I am new to this forum. I am a 42 year old male. I started ortho in September 2004 with a non-surgical palate expander. In December 2005, braces were put on. Everything was fine until March 2007. My ortho said he wanted to get more expansion. I noticed the gums between my teeth lowering. He said "it's just a space, stop looking at your mouth; things get worse before they look better, we'll close spaces at the end of treatment".
I watched the gums disappear slowly over the next several months. He kept the same wire on and never said another thing about my gums at any of the appointment over the course of 9 months. I finally confronted him and said, "what is going on with my gums". He said, "you've lost your papilla and it's common in adults; I can strip your teeth (interproximal reduction and we may be able to get 30% back).
I have visited a couple orthodontists, dentists and periodontists and they have all said that it's the orthodontics - but they are careful not to say "what" caused it but very indirectly pointing the finger at my orthodontist's treatment.
Can anyone offer a help in this situation. I feel I need an orthodontist that is experienced, compassionate, knowledgable and can fix my situation.
Just a note, I am meticulous cleaner, use extra soft brushes and very very light correct brushing methods and flossing protocol. Not harsh at all. I have been complimented on my cleanings by everyone and I do not have any periodontal disease.
Pics attached - before and current
http://s298.photobucket.com/albums/mm266/supousa/
Thank you kindly.
Orthodontic TRAUMA - PLEASE HELP
Moderator: bbsadmin
Since the orthos job is to straigten your teeth and a periodontists job is to deal with gum problems, I'd start by visitng a periodontist. They will be the ones most able to help correct the problem. They can point fingers at the ortho, but if you look at your treatment plan it should say in the risks section that gum recession is a possibility (it did in mine). But your ortho won't be able to help you unless he/she also happens to be a perio! good luck and by the way your teeth are SUPER white!! 
HELP
Thank you for your post. My periodontist was an orthodontist for 20 years before he became a periodontist. Everyone is in agreement that there is nothing that can be surgically or non-surgically done. My perio does not recommend IPR.
The consensus from my consultations have been:
Ortho 1: Remove everything, put in retainers for 6 months and see how the tissue responds and where your teeth want to go to. Then finish by going in braces again to do IPR.
Ortho 2: Finish now while your braces are on, get the roots straightened and the bite and occlusion correct and go straight to IPR and dont get in braces a second time because it's trauma to the teeth and gums to move them after they settle in and strengthen/tighten up. Risking more damage.
Perio 1: You've had bone loss, tissue shrinkage. Nothing can be done to bring it back.
Perio 2: You've had no bone loss, but tissue shrinkage. Perhaps if your ortho pulls your teeth backwards and does IPR, your gums will create a papilla by squeezing it in the space.
MY ORTHO: I really don't know what to do except IPR.
The consensus from my consultations have been:
Ortho 1: Remove everything, put in retainers for 6 months and see how the tissue responds and where your teeth want to go to. Then finish by going in braces again to do IPR.
Ortho 2: Finish now while your braces are on, get the roots straightened and the bite and occlusion correct and go straight to IPR and dont get in braces a second time because it's trauma to the teeth and gums to move them after they settle in and strengthen/tighten up. Risking more damage.
Perio 1: You've had bone loss, tissue shrinkage. Nothing can be done to bring it back.
Perio 2: You've had no bone loss, but tissue shrinkage. Perhaps if your ortho pulls your teeth backwards and does IPR, your gums will create a papilla by squeezing it in the space.
MY ORTHO: I really don't know what to do except IPR.
Re: HELP
Is that true? I always thought bone loss could be regenerated through periodontics. Don't the teeth build up bone with movement (i.e., bone gets broken down when teeth are moved but osteoclasts build it back up as it goes)??supo wrote: Perio 1: You've had bone loss, tissue shrinkage. Nothing can be done to bring it back.
Jeez, that is a terrible situation. I am sorry. It sounds like you are doing all you can and I don't know what to tell you. If you lived in SOuthern California I could reccomend some great practicioners for you to see but I don't know what can be done.
I have major bone loss from perio disease and am now in braces but I do not think (I hope) I am losing more bone or gum from the orthodontics. It is odd what happened to you.
