In braces for 12 years straight, and now toothless smile : (

[Betsy]

Hi everyone,
Thank you for letting me into your group. My story is long I am sorry. If you want to read about my latest problem only, and that's cool with me, please jump down 4 paragraphs to the paragraph that begins: "here's the problem." I would love to hear thoughts on that if possible. Thank you!

I began orthodontics just to straighten my teeth, I didn't know even that I had a 100%+ overbite until I was told, my teeth were upper tipped back and completely covered my lower. I began at a school with teachers and students who discussed my treatment with everyone but me. A couple months into braces I was going crazy with head and neck pain. I also realized during this time that my new overjet Homer Simpson bite was to prepare me for orthognathic surgery. When they talked about my case to each other, it was as if I was not there. They even talked about how I needed to fix all this stuff cosmetically, they had a laundry list. Once I realized what was going on, I told them I did not have the money for the surgery and was not made aware till months into it. At this time I also told them about my pain, which at the time I realized on my own was tmjd related, no head/neck pain ever before. I assume the tooth were moved too fast because my bite was so different so fast. They didn't like my pain complaint and the fact that I didn't have money for surgery, no insurance. I wish they had asked early on. So they let me go. There I was, no more braces, with the worst buck teeth ever and crazy amount of pain.

No orthodontist would take me even though I had only been in the original braces for a few months. Finally I found an orthodontist to take my case. Thank god too because I had already exhausted most of my city. The nicest guy ever. I wore the herbst appliance because he felt it would work even as an adult. So I went from one extreme (super buck teeth preparing me for surgery) to a bulldog underbite, I lost my upper lip and always looked mad lol. The next few years I saw many tmj dentist or so they call themselves, and oral surgeons, had many MRI's showing damage. I tried everything from physical therapy to chiropractic to tons and tons of other therapies, both traditional and not. This may account for a few years in braces that perhaps held me back.

When nothing helped the pain, I asked my orthdontist to move forward as if the pain was gone. I asked that he give me the right functional bite and aesthetic look that he felt was right, whether it be like others text book like or slightly altered but right for me. This is where I don't really understand what went wrong, I don't know what happened all those years. I know 6 years into braces my baby tooth finally fell out. I had previously asked him to remove it because it was bothering me always moving around, but he felt it helped us having it in there. When it finally came out 6 years ago, he put in a pontic. This is on top a front side tooth, meaning you definitely see if it's missing, right next to your front 4 main teeth. Sorry I should know the names by now. I was missing my 2 laterals too. Anyway, I had asked before why the space wasn't closing before but nothing came of it. Then last fall I asked again and he began closing the space and took out the pontic eventually. Now I have 3 spaces to close because all 3 teeth can't be moved at once, this was very disappointing. So one of the three have moved.

Here's the problem...when I smile now, my upper teeth barely show, just like 10%! My teeth are small anyway, so I need as much as possible to show. As early as a year ago, looking at a photo, I showed my usual 70%, I never had full tooth show unfortunately. So what happened!??! I asked my orthodontist if it was due to closing the space, if somehow losing the pontic made my lip lose support from my teeth causing it to sag? He said he only moved the teeth side to side and therefore was not possible, he said he did not move them up nor down, though didn't say if he moved them forward or backward. I have never had molars removed. It seems to that although I was told my arch is wider, my smile is narrower as is my lower jaw, you see less side teeth too now.

I am so confused, I am not in braces 12 years so that I would have this toothless smile making me look like I need dentures, I mean you don't even see people like me unless their 88 years old. I did read that if front teeth were retracted in order to close the spaces, lips can lose support? I don't know if my lips were retracted though? Does that just mean moved back?

I know that veneers is no answer, won't give me tooth support, won't show the top of my natural teeth, and I didn't wear braces for 12 years to do that. Any help appreciated, thank you!

