Metal Mouth Message Board

I posted this in my braces story forum, but thought I might put it here since it seems like more people read here. Thank you for reading!

Well, I am back from the consult. It didn't go very well but not for the reasons I expected. I guess when I look at the pictures and stories on this forum and how seemingly very complicated mouths go to looking straight and shiny in 1.5-2 years, I seemed like a simple case by comparison. Closing up spaces. Moving front teeth forward a few mm to overlap instead of meeting. I've seen total mouth transformations... my problems seem like first day of ortho school to me. Not so, apparently! (Not meaning to insult orthodontists at all! Just saying I was totally undereducated and making assumptions about stuff I didn't know anything about.)

I didn't get pictures taken because the nurses were behind, so the orthodontist was ready before we had taken pictures and he just examined me instead. Good news includes my midlines match up perfectly both upper and lower. I'm trying to think of other things that were good news but nothing comes to mind at the moment, haha.

First bit of bad news, he can't close up the gap from my extraction. Eh, I'm disappointed but was prepared for that possibility going in based on the research I've done online. I will still need a bridge or implant upon finishing braces.

Secondly, because of my edge-to-edge bite he says I need jaw surgery. I was shocked. What? "Has anyone ever told you you need jaw surgery to correct your bite?" No, they haven't. lol. Well, he says that he could put braces on my upper and lower teeth and close most of the spaces no problem, but that it would give me an underbite. So, I need the jaw surgery. I'm terrified of surgery, not to mention the cost. But, I would have awhile during my braces treatment to save up for it and maybe see a therapist to work on the fear. It's an option.

The other option is to put braces on my bottom teeth only, which would bring them "backward" causing the upper teeth to overlap them which is a little bit of a solution for the bite issue, and then get veneers on the top teeth to close the spaces and improve their appearance since I have discoloration. He kept pointing to a picture on the wall of a woman (a model, not their patient) with super bright white teeth that to me looked totally fake. He said they didn't have to look like that of course, I could choose a color "on the white side of the yellow straw family" but that it would "solve" the spacing issue by covering it up and as an added bonus I could get bigger teeth (mine are small apparently) and improved appearance.

He said I could do nothing, of course, but that I have wear on my teeth so I would need a night guard.

Here's how the options breakdown (costs are before insurance):

Option 1: Upper and lower braces plus jaw surgery
Treatment time: ??
Cost: $5580 braces treatment + $600 surcharge for surgery patient + cost of surgery
Pros: corrects bite, solves the spacing issues
Cons: cost, surgery, does not improve appearance of teeth

Option 2: Lower braces plus cosmetic work on top teeth
Treatment time: ~14 months
Cost: $3840 braces treatment + cost of veneers
Pros: resolves lower spacing issues, improves appearance of teeth, improves bite
Cons: cosmetic work not covered by insurance, upper molar contacts will still be basically impossible to floss, veneers need to be replaced after 10-15 years

Option 3: Do nothing, wear a night guard
Treatment time: indefinite
Cost: $200-400
Pros: prevents additional wear on teeth
Cons: does not correct spacing, does not correct bite, does not improve appearance of teeth

I am pretty overwhelmed. I did a bit of crying in the car, I guess because I was expecting "Sure, no problem, top and bottom braces, 18-22 months, $5000 before insurance, come back on this date for impressions." Not surgery and expensive cosmetic work and fix one problem (spacing) to cause another (underbite). I didn't dislike the orthodontist but I'm just totally in shock. I feel like I ran face first into a brick wall haha.

I have another consult in two weeks with a different orthodontist. We'll see what they say. I may end up not pursuing treatment at all, after all, my smile does not currently stop me from smiling widely, laughing, or being myself. (I sometimes put photos in black and white due to the discoloration on my front tooth though haha!) But I do want healthy teeth that will last me for the next 65-75 years. Any advice?

Hi. i am sorry your consultation was tough. My only advice would be, if you are totally against surgery, see another ortho. maybe someone else would have a better treatment plan that you feel more comfortable with

Hi. I'm sorry you had an overwhelming experience. I know from my own experience when I went for orthodontic consultations, each ortho I went to had a completely different plan in mind for how to treat me. I feel like if you go to a few others, you might get different opinions. Key word is might. I'm not exactly sure of the typical procedures people that have underbites go through to be completely honest, as I don't have one myself.
Anyway, don't let one orthodontists plans scare you off on fixing your smile (if fixing is what you truly want anyway).
Good luck!

Hi there. I saw your other thread but thought I would respond here. I would suggest getting another consultation. I do not have spaces like you do, but I also have an edge-to-edge bite. After four consults, only ONE ortho said I needed surgery. You might be able to find someone who can take care of your problem in a different way!

Best of luck.

I am glad that you're getting a second opinion; I'd get at least TWO more opinions before settling on a treatment plan.

Though my case didn't involve surgery, I know exactly what you mean about being surprised by how complicated your seemingly easy case ended up being. I have fairly straight teeth, and seriously thought that I'd be out of braces within a year. Nope, I have insane bite problems, and will have them at least two years, even though from my smile it barely looks like I need them at all. Gah.
I've learned to just accept it, and am about 1/4 the way through treatment.

Good luck with your future consultations!

Thank you every for the wonderful replies. I am much calmer than when I posted earlier. I have scheduled another consult for this Wednesday in addition to the one two weeks from today. I was going to schedule another one but that office closed at noon today. (Which might be a strike against it, goodness gracious!)

I am definitely glad to hear that some of you have had orthos tell you you needed surgery but other orthos were able to accomplish your treatment without. I am definitely hoping for the same! I uploaded my panorex here: http://imgur.com/zU6N0YT in case it helps, lol.

