Question for dr.j

[Clo]

Hi Dr. Jernigan,

before I ask my question, I want to say how awesome it is that you
joined this fabulous forum. Many thanks ! I am sure your professional
help will lift this forum up to a higher level.

Now about my question. Some weeks ago I asked this here on this
section. I would really appreciate your input on these issues.

viewtopic.php?t=6101

That was some weeks ago. Since then, I had another adjustment that
gave me the following (elastic) configuration :



I have 3 elastics on both sides to try to pull molars and premolars together
and one elastic to correct a crossbite on the left (second molars). I think
the elastics are indeed closing up my bite, but the issue of the too narrow
lower arch remains. I think I will end up with a closed bite, but with a
lower arch that fits IN the upper arch (molars and premolars) and not
UNDER it like it should be. I even feel the elastics make my lower molars
slant inwards, making it even worse. What should I do ? I really tried to
express this to my ortho. Can you give me some advice, I would so much
appreciate it ! Many thanks in advance !

[dr.j]

I recall your prior post. It looks like they are really trying to close down the bite and kick the upper second molar out of crossbite. The openbite is my primary concern if I'm your doc.
But, I feel that with time in a full size rectangular archwire your lower should expand some. This is called arch coordination and usually occurs as a product of just placing upper and lower wires that fit with each other.
I'd be suprised if they did not address your arch coordination problem.
I confess that for varying reasons I've debanded folks with lingering openbites I could not close - but no doc is going to let you out of braces with a "Brodie bite" or "buccal cross-bite" where the upper teeth telescope past the lower when you bite dwon.
ask your doc. I percieve a common thread among folks on this site - they are worried about bothering their doc with questions. You have a right to ask. When it comes to "nit-picking" the little things I'd hold off to the last few detailing visits. But this is major so ask away.

Dr.J

[Clo]

Thanks Dr. Jernigan,

I really do appreciate your answer !

I have some things I can add after reading your post. First I did mention
my concerns to my ortho. The answer was something like you told here.
I have coordinating wires, rectangular ones, so both arches should fit.
I am like hello ... I can see for myself my lower arch is way too narrow
when compared to my upper one (only thought that, you understand that
I can only ask, not discuss with my ortho). Fact is I have these same
archwires now for 10 months. Don't know their sizes, but the upper wire
seems to be the heaviest that fits in my brackets, the lower one is a size
smaller, that I am sure of.

I did not have this terrible open bite before I had braces. The TPA I had
expanded my upper arch and created this cross-bite. In trying to correct
this with elastics, I think my upper molars were extruded some. There
was a moment that I had 5 mm of open bite between my incisors. This is
now the third time I have elastics to correct this cross-bite. I should think
intruding again the upper molars, and expand my lower arch with some
kind of lingual arch or expander, and things should fit a lot better. Or am
I oversimplifying here ?

[Clo]

Please, Dr. Jernigan ...

[dr.j]

I think you need to schedule a consult or talk with the doc. These things take time. From your photo I can tell that your orthodontist knows their stuff just from your excellent bracket placement to the complex elastic pattern.

TPA's have a tendency to be quite expansive on the arch (even when we don't want them to at times) As the arch expands the bite opens. The cusps of the top teeth "ride up" onto the cusps of the lower teeth and open the bite. In fact, expansion is one the best ways to open a deebite!

It sounds like you will eventually get arch coordination back. Your elastics look to have a narrowing effect on both arches just b/c they pull vertically from the buccal (or cheek side) of the tooth. This is a tuffy!

I may consider (hindsight 20/20) - and I will never second guess another orthodontist without full records and hx - running your elastics from buttons bonded on the lower tongue side to the upper side brackets: you get concomitant expnsion of the lower and narrowing of the upper.

Suffice it to say sometimes openbites appear out of thin air b/c of skeletal clues regarding facial form. I have opened a few cans of worms myself probably.

Your idea of intruding molars is valid but is really hard. You would almost have to have implants placed in the upper jaw bone to intrude teeth off of. that's the big thing with braces - they naturally expand the arches and are inherently extrusive on the bite. Some patients with severe openbite need surgery to impact the posterior maxilla and its teeth just to close it down...

Good Luck..


Dr.J [/img]

[Chris]

running your elastics from buttons bonded on the lower tongue side to the upper side brackets: you get concomitant expnsion of the lower and narrowing of the upper.: [/img]

Whats "concomitant expnsion?"

[Clo]

Thanks Dr. Jernigan,

I will - I hope I say this correctly - rest my case and see what comes next.
Thank you very much for your time and effort. Only one thing though,

I have opened a few cans of worms myself probably.

Are you sure this is the right expression when talking about mouths and
braces ? Yikesssssss !

[dr.j]

The expression is weird. All orthodontist talk to their contemporaries about tough cases. Things that could go better. We all have a great ones and not so great ones. I hope you can get your bite settled.

PS - concomitant expansion: def - simultaneous expansion of the lower arch with opnebite closure and upper narrowing at the same time.

Joke:
If you ask an orthodontist who the top 3 orthodontists in the world are....
....he'll have trouble naming the other 2!

Dr.J

[jenns91civic]

LOL just like surgeons and trumpet SPAMMERS LIKE ME!!!....ok I'll add paramedics to that list too since I'm going to be one and I can feel my ego growing daily.