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Orthodontics/Treatment for Open Bite

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Lateral Ceph.
Lateral Ceph.  
I am seeking treatment for a "mild" anterior open bite which causes uncomfortable lip incompetence. i recently consulted
with an Ortho. who explained to me a couple different options using braces. First, he mentioned the removal of 2 upper and
2 lower teeth and braces to close the extra space & reduce the open bite and feeling of strain in my lips. However he explained this could be too much movement and result in an undesirable facial appearance.

The other option is to slim all the teeth to create extra space and use braces. This is the suggested treatment from the Ortho.

A few years ago i attempted treatment using Invisalign. That Ortho. said we could reduce time in braces by using Invisalign
for part of treatment, then braces to complete treatment. However a few months into Invisalign the extra strain of my lips to close over the appliances was too uncomfortable and i discontinued treatment.

Because my lips already feel strained to close over my teeth, and because of my previous experience with Invisalign, i am reluctant to again commit to having any type of braces attatched to the front surface of the teeth which would seemingly increase the uncomfortable feeling of lip strain.

I am wondering if i can avoid braces on the front of my top teeth by using Lingual Braces on the top teeth and regular braces on the bottom teeth?

I asked the Ortho. about Lingual Braces but he opted out of using this method based on past experiences and explained
difficulties using that treatment. I still plan to schedule another consultation with him to further discuss posibilites.

Thank you very much for your help.

Answer

Hi Eric,

Wow...what a beautiful and interesting question. You have what is sometimes called a skeletal anterior open bite, and this presents some of the most challenging orthodontic challenges in the profession.

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.

Okay… having said  that…  your  questions focused lip incompetence and the open bite in conjunction with how to chose a means of orthodontic treatment.  You  wrote,

Because my lips already feel strained to close over my teeth, and because of my previous experience with Invisalign, i am reluctant to again commit to having any type of braces attached to the front surface of the teeth which would seemingly increase the uncomfortable feeling of lip strain. </b>

I am wondering if i can avoid braces on the front of my top teeth by using Lingual Braces on the top teeth and regular braces on the bottom teeth?

I asked the Ortho. about Lingual Braces but he opted out of using this method based on past experiences and explained
difficulties using that treatment. I still plan to schedule another consultation with him to further discuss possibilities.  

Well, I have treated a lot of skeletal open bite cases, and the relapse as reported in the dental  literature, is quite high. I have also worked with lingual braces since their early days, and I concur with your one orthodontist who felt that this would not be an appropriate approach.Skeletal open bite soften really require orthognathic surgery to fully correct and to achieve stability.

In looking at your cephalometric  X-ray, it is clear that you have a very seep lower jaw angle and that the lips are remain upon passive rest. I do like the consideration of extracting four teeth and admit that there may be an impact on your facial profile, but that chance may not necessarily be an unfavorable one. The fact that you have such a strong open bite though may mean that extractions alone cannot  achieve the needed result.

There is a new option that may help, and that is TADS  or temporary anchorage devices. These are small mini screws that when placed into the bone allow very strong anchorage to be achieved. What strong " anchorage" means is that the back molars can possibly be strongly intruded into the bone, thereby lessening the effect of the skeletal open bite with out having to invoke surgery.

Eric, you present a difficult case. I do not believe that Invisalign or lingual braces have the necessary "horsepower" and control to achieve the treatment result in an efficient and timely manner. I would ask that the new consulting orthodontist review and explain to you the following:

1)  Benefits and disadvantages of extraction of teeth to help move the anterior incisors and canines posteriorly.

2)  Benefits and disadvantages of surgical orthognathics

3)  Possibilities for using TADS as part of the treatment to help actively intrude posterior  molars.

I very much appreciated the Cephalometric X-Ray Eric. You have a difficult case to both diagnose and treat.  Remember also that there may be a variety of treatment options out there, and each can be ok and achieve the desired result.  Also do not forget that some doctors may prefer certain avenues of treatment. No matter what a careful work up of this case is quite important.

Thank you for your question Eric.



Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

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

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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.

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

Publications
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.

Past/Present Clients
Available upon Request

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