I do have a question... the ortho didn't mention anything about elastics. (I meant to ask about that among other things but was so blind-sided by the surgery and him saying he wouldn't give me top braces without surgery that I got totally thrown off and didn't ask anything haha.) Aren't elastics usually used to help resolve bite issues? That was my impression from the research I've done, and I'm not sure why those weren't mentioned.

Hi parsleysage,
I'm also sorry to hear about your rough consult. I hear stories from people like you who get blindsided by the surgery idea and I think I didn't have it so bad after all. At least I knew it was coming from the time I was 10!

I'm glad to hear you're going to more orthos. That's a great next step. In the event that you get more recommendations for surgery, before you shoot it down completely, I suggest that you also consult with the oral surgeon--even if you truly don't think you'll do it. You want to investigate all of your options, and not go into braces (or come out of them) wondering if you've done the right thing.

Whether or not the orthodontist uses elastics depends entirely on your individual case. They might be needed, and they might not. It really just depends.

boodles8 wrote:Hi parsleysage,
In the event that you get more recommendations for surgery, before you shoot it down completely, I suggest that you also consult with the oral surgeon--even if you truly don't think you'll do it. You want to investigate all of your options, and not go into braces (or come out of them) wondering if you've done the right thing.

Hi boodles, thank you for the response! I am not totally ruling it out, and if I continue to receive the advice that I need surgery to successfully complete the orthodontics treatment I will definitely go see an oral surgeon. I'm just bowled over by the thought... I have no jaw protrusion, no facial abnormalities, no jaw issues like clicking or popping... just a bite that meets instead of overlaps... color me SHOCKED! when I heard it, lol! Thanks for your advice. Much appreciated!

I went into my consult knowing my teeth would need quite a bit of work (in fact, I was a little worried they would tell me my teeth were beyond fixing!), but it's still a shock to have surgery recommended. I really had no idea jaw surgery would be an option. I'm still deciding, and I have cried over it, so I get how overwhelming it can be. I just thought: braces. I didn't consider surgery, extractions, etc.

I do have a question... the ortho didn't mention anything about elastics. (I meant to ask about that among other things but was so blind-sided by the surgery and him saying he wouldn't give me top braces without surgery that I got totally thrown off and didn't ask anything haha.) Aren't elastics usually used to help resolve bite issues? That was my impression from the research I've done, and I'm not sure why those weren't mentioned.

Well, most braces patients have elastics at some point or another... most orthodontists don't go into that kind of detail during a consult. Major procedures, such as extractions or TADs might get mentioned, but not all the tiny bits that might be used at some point during your treatment.

sirwired wrote:Well, most braces patients have elastics at some point or another... most orthodontists don't go into that kind of detail during a consult. Major procedures, such as extractions or TADs might get mentioned, but not all the tiny bits that might be used at some point during your treatment.

Sure, that makes sense. I just meant as an alternative to surgery. As in, "You can fix your bite perfectly if you get surgery and this will [discuss all the benefits]. We may be able to get it 70% (or whatever) of the way there using elastics. Keep in mind that [pros and cons of not getting the surgery]." I've seen this mentioned a few times in braces stories here on archwired. He could tell I was a little freaked by the surgery which is why he spent most of the time talking about the cosmetic options... I was just wondering if he thought he could resolve it with elastics (and maybe he didn't, that's a possibility) why he wouldn't mention it, that's all.

Sorry to hear it was so overwhelming. In my experience, there can often times be a large discrepancy between what some patients think they need, and what they need from an orthodontic ideal. You have only provided a panorex, which does not show the side position of your jaws. This would be the best diagnostic x-ray to see how your jaws match in relation.

You have quite a bit of spacing in the anterior and a large full tooth space on the upper right. Closing this space would give you less teeth on the top, likely shift your midline too far to the right, and move closer to an underbite.

Elastics can be used to move the teeth to camouflage jaw discrepancies, but there is a limit to how tipped the teeth can be moved and still be safely within the bone.

Good luck with your other consultations!

DrJasonKTam wrote:Sorry to hear it was so overwhelming. In my experience, there can often times be a large discrepancy between what some patients think they need, and what they need from an orthodontic ideal. You have only provided a panorex, which does not show the side position of your jaws. This would be the best diagnostic x-ray to see how your jaws match in relation.

You have quite a bit of spacing in the anterior and a large full tooth space on the upper right. Closing this space would give you less teeth on the top, likely shift your midline too far to the right, and move closer to an underbite.

Elastics can be used to move the teeth to camouflage jaw discrepancies, but there is a limit to how tipped the teeth can be moved and still be safely within the bone.

Good luck with your other consultations!

Thank you Dr. Tam! They didn't take the cephalogram at the consult so I am not really sure how my jaws line up. I did have my TMJ checked at a recent dental exam and it was normal. I don't experience any kind of jaw issues that I'm aware of. However I am not doubting what the orthodontist told me... just in shock! I told him that yeah I guess I do need jaw surgery since my bottom jaw just fell out and hit the floor! lol.

The orthodontist did explain in detail why closing the extraction space would not be beneficial for me and said the same thing about my midlines. I think I am going to go ahead and get an implant since I will have time during my braces treatment to save up for it.

I can only imagine your disappointment, but of course you want to know where you stand. I'm not sure where you are in Virginia, but if you are close to the DC area I would recommend a consult with my ortho, Dr. Andrew Schwartz at Capitol Orthodontics. He sees patients in DC as well as Rockville. Best of luck to you and hang in there.

I'm in VA and saw 6 orthodontists before deciding. The last one was the winner. Only one of them suggested surgery to me. I am almost done with treatment and I am very happy with the results! Good luck!