Frustrated Need Opinions

[Chaplains Assistant]

So my ortho pulled one tooth on the upper left I think #5 - when he told me he was pulling a tooth on the left I asked why as I had one less tooth on that side to start with. He assured me it was the right tooth to line my bite up. He said that would make everything good but my midline would be off a little bit. I've been asking for the last 7 months or more when he's going to shift my teeth farther to the right because my midline is almost and entire tooth off to the left. Last time I went to the ortho 3 weeks ago he said it won't get much better than it is right now without pulling a tooth on the right top and bottom - WTH. Do that would put me back at day 1. My treatment time was supposed to be 24 months which is August. It took an entire year to close the last extraction gap, now he wants to pull two teeth on the other side to get my midline right.

If you were me what would you do. I'm so mad that I could punch him and realy don't want to be in these things another 2 years. But I don't want my midline off that far either. HELP!!!

[whiteswan]

I wonder if he could do some IPR (tooth slenderizing) on the other side and then use a power chain to pull them over, rather than have to pull teeth? Even a little bit of IPR on 3 or 4 teeth may make enough of a difference that the midline wouldn't bother you so much? I don't know if that would be possible or not but might be worth asking...

[Chaplains Assistant]

Well I went to the Ortho Monday and asked about my midline again. He said he'd send me to a dentist to get teeth pulled if I want to add 12-18 more months to my treatment and $100/month. Tha's just rediculous I already paid $5900 for what I thought was my entire treatment for a perfect smile.

I decided not to have them pull teeth and to just be satisfied with a shift to the left midline but a perfect bite and no TMJ with less migrains too.

Got new upside down triangle elastics again and I have the heaviest ones to. Can hardly open my mouth to talk.

I hope since I decided not to do the new midline shifting that I get my braces off soon.

[DrBill]

It sounds like you had an asymmetric Class II malocclusion; Class I on the left and Class II on the right. If that malocclusion warrants extraction then it's generally one upper premolar to correct the Class II relationship (like you had), or three premolars - one to correct the Class II relationship and two on the other side to balance the midline.

The first pattern is generally used if the asymmetry is in the upper arch - it fixes the bite and centers the midline. The second pattern is gernerally used if the asymmetry was in the lower arch. Keep in mind there are often compromises in adult treatment , and often it's a matter of balancing those compromises. For example, extracting two more premolars could have some profile implications if you didn't have enough overjet or lower crowding to warrant it, so perhaps even if there's a slight midline compromise your orthodontist took the more conservative road due to other factors.

Obviously you've already discussed this with him, and it sounds like you've come to a resolution. If he's charging you for added treatment should you go for extraction of the additional teeth he likely feels it's not in your best interest to extract. Keep in mind that the midline can deviate over 2mm to the face and not be noticed by others if the long axis of the teeth are in the proper position (teeth look like they're angled straight up and down). If the teeth look "slanted" and there's a midline deviation it's more noticable by others.

[ArchWired28]

Chaplains Assistant
I am a big fan of perfectly aligned midlines, but in your case I would have settled with what you have now. Not only additional extractions require more money and time to fix, but they will pose a lifelong risk of TMJD and bone loss. Believe me, you don't want to have a perfectly aligned midline at the cost of chronic TMJ pain. If however this bothers you that much, perhaps you can mask the midline with cosmetic dentistry a bit. That will require shaving of at least two perfectly helthy teeth for crowns or veneers which is no good, but this is an option if you want it that bad. Although I see that you have already started focusing on the positive sides of your treatment, and maybe the midline is not such big of an issue.

[DrBill]

Studies I've seen show no correlation between premolar extraction and TMD or bone loss. In fact NOT extracting in patients where it's warranted (and I'm certainly not saying it's warranted in this situation) would seem to have a much more deleterious effect on bone (overexpansion) or TMD (improper functional relationships from protrusion) than extraction.

[ArchWired28]

DrBill
given Chaplains Assistant's teeth are already straight and in the healthy class I bite, would the extractions be warranted just to move the midline a few mm's?

[DrBill]

It depends on how far the midline is off. If it's just a mm or two most patients would say definitely not! If it really bothers the patient or is quite noticable then perhaps, assuming the extraction won't detorque the lower incisors or have adverse profile consequences. Every case is different and it depends on how far the midline is off. As dentists like to often reference, Tom Cruises midline is way off, yet people think he has a great smile. Incisor angulation, smile arc, tooth display/length, etc all influence smile and midline is just one part of the equation.

It's often a balancing act with adults, and that's where discussing the pros/cons with your orthodontist is so important.

[ArchWired28]

Thanks for your detailed explanation, DrBill! I am asking because I have sort of a similar issue. I have just posted in another topic. I would appreciate very much if you take a moment and respond...

[Chaplains Assistant]

Thanks Dr. Bill. My shift is 1/2 to 3/4 of my front tooth off and my ortho did reference Tom Cruise which I never noticed and he has a great smile.

I'm trying to attach a photo that was taken 2 months ago when he took all the bracket off my top teeth to reposition them. Let me know what you think.

photo.JPG

[ArchWired28]

Chaplains Assistant
are you almost finished? Why are you not wearing the upper braces? Honestly, looks to me that you still have some straightening to do, aside from the midline issue that by the way seems to be very off to me.

[BellaBraces]

Ouch! Your mouth looks really sore.

[kennyandrew85]

Wow

Firstly..
Never ever get treatment done on a monthly paid basis which gives them an opportunity to drag treatment out or offer false promises to remedy the solution they were supposed to fix for extra money.

Secondly, your smile doesn't look great, I'm being brutally honest, I think you need to have the extractions to even your smile out. If your ortho is going to charge you a lot more, I would get out of there as fast as possible and find a new orthodontist.

I am actually appalled at this, what country are you from where they would get away with this?
I honestly think he pulled the wrong tooth in the first place, you were already 1 short and he pulled a SECOND tooth from the same side?!

I am gobsmacked.

EDIT: after thinking about this, if my orthodontist did this to me, I would actually go into his office and punch him in the face. I know violence is not the answer to anything but I would not be able to help myself.

[jem]

Hi Chaplains Assistant,

From your photo, your mid-line does appear to be way off . Do you have any pictures of your teeth before you started for comparison? Was your mid-line so far off before you began or has it been caused or worsened by your orthodontic treatment?

If your midline was OK before treatment, this might be a case of clinical negligence ( not sure of the correct legal terminology in the States)

I think you should find another ortho to give you a second opinion-perhaps someone out of town or out of state who will not feel under any obligation to defend your ortho. Ideally this should be someone of eminent qualifications and reputation in orthodontics who might, if necessary, be suitable as an expert witness ( as well as capable of ensuring you get a good final orthodontic outcome ).

Depending on the second opinion you receive, you should consider taking legal advice.


Make sure you keep all records, correspondence, photos etc connected with your orthodontic treatment. Photos may be particularly important. If you are as obsessive as the rest of us on this site you should have plenty!

Good luck

Jem

[Chaplains Assistant]

ArchWired 28 - They took my top brackets off to reposition them rather than bend the wires.

Thanks everyone for your opionions. Here is a before pic. My midline was off some to start with but nothing like it is now and I don't care if Tom Cruises' midline is off an entire tooth it's not his mouth I'm concerned with after paying $5900 for my teeth to be fixed.

My TMJ is doing better so my bite is probably right now but to sacrifice the midline as far off as it is - really isn't acceptable to me but not willing to pay another $1200-$1800 for another 1 to 1.5 years of braces.

before.jpg