Standard of Care ?

[Marius322]

Hello,

This is my first post but I have learned so much from reading this community’s answers over the last 3 months and wish to thank everyone. I do have a question. About a year ago I went to 2 orthodontists for consultations about my teeth. Both gave me about the same assessment on my mouth (which was reassuring) regarding my Class II overbite. Both also mentioned at the time that they might have to extract a tooth and would refer me to an oral surgeon for an evaluation on my jaw. I should say here that I have never had clicks, tightness to my jaw, or TMJ-related problems. Neither one really answered if I was looking at any serious mechanical problems in the future if I didn’t get treatment, which I understand because they want my business but still find frustrating. I wont post a link to my scanned diagnosis sheet since I know most users don’t like to opine without having me in their dental chair, but I can PM a direct link and your informed opinions would be appreciated).
I’ve saved my money and had molds made, 3-d scans taken, and x-rays etc. BUT there hasn’t been any mention of an extraction or an oral surgeon and they have given me a date to put the braces on this month. I am wondering if I should be concerned? Most of the Orthognathic posts mention that surgery is the standard level of care for fixing an OB and will give the best results/best keep the results after braces. I would rather do everything right instead of wear braces for 2 years and find that my results would have been best if I had the surgery. My ortho has a good reputation in the community and I will be bringing this question up with him but I wanted to get the Boards opinion as well. Thank you for your time and consideration of my questions.

Marius

[CoryDaniels]

I would just simply ask. You are afterall paying for this and you should know upfront what is going to happen. I went in my last consult with my current ortho and told them exactly what I wanted and that is what they are gonna do. they suggested that I have jaw surgery to fix my overbite, but I said no. I don't have that much of an overbite anymore and is not a big concern for me as long as all my teeth are bite are healthy, which they ortho says is coming along nicely.

[sirwired]

An overbite does not automatically mean you need jaw surgery. You need jaw surgery if jaw deformity is causing the overbite. If the overbite is caused by your teeth being tilted, jaw surgery is not necessary. The presence, or lack thereof, of jaw-related symptoms does not indicate either way the need for surgery.

I would ask what happened to the idea of extractions...

[ArchWired28]

Most of the Orthognathic posts mention that surgery is the standard level of care for fixing an OB and will give the best results/best keep the results after braces.

Not necessarily. In fact, the majority of all OB cases are treated non-surgically. It all depends if your OB is dental or skeletal in nature. Dental OB means that your upper and lower jaws are correct size, but teeth are position inefficiently for whatever reasons. Dental OBs are fixed entirely with braces and oftentimes require no teeth removal. Skeletal overbite means that your lower jaw is too small for your upper jaw. Mild to average skeletal cases could be fixed (or I would say, masked) with braces + teeth removal. Average to severe skeletal OB cases are usually managed surgically.
Which case is yours I don't know, but since teeth removal was mentioned, I would guess you are somewhere mild skeletal? This is a good question to ask your ortho prior to start of braces. Oh, and if you need teeth removed, it can be done later on in treatment while you are already in braces. Good luck!

[Marius322]

Thank you for the quick replies. I will definitely be asking, I just wanted to get an idea from members beforehand so I'd be armed with more knowledge. Sirwired's comment about the tilt of teeth seems to fit my situation, so perhaps it wasn't a skeletal cause that would require surgery and taht's why I havn't heard any more about it. I found a list of diagnosis comments and they are as follows:

-Vertical fit of the front teeth are excessive at 110% causing wear to the edges of the incisors
-Tooth #5 position is on the buccal with a slight crossbite
-Lower front teeth are left of center with the teeth in "best fit"
-The wear to the lower incisors is the result of a deep overbite. Early slight gum recession in tooth #24
-Screening suggests normal TMJ function

The rest of the notes say that my dental development is normal for my age (27), and that the molars and cuspids are in an ideal relationship. Archwired28, your comment about removal being possible later in treatment is entirely possible, I just would prefer to be told if it was planned or needed before treatment starts. Your comments have been greatly helpful.