Anyone opt for restorations rather then braces?

[overfortyish]

Hi -

I realize this is a discussion board for adults WITH braces but I'm just wondering if there is anyone on here who considered getting crowns and veneers instead of getting braces. Or perhaps even did that first and then realized it was a mistake - or vice versa - considered restorations but got braces instead and now is happy or unhappy with their choice?

I have been lurking on this board for some time. And I am VERY confused.

I am a 45 year old female - who had braces as a child for four years. I had all four of my bicuspids removed, and an expander put in to widen my arch before braces were put on.

I wore the retainers initially but then would spit them out in my sleep. I did not notice a shift in my teeth until my late 30s. There is some general crowding on the bottom, one canine has sort of recessed and the other canine has begun to twist.

But of more concern is I now have an anterior open bite and a posterior crossbite. When I chew on my back teeth not all teeth meet properly. A few years ago I had a hairline fracture in one molar that required root canal. And then eventually the tooth had to be removed because pain from the fracture continued.

I have some general muscle discomfort in my jaws/TMJ because of my improper bite and from some general clenching.

When I eat, it takes me a long time to finish my meal because my jaws get tired after a while - I get full faster and I do not eat as much.

I've consulted with a number of orthodontists - all say that closing my bite will be the biggest challenge. They will do this with rubber bands and a few orthos have said if that does not work they will use TADs. As for the proper position of my bite in the back - that too will be corrected to the best of their ability. All say my bite might reopen again - but it will be less open then it is now. They will do all they can to ensure that my bite remains stable, use retainers etc. There is also the mention of potential root canal if nerves are damaged and gum recession. Estimated time 2 years.

Aside from the enormous FINANCIAL difference between having my mouth restored with crowns vs. orthodontia, I'm a little nervous about 'ruining' my teeth with crowns. However I had a consult today with someone who really made me wonder if orthodontia is for me. This is a dentist who has an orthodontist as a partner - so ortho is an option for some people. Here is what he said:

He does NOT recommend orthodontia for me. He said there is no way that closing my bite will align my back teeth, it is close to impossible. He said he'd focus on giving me a functioning bite (in back) - first and foremost. How would he determine my natural bite? He uses a TENS (Transcutaneous electrical nerve stimulation which works on relaxing the face and jaw muscles. Once the muscles are relaxed he can determine the natural physiologic position of the jaw. He said he'd temporarily build up my teeth in the back and I'd leave and see how I feel for a week or two. As long as I feel good - we can begin with the restorations.

He told me he already sees a # of fissures and cracks in my back teeth from so much force being applied to certain teeth. So he will not feel bad crowning some of those teeth in the back because they will eventually crack and cause pain and need root canal anyway.

I'd have approximately 15 teeth on the side/back top and bottom of my mouth crowned. If I wanted, I could have my top front 6 teeth veneered so I have a prettier smile. We'd leave my bottoms alone.

The TMD treatment and diagnosis alone will cost me $5K. Crowns and veneers thousands and thousands more.

Again this dentist said he does not recommend orthodontia for me. And he is someone who could provide it for me - if he thought it was an option.

His credentials are extremely impressive. He has his doctorate in dental surgery as well as a degree in general dentistry. He also received credentials at the Las Vegas Institute for Advanced Dental Studies and is a graduate in advanced cosmetic dentistry and neuromuscular dentistry. Also completed graduate courses in orthodontics and dental implants.

I am SO very confused. I have hesitated about braces for a long time now. I do not know WHAT to do. As it is, I feel 2 years in braces is a long time and it will likely be longer. And then if I do it - my bite could shift again and also reopen.

Financially - restoration is much much more expensive, but if that is the ONLY negative of doing it - I will find a way to come up with the money.

Just wondering if anyone on here as ever received a similar opinion or if any of the orthos on here can offer me advice. I realize that it is very hard for anyone to make a definitive diagnosis without seeing me in person - but any advice or feedback is welcome.

Thanks!

[overfortyish]

I forgot some additional, important information:

My upper arch is quite narrow. My teeth are kind of moving inwards. He watched the way I swallow and sees my tongue is pushing my teeth out. He said I will continue to do this with braces and once braces are off.

All orthos have said they can't widen my arch noticeably at my age. However restorations can indeed widen my arch.

Esthetically I notice my mouth is sagging - I have VERY little upper lip support and a I tiny upper lip. So a fuller smile can be achieved by restorations vs. with braces it can not.

[overfortyish]

Also wondering if I should go see a Prosthodontist for his opinion.

[drrick]

Sounds like what is called neuromuscular dentisrty (they also do neuromuscular orthodontics -- moving the teeth to match the position determined by the TENS, etc without crowning the teeth)

This will not correct your posterior crossbite either but you can likely get a functional bite with either ortho or with FMR (full mouth reconstruction)

Restorations wil not appreciably widen the arch IMO. You can only make them so thick before you get a ledge at the gumline and this can cause periodontal problems.

It sounds to me as if surgical orthodontics should be considered to widen your upper jaw.

