Metal braces for a crowded, gummy smile

[ItsFreyja]

Just back from adjustment #4. I was worried they weren't going to change anything, like last time, since the rotations of my right lower canine and lateral incisor still haven't really improved. Fortunately, the ortho decided to move me up to a .019 x.025 heat-activated CuNiTi wire on the bottom -- not the TMA wire he'd been hoping to be able to use, but still progress. Putting the .019 TMA wire on the uppers two adjustments ago was quite the ordeal, so if this new wire can sort out more of my rotations (it's entirely steel-tied in) during the next month, it might save me some agony at my next adjustment.

The ortho talked about possibly using powerchains to help sort out that canine-lateral trouble spot; anybody know what that would look like? If it continues not to improve I will ask him to do it at my next visit. Out of habit I also asked about removing what's left of my bite blocks, but he said not yet; oh well.

I am still impatient to get on with the major mechanics of treatment -- opening my bite, obtaining complete Class I relationships on the right side -- but I must say I am pleased with the superficial results of my treatment so far. Straightening up the upper teeth that were retroclined, intruding my upper central incisors, expansion in the buccal segments (yay Damon archform!) are all making an appreciable cosmetic difference, and I haven't been experiencing the occasional gingivitis I used to get in the more crowded spots in my mouth.

[ItsFreyja]

Five month update photos:

Month5.jpg

My deep bite continues to deepen (!) since getting my bite blocks reduced 2 months ago. And the lower right incisor/canine rotation problem is unchanged with my new wire, so I will ask for powerchains at my next adjustment per the ortho's musings last time.

There is one good change that doesn't really show in these pictures: my lower incisors have finally started to intrude! As my teeth crowded over the last few years, the lower 4 incisors extruded 2 or 3 mm as a result. I didn't realize how bad it was until last week, when I found in a box of old stuff from college the impression of my lower teeth that was made after I had a rotated lower incisor fixed with a spring aligner 15 years ago. My lower teeth used to be the same height as the others! What happened was a result of the lingual bonded retainer I wore until 5 months ago. I don't know why the ortho only put the retainer on 4 teeth -- I now know that canine-to-canine is the usual setup -- but since the teeth weren't able to rotate when crowded, they got pushed up. I'm glad I am taking care of this now; I don't know how much further they could have gone without causing periodontal problems!

[Viconia]

Happy I've finally read your story, you're making incredible progress and everything looks super good, you must be chuffed.

I've recently been biting into softish cheese to see what my bite is doing, so hard to tell when you're staring at your reflection in the mirror isn't it?

[ItsFreyja]

Thanks Viconia! "Chuffed" is one of my favorite Britishisms, and yes I am!

[ItsFreyja]

Today was adjustment number five. The orthodontist was disappointed (as am I) that my lower incisor rotations have not improved since my last adjustment, so he just had the tech ice and retie those teeth quite thoroughly (ouch!). He also applied a few links of powerchain on that side of the mouth to help make room for the teeth to rotate. I can definitely feel it pulling, so I hope that will sort things out. I'm a little concerned that the chain may pop off or break before my next adjustment (the tech broke a couple of them trying to install them), but I don't think I've seen people post here about that happening, so maybe I needn't worry.

The ortho wants to put a SS wire on my lowers in 6 weeks; yes, the arch with the stubborn rotations. I appreciate his optimism! He also mused about putting a reverse curve wire on my uppers next time, to begin opening my bite. I recall reading here that those are pretty painful but I am really eager to get on with it! Anyway, I've had babies... so how bad could it be? I admit I'm a wimp when it comes to the acute, momentary pain of a technician cranking on my teeth, but I haven't found the long-term soreness of braces to be too problematic yet. I hope it's not tempting fate to write that....

[NeilH]

At one point I thought my lower incisors would never rotate but they eventually do. In my case, a tiny bit of IPR and a lighter wire for a few months did the trick and they quickly lined up. I've had two reverse curve arch wires and to be perfectly honest, didn't find them any different to normal steel arch wires although they did the trick and reduced my overbite over around six months. I had them in conjunction with class 2 elastics and saw some great results over this short time. I've never had a powerchain break and can't recall anyone reporting this on their posts so hopefully that's one less thing to worry about.

[ItsFreyja]

At one point I thought my lower incisors would never rotate but they eventually do. In my case, a tiny bit of IPR and a lighter wire for a few months did the trick and they quickly lined up. I've had two reverse curve arch wires and to be perfectly honest, didn't find them any different to normal steel arch wires although they did the trick and reduced my overbite over around six months. I had them in conjunction with class 2 elastics and saw some great results over this short time. I've never had a powerchain break and can't recall anyone reporting this on their posts so hopefully that's one less thing to worry about.

Thanks NeilH, that's reassuring all around! I have come to terms with the fact that I'm probably not going to be done after 12 months, but hopefully the incisors will sort out this month and it won't be too much longer than my original sentence.

[LittleSern]

Thank you so much for posting your experience on here! I know you posted on my thread as well - we have similar issues. I also have a deep bite and a gummy smile and I'm hoping the reverse curve wire helps that. I'm so tired of being insecure about smiling hard.

I'm about 8 months in and my ortho says I'll get a reverse curve wire on my upper arch after my next wire change. He didn't mention anything about putting it on my lower arch. I've been set back a bit because my upper lateral tooth #5 on one side is pretty rotated, so at my 6 month appt they had to repo the bracket and drop two 2 wire strengths to try to get that tooth in the right position before we proceed. I'm so impatient!

