Lower midline is slightly off & causing my bite to be off?

[BraceFace2o1o]

I have just had a moment where I think I have finally discovered why my bite on the right side is screwed, not only that, if I am correct then I've been wrong all along as to why my bite on that side's been messed up (I thought it was because upper arch was wider than lower arch).

My lower midline was off to the right prior to braces. Since being in braces (nearly 22 months) I think it has improved a little although it's not something that's ever been mentioned or discussed, so I never expected it would be fixed and to be honest never really thought about it. So basically it is still off to my right by about 2-3mm (a rough estimate) and although it has only recently started bothering me for cosmetic reasons I have never bothered to mention it to my ortho and decided not to as no one can really see my lower teeth anyway.

So I was looking at my teeth earlier with a small dental mirror (the type your dentist uses) to check my bite on either side and to try and see what was going on with my molars because they aren't meeting well. I noticed that on my left side (where my bite feels fine) the upper and lower 1st molars meet in the correct way, like in the pic below:



But on my right side this is not the case. On my right side my upper 1st molar sits directly on top of the lower unlike in the picture above. It's not easy to explain, but in the above photo the lower 1st molar is slightly more forward than the upper 1st molar so that the 1st point of the upper molar sits in the groove of the lower molar (that's what the blue lines are indicating)... but on my right side my upper 1st and lower 1st molar are pretty much directly in line/on top of each other... a bit like in this photo:



These are not pictures of my own teeth they are just the closest I could find online to show what my teeth sit like.

Because of the position of the teeth on my lower right side it makes all the other lower teeth on that side, like the 1st & 2nd premolars and the canine sit about 2-3mm further back than they should be (like in photo 2), which explains why they clash wrong on my upper premolars.

I am assuming the problem on my right side can be corrected by moving the midline to the left. If so can this actually be done and if so how? I am assuming IPR on the left side then elastics to move the teeth from the right side round to the left?

Currently 1/4 of my upper wire on the right side has been removed to try and let the upper 1st & 2nd premolars and 1st molar 'settle' so the bite on my right side improves but after what I have discovered tonight I don't think it's going to happen while my lower teeth are shifted to the right. In the process of having 1/4 of my upper wire removed it's messed some of the alignment of my upper teeth, first it created a gap between my upper right central and lateral incisor which my ortho corrected but now the upper right central incisor and canine have gone up higher into the gum... So now my smile looks slanted! (the left central incisor and canine are now lower/longer than the teeth on my right side). I am so frustrated with my braces just lately.

[BraceFace2o1o]

Because of the position of the teeth on my lower right side it makes all the other lower teeth on that side, like the 1st & 2nd premolars and the canine sit about 2-3mm further back than they should be (like in photo 2), which explains why they clash wrong on my upper premolars.

Made a mistake above so just correcting myself

Because of the position of the teeth on my lower right side it makes all the other lower teeth on that side, like the 1st & 2nd premolars and the canine sit about 2-3mm further back (like in photo 2) than they should be, which explains why they clash wrong on my upper premolars.

[BraceFace2o1o]

I forgot to mention that I don't think my jaw is off to the right, it's my actual lower teeth. If I look in my mouth and start from the back teeth I can see that my lower right 1st molar is further back than the left 1st molar... you can see what I mean in this picture (this is my teeth a few weeks after getting braces and the position of the right 1st molar is today still further back than the left):



I also found this photo that was taken earlier than the one above and it seems that my midline got worse in braces, maybe because of the IPR:

[vegathestar]

Well don't worry!
I am also undergoing braces treatment and I dare say my arch is also asymmetrical (with one side shorter than the other),
because one of my back molar is WAY WAY WAY behind the molar on the other side.
My midline is off by around 3mm before the start of treatment, so my orthodontist extracted one tooth to sort out my midline. But thanks to that I have uneven arch now with 13 teeth on the upper arch and 12 teeth on the lower arch.
I wish I can take a photo of my upper arch to assure you, but damn its too difficult to take a photo of the upper arch with iPhone.

Hey man, I guess I have the bite problem as well. I can't even clench my teeth and get my teeth to meet currently. Whatever problem you have, I probably have it far worse off than you.

I guess we should just give our orthodontist a bit of time to sort out all the problem. It is actually possible to correct the midline, but it would only be done at the later part of the treatment when he starts using elastics to hook your upper arch to your lower arch or something.

Updated:
Alright I just tried to take a photo of my upper arch. Looks like my orthodontist is much more of an asshat than your orthodontist. My arch is clearly uneven!

[fosterp]

I think your diagnoses is probably right, however I think the process used to fix this kind of problem is a lot more complicated than it would initially seem.

That said, I believe generally that the midline is one of the last things that orthodontists correct during your treatment since all of the other movement they do to your teeth to correct other problems will have subsequent effects on your midline. I would assume your ortho is aware of your midline but probably hasn't mentioned it since it isn't an immediate concern. You generally need to ask specific questions about things being done to get that kind of information, otherwise you would probably be overloaded with all kinds of things you don't need to know if they simply just told you everything they were looking at during each adjustment.

