Relapse prevention of deep bite (not overjet)

[tiffingirl]

Hi!

I am 50 yrs old and recently got braced 5 weeks ago. I have clear damons on upper and metal on lower predicted to be for 18 - 24 months. I have a very deep overbite (top incisors cover lower 90% ) and mild (2mm) overjet. I started on class 2 elastics from day one plus the bite turbos (which annoyingly snapped in the first 2 weeks due to tooth grinding!). It has been a bit of a roller-coaster but I am seeing changes already which is encouraging.

Anyway, my question concerns how the relapse of a deep bite can be prevented once braces are finished, given that (as I understand it) it is elastics which are responsible for the bite adjustment and that if the elastics are not worn, the bite shifts back again. The ortho has said I will have a permanent wire retainer on both upper and lower to stop teeth shifting but I am wondering what are the experiences of others here who have more knowledge than myself of how the relapse can be prevented. I am not convinced the wires will keep the bite from relapsing without elastics.

Of course I will ask my ortho but he is on hols for a month so am hoping to have some input before that!

Thanks!

[C11]

I'll be interested in any answers to your question.

[22at26]

Balanced occlusion should allow your teeth to contact in such a way that they will not shift- the retainers maintain the teeth in the desired position long enough for the bone and ligaments to settle permanently, and the lack of excessive pressures (which are caused by malocclusion) will mean your teeth should not shift once your prescribed retainer wear is complete.

Elastics are meant to keep a constant light force in the teeth to keep them moving- not to keep the teeth forever in one spot.

[tiffingirl]

Balanced occlusion should allow your teeth to contact in such a way that they will not shift- the retainers maintain the teeth in the desired position long enough for the bone and ligaments to settle permanently, and the lack of excessive pressures (which are caused by malocclusion) will mean your teeth should not shift once your prescribed retainer wear is complete.

Elastics are meant to keep a constant light force in the teeth to keep them moving- not to keep the teeth forever in one spot.

Thank you for the great explanation, very reassuring.

[pcspinheiro]

I'm usually the naysayer here but it really depends on how the bite will be opened. I too had a very deep bite, worse even: if your top teeth cover 90% of lowers mine covered 110%... My Ortho, probably unaware of the abundant literature on the subject, tried to open my bite through molar extrusion, which did work, for about 2 months... But it left all my teeth tilted inward and then fully relapsed at the cost of my TMJ health due to uncontrolled night time clenching, so I was back to square one much worse off than when I began. Beware of the methods used and, in doubt, research them before accepting having them used on you.

[tiffingirl]

I'm usually the naysayer here but it really depends on how the bite will be opened. I too had a very deep bite, worse even: if your top teeth cover 90% of lowers mine covered 110%... My Ortho, probably unaware of the abundant literature on the subject, tried to open my bite through molar extrusion, which did work, for about 2 months... But it left all my teeth tilted inward and then fully relapsed at the cost of my TMJ health due to uncontrolled night time clenching, so I was back to square one much worse off than when I began. Beware of the methods used and, in doubt, research them before accepting having them used on you.

Oh dear! I believe that my ortho is reducing the overbite by intruding the lower incisors to level the Curve of Spee (there is a large height differential between the incisors and the molars. Perhaps he is intends to extrude the molars as well? I will ask him about it. I have read that extruding the molars may not always yield a stable result.

[Gia]

From what I've read and discussed with my doctor, there is "true" intrusion of the incisors and intrusion by extrusion of the molars. He said that the latter is not generally stage in adults. Haven't gotten there yet so don't know more.

[pcspinheiro]

I'n funny how everyone seems to know that molar extrusion is a terrible idea in adults, EXCEPT for my former ortho, or course! She was such an idiot, un freakin believable! And I'm suffering the effects first hand, just as described in the literature: full relapse and TMJ problems. I just got the results from my MRI and I have bilateral anterior disc dislocation... yay... Plus one dead tooth due to her inability to listen to my complaints, plus 1 missing healthy premolar due to her inability to understand my simple and basic goals. God, I have such bad feelings toward her...

[tiffingirl]

I'n funny how everyone seems to know that molar extrusion is a terrible idea in adults, EXCEPT for my former ortho, or course! She was such an idiot, un freakin believable! And I'm suffering the effects first hand, just as described in the literature: full relapse and TMJ problems. I just got the results from my MRI and I have bilateral anterior disc dislocation... yay... Plus one dead tooth due to her inability to listen to my complaints, plus 1 missing healthy premolar due to her inability to understand my simple and basic goals. God, I have such bad feelings toward her...

Poor you. That really sucks! Are you having further treatment to rectify the problems?

[pcspinheiro]

Hi tiffingirl,
I debraced with her out of site and frustration, told her I had had enough. After all these bad things happened I spent almost 1 and 1/2 years asking her to JUST please close the extraction gap as best as possible (as I would NEVER EVER remove the contralateral tooth) and to put my smile back as it was (as she leveled all my front teeth, like on old people's dentures). I tried to be patient and kept insisting, but she never did any of that, so at the 2 year appointment I called and said this would be my last one, and that I was going in for debracing. At the end she even wanted to make a retainer for me but I hated my teeth so bad that I refused. I even must have told her I WANTED the almost inevitable relapse, which did happen and made me happier, even if the teeth are now crooked again, though less than before. I have since checked up on my TMJ issues and they don't seem to stem from the actual TMJ, as they both have the same, mild problem. The TMJ specialist said my problem is likely of muscular origin and I think I have figured out myself what the problem may be. You see, when my former orth (stupidly) extruded my molars, two tings happened: my right side extruded slightly more, as I tend to chew more on the left side, and my teeth tilted inward, toward the tongue, but more so on the bottom. Even after all the extrusion relapsed some damage remained, and my bite does not "fit" on both sides at the same time (meaning that, laterally, the teeth either fit together on one side or the other, but never on both at the same time), leading it to "slip" to the left since it's an ever so slightly lower biting position. This means that I constantly rest my teeth only on the left side, leading to muscle and TMJ pain.

So, yes, I'm going to try to fix this I'm now wondering how this might ever be correct on my next ortho. I already had some appointments with her but she wanted to have some answers about the TMJ before making any sort of plan. Unfortunately she is very solicited and my next appointment is still more than 1 month away (and was booked almost 2 months ago !). Hopefully this one will understand that I'm OK with not having perfect results and that i just really want to fix the other one's wrongdoing, and that's it. I'm not going to spend another 2 years in braces. I just want the best/most efficient way to fix my problems (which unfortunately were way less the first time around and could have been fixed so easily, IF I had been listened to!)

Better luck for everyone else!