Orthodontics/open bite

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QUESTION: Hello my dentist told me that I have a anterior and posterior open bite and that I will need to see a orthodontist to correct it. I'm 25 and never had braces before. Is this hard to treat? How long does the treatment usually last? Can I use invisalign to treat it?

ANSWER: Ho Randy,

I just got your  question...pardon the delay.

What I write here are only my opinions based on very limited information. My comments should not be viewed as a definitive diagnosis or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on changes in root length and shape in conjunction with orthodontic treatment..  You  wrote: I have a anterior and posterior open bite and that I will need to see a orthodontist to correct it. I'm 25 and never had braces before. Is this hard to treat? How long does the treatment usually last? Can I use invisalign to treat it?  


It is a great question, because I have had a lot of experiences treating open bite cases, and they are some of the most difficult situations to resolve. I am going to share with you my personal opinions and experiences. I do not claim that what I say is the absolute standard of fact, and indeed I have discussed open bite treatment with a number of colleagues.

Skeletal anterior open bite cases often will relapse after treatment, even those which have been surgically addressed. A non surgical approach to a skeletal open bite often must use dramatic movement of teeth to camouflage or dentally compensate for what s essentially a profound mismatch in the skeletal architecture of your upper and lower jaws.

There are doctors who claim that TADS ..that is temporary anchorage devices .. can be used to treat this problem. Again, these are dental approached of moving teeth which do not surgically address the skeletal issues.

Your dentist's advice to see an orthodontist s excellent. He or she may inf act in turn recommend yet another consultation with an oral surgeon. These are extremely challenging cases. The use if clear aligners should not be completely dismissed, but employing them as the sole method for managing a skeletal open bite is probably not a wise approach.

Here is what you need to do Randy:

1)   Assemble and gather any X-rays, photos or study model records you may have from your family dentist.

2)   Visit an orthodontist or two to get an opinion(s).

3)   Visit an oral surgeon or two to get an opinion(s)

4)   Meet back with your family dentist to discuss which approach best matches you  needs.

5)   Develop a comprehensive written treatment plan to be shared and approved by ALL your doctors so that everyone is on the same page as far as your treatment goes and there are no misunderstandings.

Thanks for writing. Rest assured...you may have a very challenging situation, and multiple consultations may be called for. I wish you the very best Randy and please write back if you have any additional concerns.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply. This sounds like a very difficult issue to treat. It also sounds that I might as well not do anything since its not certain any of these things will fix my issue. Can invisalign work for this or no? I'm terrified of surgery as well.

Answer

Well Hi again Randy,

you wrote:

QUESTION: Thank you for your reply. This sounds like a very difficult issue to treat. It also sounds that I might as well not do anything since its not certain any of these things will fix my issue. Can invisalign work for this or no? I'm terrified of surgery as well.

Again, I have no records to make a definitive statement or diagnosis. As such let me again say the following:

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise, or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Randy, in my opinion, to treat a skeletal open bite, if that is indeed what it is based on your descriptions, managing it with Invisalign or another brand of clear aligner alone would be something which I personally would not attempt. I have been a dentist for 33 years, and in my experience, and in attending thousands of hours of continuing education courses, I have yet to see a presentation where a skeletal open bite was managed solely with clear aligner therapy.

Randy, as I said earlier, do seek SEVERAL opinions from experienced oral surgeons and orthodontists. Collect their recommendations and then meet with your family dentist. Please feel free to write back again with your findings.  And again, good luck managing what is truly one of the most difficult challenges facing orthodontists.

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

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American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

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Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

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Available upon Request

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