[BraceFace2o1o]

Thanks vegathestar and fosterp for your replies

vegathestar I understand your frustrations but would say try not to worry too much if you are very early on in treatment as a lot can be changed before you are done. Myself, I have been in braces 22 months now and my ortho was ready to remove my braces this month even though I still feel things aren't right.

I am not sure how they will correct with the removal of one of your teeth? Maybe someone on the board can reassure you with that one. I never had any teeth removed (just my wisdom teeth) and to make room for my crowded teeth to move I had IPR, although a part of me feels too much on the right side so gaps appeared and since closing them my lower midline has shifted to the right even further

I think your diagnoses is probably right, however I think the process used to fix this kind of problem is a lot more complicated than it would initially seem.

I had a feeling that could be the case

That said, I believe generally that the midline is one of the last things that orthodontists correct during your treatment since all of the other movement they do to your teeth to correct other problems will have subsequent effects on your midline. I would assume your ortho is aware of your midline but probably hasn't mentioned it since it isn't an immediate concern. You generally need to ask specific questions about things being done to get that kind of information, otherwise you would probably be overloaded with all kinds of things you don't need to know if they simply just told you everything they were looking at during each adjustment.

Even though I have been in braces 22 months I don't think my midline is going to be fixed, the reason I say this is because my ortho wanted to remove my braces earlier this month. The only reason my braces weren't removed this month is because I said my bite still wasn't right on the right side of my mouth. He is trying to work with it (by removing part of the wire on that side) but since I have very recently discovered the relationship of my upper and lower 1st molars on the right side I realise it's not going to correct the problem because the lower teeth are not in the correct place. I feel a lower midline/tooth shift will correct or at least improve my bite problem on that side, but like you say could be more complicated than it seem.

It looks like I will have to mention to my ortho my lower midline is off and see what he says. I don't want to go in there saying my bite isn't right because of the position of the right molars etc because I don't want to sound like I am telling him his job and feel silly, also his first language is not english so I feel sometimes this can make things a bit difficult getting him to understand what I am trying to explain.

Something I have been thinking about is if the midline could be shifted a couple of mm to the left and correct the right side would it then create a problem on the left side? it seems that it would just shift the issue to the opposite side

[Keir]

Thank god! I've had a quad helix for nearly two months now and I've found that my bite on one side is nearly perfect whereas the other seems worse as a result of the treatment. I've had my quad helix adjusted once and I'm having the bands on next month.

I think orthodontist will make adjustments accordingly. Don't worry, I've decided not to.

[BraceFace2o1o]

Thank god! I've had a quad helix for nearly two months now and I've found that my bite on one side is nearly perfect whereas the other seems worse as a result of the treatment. I've had my quad helix adjusted once and I'm having the bands on next month.

I think orthodontist will make adjustments accordingly. Don't worry, I've decided not to.

I also had a quad helix during my treatment, such fun aren't they? argh I hated mine!

[trisportgirl]

I wouldn't worry too much about the simple fact that your midline is off on the bottom...mine is completely off because I had a single incisor pulled, which means I have an odd number of teeth on the bottom, with one tooth in the centre (rather than a gap in the centre). My dad had the same thing done by a completely different ortho and you'd never even notice.

[BraceFace2o1o]

I wouldn't worry too much about the simple fact that your midline is off on the bottom...mine is completely off because I had a single incisor pulled, which means I have an odd number of teeth on the bottom, with one tooth in the centre (rather than a gap in the centre). My dad had the same thing done by a completely different ortho and you'd never even notice.

trisportgirl the thing is I don't actually have an issue with the way my lower midline looks because no one can really see my bottom teeth and this is why I have never mentioned it to my ortho even though it's been off all the way through treatment. The issue I have with my lower midline is it's causing my bite to be off and therefore I cannot chew properly. I do not want to be left like this after my braces are removed. If my midline/teeth on the right side can be shifted to correct my bite then I'll be happy. Currently in my mind my bite being as correct as possible is more important to me than the way things look.

[ArchWired28]

From the pictures in the first post, you have a class II bite on the right side. That is also why your midline is off. On your left side, is your upper canine not lined up with the teeth? I cannot quite see from the picture.
I am not sure but according to my understanding, you need to wear a class II elastics on your right side only to fix the bite. That should also fix your midline. This is not something minor, this is a major bite problem that needs to be corrected. Do not get debraced until this is resolved, seek another opinion if needed.

[ArchWired28]

I don't want to go in there saying my bite isn't right because of the position of the right molars etc because I don't want to sound like I am telling him his job and feel silly, also his first language is not english so I feel sometimes this can make things a bit difficult getting him to understand what I am trying to explain.

