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Orthodontics/should i get braces again?

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Question
hello ,i m simran and i got braces about year ago ...i used retainer only while sleeping for about a month ..and now my front teeth are getting over each other like it was before and even the space from where teeth where taken out is bit visible now ..i m really tensed about it ..the retainer is no more fitting in my mouth ... can this problem be fixed by the same retainer by reshaping its wire or something or should i get new retainer or braces again? even i think that after getting braces only on my upper set of teeth  my face shape is changed as from one side my cheeks look fluffy and on the other side hollow as if my face is no more in proper shape ..and now i thinking of getting braces on my lower set as the lower teeth do need but can this problem be fixed by getting lower teeth braces

Answer
Upper & Lower Retainers - Braces.com
Upper & Lower Retainer  
Dear Simran,

I would like to answer your question, but it is very difficult with no photos, study models, or radiographs. There are just so many variables to consider.  In addition you have made some comments about your facial esthetics. As always, 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.

Your wrote:
“   teeth  my face shape is changed as from one side my cheeks look fluffy and on the other side hollow as if my face is no more in proper shape . “


Again, this is very difficult to judge. Many facial asymmetries in adults require surgical assistance to correct. Chronic sleeping on one side of the head beginning in childhood can affect the balance and symmetry of the face. Simran, you may wish to look at facial photos from earlier years and ask if the asymmetry was already present. Due realize that growth can of course greatly influence many changes as well.

You also wrote:
“and now my front teeth are getting over each other like it was before and even the space from where teeth where taken out is bit visible now “


Sometimes an initial orthodontic condition has been treated, albeit incorrectly, and the result is unstable. There are some borderline cases where the decision to extract or not extract is very difficult. Extraction sometimes makes for a more stable long term result.

Some orthodontic cases just have to have an extraction in order to achieve an esthetic and stable outcome.  Yet, due either to doctor misdiagnosis, patient demands, or a combination of other factors, the orthodontic treatment proceeds without the needed extractions. The outcome is often a compromised smile that has very little, if any, stability. Orthodontic relapse occurs, and everyone seems surprised.

I am assuming from that statement that you did have extractions. When spaces return after an extractions have been done, the cause sometimes is due to disproportionately undersized teeth. An Orthodontic review known as a Bolton Analysis can shed some light on this. You may wish to ask your Orthodontist or family dentist to evaluate whether tooth size discrepancies are present.

You also wrote:
“the retainer is no more fitting in my mouth ... can this problem be fixed by the same retainer by reshaping its wire or something or should i get new retainer or braces again? “


Well this really is THE BIG QUESTION. In some cases, if the changes and relapse are slight, use of a retainer, or a limited series of clear aligners can reverse the relapse. In other cases, where there are factors such as an initial  misdiagnosis of the case, tooth size discrepancies, strong architectural imbalances of the face and jaw, correction with an aligner or retainer alone may not be the right solution.

From the preceding snippets of your questions and my limited replies, you can see that I am not able to really give you specific recommendations; I can only respond with generalities.  I cannot offer more about your case without some additional information. Perhaps you may wish to resubmit this question with more detailed clinical information.

In summary, here are some possible next steps to consider.

1. Return to your Family Dentist for a review of your overall dental status
2. See you Orthodontist for an Orthodontic examination including new diagnostic records if needed
3. Decide upon Orthodontic treatment options including any necessary adjunctive cosmetic procedures.
4. Make sure the treatment plan has the approval of you the patient, the Orthodontist, and the Family Dentist.
5. If you do seek retreatment, ask the Orthodontist about multiple retention strategies to help ensure against Orthodontic relapse.

I hope my comments have been helpful Simran. I am told the website here encourages you to rate the answers and to resubmit with follow up questions. Good luck with your upcoming Doctor visits Simran, and 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 full week for a reply; my replies are generally fairly extensive and researched. 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. I sometimes consult with other doctors on complex interdisciplinary questions. This of course takes time.  Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

Expertise

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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