Functional Orthodontist anyone? Repositioning the lower jaw?

[Harmony]

Hi again

I'm currently 8 months into my metal braces (NHS in the UK) and yes it's been a journey! Just a little reminder about me. Ok I have a Class II Division, increased overbite - increased overjet of 12mm. My ortho said my problem wasn't my teeth it was the size and position of my jaw and said the braces would be used to align and coordinate the arches after which a mandibular advancement osteotomy would be required (bring lower jaw forward) he said braces alone won't help my problem as I need surgery. I got lower left wisdom tooth removed recently for surgery purposes.

However, lately I'm so so dreading surgery and not sure I want to go now Just heard so many bad stories (I know I can't judge we'll all be the same) but I'm just really against it now and not sure what to do! My ortho is treating me as if I'm going for surgery and I haven't mentioned it too him yet.

Another thing I thurst my tongue on the roof of my mouth, doesn't touch my teeth though and I'm just thinking did I even mention this to the ortho - oh dear!

I read somewhere about Functional Orthodonist v Traditional Orthodontist. Basically it said there is a major difference ie. Orthodontic treatment is straightening the teeth whereas Functional Orthodontic treatment is reshaping and repositioning the jaw to a more harmonious position as well as straightening the teeth. Obviously, Functional orthodontic treatment is more complicated and more involved; however, if done correctly, it can enhance facial profile and facial appearance. Functional appliances are used that take advantage of growth to address under developed jaws and reposition lower jaws. A functional appliance is a brace that is worn on the upper and lower teeth at the same time in order to correct the way upper and lower teeth fit over each other. It may be used to correct very protruding upper front teeth, improve the way in which molar teeth bite together, or even improve your facial profile so that the jaws look more aligned with each other when you look at the face in profile.

Anyone have any success with a functional applicance? I'm adult (39) and not sure if it's succesful. I'm still searching to find a Functional Orthodontist! Just wondering if a functional applicance would help my overjet?

Yes I'm probably looking for a miracle here but surgery is really really scaring me now!

Gosh I really do hate my side profile worse in the morning and my upper teeth rest on my lower lip

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[sirwired]

If you've decided against surgery, you need to let your ortho know now. The treatment plan for a non-surgical patient is very different than a surgical one. (The beginning stages are the same, but they do diverge at some point.)

I'll warn you that there aren't really any standards for calling oneself a "functional orthodontist" other than being a dentist, of course. Unlike what some websites might imply, "traditional" orthodontists of all stripes routinely use functional appliances, and they all are supposed to concern themselves with proper bite and jaw mechanics. When looking for treatments, I'd shy away from any that promise orthodontic miracles, yet are mainly marketed towards and/or primarily sold by, general dentists. There's a reason orthodontists take several years of additional training beyond basic dental school...

As a fully grown adult, there is going to be a limited amount a functional appliance is going to be able to accomplish

[Harmony]

Yes I really do need too tell the ortho now in a few weeks times about not going for surgery, its just freaking me out and think I'm disappointed in myself and after having the numbness in my lower lip/chin from having my wisdom teeth removed it's scared me too think that could be a permanent risk from the surgery. Yes I have the feeling back now after the 1 extraction so that's fine - feeling silly now getting an extraction as it was for surgery purposes!

I've spoken too another man who uses twin block appliances and works with the muscles etc (hopefully i've understood that right, I just spoke with him on the phone and didn't go to see him, he's a Dr/Surgeon/Ortho) and he said he has very good results from adult patients who don't want too go down the surgery road. He's a specialist in this area and I'm just not sure if a twin block would work for me but he seems to think it would if I don't want to go down the surgery route. Anyone have any success from the twin block appliance and whether it would help with my 12mm overjet? He said he has success stories of adult patients bringing the lower jaw forward? Any view welcome!

[malilou25]

Hello

In my opinion what you need to do is find a functional orthodontist who has a good experience in using functional appliances and select one to bring your lower jaw forward. Then your jaws should be expanded (with an expander, or a Quad Helix). Do NOT extract teeth. I did it and I regret it so much now. Best of luck

[sirwired]

Malilou,

Just because your extractions didn't work out doesn't mean that extractions are never called for and should always be avoided. Yes, sometimes extractions are done when not necessary, and the result is bone loss and other problems. Conversely sometimes extractions aren't done when they should be and the long-term result is insufficiently stable.

The best sort of orthodontist is one that works from the largest toolchest. A "never extract" ortho is just as bad as a "always extract when things are a little tight" ortho. Functional appliances work in some cases, not in others. Certainly functional appliances are useful under some circumstances, and it would indeed be a poor ortho that never used them (if one even existed... functional appliances get a chapter of every ortho 101 textbook I've seen), but they aren't a cure-all for arch shape and size problems; sometimes surgery is necessary and there's no avoiding it for a long-term stable and aesthetic result. (And you certainly don't need to limit yourself to "functional orthodontist" to find one that makes extensive use of functional appliances.)

[vvirag]

sirwired is probably right, there is no global perfect treatment for everyone. However, it would be worth to consult with your ortho about alternative solutions right now, or if he is not well-qualified in that field, then consult with other orthos also. There are many appliances on the market which can transform someone's arch dramatically (even at late age!). A surgery is a big change, but sometimes is not avoidable. So be sure, that there is no other way.
On the other hand, a surgery would also not be the end of the world. Talk with people who had jaw surgery or watch videos (there are a lot), it could be really comforting.

[Harmony]

Hi everyone

Well I've spoke too 2 ortho's on the phone and they use the alf appliance which apparently helps too bring the lower jaw forward, however, they said it wouldn't work on it's own and I'd need myofunctional therapy (daily exercises for the muscles) as well.

Just not sure what too think about this really - has anyone ever had or knew of anyone who got myofunctional therapy and if it was a success?

Harmony

[Katie310185]

I'm in a very similar situation now. Had traditional ortho as a kid, but carried on thumb sucking and back whre I was now aged 31. Have a 10mm overjet, a narrow slightly upper jaw where I have thumb sucked and pulled front teeth forward the sides have come in etc and two options and quotes to fix it.

1) traditional orthodontics, extraction of two upper teeth to create space then braces to bring firnt teeth back. 5k

2) functional orthodontics using the Alf expander, to widen the upper arch without extraction to create space to bring front teeth in. 7.5k

I prefer the idea of option 2 but worry whether they teeth will stay afterwards or will they try move narrower again etc.

I have had full depth quotes and conversations with both professionals, 1 says don't do option 2 widen your arch as it won't last and that functional orhos are not qualified and option 2 says don't do option 1 coz your face will flatten and change your profile.

I'm so undecided what did you do in the end????

I had option 3 of jaw surgery but declined

[sirwired]

You'd probably do well to read my sticky post on avoiding quackery... it contains my opinion anyway on "Functional Orthodontics", has a mention of ALF, and talks about conflicting advice on extractions.

[Katie310185]

Where do I find that? :-)

[Katie310185]

Thank you

[sirwired]

It's one of the "sticky" posts at the top of this forum.

[djspeece]

http://www.archwired.com/phpbb2/viewtop ... 13&t=47522 will take you to the sticky.

[scopus]

sirwired is 100 percent right in his posts regarding this. I also was about to go down this "functional orthodontist" route till i did a lot of research, and i think it can be very dangerous as any dentist can call himself one. Don't believe anyone who considers "functional orthodontics" a seperate field of treatment. Any good "traditional" orthodontist is aware and skilled in the use of functional appliances, which they often use on non-adult patients with misaligned jaw issues. If the ortho is recommending surgery, it is probably because that is what he believes is the best option since as adults our jaws are no longer growing.