[BracedSurgeryStudent]

Sooooo sorry you had to go through all of. I was told at the first consultation I would need jaw surgery to get this overbite thing 100% perfectly corrected. I was ok with that. I went to two consults that first dude was a jerk who was gonna take my money and butcher up my face. And the second lady told me she didn’t want to do the surgery on me because my bite looked fine. So I said whatever, no surgery for me. So anywho then we were supposed to do the herbst appliance on me as an adult as well. So, last minute the day before herbst appliance stage one appointment I got a phone call saying no herbst appliance but full braces for me. Which they’re working fantastic now. But I understand your case, you may not have had any molars taken out but your teeth were straightened and pulled all around moving them back in your mouth, thus causing it to appear narrower in smiling when in fact it is wider. And you are absolutely right, when anything is pulled that much back (esp. with that much gapping to close) then the structural support of the lips gets lost. If the gaps are still there you can always get dental implants, Better than veneers and they’re like putting fake teeth in there, the kind that stay in there no matter what. However if your gaps are all closed you can go to consultations to the orthodontists’ offices and tell them “Look I want to reverse the gaps for the two missing incisors and that one canine (tooth next to the four front ones) and that you want to get implants in the anatomically missing spaces. It seems as simple as you getting an expander then braces with activators. Then once the spaces are open the dental implants.

[Betsy]

Thank you for your reply bracedsurgerystudent. So in your opinion, if I am understanding correctly, losing the pontic in the front then closing that space is what resulted in the loss of tooth support? It didn't affect my upper lip volume at all, so not sure if that means anything. So would this mean that I'd need to get an implant in order to get back the lip support and show more teeth vertically or is this a temporary thing while the spaces close? One space is closed, now a couple more need to follow, they can't all close at once I was told, it may ruin the rest apparently.

I am glad you didn't have to go through with the surgery and even skipped out on the herbst! That's awesome luck! Crazy how orthodontists can be of such differing opinions.

[BracedSurgeryStudent]

You are very welcome. Yes, that is what happened. Correct and no an implant is a permenant tooth put in the space where the real tooth would be thus giving you that fuller smile. That way there that nomal space is still there onl you get a permenant tooth there. Your smile may even look wider whichis always a plus

I agree with you I had many different opinions over the years:
-Just Bottom braces to widen the lower arch to fix the crowding and overbite.

-Top and Bottom expanders, sanding in between the teeth, full braces.

-Surgery and full braces with two bottom extrations.
-Herbst appliance ad top braces, maybe later bottom ones.
-Full braces and elastics.

[Betsy]

Thanks again. In my case every orthodontist said I needed the surgery (though would not take my case as a transfer case) but I had no insurance at the time and didn't have 20K lying around lol. My current orthodontist was the only one who offered no surgery herbst instead. I was so happy to have found him then, that was 12+ years ago lol.

Anyway, I wish I had known that an implant was the way to go before the 1st space closed. If an implant is put now in the 2nd space, would it work the same? I guess I didn't want an implant because not just the cost, but the risks. Also, I worried if a tooth was added, then I'd have an additional tooth on that side and wouldn't that put me out of balance?

Technically I am missing a couple more teeth on the same side, I'd add more implants if it meant improving my vertical show, but then I'd really be out of balance. Right now one spot has closed, now there is two more spots as a result behind it because he said he cannot close all three at once.

I wish someone would be willing to see me to confirm that an implant will fix my problem rather than continuing to close spaces, but no one will see me locally

I saw a periodontist the other day to see what kind of damage I am looking at after all these years in braces.

[BracedInNOLA]

I guess I don't understand why nobody will see you to give you a consult/second opinion/etc.

What does your current ortho say regarding an implant? If you need to make a 'talking appointment' so you can sit in the office with him to discuss treatment/etc, then just tell the scheduler that's what you'd like.

[Betsy]

I have done that but it goes nowhere :( The reason why others won't see me is because I am a huge liability. I have even said I would sign whatever legal form gets them out of anything litigious, just please help me, but still no, I was told they don't want such a challenging case and I have asked so many offices.

I just received an email from an orthodontist who was so nice to give me his expert opinion. He said that it would be a few more years and huge expense even if someone would do what needs to be done now, which is undoing some of the current work. To say I am depressed is such an understatement.

[BracedSurgeryStudent]

You can always get braces again to repoen the closed spaces where all the missing teeth are and you can get all the missing teeth inplanted because it would definatly help your situation drastically.