Sorry--
I have major bone loss from perio disease and am now in braces but I do not think (I hope) I am losing more bone or gum from the orthodontics. It is odd what happened to you.
Sorry--
Hi supo,
My gums look a lot like yours. I have none of those "points" left between any of my lower front teeth, and betwee some top ones too. I asked my ortho about it, and basically it's because my teeth were really crowded, my gums didn't have much room to grow up in between them. Now my teeth are straight, and I am left with those triangle-shaped gaps, just like you. If I had done this ortho treatment as a kid, my gums would have re-shaped themselves, but unfortunately that doesn't happen in adults. I asked about IPR, and my ortho said that is not an option, because my teeth are too narrow. So, I can do nothing - just live with it.
However, it looks to me like your teeth were not that crooked to begin with, so it does seem a bit odd that your gums have lost all their points. Then again, micachica has a good point - gum recession is a possibility with any ortho treatment.
I wish I could offer advice on what to do. Have the other orthos/perios told you that this could have been avoided, had your ortho done things differently?
My gums look a lot like yours. I have none of those "points" left between any of my lower front teeth, and betwee some top ones too. I asked my ortho about it, and basically it's because my teeth were really crowded, my gums didn't have much room to grow up in between them. Now my teeth are straight, and I am left with those triangle-shaped gaps, just like you. If I had done this ortho treatment as a kid, my gums would have re-shaped themselves, but unfortunately that doesn't happen in adults. I asked about IPR, and my ortho said that is not an option, because my teeth are too narrow. So, I can do nothing - just live with it.
However, it looks to me like your teeth were not that crooked to begin with, so it does seem a bit odd that your gums have lost all their points. Then again, micachica has a good point - gum recession is a possibility with any ortho treatment.
I wish I could offer advice on what to do. Have the other orthos/perios told you that this could have been avoided, had your ortho done things differently?
The thing is, I had perfect expansion and was in correct verticle relationship in an expander. At 1 year ago I was near perfect - gums and everything. He said, "I want to try and expand the right side". I didn't question him about it. I had complete trust. The very next month I noticed the papilla in one tooth gone. You know the rest of the story.
I've had several appointment with other orthos and they said your ortho overexpanded you in the jaw, but in the front of my mouth. It pushed through the front of the bone and the gums cannot hold on.
So, this is why it's complicated. Some orthos want to put me in retainers, then shave them back in the front to collapse and allow the teeth to go backward in the bone, but they said there is no guarantee and highly unlikely gums will respond positively - but they said the human body is an amazing thing, and it just may help. Others have said to finish ASAP and live with what you get because removing braces equals trauma. Letting them settle in the applying force again by going in braces again is trauma. Then removing again and letting them settle in again is trauma and they are concerned about further problems.
I will post the pics shortly of where I was one year into expansion, one year in braces (I was perfect) and then one year later (total destruction of gums - which you've seen).
I've heard of www.peternordland.com that claims papilla reconstruction. Anyone have any experience? And by the way, I will travel anywhere in the US for a good ortho recommendation to fix this. The money to travel is worth the peace of mind knowing I'll be fine. I'm sure those of you with similar issues can understand that.
Thanks for all the feedback!!
I've had several appointment with other orthos and they said your ortho overexpanded you in the jaw, but in the front of my mouth. It pushed through the front of the bone and the gums cannot hold on.
So, this is why it's complicated. Some orthos want to put me in retainers, then shave them back in the front to collapse and allow the teeth to go backward in the bone, but they said there is no guarantee and highly unlikely gums will respond positively - but they said the human body is an amazing thing, and it just may help. Others have said to finish ASAP and live with what you get because removing braces equals trauma. Letting them settle in the applying force again by going in braces again is trauma. Then removing again and letting them settle in again is trauma and they are concerned about further problems.
I will post the pics shortly of where I was one year into expansion, one year in braces (I was perfect) and then one year later (total destruction of gums - which you've seen).
I've heard of www.peternordland.com that claims papilla reconstruction. Anyone have any experience? And by the way, I will travel anywhere in the US for a good ortho recommendation to fix this. The money to travel is worth the peace of mind knowing I'll be fine. I'm sure those of you with similar issues can understand that.
Thanks for all the feedback!!
