Big issue ...

Message

#1 Post by **Clo** » Mon Jan 30, 2006 7:26 am

Hi Doc,

last week, I posted this in the section Metal Mouth Forum :

viewtopic.php?t=8823

Can you spend some words about this. What should I do according to
you ? I don't want to 'start a fight' with my ortho. But on the other hand,
I feel trapped somehow. I feel my treatment like it is now, leads to no
solution ...

By the way, I took a new pic of my teeth today :

The opening between my teeth is now 2 mm, measured vertically. And I
have again a class 2 bite too. The point of my upper cuspids is slightly
in front of the lower cuspids. And all this after only 2 weeks since I had
my last adjustment. Can you give me a 'push in the back', please.
As I feel stuck and lost at this moment.

#2 Post by **dr.j** » Mon Jan 30, 2006 9:20 am

It may be that your case is best treated with jaw surgery: to impact the upper jaw in the back and allow the lower jaw to close up and forward. If I had a patient that is going nowhere with elastics for over a year I think it's time to re-visit the initial diagnosis. You may have a condition called skeletal openbite characterized by a class II malocclusion, anterior openbite and long lower facial third. We come across these "vertical cases" all of the time and it's like opening THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR.'s Box. Ask your doc if your case would have been a candidate for jaw surgery. If she says no: I highly recommend going to another orthodontist.

#3 Post by **weird_wired** » Mon Jan 30, 2006 1:10 pm

I have to say your teeth are beautifully white and bright looking! Despite your issues you report with your bite, they are really good looking teeth

#4 Post by **Chris** » Mon Jan 30, 2006 7:27 pm

Clo, it doesn't show you biting down in the back. Are you?

I thought an open bite is when only your molars touch?
Are you saying that you cannot physically bring any of your teeth together as if your jaw is stuck?

Please clarify.

#5 Post by **mackenzie** » Mon Jan 30, 2006 7:37 pm

Chris wrote:Clo, it doesn't show you biting down in the back. Are you?

I thought an open bite is when only your molars touch?

I was thinking about the same thing while doing my homework so I came here to post the same question! I thought this was open bite, is yours different?

#6 Post by **Clo** » Tue Jan 31, 2006 2:36 am

Hi,

to Chris and Mackenzie. It is difficult to show in one pic my complete bite.
I can say it is very much like the pic Mackenzie posted. I only can bring
together my second molars, and in fact only the left ones. So that pic
on top could almost be my bite. So yes, yes, I do bite down completely.
Even as hard as I can !

Thanks dr.j for answering this quickly. What do you mean by opening
THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR.'s box ? Could micro implants to intrude my molars or a pull-up
headgear help in my case ? BTW, does my bite look bad or very bad ?

#7 Post by **Clo** » Wed Feb 01, 2006 1:34 am

Dr. j, can you answer these last questions I put here, please.
I would be very grateful. Thanks in advance !

#8 Post by **dr.j** » Thu Feb 02, 2006 9:25 am

The THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT TO THE ADMINISTRATOR.'s box allusion refers to how at imes placing braces on "vetical cases" can crack open an openbite. Sort of like "opening a can of worms" to use the expression.

Mini implants in the bone to intrude molars is used but is still not widely accepted by the Ortho-World as feasible to close major openbites. I personally have never used them and while they are gaining popularity they are still considered somewhat "maverick" by many doctors. High pull headgear is used for vertical control especially on active growers but I find it difficult to believe that one can intrude the posterior maxilla and close the bite like that. What you might need is posterior maxillary intrusion - this is usually done by maxillary jaw surgery to impact the back of the upper jaw and - depending on how much gums and tooth you show at rest and smiling - bring it down in the front. Sometimes a lower jaw surgery is needed to approximate the occlusion. Other times - the patient "auto-rotates" the mandible forward to close the vertical dimension of the bite and correct the class II malocclusion. I may also make a case that you look narrow on top because your upper back teeth appear flared: the lingual cusps are dropping down and maybe propping you open even more.

I would recommend a consult with an oral surgeon that does jaw reconstruction AKA orthognathic surgery. I know this sounds harsh but just check it out. The failure of elastics sort of helps diagnose the problem that much better. Sometimes diagnosis through failure of a tx regimen is the only way to get the true diagnosis! I have had cases like this myself and I feel for you - and your orthodontist.

Good Luck?

dr.j

#9 Post by **mistake56** » Thu Feb 02, 2006 9:39 am

The mini-implants Dr. J spoke of worked miraculously on my daughter's open bite...which was at least as severe as yours.

Perhaps you can ask your doctor about that procedure.

I think Dr. J is correct when he says it is a rather "maverick" procedure. Our orthodontist, however, is using it more and more. At one time he was the head of orthontics at a university in the Chicago area and it is one of his students who has really been instumental in the development of this procedure.

It wouldn't hurt to ask.

#10 Post by **Chris** » Thu Feb 02, 2006 6:36 pm

This probably sounds oversimplistic or unrealistic or just plain dumb...but would just grinding down the molars do any good?

Ok, if that was an utterly stupid question, you can ignore me, Dr. J.