Dr. J, Dr. R, anyone? Class II div2, TMJ problems. Pictures

[krzysiek]

My name is Krzysiek (from PL). I have found your forum on the web.

I always had crowded/crooked teeth, I am 24 years old now. I used to wear a removable braces, with a bolt to expand my arches when I was young and... stupid . I have refused to wear that thing and my mother did not force me to wear that device and my treatment had been canceled. Now, 12 years later I am a little bit more clever and I'd like to make my smile as nice as I can. Moreover (1'st thing) my TMJ might not stand that bad bite anymore and I can have pain in my TMJ (I can hear clicks and pops now, no pain yet but it will come in the future I think. When I swallaw my saliva I can hear snaps/cracks in my ear (TMJ does not move, it must be a fake sound caused by TMJ problem) :-(
I know that my TMJ might fail if I keep my bad bite.
I have asked 2 orthodontists so far and their diagnosis and treatment plans are different ;-(

1st orthodontists wants me to wear 2 hyrax devices (both jaw parts) for 4 months (up to 4...) and it is very expensive, I can not afford it :-( ! Later he wants to put braces on my teeth and continue my therapy (He did not see my X-rays, nor casts).

2nd. He wants me to wear a removable braces during night and few hours per day. This will expand my arches a little bit (will it? I am 24...) and push front/upper teeth forward, then he wants me to wear normal, metal braces glued to my teeth (up to 3 years he said) . I like that option but is it good for me? People say that removable braces is a cr*p (they are said to work only for children, I am 24 years old). And they say it is a waste of money (removable braces are much cheaper and I can afford to buy that device). But is it true? I would only like to avoid hyrax things (+cost!). I know that only metal braces can help me but it will be a second stage of my treatment, after removable braces stage. Stage 2 will also pull my low jaw forward (is it possible only with braces in my case, with out surgery?). Dr. has also said that teeth extraction in the upper jaw is not a good option in my case (after doing some research, computer program calculations - based on x-rays, watching jaw casts)
Is this plan good/acceptable?

Here you can see x-ray pictures taken by the doctor and some pictures taken by myself (upper jaw is the most crooked/crowded one), my lower jaw is not as crooked as the upper one, it is mainly crowded. I will have lower wisdom teeth extracted this week.

X-Ray1 (Cef)
http://img123.imageshack.us/img123/5892/cef6zm.jpg

X-Ray2 (Pan)
http://img326.imageshack.us/img326/2941/pan6xt.jpg

Now some horror pictures, I hate watching them :(

My upper jaw picture (dead tooth can be seen, I can see the change of colour only with flash light pictures, sun light does not show the color change)
http://img44.imageshack.us/img44/3986/ortho2jh.jpg

Crowded, crooked teeth on my left(!) side
http://img57.imageshack.us/img57/6818/17gf.jpg

Deep bite, bad midline
http://img231.imageshack.us/img231/4347/deep7ov.jpg

And the low jaw (mollar teeth are in that position / tongue \ I think that can be fixed with removable braces?)
http://img244.imageshack.us/img244/7677/lowarch2mv.jpg

It might look more crooked but It is a wrong digital-camera angle I have used to take that picture.

-------------------------

So I have overbite, class 2 division 2 + crowded and crooked teeth?

I also have 2 dead teeth ;-|
DR has said that it could be a problem sometimes, does "sometimes" include me?! My palate is said to be "high arch type" is it a problem? I saw a real high arch palates pictures on the web, my does not look bad imho, it is not low for sure :-).

I am sorry, I know my English is not perfect.
Thank you very much for your help.
Your feedback is greatly appreciated, please tell me what I shall do.

I am also thinking of a psychiatrist therapy now… I regret I did not listen to my mum and now I can have a serious problem, TMJ might be starting to break down, I look bad etc :...-/

[dr.j]

K: (this is all based on a cursory evaluation of the pictures, please note that only with a comprehensive exam -in person- can an orthodontist readily give accurate information.)

