars banded w/ a new TPA. So far I love it and it's easy to rest my tongue.

Added power chain to left rear molar as it was drifting back just like the right. Had huge chunks getting stuck there and made me very paranoid. So the power chain idea was actually mine!

You can see the little curvature at the middle of the TPA. A TAD will be installed on the roof of my mouth and connected to that.

They are using this flexible rubber string stuff because they said that way if the tad falls out they won't lose the $60 dollar screw. I told them to amp up the force because I've experienced no pain at all.

When I told my ortho this he said it's because I'm highly motivated and my brain is perceiving the pain differently than when I was an adolescent. Lol.

Anyway I feel confident with time my molars will intrude. 1mm of posterior intrusion yields 5x as much intrusion anterior. Which sounds promising.

Thanks for reading everyone and hopefully you're having a good week and learning or experiencing successful treatment.

[jfriend33]

Well life officially sucks. I just broke my second transpalatal arch....sigh....

I cannot bear to drive another 4 hrs round trip just to have this thing removed, spacers put in and go back a week later. Something has to change here...

I am thinking if it was closer to the roof of my mouth, or if they just get rid of it altogether and use extra palatal TADs.


I am just feeling frustrated. I am ready to have full frontal braces as well because I am not happy with the appearance of my front teeth. Most importantly because of where food and plaque accumulates next to my front teeth!

Last time it was weaker wire that broke. This time it was the welding. It broke off clean from the band.

I said last time why not removable and they said they want equal force between molars. I've seen some pretty cool tpas that are rigid yet office removable and would save us some hassle.

Any suggestions or ideas here would be great. At least I'm not in pain, I'm not getting cut, and wax can hold this in place comfortably.

Thanks for reading my rant. Take care guys.