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

[jfriend33]

Well after switching dr's, and dealing with 7 week appt intervals, vacations, etc, I did something fairly bold. I ordered continuous powerchain from a dental supply company because my powerchain always breaks where my rubberbands attach. And this new dr does not place a ligature over the power chain since we are closing all these gaps. It was actually pretty easy to do with a hemostat. I will tell them about this at my next appointment and ask them for a roll of what they use just to be safe, and what risks there are with changing this myself aside from a bracket breaking.

I am really focusing on retention planning now. Research seems to say that open bite cases are the most difficult to but with proper tongue position and lip closure, your mouth and tongue are basically a retainer,

Debating on a tooth positioner especially for "exercise wear" to reinforce molar intrusion
100% getting wave/vloop lingual bonded retainers upper and lower (especially after all the IPR and gap closure)
100% essix upper and lower for daytime wear, with upper modified with a hole cut out to encourage tongue position.
100% begg style wrap around upper and lower for nighttime wear, also with modified upper hole cut out

http://www.tripleodentallabs.com/labora ... p-retainer
http://www.oralhealthgroup.com/features ... -retainer/
http://www.ncbi.nlm.nih.gov/pubmed/19361737 (failure rates)
http://www.angle.org/doi/pdf/10.2319/060314-398.1
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783768/ (tooth positioner)
http://webcache.googleusercontent.com/s ... clnk&gl=us
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345110/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495257/
http://www.ncbi.nlm.nih.gov/pubmed/22051489
http://www.tportho.com/wp-content/uploa ... 015_0W.pdf

Lots of links here, I apologize if it seems daunting.

[ajs604]

Hey how's your treatment going? I'm only sitting at 1.5-2mm over bite at present so it's a worrying time. Unfortunately my orthodontist is not concerned. I have been pushing her to do more but nothing. I've begged for a tooth positioned and a Hawley wrap around retainer but she says I'm fine with the Essix. Do you have a debrace date yet?

[jfriend33]

Hey how's your treatment going? I'm only sitting at 1.5-2mm over bite at present so it's a worrying time. Unfortunately my orthodontist is not concerned. I have been pushing her to do more but nothing. I've begged for a tooth positioned and a Hawley wrap around retainer but she says I'm fine with the Essix. Do you have a debrace date yet?

My treatment is going ok. I have about 1mm of overjet, so they decided to do even more IPR. In between my two front teeth just a bit, and then in front of each upper k9. I was happy about the k9 ipr because I had visible black triangles there anyway.

Funny thing they sent me home with more power chain and want me to change the top every two weeks.

2mm overbite is still pretty good. How much did you start off with when you finished again? I am gonna go check out your thread just to be sure. Maybe you have posted some pics there too?

I don't have a debrace date yet. We are hoping for before christmas. But now its time to fine tune everything. I still think the overall look of my teeth are strange. I am going to consult some cosmetic dentists and see what they can do with the mottled appearance of my top teeth (from antibiotic use at young age) and also some computer generated images with my k9s upper and lower not so sharp looking. Regardless our smiles both look like a million bucks compared to where we started. Hopefully you are just settling in. I mean really you got more molar intrusion than I did and that is easier to retain than extrusion of the fronts.

They stepped down my front teeth a tiny bit more as well. Wearing rubber bands at night only from upper k9 to lower first bicuspid.

[samoorelaw]

I recommend pushing for the positioner. I did the research on it and believed that having one gave me a better chance at retaining my bite than without it.

I'm 7 weeks post removal as of tomorrow and my posterior open bite hasn't returned like last time after only 2 weeks. I believe this is in a large part due to my positioner, which I only wear about 30 minutes per day. It could be just a coincidence but I don't think so, and I relapsed twice before. My ortho wasn't too keen on ordering one for me but I demanded it, albeit nicely. At the end of the day, this is our treatment and our money and they need to do what we want.

[oldfart]

Why are you going to cut a hole in an Essix? Most just cover the teeth and maybe a little bit of the gumline. Why not a Hawley with a tongue guard? The hole wont train your tongue while your sleeping where a lot of tongue thrust problems occur. While the guard will block it all the time.

Just curious. Playing armchair ortho

[jfriend33]

The essix is for daytime wear

[ajs604]

Hi Jfriend

Your teeth look great. I started at about 6-7mm open bite and finished with a 4mm overlap. I have upper and lower bonded retainers then the Essix for nighttime ware which I wear for 12 hours a night. The Essix is great for horizontal retention but does nothing for vertical retention. I have asked my orthodontist for a positioner but they won't order me one, it's really frustrating. Do you have a picture of one? Also I was thinking would it be worth me getting a tongue crib? I have found various studies which have even reversed a relapse without further orthodontics. The trouble is my orthodontist is happy to treat the problem but not willing to identify the causes. There's not really much I can do as open bites are seldomly treated non-surgically in Australia due to limited research. Its a shame I didn't live in the US as the research and treatments are much better over there as you know. If I had the money I would fly over every 6 weeks and see and ortho there as I firmly believe it can be treated non-surgically with a good doctor.

