Did you know that to level or straighten your teeth is not the same thing as to do an orthodontic treatment?
Lately many patients have been coming to my office to ask for a second opinion about their orthodontic treatment. Most of them have been wearing brackets for some time (usually a couple of years) but they are not satisfied with how they look.
There are some dentists or “pseudo-orthodontists” that have decided to level or straighten these patients’ teeth without paying attention to other structures of the mouth such as the gums or TMJ (mandible joint), without care for occlusion (the bite) or for function.
Leveling and Straightening in Orthodontics
In a case of orthodontics, leveling is only the initial phase of an orthodontic treatment; it is the easiest and simplest part and usually takes just a few months (3 to 6). In fact, sadly, in order to level or straighten teeth, all you have to do is fit the brackets in their place and place an orthodontic wire, there is not much to it.
Leveling makes the most visible change for patients, and so, unfortunately, they think that their treatment is going quite well. A good orthodontic treatment does not consist of leveling or straightening your teeth and then you’re done. A good orthodontic treatment consists of making both dental arches fit together correctly in a comfortable position for the patient’s muscles and joints, and achieving this leveling without affecting gum health or the patient’s facial profile. If these objectives are not met, the inevitable outcome is discomfort and pain, poorer aesthetics, and pathology of different structures.
Example 1: patient with 2 years of braces
In the following example we will look at the situation of one patient’s teeth after more than two years of wearing braces. She came to our office for a consultation, since she felt she was looking worse and worse. Due to the Class II elastics she had been using, her bite had opened further and the lower incisors were too protruded. The mouth was almost leveled or aligned; however, the patient presented a severe Class II, an open bite with pain in the TMJ (the mandible joint) and moreover she could not chew.
Example 2: patient with 3 years of braces
Another example of a patient referred by a colleague in order to try to solve her problem. The patient had worn braces for 3 years, she came to see us because she could not close her mouth. Due to the Class II elastics she had been using, her bite had opened further and the lower molars had vestibulized (they were inclined outward). The mouth was almost leveled or aligned; however, there were many gingival recessions due to the upper expansion, a Class II, crossbite, deviated upper midline and an open bite, she also stated that she could not close her mouth properly.
In cases like this we have no other choice but to remove the existing appliances, do a complete cleaning and begin the treatment again (sometimes micro-screws are needed to intrude molars or even for orthognathic surgery). The damage caused is irreversible (if there are gingival recessions or loss of a tooth). Many patients decide to give up treatment because of the cost or because they are tired of wearing braces for so long.
My advice to avoid such misfortune is to make a good choice of orthodontist. Always consider carefully who is treating you, and ask the professional to show you cases he or she has treated, not one or two, but several cases. Everyone says they are very good at what they do, but only the one who can demonstrate this with photos of cases completed is supported by the evidence. Without evidence, you cannot know whether the orthodontist is going to solve the problem or only cause you misfortune.
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