Metal Mouth Message Board

Hi there

SO glad I found this forum!

I'm 27 years old and got braces 6 months ago for a 9 mm overrate. Saw three orthodontists. 1 suggested 2-pre-molars and one lower incisor to be extracted. The other two suggested jaw surgery to move my lower jaw forward OR no surgery with just 2 pre-molars extracted.
But they both said jaw surgery would be the only option if I am to get perfect results.

I was worried about a sunken lip/face from extractions but the orthodontists advised me it would most likely be unnoticeable as I have quite a full/thick upper lip.

I decided against surgery because it just sounded too painful with the long and difficult recovery time.

But now I am starting to have second thoughts and possibly want to go the surgery route instead as I am quite unhappy about my side profile.

Before the orthodontists told me this I had no idea that my 9mm over jet/ overbite was caused by my lower jaw which is underdeveloped. I always blamed it on my upper teeth.
I feel so stupid now that all these years I never realised what the problem was myself and had always just blamed my side profile on my upper teeth.

I am getting rather self conscious about my chin now. Maybe I'll get a Genioplasty after my braces to ease it. But I just feel I made a massive mistake. Before my extractions I was given the opportunity for braces with lower jaw surgery which would have included a genioplasty already.
And the orthodontist said I wouldn't be able to go surgery route if I go the extractions route.

Its only been 6 months and my lower teeth have all straightened. But with my upper teeth the gaps where my pre-molars were appear to have no change. So I think maybe I could make this drastic change and see a maxillofacial surgeon still?

I also feel that maybe what I am doing now will also improve my side profile. If my upper teeth end up protruding less then it may mask my undeveloped lower jaw?

My next appointment with my orthodontist is on Monday and I just don't know what to do. Carry on with my current treatment or mention the above. I just a bit afraid to say anything.

Anyone else been through a situation similar to this? any advice/comments would be most appreciated.

Thank you

Hey!

I'm in the same boat you are, so I wanted to share my story.

When I was a kid (probably 11 or 12 years old), my dentist told my parents that I was a good candidate for braces. And, unfortunately, my parents followed the "We can't afford it" path. So I went through my teenage years with crowing, rotation, and overjet issues. When I was 18 or 19, I started grinding my teeth. My parents opted to get my a fitted night guard, which helped protect my teeth, but didn't prevent the TMJ problems that would arise from bruxism. I kept my night guard and used it pretty much religiously until I was 24.

In September of 2014, I visited an orthodontist for a consult. My primary concern was the loud popping in my jaw and the pain that came along with it. Knowing that I had an overjet and that I should have had braces when I was a kid, I thought it might help. This orthodontist told me that while he could correct my teeth with braces, he was not comfortable treating my overjet. I was a fully grown adult so manipulating the bones was much harder. I opted to take his referral to another orthodontist, knowing that I was probably a good candidate for surgery. So I visited another orthodontist. This one confirmed that I was a good candidate for surgery and basically told me the same things, but also warned me that braces and the surgery MIGHT NOT fix the TMJ problems I have. Knowing this, and knowing that it would be better for me in the long run regardless, I decided to do it. At the end of October, I had two lower pre-molars extracted and a week later, I was in full braces. My overjet was measured at 8 mm and is slowly but surely getting worse, as I was told it would before the surgery could take place.

I totally know where you're coming from being self concious about your chin. I had never really thought about my side profile before I started this journey. I guess that's probably because I had developed an adaptation to compensate for my poorly performing jaw. I still really don't think about how I look now compared to how I will look after because I never signed up for this for the cosmetic side. I really didn't even care that my teeth were crowded and rotated. I just want my TMJ problems to go away.

5 months in, I am so happy with my teeth. I just had an adjustment yesterday and even though I am in a massive amount of pain (probably super exaggerated because I am such a weenie when it comes to mouth pain), I don't regret it at all. In case you're wondering, I had my 4 rear molars banded and received a thicker wire to start closing the lower gaps, which is killing me because most of my rotated teeth are on the lower arch.

My orthodontist said there are at least 6 more months before we start looking at the surgery. The lower gaps have to close first, then there will be a period of arch correction.

If I were you, I would ask your orthodontist and plan to see an OMFS. If your orthodontist didn't address your facial aesthetics, he may not see it as a concern or he may see it as something he can correct with braces alone. I've never heard of a case where orthognathic surgery wasn't paired with braces, as the movement of the lower jaw will affect your bite. If you're going to put the money (and a lot of it) into fixing a problem, you should get the best solution available.

