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Orthodontics/Issues after braces removal

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QUESTION: Hello dr paul,
Thank you for your recent suggestions regarding my treatment ,it really helped me a lot.
my orthodntist removed my braces yesterday ,but i still have some problem that my lower front teeth
Are touching behind upper front teeth which is causing me trouble such as feeling pressure in jaw when mouth is closed. I am attaching a pic of my teeth, please advice me regarding this

ANSWER: Hello Varun,

Thank you for your follow up. Again, let me say that you have some very good questions and observations. I do believe your Orthodontist achieved a very good result.

before I say anything more, again let me state, as always, that 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. Now, you asked about your current Orthodontic treatment result.

The small spaces you see will in all likelihood slowly settle in over time as the teeth passively erupt and better mesh in with one another.There are a wide variety of retainers, both clear and traditional, that can be used to help guide such final fine tuning.

Another option Varun is for the Orthodontist to use what is called articulating paper to check the contacts of the teeth. An occlusal equilibration can then be performed. I usually do this after a month or two after the teeth have had a chance to perhaps settle a little more. Overall, I very much like what i see,and I feel you have been fortunate to achieve such a  good end result.  Please follow the instructions from your orthodontist regarding the wearing of retainers. You do not want these nicely aligned teeth to shift back again.

Finally Varun, for the benefit of the many readers here, would you mind if these questions you have pose are made public. Your questions have been very interesting, and of course I have spent a great deal of time trying to answer them in detail. I feel it would be a nice service to the readers and this website of you would share all this information.

Varun, be so kind as to please consider this.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

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


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

QUESTION: Yes sir make them public if you like so,thanks a lot for your encouraging
Words,but sir in this configuration my lower teeth touch upper teeth from behind
And i have difficulty in closing mouth as my lower jaw feels some pressure

ANSWER:
Hi Varun,

Can you ask the orthodontist to examine the contacts. Ask him what lies ahead in the next few weeks and months as the teeth continue to settle in. I believe that if he adjusts the upper retainer so as to allow the teeth to settle in, then the bite will begin to feel more comfortable.

The front teeth of course are very important esthetically. The left and right canines also are very important to help guide the bite together. In dentistry this function is known as canine guidance. Your condition I think is actually not as alarming as you may perceive it to be. I would give the teeth some time to settle in and then ask your orthodontist to monitor the retainer wear and to make adjustments as he deems appropriate. This will help to ensure that you end up with a harmonious bite relationship.

I had mentioned earlier the notion of an occlusal equilibration. Do bring up this possibility with your orthodontist and ask if it is appropriate in your case. Varun, give this all about 8 to 10 weeks to settle in, and then resubmit your images and a follow up question. I think at this point you need to let the teeth settle in a little and give your orthodontist the opportunity to make any appropriate fine tuning adjustments, including an occlusal equilibration, if he feels it is needed.

Again, I think you have achieved a very nice result. I look forward to hearing again from you, and hope for sure that you will be back in touch in about 8 weeks.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

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




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

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QUESTION: Hello dr paul, glad to talk to you after 8 weeks.Sir i closely monitored my teeth during these days, but sir i have some pending issues that my lower front teeth collide with upper front teeth when closing my mouth.When i talked to my orthodontist he said that i have a lower prominent jaw(class 3),he advised me not to wear upper retainer anymore,just wear lower retainer but confusing part is i never had any jaw issue before my treatment , i went through the treatment to reduce the gap between upper front teeth.Sir kindly share your thoughts on this, i am attaching the pictures of back molar touching the upper molars , kindly see.
Again thank you very much, you are doing a great job by helping the people like us

Answer
Hello again Varun,

I somehow am not getting notifications of questions in my box. Pardon the delay. You asked as a follow up:

==snip==
  "..... I still have some problem that my lower front teeth
Are touching behind upper front teeth which is causing me trouble such as feeling pressure in jaw when mouth is closed. I am attaching a pic of my teeth, please advice me regarding this.
==snip==

As always let me say the usual : 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.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 Varun, first of all thank you so much for enclosing some pictures. I hope you and other readers can understand how difficult it is to answer complex questions about orthodontics based only on vague descriptions.

I have looked at your pictures and I think, as I said before, that you have quite a nice looking result. In very general terms, one way to  evaluate an orthodontic outcome is to look at three things:

1)  How nicely aligned are all the upper teeth
2)  How nicely aligned are all the lower teeth
3)  How good is the resulting functional bite or occlusion; ie how well do the teeth mesh.

The meshing of the teeth of occlusion can be regulated or adjusted in many ways. Often it is not enough to simply move teeth with orthodontics. For example, in adult dentitions, teeth which have been crowded or out of alignment for many years ay have worn down.Th wear and abrasion one one the left side may not be the same as on the right side. In such a case, restorative dentistry or occlusal adjustments (dental reduction or polishing of tooth surfaces) may be needed. Sometimes a combination of both may be appropriate.

A Second issue in cases like yours where there is a slight bite issue has to do with the skeletal match of the upper vs lower jaw. Varun, imagine a scenario where the lower jaw is slightly over-sized, and therefore is positioned a little more forwards of the upper jaw. In this case the teeth also would be slightly forwards. An Orthodontist can sometimes make a dental compensation ( ie move or angle teeth ) to balance out a skeletal imbalance.  This however has its limits. You may n fact have a pronounced and larger lower jaw which does not match up ideally with the upper jaw. This may affect the manner in which the lower incisors contact the upper incisors.

Finally, Varun, there is a very subtle thing in Orthodontics called a Bolton Analysis, It is almost beyond the scope of this forum to explain this. In brief, there are both complete as well as anterior only Bolton Discrepancy Analyses. It is an analysis that measures say the combined widths of all the upper six teeth and then compares it to the combined widths of all the six lower teeth (canine to canine). In some cases a Bolton Analysis will reveal that there is a dental size, meshing discrepancy due to the act that certain teeth may be undersized. This may cause the contacts of the teeth, such as in your case, to not be ideal. I just had such a case this week where the patients had very small undersize upper left and right lateral incisors. If I were to try to close all the spaces among the upper front teeth give the undersized lateral incisors and the results of a Bolton Analysis, the bite would be way off.

Varun, at this point, return to your orthodontist and ask him/her to explain why the front teeth do not contacts ideally. Sometimes an open contacts is acceptable. If the teeth contacts excessively, perhaps one of the three factors I outlined is responsible. Occlusal adjustments or supplemental cosmetic bonding often will address these conditions.

I hope that this has been helpful Varun.  Thank you for writing.

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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