[oldfart]

Playing armchair ortho and reserve the right to be completely wrong. Still wonder why you would cut a hole in your Essix. They are substantially more fragile than the Hawley to begin with, and a hole would just put your tongue directly on your teeth. And make it even more fragile and likely to break. If you are concerned about tongue thrust, a crib is about your only good option in a retainer. Or get one that they build up the acrylic behind the teeth so your tongue doesn't rest on them.

As a reminder, you can go to other orthos to have a retainer made. You just may have to pay for it.

OF

[jfriend33]

Hi Jfriend

Your teeth look great. I started at about 6-7mm open bite and finished with a 4mm overlap. I have upper and lower bonded retainers then the Essix for nighttime ware which I wear for 12 hours a night. The Essix is great for horizontal retention but does nothing for vertical retention. I have asked my orthodontist for a positioner but they won't order me one, it's really frustrating. Do you have a picture of one? Also I was thinking would it be worth me getting a tongue crib? I have found various studies which have even reversed a relapse without further orthodontics. The trouble is my orthodontist is happy to treat the problem but not willing to identify the causes. There's not really much I can do as open bites are seldomly treated non-surgically in Australia due to limited research. Its a shame I didn't live in the US as the research and treatments are much better over there as you know. If I had the money I would fly over every 6 weeks and see and ortho there as I firmly believe it can be treated non-surgically with a good doctor.

I thought that you didnt have any issues with your tongue to begin with though? If memory serves me right your posture was pretty good to begin with. (I think i had you do a test?) It is normal for them to over correct an open bite, so maybe you are worrying a teeny bit too much (no offense?)? I always heard that essix retainers had a side effect of closing bites especially with non-open bite cases. Have you considered doing an online consultation with someone to see if you have any issues? Even though things look like I am in the clear, I am going to consult with yet another COM just to be safe, and its a free consult over skype. PM me if u want the details. Tongue cribs scare me. I have seen the type that are directly bonded to the molars usually when worn with braces, and its caused many problems, especially pushing your tongue causes force on the molars its bonded to. But maybe a different type of retainer would be better? Still, your bite is closed, things are still settling maybe? I would ask ortho, hey, what happens if bite opens? What are the options? What will it cost? ( i dont see why he/she couldn't send in your impressions to a lab that makes them, just search here or google and u will see plenty of pics) You had such amazing treatment especially with the amount of molar intrusion, and how they fabricated that appliance, even my dental school couldnt make one that good (remember the one I had broke! TWICE!). Good thing is you are aware of it and thats what matters most. Youtube has a few videos that you can watch if you want an in depth list of the good ones message me for them. I do not condone someone go watch them specifically for self treatment, I only used them so I knew what I was getting into before I started my myofunctional therapy.

I would also ask if you could get a wraparound hawley or something different. But really things look good from your last photo. I would be scared too if I were you so I understand. Hopefully my posts dont fill people with paranoia. But its my 2nd rodeo and I am not going to have surgery. (how is your back posture? do you mouth breathe? any allergies? see a chiro at all?)

Its funny that you say my teeth look great. I dunno. Some days I think that they went a little crazy with the IPR and they basically are making my mouth even smaller (remember they said my tongue situation is basically like size 12 feet wearing size 10 shoes). If we can get this overjet situation fixed then life will be good! I just dont see how they can properly do this because my archwire has so many steps in it I feel like its going to cause issues (where a tooth cant move beyond the step) and bracket re-positioning would have been the wiser choice. I have a funny feeling I will end up having 2 archwires up top before things are finished....


Ah well. I am going overboard with retention and I don't care if it is crazy. I had braces once, the ortho did not even fully close my bite the first time, and thought handing me a bag of rubber bands to put on my tongue would help (uhhh ya sorry not a fifth grader, WTH).

Playing armchair ortho and reserve the right to be completely wrong. Still wonder why you would cut a hole in your Essix. They are substantially more fragile than the Hawley to begin with, and a hole would just put your tongue directly on your teeth. And make it even more fragile and likely to break. If you are concerned about tongue thrust, a crib is about your only good option in a retainer. Or get one that they build up the acrylic behind the teeth so your tongue doesn't rest on them.

