Metal Mouth Message Board

I'm still here, still unbraced! I changed or this after having a few misgivings about the first one. Now I'm getting clear self ligating on top and metal below, but the lower arch will be added later as most of the work is up top.

I was wondering if anyone had an opinion on my options? I have a top right canine missing and my teeth have shifted over to compensate (gaps all over the top front), and also my teeth point inwards so they're grinding the bottom front. And I have peg laterals.

Option 1: surgical. Correct midline, pull teeth forwards to a better angle, leave a gap for a canine implant (actually move right premolars forward and put the implant in the premolars location as it will be less noticeable). build up the peg laterals, and I'll have a big overbite. Then jaw surgery as my bottom jaw is far back.

Option 2: non-surgical. Bring all my upper teeth forwards to fill the gaps, pull front teeth outwards, and wear my retainer every single night for the rest of my life (as well as fixed upper and lower retainers), plus the midline will stay slightly off.

Obviously option 1 is about 8 grand more but ultimately that won't be my main deciding factor. Are there sequelae from jaw surgery that I don't know about? Is it worth it?

I've got a couple of months to decide as I need a gum graft before I can start!

I'd go with the surgical option if I were you. Even if the perm. retainer holds your teeth in an arch, it may not provide an optimal set of forces pushing your teeth into your gums. Gum recession due to a poor bite is the only reason I'm getting braces and surgery (I was fine with my cosmetics.) My ortho had a non-surgical proposal, (one extraction, a TAD, and a lot of time) but really prefers the surgical approach for significant jaw alignment problems. (I have an extensive lateral cross-bite due to a crooked lower jaw AND narrow palate.)

Thanks sirwired- do you think your opinion would be the same if it was 3 years in braces then surgery?

I'm also wondering if the surgery will be necessary at all. Maybe I can have the implant and not be left with the huge overbite my ortho thinks I'll have.

My dentist gave me a deprogrammer a while ago that seemed to show that my lower jaw naturally wants to sit farther forward than my teeth allow. However my ortho doesn't agree that deprogrammers work! He says he's never seen anyone's lower jaw 'naturally' move out when the upper teeth are moved out of the way. He says there's a lot of disagreement about deprogrammers and they are not proven at all. My instinct says my lower jaw really does want to be farther forward, the deprogrammer felt great, but of course that could be wishful thinking. Confused!

Well, I'm due for 1 1/2 to 2 years of braces before surgery. If I had not had braces as a child, I imagine that my pre-surgery treatment could have been 3 years.

While I'm neither an ortho, nor an oral surgeon, nor a dental professional of any kind, I'd have to agree with your ortho on the deprogrammer. If your bite is off, your bite is off. Some quick googling showed a lot of evidence for deprogrammers being used to treat TMD; they help train the jaw to be in the most relaxed position, relieving the pain. However, the most relaxed position does NOT necessarily mean the best position for your bite. If the deprogrammer holds your jaw into a place where your bite is not integrated, I don't see any changes "holding" without the deprogrammer in place permanently. Without any appliances forcing it otherwise, your jaw is going to "want" to be in the place where your bite is well-integrated.

I have an overbite too, and yep, I can slide my jaw forward so the top and bottoms line up, and I imagine an appliance could hold it that way. But I can also feel that my molars don't meet well at all that way; just the "tips" touch; I cannot imagine my jaw being "trained" to hold this unnatural bite.

I think I just understood for the first time why a relaxed jaw doesn't necessarily mean the teeth will be properly aligned- thanks for taking the time to explain it.

I'm struggling because I have to choose either surgery or an off midline. When i look at my teeth I'm having a hard time picturing why I can't have the implant (and thus a fixed midline), but no surgery. I can kind of picture that my small jaw closes at too small of an angle, but it's not obvious enough to be convincing. I'm going to have to go back for another discussion now that his suggestions have sunk in.