That is indeed complicated. With either of the proposed solutions, are you going to have a stable bite at the end of it? Personally, I would be as much (or more) worried about that as the state of your gums. If your ortho has indeed over-expanded you, I am guessing your teeth are NOT going to be very stable where they are, because they do not have enough support. So that has to be dealt with. So I would go with whatever course of action will provide the most stability. Then deal with your gums. Gum grafting can do amazing things. Perhaps you will also be able to have some IPR eventually. As I mentioned before, I have quite a few black triangles between my teeth, and my ortho does not think it is anything to worry about. Although I suspect that I will have some grafting at some point in my life, because I have some recession around the lower front teeth and my gums were generally thin and fragile to begin with.
I would post a picture to show you, but I do not have a proper camera and the pictures I took with my cell phone are just not clear enough.
Do you think it's possible for you to get some money back or some compensation from your current ortho, for the trouble he's caused you?
I would post a picture to show you, but I do not have a proper camera and the pictures I took with my cell phone are just not clear enough.
Do you think it's possible for you to get some money back or some compensation from your current ortho, for the trouble he's caused you?
OMG! Peter Nordland is who I use!
He is AMAZING.
Remember how I wrote that if you lived in Southern California I had some amazing docs to recommend? HE is the one!
I havehad two surgeries with him and I travelled accross the country to do so and would do it again. Might even.
My situation is way different than yours- I have no papilla at all anywhere from perio disease followed by traumatic surgeries from terrible periodontists.
After that I researched forever until I found Dr. Nordland and he was able to regenerate some gum for me. There are limits as to what can be done but I defintately got some. For you, with no perio disease and no bone loss, you could probably have great results.
In addition to some papilla he also put some gum back over some of my roots.
He invented some microsurgery procedures and he travels all over teaching them.
I had been to tons of periodontists all over the place and everyone said I was un-helpable until Dr. Nordland.
He is also an awesome guy- I love him. thorough, calm, kind and super good at what he does!
He totally does papilla regeneration- I had it done though on me I couldn't get it 100% back cause of my significant bone loss.
But he is the real deal.
I am curious how you heard of him?
He is AMAZING.
Remember how I wrote that if you lived in Southern California I had some amazing docs to recommend? HE is the one!
I havehad two surgeries with him and I travelled accross the country to do so and would do it again. Might even.
My situation is way different than yours- I have no papilla at all anywhere from perio disease followed by traumatic surgeries from terrible periodontists.
After that I researched forever until I found Dr. Nordland and he was able to regenerate some gum for me. There are limits as to what can be done but I defintately got some. For you, with no perio disease and no bone loss, you could probably have great results.
In addition to some papilla he also put some gum back over some of my roots.
He invented some microsurgery procedures and he travels all over teaching them.
I had been to tons of periodontists all over the place and everyone said I was un-helpable until Dr. Nordland.
He is also an awesome guy- I love him. thorough, calm, kind and super good at what he does!
He totally does papilla regeneration- I had it done though on me I couldn't get it 100% back cause of my significant bone loss.
But he is the real deal.
I am curious how you heard of him?
I would love to see some pictures. Every perio I visited said - papilla isn't coming pack. The only hope was to squeeze the roots together through IPR and allow nature to take it's course. I found Peter Nordland through being a "Google-ologist". When there is a problem the internet "can" be an useful place to find help. Peter Nordland's photos look good. My ortho and perio said that he doubts the results are this good as his website, that overtime, the stability of the grafts will diminish and return you to presurgery results and could potentially look worse. It's very difficult as a consumer to get the facts.
Regarding some other posts, yes, Dr. Birte Melsen, adult ortho expert writes that bone "should when done properly" build bone. However, my situation is inappropriate strength of wire, incorrect arch wire shape and as one consultant ortho said "your ortho does not seem very focused on your care". I would agree. Him, his assistants all saw me 5 times and nobody, but myself, pointed out to him "Hey, I'm losing gums inbetween my teeth". The response, quote from my ortho was, "stop looking in your mouth. It's just a space". So I did, and I was watching before my eyes, the gums disappear until I finally confronted the ignoring of this issue. He immediately put on very light wires. Because of this, I am back in cross bite, I am relapsing (gingivally a good thing, orthodontically not). The consultants I am seeing want to do a controlled relapse with retainers from the front portion of my mouth where the destruction is and then expand me in the back again and finish (through braces or acceptance).