As a reminder, you can go to other orthos to have a retainer made. You just may have to pay for it.

OF

This would not be a traditional essix retainer. It was explained to me that it would be a modified essix and the plastic would extend to the roof of the mouth ever so slightly. And may not be a "hole" per se or just an area that is roughed up just to reinforce posture to "the right spot" (aka bony ridge). (now with the hawleys it would be a hole drilled through). I understand what you are thinking, and my explanation was not very clear, my apologies!! And I may sound like I know everything but I don't. Your input is greatly appreciated!


(just a funny back story I do remember this wild idea I had once. It would have been about 5 years after my first round of braces came off, my lower arch had widened so my ortho made me new set of hawleys maybe 2 years later. So I had him make me a essix retainer for the upper only based on that most recent mold but still not new, in hopes that it would help move my teeth. HA. It cut into my gums and did not work at all whatsoever!)

I am sure that there has to be some level of risk involved when mixing in too many forms of retention. The fact is even if I had a vloop bonded retainers on upper and lower paired with all the retainers in the world theres still potential it could relapse. I do remember once seeing pictures where a person wore essix retainers and then in addition to that they had 2 tads up top near their k9s and the same on the bottom and they wore elastics from tad to tad. That seems very extreme and is obviously compensating for an underlying cause.

The only thing that worries me about tooth positioners is night-time wear if it falls out. I am not a big mouth breather at night any more but I still think using one a few hours a day would be great regardless, especially to reinforce molar intrusion.

The fact is, as long as my molars touch evenly and don't have excessive wear, that is all I care about really. I want a healthy smile and am going to try to not become a perfectionist.

Thanks for the replies guys!

[jfriend33]

I hope I can get some input from you guys on this. I just had a session with a Certified Oral Myologist. She said that it is a myth that palate expansion in adults is difficult or not a wise idea. When I explained to her that I sometimes have a scalloped tongue, and that my ortho said its not a big deal, that it should not be dismissed.

Especially since my tongue is larger than normal (remember their previous analogy of it being like a size 12 foot in a size 10 mouth) and that palatal expansion should be considered.

This late in my treatment, what are the risks, benefits, etc? My arches are pretty well aligned so my concern would be then the lower arch would not match up, and thats more of a surgical type thing?

What should I do?

[jfriend33]

Well tomorrow is my next adjustment. Gonna find out how much lounger I'll be in treatment if we entertain the idea of palatal expansion. Not sure how safe that is with my banded molar that is a crown?

Anyway you can see overjet is closing up nicely. Wearing double power chain upper, changed 2x weekly. Also had to reconfigure my rubber bands because my bite was opening up on the closed side (was told to watch for this, it was just from k9 moving to close gap).

So what should I do? I am still irritated that this left side of mine will not close! Even the molar behind has not touched. And ya know the other side has a step in the archwire before the same tooth so I don't get why they are refusing to match.

I'm also demanding bracket repositioning and new wire up top. This tma wire has too much friction and too many bends. My teeth end up hitting the steps and then are stuck in gd limbo for 4-6 weeks.

Am I crazy for doing this?

[lmk]

Your teeth are really looking great! I have a question about the palate expander. What would be the long term benefits of doing that? I understand about the tongue fitting better but is there more? I'm curious too about the bottom arch not lining up with the uppers...That could be a whole new treatment plan, like starting over?

[ajs604]

I wish I had pallet expansion but that really needs to be done prior to orthdontics treatment from what I've read. I just maintain an effort to keep my tongue behind my lower front teeth. I stick a bit of sugar free gum on my upper pallet and find it really helps retain the tongue in its correct posture.

[jfriend33]

Your teeth are really looking great! I have a question about the palate expander. What would be the long term benefits of doing that? I understand about the tongue fitting better but is there more? I'm curious too about the bottom arch not lining up with the uppers...That could be a whole new treatment plan, like starting over?

Thanks!

I don't know if it will happen. There are ways to expand lower arches I'm sure. I wasn't needing much expansion anyway.

They were looking at my panos and said normally with this low angle I have (?) , a person would have a deep bite, and I don't. High pull headgear could be used but my jaw and profile are fine.

We looked at smile arcs and all agreed on the same one. Also don't seem to care about openings on one side.

I asked for bracket repositioning and was told each bracket removed is another month in treatment.

Back to wearing elastics again 24 hrs and did a little more IPR. Slight step in front two teeth.

Was told I had quite a few size /bolton discrepancy issues in my teeth.

Sigh

[ajs604]

I think your have a good result with your current plan. Some relapse is always going to happen whether its surgical or non-surgical.