Lateral archwire bends - reasonable solution or plain stupid?

[pcspinheiro]

Hi again,
still dealing with TMD symptoms and still unhappy with my treatment progress... Got diagnosed with TMD (possibly just functional, no damage... yet) a couple of months ago and both the TMJ specialist and a really experienced ortho at the same clinic suggested I just do some "quick and dirty" finishing (close lower front gaps and get an implant on the extracted premolar space) and be done with it (remove braces). Problem is, I'm really unhappy with how my teeth look now, since my previous ortho use a stupid treatment plan to address my simple problem and hid almost half of my upper incisors to open my bite (instead of the more logical intrusion of my over-erupted lower incisors...), so my smile is horrible and I really want to get at least that fixed before I abandon this for good. The major problem right now, and one of the likely culprits for my TMD (together with a bad extraction of a lower wisdom), is that upper canines hit the lowers (or their brackets), forcing me to bite/rest my mandible too far back and causing joint pain. I would like to suggest that slight lateral bends are made to the upper archwire, on the canine area, to slightly open them sideways and remove this contact so that I can close my mouth where it wants to close. Would only need 0.5 mm or so per side, might look better too, as I used to have more prominent canines before braces. Would this be a stupid or reasonable suggestion/request to make? I was offered to shave the inside of the upper canines but I'm done regretting things that can't be undone (like extracting healthy teeth...), so I refused. I never had tooth sensitivity before and I'm not going to risk it now.

Cheers!

[Prometheus]

You should insist they leave you with a comfortable and functional bite. I had to force my mandible backward into a very uncomfortable position just to chew. This resulted from a posterior cross bite. I damaged the right TMJ and had bone rubbing against bone, the pain from that was extreme. Took nearly three years but now I have a comfortable bite and am largely pain free. Make sure it is right before you finish up.

[pcspinheiro]

Thanks for your input Prometheus. My bite has never been right (class II on one side, 1/2 class II on the other, some top crowding), but that's how I grew and all was fine (well compensated, according to second opinions that I got too late; should not have been touched if I did not want surgery). That is, until I got lower brackets and, concomitantly, a bite plane to make distance and elastics to extrude molars... After one painful as hell wisdom tooth extraction, and once the elastics and bite plane were off, I was unconsciously fighting the extrusion of the molars all night long, clenching hard. This led to a full remission of the extrusion and brought the upper canines into contact with the lower brackets, forcing me to bite too far back. This is when the problems started... So I would gladly remove this crap from my teeth, were it not for how ugly my smile is now... can't bear to look at it in the mirror and looking at pre-braces photos makes me want to cry... So I'll endure this a while longer, but at my next appointment, I'm going to discuss options to deal with my extraction gap. If orthodontics doesn't offer the prospect of a satisfactory outcome, then I'm going to follow on the TMD specialist's (and other ortho's) strong suggestion and simply request that my smile is restored to its pre-braces condition, lower gaps closed and braces off as soon as possible. Then a costly implant, to replace a healthy tooth lost for no good reason... But as a fix (even if temporary) I would like opinions on the lateral bends. This might actually solve my issue and allow me to progress with the treatment if it relieves the TMD symptoms.

[assertives]

I can't answer your question about the lateral bends since I'm not a pro nor did I have any experience with it. But I wanted to say that perhaps you could just go ahead and suggest it to the ortho regardless if it's stupid or not. Since you said the ortho is very experienced, they should be able to tell you right away if the idea has any merit or offer you other options.

[pcspinheiro]

Thanks assertives. The reason I'm asking here beforehand is that the only option offered was to shave down my teeth... which I don't want. Forgot to mention that she already replaced the original brackets with smaller ones and ground them down a little. So I believe that 0.5 mm lateral movement of each upper canine should do the trick. Problem is, I can't find much over the internet about it. I've seen archwires with lateral bends but I'm not sure they were premade like that or made by the ortho "on demand"... I myself don't seem much harm in that; they often torque out the upper teeth to accommodate for the lower brackets, and then put them back. I'll just suggest it to her, if it's stupid I'll know soon enough!

[pcspinheiro]

Just to post an update; I'm guessing it might not be completely stupid. I texted my ortho with this suggestion (she gave her personal number for important matters, which I believe this is, as I don't want my TMD to progress...) and immediately got a call from her office to come by on Monday in between her other appointments. I did not talk to her, so I don't know if she will do this or if she has another option for me.