I hope this helps!

Hey thank you so much for replying.

Its good to hear you are getting your problems solved.

For me I don't really feel that I have any TMJ issues. I can eat anything and never feel discomfort when chewing etc. One orthodontist just said that I have developed a way to open and close my jaw so it doesn't affect me at the moment. But he fears in the future I may get symptoms of TMJ.
My current orthodontist is SO QUIET, he never tells me anything and my appointments are kept to the minimum. So I have composed an email and hope to send this to him next week, once I have done enough research online.

Did your orthodontist or surgeon tell you what sort of procedure you will get? Lower jaw surgery only or both? I have heard cases where people with an over jet had to get both lower and upper. For some reason I am not that keen on upper jaw surgery, it looks brutal.

I guess my only concern now is that I lost to upper pre-molars for nothing

Also how do you feel about being able to get time off for surgery and recovery? I am working full time and I also cannot predict my future i.e. if I'll get a new job
So in the back of my mind I am also concerned about how I'll fit all this in my life. Maybe I shouldn't worry so much and just go with the flow. I think it'll be easy to get 2 weeks off work but to get 3-4 weeks off simultaneously maybe pushing it i think.

The orthodontist and surgeon agree on Bilateral Saggital Split Osteotomy (BSSO), which is lower jaw only. No genioplasty involved either. There are two doctors at my orthodontic practice...and one is the wife of my OMFS...so they are pretty well connected. I am very thankful to avoid having both jaws worked on. On another note with this part, I am very lucky to work for a company that is flexible with leave for this kind of thing...we have what is called FMLA that will cover it as paid and protect my job for the time that I can't work. After that time is up, I will be working from home for a few weeks more, just to be sure I am cleared to drive. There is no anticipation that I will need to be wired shut or have a splint after the surgery.

I don't have a ton of discomfort when eating any more. I used to have serious problems with locking, especially when I would open my mouth very wide. For a while now, I only hear popping and clicking when I open and close...nothing horrible when I'm chewing, except for a few days after an adjustment while ligatures stretch out a little bit.

Often times, teeth are removed to make room for the movement. I don't think your upper pre-molars coming out will be in vain. I know that my lowers were removed to make room to correct rotation. It really depends on your case. Never be afraid to ask questions and pry for information from your ortho. They should be communicating everything to you, all the time, and be willing to answer any questions you have regarding your treatment. After all, you pay them. You should be able to call their office and talk to a treatment coordinator if the doctor isn't available. And any time you're there, any of the clinical staff should be willing to help you out.

You say you've had braces for 6 months. I think you need to give it more time. I've had braces for a year, and my extraction gaps aren't completely closed yet. It takes time.

EWUgal15 wrote:The orthodontist and surgeon agree on Bilateral Saggital Split Osteotomy (BSSO), which is lower jaw only. No genioplasty involved either. There are two doctors at my orthodontic practice...and one is the wife of my OMFS...so they are pretty well connected. I am very thankful to avoid having both jaws worked on. On another note with this part, I am very lucky to work for a company that is flexible with leave for this kind of thing...we have what is called FMLA that will cover it as paid and protect my job for the time that I can't work. After that time is up, I will be working from home for a few weeks more, just to be sure I am cleared to drive. There is no anticipation that I will need to be wired shut or have a splint after the surgery.

I don't have a ton of discomfort when eating any more. I used to have serious problems with locking, especially when I would open my mouth very wide. For a while now, I only hear popping and clicking when I open and close...nothing horrible when I'm chewing, except for a few days after an adjustment while ligatures stretch out a little bit.

Often times, teeth are removed to make room for the movement. I don't think your upper pre-molars coming out will be in vain. I know that my lowers were removed to make room to correct rotation. It really depends on your case. Never be afraid to ask questions and pry for information from your ortho. They should be communicating everything to you, all the time, and be willing to answer any questions you have regarding your treatment. After all, you pay them. You should be able to call their office and talk to a treatment coordinator if the doctor isn't available. And any time you're there, any of the clinical staff should be willing to help you out.

hey thanks so much for your reply. I really appreciate the time you have taken out to respond to me. Yes I will contact my orthodontist next week and see what he saids. I'll look into the policies at work too. Especially in England I believe we are protected for things like this as you mentioned so maybe I shouldn't worry as much. Thanks again

cata wrote:You say you've had braces for 6 months. I think you need to give it more time. I've had braces for a year, and my extraction gaps aren't completely closed yet. It takes time.