You appear to have the classic Class 2 Division 2 malocclusion. The lateral ceph is the really telling image. You appear to have a skeletal deepbite pattern characterized by a short lower facial height, likely strong muscles of mastication, and a low mandibular plane angle i.e. the angle of your jaw is almost 90 degrees square and is small in length. Your upper front teeth are torqued back on themselves. If your upper front teeth were at a more correct inclination you would have a severe horizontal overlap of the front teeth or severe overjet as we call it.

The upper jaw appears narrow from the pics (this is a bit of a guess). You are likely very narrow if models of your teeth were placed in an ideal bite b/c the lower needs to come forward quite a bit. When the lower jaw comes forward it will accentuate the width discrepancy.

I can only yield a cursory opinion of what you may need and it is not my place to diagnose or tx plan on the web. However, I could say that if you were in my office we would have to at least talk about the following:

1) Surgically assisted Hyrax expansion of the upper jaw.
2) Full upper and lower braces
3) Surgical advancement of the lower jaw to bring it anterior to give more chin projection and inferior to increase the lower facial height.

I see a good orthognathic surgery candidate. There is little data to suggest that your TMJ signs and symptoms would improve with any orthodontic treatment. Good Luck. consider a third opinion

Dr.J

[caryca]

Krzysiek,

Where are you from? If I were you I would either go to a large place where there have many speciallists (in Warsaw it would be Eurodental).

Knowing PL I would say if you are more complicated case go to the best ones- it will cost more, but you would be happy with the results!

I had a bit of TMJ and it's all gone now (let's cross the fingers)

BTW if money is the biggest concern go to AM - there is one place in Warsaw- in other cities I don't know. But then they can do things using your national incurence

[krzysiek]

Thank you Dr.J.

But what about dead teeth (you can see them on X-rays)?

We are talking about SARPE in my case?
Is a removable brace expander bad idea? I know that is a web-help not a real comprehensive exam in person but it will be a little hint. My Dr. said that we will see how does removable brace work for me first.



caryca:
duze miasto, zobacze na jakas AM ale kto da mi skierowanie, do kogo prosic o skierowanie od lekarza 1 kontatku? Widzialem Twoje zdjecia, nie wiem po co zakladalas aparat, wada mala no ale jest lepiej. Milo spotkac krajana, szkoda ze w takich warunkach, mam dola ze blisko do samob.... ;[

[caryca]

sorry guys for polish....but is like NHS thing question so it's easier to do it in polish

co do skierowania to nie wiem bo nie mieszkam w polsce od 7 laty i ten system ktory teraz jest jest ciut dla mnie skomplikowany

wada moze mala ale coraz gorzej bylo pozatym staw strzelal mi co chwile i juz zaczelo mnie bolec...pozatym mialam jednego zeba w podniebieniu...czego nie widac na tych zdjeciach
ja akurat jestem bardzo zadowolona i bardzo szybko sie wszystko prostuje

[Gable74]

true, however.....

ten isssue od całkowity masa przez entropia przyjechał w grać tutaj mimochodem od pewien odwrócony grawitacyjny strefa. Odcinek a propos ziemie silny magnetyczny wystawiać weksel na jego otaczanie roślina. Ustalony ten podstawowy Ławsk od interdemensional różnice ilościowe fizyka , wszystko emalia teoria idzie na zewnątrz ten okno. Spodziewać się ten współpracownik.

[dr.j]

It has been shown in the orthodontic literature unequivocally that removale plates are not capable of expanding the teeth toa stable degree in adults. In fact they are so unstable on kids that I do not use them unless the child is in the primary or ealry mixed dentition. SAPRE is the tool of choice. It allows for expansion of the skeletal units.

Don't forget that if your lower jaw needs to come forward a wider portion of the lower jaw will be moving into a narrower portion of the upper jaw. So you are relatively more narrow on top than you appear to be.

Dr.J

[caryca]

Gable you are right I should PMs him....as i am at work it's a bit more tricky...

any way if you want to transelate something to Polish never use the electronic things Polish gramar is just too complicated