[Betsy]

Hi Braced,
Do you mean remove my braces and start over with another orthodontist? I fear they may still not take me because if I keep my past records from them, it could affect getting the best possible treatment. But if I give it to them, they may once again say too much of a challenge. I am still not totally clear if it's losing the pontic or retraction of the teeth that made me lose my vertical show so much. I wish I could post my before and after on here but I don't see an attachment option.

A couple orthodontal office scared me by telling me that it's possible my teeth may never move where we want so far into the treatment, maybe that can happen, but wish they hadn't said it without evidence as it really depressed me.

[whiteswan]

No one should be in braces that long. You need to have your roots checked to make sure that all that movement over the last 12 years hasn't caused resorption. It surely isn't worth keeping them on if if is causing bone, gum or root problems...so be sure to check that out. Maybe it would be worth taking them off for a break and then finding another ortho in a year or two? This would let the teeth recover a bit from all they have been through. Then, a new ortho could look with fresh eyes and your could determine whether it is worth it to you to continue with another bout of treatment.

You can post pictures after you have posted on the board 7 or 8 times. Your name will turn green when you have gained these privileges (to deter fetishists).

[Betsy]

Thanks Whiteswan. I am anxious to post pics. I did actually see a periodontist, only because I bugged my general dentist office, I am surprised all these years they didn't send me on their own. Anyway, he said that I do have some more than average bone loss for someone my age (30's) but that it's much less than he would have expected considering how long I have been in braces. It's not like anyone does studies on people with braces so long. I have totally lost faith in my orthodontist not just because of the length of time, but also because anytime I ask why this or that, things I know are off, he turns it back on me. Example: Why have I had a pontic the past 6 years? Well you wanted one! This would be the response. Well of course I'd want one, my baby tooth in front fell out after all these years! But that didn't mean I thought it would be there forever! I had to remind him every year before he would then start closing the space.... end of last year!

I'd be happy to remove them, but how the heck do I deal with a HUGE open space in front, how do I deal with almost NO tooth show after everything I have been through. It all just makes me sick. I guess I will post photos when the system lets me.

[BracedSurgeryStudent]

Oh well if you still have the braces it should make it easier, ask your othodontist if he could open all the spaces where all the missing teeth are to put impplants. If he says no go to other oes and get opinions, there ought to be someone out there who will fix it.

[Betsy]

Right now my canines are moved to where the incisors would be if they had grown in, one orthodontist in another state told me that that is where I should instead have had implants. So now my space is like this: 2 front teeth, then my short tiny out of balance canines, then the tiny tooth that moved over to close the big space then one big space it and 2 teeth behind it to follow. Not sure if you can picture that. I only have space for one tooth as it is now and not sure it's the ideal spot either. I knew that my canines would need to be capped or whatever it's called to look normal up front. Not sure how that differs from a veneer. But now it appears those teeth shouldn't even be there, ugh.

If I put an implant where the side space is, wonder how or if this would help with tooth show? I was told too that intrusion of my maxillary incisors is the cause of my lack of tooth show in an email from an ortho in another country who I emailed, but another one in another state said that my upper anterior teeth being retracted caused this. It sounds like their saying the exact opposite?!??

Shute, I still can't post photos yet.... :/

[Betsy]

Pic 1 - The way I look now, this is as far as I can smile and hurts like heck to do so. I may even have less tooth show than that and this pic was taken just weeks ago. My lower part of my face is narrower, I do not understand why but if you see my whole face you can tell how the change is very undesirable.

Pic 2- One year ago when I had tooth show, granted I never had 100%, I had hoped that was fixable, but at least I had some.

Pic 3- 6 years ago my braces were temporarily removed to get an MRI, I was so excited to take a pic. This was before my baby tooth on top fell out and I had to get a pontic in there for an additional 6 years. I have in fact worn the braces for 12 years straight minus 2 times removed for 2 weeks for MRI's, that is it.

Now you likely see why I am freaked out to hear that my teeth "may" never go back to that smile.

[BracedSurgeryStudent]

Well fromt he pictures it does look like its because of the retractions because you had what apperars to have been an open bite, retracted and pulled down then your dentist made your arch smaller because of closing the spaces where you should have gotten implants. It's not too late to get a palatal expander, and wide the arch and move around the teeth to make the spaces where the missing teeth are and make the arch normal again thus creating more vertical show