Yeah I know its just now I have decided that I may want to completely change my treatment plan. Which doesn't involve upper extractions so having already done them I'll be left with two gaps. But like EWUgal15 said each case is different and maybe these extractions won't have been done in vain. I only find out when I see a surgeon I guess.

Hi, I was just reading your post. Was your night guard made by your dentist?

EWUgal15 wrote:Hey!

I'm in the same boat you are, so I wanted to share my story.

When I was a kid (probably 11 or 12 years old), my dentist told my parents that I was a good candidate for braces. And, unfortunately, my parents followed the "We can't afford it" path. So I went through my teenage years with crowing, rotation, and overjet issues. When I was 18 or 19, I started grinding my teeth. My parents opted to get my a fitted night guard, which helped protect my teeth, but didn't prevent the TMJ problems that would arise from bruxism. I kept my night guard and used it pretty much religiously until I was 24.

In September of 2014, I visited an orthodontist for a consult. My primary concern was the loud popping in my jaw and the pain that came along with it. Knowing that I had an overjet and that I should have had braces when I was a kid, I thought it might help. This orthodontist told me that while he could correct my teeth with braces, he was not comfortable treating my overjet. I was a fully grown adult so manipulating the bones was much harder. I opted to take his referral to another orthodontist, knowing that I was probably a good candidate for surgery. So I visited another orthodontist. This one confirmed that I was a good candidate for surgery and basically told me the same things, but also warned me that braces and the surgery MIGHT NOT fix the TMJ problems I have. Knowing this, and knowing that it would be better for me in the long run regardless, I decided to do it. At the end of October, I had two lower pre-molars extracted and a week later, I was in full braces. My overjet was measured at 8 mm and is slowly but surely getting worse, as I was told it would before the surgery could take place.

I totally know where you're coming from being self concious about your chin. I had never really thought about my side profile before I started this journey. I guess that's probably because I had developed an adaptation to compensate for my poorly performing jaw. I still really don't think about how I look now compared to how I will look after because I never signed up for this for the cosmetic side. I really didn't even care that my teeth were crowded and rotated. I just want my TMJ problems to go away.

5 months in, I am so happy with my teeth. I just had an adjustment yesterday and even though I am in a massive amount of pain (probably super exaggerated because I am such a weenie when it comes to mouth pain), I don't regret it at all. In case you're wondering, I had my 4 rear molars banded and received a thicker wire to start closing the lower gaps, which is killing me because most of my rotated teeth are on the lower arch.

My orthodontist said there are at least 6 more months before we start looking at the surgery. The lower gaps have to close first, then there will be a period of arch correction.

If I were you, I would ask your orthodontist and plan to see an OMFS. If your orthodontist didn't address your facial aesthetics, he may not see it as a concern or he may see it as something he can correct with braces alone. I've never heard of a case where orthognathic surgery wasn't paired with braces, as the movement of the lower jaw will affect your bite. If you're going to put the money (and a lot of it) into fixing a problem, you should get the best solution available.

I hope this helps!

clairesky wrote:Hi, I was just reading your post. Was your night guard made by your dentist?

Well, sort of. My dentist took molds for it, but I think they sent it to a lab to actually have it made. That was for my first night guard. I recently had a new one made, so new molds and everything, that is flexible and a little over-sized to fit over my braces. This was with a new dentist (since I moved to a whole new city between dentist visits) and this one was made in the office by my dentist.

My ortho suggested BSSO as well but I worry about permanent numbness like hell..I mean c'mon what's the point of having a perfect smile and profile if you can't even feel what kisses are like!!! A genioplasty seems a lot easier and like on the lower risk side but the outcome is just different..it can't duplicate what BSSO brings.

Numbness is definitely a concern to have, but most of the reading I've done, people have almost 100% feeling returned within a year. It takes a long time for nerves to regenerate, but physical therapy, acupuncture, chiropractor visits, and vitamin supplements have all been used to speed that time up successfully. And I think a surgeon with plenty of experience with BSSO will do everything they can to prevent and minimize nerve damage. On my list of concerns, its not very close to the top.