Issues with ortho - they're ready to remove braces but I'm not happy

[diamond63]

Hi everyone! This is my first post. I am 28 and have had braces for almost a year and a half. My treatment includes fixing rotated teeth, closing gaps, and making room for 2 dental implants to replace my congenitally missing lateral incisors (next to front teeth). The effect of never having these 2 adult teeth meant my teeth spread out evenly and I had several small gaps rather than 2 big ones. So they needed to pull some teeth together and push others apart to make room for the implants. My ortho and dentist, who I have a lot of respect for and who work closely together, are both happy with my teeth and ready to move onto the oral surgery phase of my treatment. The problem is, I'm not happy.

At one point near the beginning they tied my front teeth together to close the gap between them. However the gap closed quickly, and then the teeth were being pulled against each other and had nowhere to go, and by my next appointment one was crooked and pulled further out of my gums. Maybe this was more due to bracket placement, but it seemed to happen at that time. I kept asking my ortho, "When are we going to fix my front teeth" and never got a straight answer. Or at least, one I could understand.

Whatever the case, my front teeth now A. Flare out too much, B. The edge of one tooth sits slightly lower than the other and C. They now have little gaps at the gumline, aka "black triangles" because the teeth got pulled down exposing the part where the tooth starts to curve in (ie; a tooth is not one width from top to bottom, they are widest at the base/exposed part and get narrower closer to the roots). (Does this make sense?)

I brought this up fairly early on and my dentist seems to think that to fix the black triangle effect they need to add fake material to the tooth to build it up, and that they can't push the teeth back up because it causes your gumline to recede. Has anyone ever heard of this? Does this sound legit?

And as for the flaring, my dentist wants 7mm allocated for each implant (currently the space is filled in with pontics attached to archwire). Both dentist and ortho say that fixing the flare and tilting my teeth back in will take room away from my implants and then they will only be able to do narrow implants and it'll look funny. I'm still having trouble picturing how tilting them back reduces space when the implants are meant to sit flush and at the same angle, but I can kind of see it? Well, regardless, I don't want tiny, ill proportioned lateral incisors - I don't know what'd be worse, that or the flaring!

They say that because I'm an adult and my jaw is done growing they can't make anymore space. But it seems like there HAS to be something they can do. What about shaving down other teeth further back like molars? The amount of space they need seems like not much. But they're both acting like I need to learn to live with it and that the flaring isn't bad. I get they are not supposed to be straight up and down and are supposed to flare some, but I feel like I have rabbit teeth. I have spent so much money on my teeth all out of my own pocket and have waited so long to have a decent smile. Now, I'm terrified this is it, and I'm not pleased!

If anyone has any advice or had a similar experience, I'd love to hear it.

[diamond63]

I don't see how to edit on my phone but wanted to add I think them pulling down my front teeth further from my root was partially intentional - my dentist says x amount should be visible from underneath your upper lip.

Neither of them admit they made any mistakes and they seem to talk as if this is just how my teeth "are" as if they are working with how my teeth have always been, not acknowledging this flaring and triangle effect happened directly from ortho.

One other point, they do have me in rubber bands for sleep only (I have "Mountain Gorilla"s). They seem to do nothing, and I think now the front teeth are coming back against and hitting my lower braces so they can't tilt back anymore with the lower braces in the way.

[metalliKa]

Sorry you're going through some frustration. It is annoying when you try to voice your concerns regarding your treatment and they dismiss you. That's rather unprofessional and you do lose a bit of respect for them and question if they at least know what they're doing. We do pay them a sizable amount of money to make our teeth perfect and if it's not up to our expectation, they should at least consider our inputs.

Do you have prebraces and in-treatment photos so we can see to give our non-educated and non-biased opinions?

[BracesGuy]

Tilting the teeth back will indeed reduce space. That said, using IPR (shaving) various teeth in your mouth can create more space.

Regarding bonding your teeth to cover the black triangles, I would want to be sure it's not possible/correct for those teeth to instead be intruded into the gum.

Each ortho you go to will have a different approach. If you are not happy why not get a second opinion, even if it costs you a consultation fee? Overall, they are your teeth so be sure you are happy with the treatment plan.

[diamond63]

Thanks for the replies metalliKa and BracesGuy - and sorry for the late response.

Here is a link to pictures: (I don't see how to post them inline since it says BBCode is off)
https://www.dropbox.com/sh/ruew41nitd16 ... gIHDa?dl=0

I've certainly come a long way, but I am nowhere near happy with them yet. Note that the 2 lateral incisors I have now (on either side of my front teeth) are just pontics attached to the archwire. In the pictures you can see the way my bone structure slopes down a lot where the pontics are - I need bone grafting when I get the implants. :/ :(


I actually had another ortho appointment on Friday and his tone was much more positive. After my recent consultation with my dentist, he and she talked, and I guess they came up with a game plan. He is now working on both intruding the front teeth, and tilting them back.

To intrude them, I thought he would move the bracket, but instead, he added 2 "steps" to the wire on either side of my front teeth. His idea behind intruding them is that he will have more room to tilt them back (so the backs of them are not hitting my lower teeth, which I guess was a concern). But it also takes care of my feeling they were coming down too far.

To tilt them back, now that I think about it, I am not quite sure how he is tilting them back. He said he is doing both intrusion/tilting at the same time; so it may be through the powerchains he just put across my upper teeth (centered on the front teeth)? As I mentioned before, he has me in bands while I sleep (originally was full time), so that may be part of it as well, although he hasn't mentioned the bands in awhile and I forgot to ask him if he wants me to keep wearing them.

As for the "black triangle" problem, ortho says intruding the front teeth won't help because the gums and bone will move with the teeth. His idea for fixing the problem is shaving down my front teeth a bit (which would also free up space for the incisors). I had already asked my dentist about doing that previously, though, and she didn't seem to go for it, so I don't know. Her idea is to build them up. You can really see when you put the before and afters side by side, just how much my front teeth have been pulled down, creating this problem.


I also asked the ortho about shaving down some of my back teeth to make room for the laterals, and he agreed that was also an option, although he says my bite is perfect now, and that would mess it up.

So, I guess we'll see. I do feel better after this last appointment though. And I know it has only been a couple of days, but I already feel like I'm seeing an improvement, both in the flaring and the intrusion. We'll see how these next couple of appointments go. If things don't improve a lot I may take BracesGuy's advice to seek a 2nd opinion.


Please let me know what you think regarding the pictures. (By the way, who knew getting a decent picture of your teeth was that difficult?!)

[diamond63]

Edit: I read that I can't add the pictures inline until I have >7 posts. So sorry to have to post a link to an album. Anyway, in that album, the first 3 with top-braces only are the "befores", the rest are the "afters" aka the current. It only displays thumbnails; you have to click the picture to view the whole thing.