I am concerned about flattening of my smile arc, but my ortho said it wouldn't be on for very long and that we will be making sure to preserve an aesthetically pleasing smile arc. Do you know if the reverse curve wire on the upper arch will extrude the molars? I think I just want my front incisors to intrude, not my molars to extrude.

[ItsFreyja]

Thank you so much for posting your experience on here! I know you posted on my thread as well - we have similar issues. I also have a deep bite and a gummy smile and I'm hoping the reverse curve wire helps that. I'm so tired of being insecure about smiling hard.

I'm about 8 months in and my ortho says I'll get a reverse curve wire on my upper arch after my next wire change. He didn't mention anything about putting it on my lower arch. I've been set back a bit because my upper lateral tooth #5 on one side is pretty rotated, so at my 6 month appt they had to repo the bracket and drop two 2 wire strengths to try to get that tooth in the right position before we proceed. I'm so impatient!

I am concerned about flattening of my smile arc, but my ortho said it wouldn't be on for very long and that we will be making sure to preserve an aesthetically pleasing smile arc. Do you know if the reverse curve wire on the upper arch will extrude the molars? I think I just want my front incisors to intrude, not my molars to extrude.

Hey LittleSern! I just replied to you where you asked about this on the other board. It sounds like we're very much in the same boat and I too am feeling the impatience! I bet a few weeks with the reverse curve wire on top will be just what you need to move those uppers up. I don't think the molars will extrude significantly in such a short time. My bite blocks have allowed my premolars to extrude a little bit, which I guess they needed to, but, like you, I also want most of my bite opening to come from intruding upper incisors, and so does my ortho. He has had me doing squeezing exercises from the beginning to discourage the molars from extruding and I guess they must be working, since my bite is still quite deep.

I've got to post some 6 month pictures today... spoiler alert, my rotated incisors are definitely improving. Finally!

[LittleSern]

Can't wait to see your pics! I was reading some of your earlier posts in this thread and you mentioned you have a Damon archform, but it doesn't look like you have Damon brackets. Why are they using a Damon archform but not the passive self ligating brackets? Is there a reason you went with metal instead of ceramic as well?

[ItsFreyja]

Can't wait to see your pics! I was reading some of your earlier posts in this thread and you mentioned you have a Damon archform, but it doesn't look like you have Damon brackets. Why are they using a Damon archform but not the passive self ligating brackets? Is there a reason you went with metal instead of ceramic as well?

You know, I've been wondering whether Ormco tells orthos that they can only use Damon wires with Damon brackets. I didn't want to pay extra for the self-ligating brackets as I'm not convinced they make a big difference. So I have plain old traditional twin brackets but my ortho is using Damon-shaped wires, which are a bit wider through the canine and first premolar than the traditional ovoid archform. The difference is pretty subtle, but as I have a very small mouth and narrow arches, I think it is giving me the appearance of a wider smile.

I went with metal primarily because my ortho said he prefers it for finicky tooth movements. Also, I don't really think that ceramic is that much less noticeable up close (and I really only deal with clients 1-on-1) and I also didn't want to pay more for ceramic or worry about staining the ligatures.

[ItsFreyja]

I have had my braces on for 6 months now. Time certainly has sped up since the first few weeks!

No big changes this month, but I am pleased that my stubborn lower right incisor/canine rotation situation seems to be improving. You can see the grey powerchain in this photo -- it looks like it is giving the incisors a bit more breathing room. I hope it will be enough to get back on track with the wire progression at my next visit. I'm also pleased that the powerchain hasn't really stained despite my coffee and red wine drinking, so I may just have to let my kids pick out colored ligs for me next time.

6month.jpg

Since it's my six-monthiversary, I thought I'd post a before-and-after of my natural smile. I am thrilled with the reduction in the amount of gum that shows when I smile! As best I can tell, the incisal edges of my upper central incisors are 3 mm closer to the base of my nose than they were. That's huge, and I expect even more intrusion since my bite still needs to be opened.

smile.jpg

[LittleSern]

Wow your teeth look amazing!! I am super impressed with the reduction in gumminess as well - I can only hope for as good of an outcome!

[ItsFreyja]

Today was adjustment number 6. I got promoted to .016 x .022" stainless steel wires on top and bottom. I'm glad I premedicated, because installing them and cranking on the steel ties was no picnic. Tomorrow is going to hurt.

The top wire got a second-order bend to tip my left central incisor -- if you look at my unbraced picture above, you can see how that tooth is subtly tilted. It's not as noticeable behind braces, but correcting that should nicely improve the symmetry of my smile.

The bottom wire has a slight reverse curve of Spee to complete the intrusion and proclination of my lower incisors. This should open up my bite some and maybe allow me to get my molar buildups off soon. But I'm definitely feeling it already. I also have a fresh rotation chain going back from my lower right canine.

My young kids accompanied me to the ortho today and were disappointed I didn't get "colorful braces." Alas, I'm still mostly in steel ties (including the upper incisors) so I had to convince them that a few posterior colored ligs wouldn't be noticeable.

I need to take and post some 7 month photos, but I'll wait until tomorrow when all of the tech's Sharpie marks have worn off the wires. Actually, the Sharpie smell is starting to drive me crazy... maybe I will see if I can scrub the marks off with some bourbon if toothpaste doesn't do it....

[NeilH]

That sounds like you had a lot done in just one appointment so no doubt your teeth will be complaining by now. I remember one appointment when I went into steel rectangular wires and reverse curves on both together with class 2 elastics and thinking this is going to be sore in the morning but looking back now you don't remember the soreness, only the great job the new wires and elastics did.

Take every opportunity to try different colours whilst you can. With only a few months to go, I have run out of time to get all the colours I wanted so at best will have only two more opportunities to try different ones. I look forward to seeing the photos.