FWIW, If you have a tongue thrust or other issue that can also cause 'relapse' of your case even if crowns are used instead of braces.

I would likely consider another ortho consult (again discussing surgical options) and a prosthodontic consult would not hurt either. SOunds like you are a bit of a complex case.

Good luck!!!

[overfortyish]

>Sounds like what is called neuromuscular dentisrty (they also do neuromuscular orthodontics -- moving the teeth to match the position determined by the TENS, etc without crowning the teeth)

Thanks Dr. Rick. Yes one of his specialities is neuromuscular dentistry. I forgot to mention that. I saw a NMD a year or so ago who treated me for a while for my TMJD - he actually said braces for sure once my jaw was in a comfortable position. So I was surprised to hear today that this dentist did not recommend them.

>Restorations wil not appreciably widen the arch IMO. You can only make them so thick before you get a ledge at the gumline and this can cause periodontal problems.

Good to know - though I have had a dentist make me a model to show me what kind of support I could achieve on my upper lip with veneers on the top 8 teeth. I really liked how it looked.

>It sounds to me as if surgical orthodontics should be considered to widen your upper jaw.

I've met with about 8 orthos over the span of a 18 months, no one has ever suggested surgery and infact said no to it. I've seen a few oral surgeons too who all said no.

>FWIW, If you have a tongue thrust or other issue that can also cause 'relapse' of your case even if crowns are used instead of braces.

Thanks - good to know. All the more reason for me to not bother trying to close my bite with yrs of orthodontia. Try to get a functional bite and straight front teeth and be done with it. The closing of my bite is what all the orthos have said will be most time consuming. I'm fine with taking a pass on the rubber bands as well! lol

>I would likely consider another ortho consult (again discussing surgical options) and a prosthodontic consult would not hurt either. SOunds like you are a bit of a complex case.

I have yet to find an ortho who felt a surgical correction was an option for me - but I will look into speaking to a prosthodontist.

Thanks again!

[fosterp]

A lot of what you said is unfamiliar to me, but as far as credentials go, the guy you listed is no more impressive than what any specialty doctor should have. A doctorate in dental surgery and degree in general dentistry = same thing, just different wording. I checked out the LVI web site and I might just be making hasty judgements but it looks like just another university of phoenix version of dentistry. Its so called "reasons" for taking courses at the school provided nothing in the way of clinical ability, it had stuff like:

92% enjoy their profession more since they started at LVI."

"Over 83% of LVI alumni have seen an increase in their net incomes."

"92% of the dentists were either extremely or very satisfied with their LVI education, while 7.2% of the remaining 8% were satisfied."

I don't see anything on their website that shows endorsement by any independent dental association approving the school for anything.

Also completing graduate courses in orthodontics and implants does not knowledge compared to a certified prothodontist or orthodontist, and I wouldn't take their opinion about the merits of orthodontics as an expert evaluation.


I think you should continue searching out opinions in order to get a general consensus of what the experts agree on what can and can't be done. From what it sounds like your open bite cannot be fixed without surgery, and I would be cautious of any ortho who says he can fix it completely when everyone else says that it cannot.

When evaluating a professionals credentials, I would take the number of "degrees" and "certifications" listed on their credentials with a grain of salt. Higher education has become somewhat of an assembly line, with many of the great schools producing great doctors being polluted with profit driven commercial schools whos only purpose is to pump out degrees with fancy wording that are accredited by nobody.

I would first and foremost look at the doctors experience, his results from treatments of other patients, and reputation in the area.

[drrick]

In regards to surgery I thought I read that you had a narrow upper jaw and that lead me to believe you likely had a posterior crossbite. I wasn't talking about sx for the open bite.

That was also what I was referring to in regards to making the restoration bigger/wider -- the posterior teeth.

Lvi is probably the best know neuromuscular based training institute. The docs get plenty of clinical training. I know some instructors there. Not every doc believes in NM but again that is the best known institute.

[overfortyish]

In regards to surgery I thought I read that you had a narrow upper jaw and that lead me to believe you likely had a posterior crossbite. I wasn't talking about sx for the open bite.

Sorry didn't mean to confuse things with my reply. Dr. Rick you are right - yes, I do have a narrow upper jaw. Not horrendously narrow - but narrow nonetheless. I had an expander as a kid and now, later in life my teeth have migrated inwards somewhat. I don't know if that is what has caused my posterior crossbite or not, but that is my diagnosis - along with an anterior open bite. The open bite is not visible to others -the way some are. But when I try to make my front teeth meet, no matter how hard I try - I can't. That bothers me less - then the fatique I get in my jaws overall when eating because my back chewing in general is not as affective as it should be.

>Lvi is probably the best know neuromuscular based training institute. The docs get plenty of clinical training. I know some instructors there. Not every doc believes in NM but again that is the best known institute.

Yes I've heard a lot about it - and also know it to be a highly reputable educational institution.

Thank you again for the input - I'm going to have to just take a leap of faith in someone I suppose.