[pcspinheiro]

Final update on this (may interest someone in the future): I went to the appointment and the doc said that, even though it was an excellent suggestion, she could not do it since I'm still on NiTi wires and they would not hold any bend. Instead, she proposed to intrude the canines just 0.5 mm to see if that would do it. I don't think it will, but it's worth a shot. I made it clear to her that I wanted them back in the end, as I already hate my messed up braces smile (she basically levelled all my front teeth, which I find horrible) and will demand that the vertical proportions of my front teeth be reset to what they used to be, either along the way, at the end, or when I just give up on this, whichever needs to come first. Will largely depend on what she plans to do to address my wrongfully missing premolar and whether I like the plan and likely outcome. I'm so fed up with this... My overbite problem was solved with some overjet, the rest has just been creating problem after problem, that I can't bear to deal with creating yet another...

[EmilyTravels]

I don't get why she can't change you to a different type of wire that would hold a bend?

Obviously I am not an orthodontist, nor do I play one on TV, but just reading her proposed solution has me scratching my head as it seems so illogical.

[pcspinheiro]

You are absolutely right! I only even thought of this after my last post: I've been on the same stupid wire for over 4 months, why the hell didn't she just put on a steel wire??? It would seem this is the thickest NiTi wire anyway, so steel would be the logical progression... The worst is that I'm now pretty sure her solution won't work... I can definitely feel teeth aching, but only the lateral incisors being extruded even more ( and not the canines intruding), to my despair, as I already hate my almost leveled front teeth... my solution would have been far better, and that's what I was hoping to do when I got called for an appointment...

I don't know how to deal with this hell anymore... I just want to rip this stupid metal out of my mouth, as frustration is really starting to mess me up... I think I'm going to tell her this on the next appointment: just put on a stupid steel wire, do as I asked to get my canines away from each other and BTW, put my freaking front teeth where they used to be, as I HATE them now. Then TAKE IT ALL OFF! To think that I'm enduring all this bull when all I wanted was to straighten my front upper teeth so they wouldn't push and wear out the lower ones...

[assertives]

I think generally, the type of wire used depends on which stage of the treatment you are at or what your ortho is trying to achieve currently. Steel wires are sturdier, and not very elastic. So they are typically used during the later stage of the treatment where the ortho is holding the teeth in their new desired positions. The niti wires are used in the initial stages of the treatment where more alignment and movement is needed because of their elasticity. But that said, it also does depends on the type of techniques your ortho may prefer.

Orthodontic work is a long process, and progress is sometimes not linear. It does take time to see results, and some teeth move slower/respond differently than others. A dentist once described to me that orthodontic work is like parking cars, you sometimes need to move certain cars to make space for other cars to get in line. Same for teeth, some things may need to happen first before the desired outcome can be achieved e.g. a previously straight tooth now becoming crooked to make space for another tooth to join the arch, etc.

Perhaps give it some time to see how things pan out for now?

But if you are continually upset about how each step of all the treatment options are panning out, perhaps you may wish to be a little more specific with your requests and expectations. Discuss with your ortho and see if it's possible to maybe ask for only partial or semi-partial treatment? That way the ortho knows that you are not looking for a perfect bite, leveled occlusal plane etc, but just to move specific tooth/teeth a wee bit, make enough space for implant, etc and just work towards a good compromise that it's functional and call it a day.

[pcspinheiro]

Hi assertives and thanks again for posting. My (former) ortho knews from day 1 that I was not looking for perfect teeth. I made it very clear to her, she just chose to ignore everything I told her and take things her way! I was completely uneducated when I first went there, so unfortunately I went along with it. But seeing as she was demanding so much of me for my simple treatment request I put a break to it (unfortunately as well, after a perfectly healthy premolar was gone, due to her lie of "lack of space" when she wanted to do a class II camouflage , that I did not request and could not care about. Right now I'm still pondering my options, but just giving up on this is one of them. I'm far worse now that I was when I began with all my teeth, no TMD and no horrible smile (well, crooked teeth wearing each other out, but the crooked part never bothered me one bit). These problems are the only reason I may consider enduring a little longer but ONLY if the new plan and expected outcomes suit my interests, otherwise no.