Ask him plain and simple, do you have a class II bite on the right side? From your pics, this is obvious. And this should not be the case because as I said, this is a MAJOR bite flaw. I think it is easy to correct with a unilateral class II elastics, I am not sure why he is ignoring this issue??? This is not something complicated, these are basics.

[BraceFace2o1o]

Thank you ArchWired28 for your reply

The pics in the first post are not my own teeth. I found them while doing an image search. I tried but I could not easily get a photo of my own teeth from the side so I searched for a class II bite and a normal bite to help me  explain in my original post. 

I have had my latest appointment and I did mention the class II on my right side but he seem to frown when I said it. He checked my right and left side and then told me I would have to wear elastics. From research on having a class II on one side only I assumed he would say to put an elastic from my lower right molar to my upper right canine but he did not. Instead I am to wear a long elastic in what I would call a zigzag pattern (starting on the lower 1st molar - upper 2nd premolar - lower 2nd premolar - upper 1st premolar - lower 1st premolar - upper canine). Here is a photo that I  just took of my zigzag elastic (I have purposely parted my upper and lower teeth so that the elastic is visible in the photo):


Later that day I felt unsure whether this is an elastic configuration that corrects the bite problem that I have or if this elastic configuration is normally used for an open bite? (I am still unsure if he understood me correctly or not). I mentioned the issue I have on my right side does not allow me to bite down properly and now I wonder if he got the wrong end of the stick. I didn't mean I cant bite down at all, what I meant was that the teeth are meeting but in the incorrect place, so therefore the bite is not right.
He said if these elastics do not work he will also remove part of my lower brace (archwire) on the right side like he did the upper... but I'm not so keen because surely that will in no way correct the bite problem that I have. The lower teeth on my right side need shifting by about 2-3mm towards the front of my mouth so elastics are surely the way to go. Argh I'm getting quite frustrated now. 

I have been trying to search google for posts on elastics to correct class II etc but I could not find anything on using the zigzag configuration. Some searches brought me to some threads here on the forum, a few posts in these threads were made by yourself and I see that you have, or had a similar issue to me? Was it your upper or lower midline that was off? How has the treatment to correct the one side class II gone so far?

I just want to get this bite problem sorted because then I'll be finished and can have the braces off, oh and most importantly be able to chew my food properly!

[ArchWired28]

This elastics seems to close the bite and move your upper teeth a little back compared to the lower teeth (reciprocal movement: uppers - backwards, lowers - forward). Is it on the right side only? On your last pic, are you biting down all the way?

I'd say, give it a chance. Maybe it will work. If not, you bring it again next time.

I had a slight class II on the right which my ortho says was corrected with the class II elastics. He said I was borderline and very slight. My midlines now match each other and are almost centered. I'd like to move them more to the right but my ortho says I have no space? I have a slightly asymmetrical upper jaw hence my upper midline will be off unless I have some IPR done or something (which my ortho does not recommend). I am over that now and ready to move on. If that is how I am, what can I do?

[BraceFace2o1o]

This elastics seems to close the bite and move your upper teeth a little back compared to the lower teeth (reciprocal movement: uppers - backwards, lowers - forward).

Ah well if this is correct then it doesn't sound good because my upper arch is fine, the midline is centerered. It's just the lower midline that is off to the right. If my upper arch moves to the right then it will make my upper midline no longer centered and would also cause the left side of my bite to be off, so in a way just switching the problem to the opposite side while centering the lower midline and messing up the upper midline.
I am unsure how elastics can only move one arch and not the other though, even if in just class II elastics on one side. I just found this (a post about correcting one midline only) http://forum.posortho.com/smf/index.php ... 434.0;wap2
A quote from the above link:

b) class II elastics on one side (risk of making the upper arch asymmetric)

Is it on the right side only?

I only have a problem on the right side, the left side of my mouth is 'perfect'. I only have to wear the zigzag elastic on the right side.

On your last pic, are you biting down all the way?

In the pic I posted in my previous reply I am not biting down I have kept the teeth apart so that the elastic could be visible in the photo

I had a slight class II on the right which my ortho says was corrected with the class II elastics. He said I was borderline and very slight. My midlines now match each other and are almost centered. I'd like to move them more to the right but my ortho says I have no space? I have a slightly asymmetrical upper jaw hence my upper midline will be off unless I have some IPR done or something (which my ortho does not recommend). I am over that now and ready to move on. If that is how I am, what can I do?

From your post I am assuming it was your upper arch creating your class II on the right side? I wouldn't say I'm dead on class II, but close to. The molars - canine on the lower right side need to move towards the front of my mouth by about 2-3mm to correct the bite on that side.

I am not comfortable wearing these elastics until my upper wire is put back on the whole arch. My premolars on the upper right side have already relapsed some in the last 4 weeks and I am worried they will naturally relapse further and the pressure of these zigzag elastics could increase this further.