Metal Mouth Message Board

OK, you experienced people tell me if I'm all wrong about this ...

My first phase of braces is done, my teeth are aligned now, arches look good. Because my teeth are all upright now, my bite has opened. I used to have a slight (1+ mm) overlap in the front as you can see by my picture, now it's 0mm and I am actually a couple of mm's open between upper and lower lateral incisors. We need to close me up ! That much is clear.

So the orthodontist gave me elastics to start closing the bite. But you know how it is, everything is moving quickly during the appointment and you're surprised by some new thing and you don't think to ask questions, they crop up later after you've left the office.

I'm concerned about aesthetics.

I have a short nose and a bulky lower face. I feel the distance from my nose to the bottom of my upper teeth is great enough, I don't want to increase it. I also don't want to end up with a gummy smile. Regarding the lowers, if my lower teeth are raised at all I feel it will accentuate my bulky chin, plus I don't want my lowers to show too much when I smile.

So I'm not wearing my elastics and will discuss the matter with the orthodontist at my next appt on Jan 23. Until then, I'm wondering if anyone else has gone through this type of situation, or I'm wondering if I'm misunderstanding the mechanics ... am I right to think that my upper teeth will move down and my lower teeth will move up ?

I'm wondering what my other alternatives are. I could probably benefit from another Le Fort I posterior impaction but there is no way in hell I'm going to do that again at my age (47), and I don't think my bite is open enough to warrant the risk. I think a better option is occlusion equilibration to reduce some of the molar cusps and allow my bite to close down more. I read one case where reducing the molar cusps by 1mm effected a 3mm anterior bite closure. I need 3mm, so voila. I was going to ask the orthodontist about equilibration, perhaps she even does that kind of thing herself.

I also don't believe that my upper and lower molars are in final position with respect to how the outer cusps of the lowers fits into the grooves of the uppers. I have a little way to go yet ... or maybe not ? Maybe they ARE in final position ? Another question for my orthodontist.

Anyway, seeking opinions here !

Interesting issue. I had an anterior open bite that was corrected with upper and lower jaw surgery. I remember being thrilled that my bite was closed after surgery but also wishing I had more overlap in my front teeth. I thought the same thing, my ortho will pull the top teeth down....nope he furher impacted my molars (with bends in the wire) which closed the bite a bit more in the front. This was followed by elastics on one side to pull down a lateral. I can also say that my braces have been off nearly three months and due to natural settling the overlap has increased a wee bit more. I wouldn't panic yet and I'd wear the elastics or get an emergency appointment to discuss the issue. It'll all come together in the end!

Denise, before I saw your reply I decided that I will call my orthodontist on Monday and if she wants to wait to talk to me about it til my appt then we will wait. So good idea !

smile2006, interesting that you mentioned bended wires, because my orthodontist did that at my last appt and I forgot about that. She is trying to impact my lower molars which are too erupted. She was going to do bends in the upper wire too but I had a big social event to attend for 3 days just a few days after my appt and asked if we could just do the lowers this time, "so I can eat". It didn't create as much soreness as I thought it would, though, I could have done uppers too. Oh well, next appt. Anyway, thanks for reminding me that she's doing something else to help close my bite.

Sandra, I'd be inclined to speak to your ortho rather than just deciding not to wear the elastics off your own bat.

I seem to remember you saying you were willing to use HG if necessary because you didn't want to wear class II elastics. A high pull HG has the capacity to intrude molars and close a slight open bite. Mini screws or bone anchors can also be used, but of course it depends on the individual case.

You're paying for your ortho's knowledge and expertise. Unless he has given you reason to doubt him, I wouldn't start taking matters into my own hands.

edit - we cross-posted Glad you have decided to give him a call.

I did say I would be willing to use headgear, and in fact it's a very similar issue and will come up later when my orthodontist asks me to use elastics to reduce my overjet. I like the idea of pulling my uppers back by pulling against my head and not disturbing the lowers. But even then I kind of like the current state of the soft tissue in profile, I like that my lower lip does not quite stick out as far as my upper lip, and I'm afraid that will be disturbed if I use elastics and my uppers move back and my lowers move forward.

I'm sure this seems way too picky for some people but as I wrote in another thread, they are my teeth, it's my money, and I have to be happy with the result. I already have so many imperfections, I'm not requiring perfect teeth.

Regarding postponing the elastic use, I'd already told the orthodontist that I wouldn't wear them until after Jan 1 because of my social obligations, and I asked her if she wanted me to push forward my next appointment because of that but she said no, and she said it was fine if I waited to start using the elastics. It only means I'm delayed a bit, at most 4 weeks. It's not a big deal to me.

Regarding knowledge and expertise, I trust that my orthodontist is highly skilled in alignment and occlusion and other orthodontic issues, but I'm not counting on her being highly skilled at determining what is best aesthetically. *I* am concerned about aesthetics, that's why I got the braces on again.