Help with my question please

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#1 Post by **john lewis** » Sun Jun 22, 2008 11:43 am

HI guys^^ Just had a question and was hoping u guys could help me out.

My ortho decided against extractions for my treatment. Towards the end of the treatment, the top teeth were flaring out considerably despite the fact that they were aligned. After getting a second and third opinion about this form other orthodontist, i went and asked my ortho to extract and fix the problem. She has now extracted the four teeth and I am undergoing my treatment again to fix the problem.

My ortho is now pulling the top premolars back to make space for the front six teeth to come back. The weird thing is that she is not doing this for the bottom teeth. She says it is impossible to move the bottom teeth back because that would mean moving the actual bone. Is this true? Why is it that the top teeth can be moved back but the bottom teeth cannot? She says the only thing she can do to accomodate teh top teeth moving back is by brignign the angle of the bottom teeth in by alot.

I would appreciate your opinions on this. Thank you.

#2 Post by **PigletInIowa** » Sun Jun 22, 2008 12:09 pm

Sounds like you have a similar case with mine. And I only had 2 upper premolar extraction to correct the overjet (I guess also partially due to flaring). My ortho also gave me the option of extracting 2 lower premolars, too, but I would have to wear headgear, which I decided against. BTW, if you have a picture, maybe I can take a look to see if it's the same case with me. But either way, I feel 2 gaps are already making my eating quite hard, I'm happy as long as the final result would be fine. But there are plenty of cases here people have 4 premolar extracted and they don't seem to need headgear and their gaps closed up fine. So have your ortho mentioned anything about how she can bring the lower teeth angle back? By shaving down the teeth?

#3 Post by **john lewis** » Sun Jun 22, 2008 7:35 pm

She has connected the front six teeth of my bottom arch with a zig-zag wire. She then connected a power chain from the molars to the canines, bypassing the first premolar. She says the back molar will now move forward to close the extraction gap while the front 6 teeth will not move back but only change in angulation.

What i am concerned about is that although teeth are currently flaring and looks bad, the bite is correct because my ortho has completed her treatment and is currently starting a whole new treatment plan on my request and the suggestion of two other orthodontist.

If the top teeth were to be brought back while the bottom teeth are only changing in angulation, wont the bite be off? Why is it that it is physically possible to bring back the top teeth but not the bottom? Do other people that get braces also close theyre gaps by bringing forward the back teeth instead of bringing back the front teeth?

#4 Post by **PigletInIowa** » Sun Jun 22, 2008 7:53 pm

She has connected the front six teeth of my bottom arch with a zig-zag wire. She then connected a power chain from the molars to the canines, bypassing the first premolar. She says the back molar will now move forward to close the extraction gap while the front 6 teeth will not move back but only change in angulation.

Yeah, I agree that do sounds weird, but is in line with my ortho's words that if you want a absolute anchor, you have to wear head gear. Maybe you want to try PM some people here on the board who has their lower premolars extracted such as Miss smiley. I usually just go through everybody's braces story, but there are so many of them that sometimes I can't remember all the names

Sorry I'm also new here and don't know too much:( [/quote]

#5 Post by **Miss Smiley** » Tue Jun 24, 2008 1:52 am

I had double protrusion which left me with a slightly open bite and both my lowers and upper front 6 were pulled back. My molars have barely budged and my lip strain has been greatly reduced to near nothing. I don't know what your exact case is, but my ortho was going to use TAD if my teeth didn't move on their own. Powerchains and rubberbands did the trick, I did need a bit more IPR on my uppers and lowers. Luckily my case seems to have been fairly simple, responding well to elastic tricks. I did not need any of the TAD, headgear or other metal accessories. Take a look at my WWW link, you can follow my story. I am thrilled at my progress and am sure I made the right decision with the right ortho for me.

#6 Post by **PigletInIowa** » Tue Jun 24, 2008 5:56 pm

If the top teeth were to be brought back while the bottom teeth are only changing in angulation, wont the bite be off?

john lewis, here is some update of the answers from my newest adjustment: as I mentioned that I only have my top 2 premolars extracted (and it's not even the same premolar: 1st premolar on one side and 2nd on the other). So for a long time I freaked out about not having enough teeth to close the 2 giant gaps, so I asked my ortho how he planned to do it. His explanation is also that my front teeth will move back and back teeth will move forward (only the uppers). Then the 2nd and 3rd molars will follow. but if they don't, he will have to use brackets to tie them to close it. Then I asked wouldn't that throw off my bites? His answer is that molars are not important for bites, they can be anywhere (if i'm not mistaken his answer) It's the premolar that is important for the bite. so the end result will be that I will have a class I premolar relation, but class II molar relation. in the office, I was ok with the answer, but when I got back home, I felt really upset since I was thinking: I had perfect class I relation, now just for that minor overjet, he is changing it to a sub-optimum one!!!??? But then when I look into the mirror more carefully (pulling open my lips super wide and look at my molar bite in a folding mirror, then, for the first time in my life I realize I actually have a class II occlusion Division I, instead of class I!!! my molars are actually one on top of the other!!! So I guess I've lived all these years with this and it was FINE. So I guess the biggest problem is to get your premolar at the right position, the rest is ok. Though, this is all just in theory, from what I can understand, I still have a long way to go (he said 8-14 month to close the gap completely, though a lot of ppl I saw here had it way less than that!) . Hopefully yours were not quoted that long.[/quote]

#7 Post by **PigletInIowa** » Tue Jun 24, 2008 6:38 pm

I think you might be right, Meryaten! I'm actually not that sure if it was canine or the premolar relation. either way, sounds like the molars are not essential

#8 Post by **CNickyD** » Tue Jun 24, 2008 7:46 pm

Meryaten wrote:Absenting some form of absolute anchorage, both the front teeth will tend to move backward and the back teeth forward. Headgear is not the only option - a Nance, or TADs (miniscrew implants) can also serve this role.

Yep, I have the mini-screw implants, top & bottom (along with the 4 extracted pre-molars). My ortho actually said headgear doesn't work that well for adults.

#9 Post by **Miss Smiley** » Fri Jun 27, 2008 2:23 am

No HG or TAD for me! WOOHOOO!

#10 Post by **PigletInIowa** » Wed Aug 06, 2008 10:16 am

john lewis,
I'm not sure if you are still reading this board. I'm not sure if you have got any satisfying answer from your ortho, but I just recently had a revaluation: where your teeth go all depend on your molar relations. You have to have a corrected class I molar relation if you get 4 teeth out. for me, since I only have 2 top premolars out, my molar relation would end up being class II. So the reason your ortho want you lower molar to move forward might be because you are having a class II right now, so she needed your lower molars to come up to become class I. Though I'm not really sure that's the exact reason since she decide not to anything about the molars in the first part of your treatment...

Well, just a thought.