In other words, clean-up duty and redoing ortho.
I think I've told that story enough and as you can see, it's a traumatic emotional and physical experience for me. I went in to braces to improve a situation and instead got a life-long trauma. I was looking at all the magazines and peoples teeth knowing I was going to look like that - and for 4 months I did (November 2006-March 2006). Then the infamous "I'm going to try and expand your right side some more and I'm putting in thicker wires on the upper and lower arch" haunts me that I didn't know any better. Then I feel justified because I pointed out the issue at my next appointment when only one tooth was affected. I remember seeing white along my gums also like the teeth were going to come shooting out my gums. I felt no pain, but constant pressure. He dismissed me and so did the staff.
Thanks for bearing with the emotional outlet here. I apologize. As my ortho consult said, "you have been handed a new deck a cards, and you have to play these cards". The thing is, I need to find someone who I can trust and I come to this forum to receive hope, support, advice and recommendations. And I thank you again so much for all who write and share. I will, when I get a chance, upload progressive pictures.
The bone loss I've had, btw, I've been told is marginal from a crestal point. But, the interdental bone, periodontal ligament has been destroyed and the gums have shrunk to the crestal floor. There is no "predictable" way to reconstruct this. Gum surgery is usually for the front of the teeth. My perio said that gum surgery is contingent upon the structure of the interdental papilla and interdental bone (which is gone), so surgery they say is not an option. My only hope is through careful orthodontic movement to move the teeth and create new structure - so this is why the orthodontist is key. I need someone with experience in this issue.
BTW, also, my ortho consultant said "I had a patient who had this problem in 1985". So much for my ortho saying "Oh, this is a common occurance in adult orthodontics". Birte Melsen writes "anytime you have a negative result in an orthodontic patient is because your force system was wrong".
I thinking of taking a dental allergy test (Clifford and Melisa). Anyone have that done. Is allergic reaction a possibility? My sister and neice have a nickel allergy. I went into the hospital with acute pericarditis. Cause unknown. Heart doctor didn't mention my braces as a potential, but, since an ortho consult brought up the potential, I'm wondering if I should get this test done (he wants to just remove the braces and control/retain).
Sorry for the long post. I'll keep it shorter next time.
Regarding some other posts, yes, Dr. Birte Melsen, adult ortho expert writes that bone "should when done properly" build bone. However, my situation is inappropriate strength of wire, incorrect arch wire shape and as one consultant ortho said "your ortho does not seem very focused on your care". I would agree. Him, his assistants all saw me 5 times and nobody, but myself, pointed out to him "Hey, I'm losing gums inbetween my teeth". The response, quote from my ortho was, "stop looking in your mouth. It's just a space". So I did, and I was watching before my eyes, the gums disappear until I finally confronted the ignoring of this issue. He immediately put on very light wires. Because of this, I am back in cross bite, I am relapsing (gingivally a good thing, orthodontically not). The consultants I am seeing want to do a controlled relapse with retainers from the front portion of my mouth where the destruction is and then expand me in the back again and finish (through braces or acceptance).
In other words, clean-up duty and redoing ortho.
I think I've told that story enough and as you can see, it's a traumatic emotional and physical experience for me. I went in to braces to improve a situation and instead got a life-long trauma. I was looking at all the magazines and peoples teeth knowing I was going to look like that - and for 4 months I did (November 2006-March 2006). Then the infamous "I'm going to try and expand your right side some more and I'm putting in thicker wires on the upper and lower arch" haunts me that I didn't know any better. Then I feel justified because I pointed out the issue at my next appointment when only one tooth was affected. I remember seeing white along my gums also like the teeth were going to come shooting out my gums. I felt no pain, but constant pressure. He dismissed me and so did the staff.
Thanks for bearing with the emotional outlet here. I apologize. As my ortho consult said, "you have been handed a new deck a cards, and you have to play these cards". The thing is, I need to find someone who I can trust and I come to this forum to receive hope, support, advice and recommendations. And I thank you again so much for all who write and share. I will, when I get a chance, upload progressive pictures.
The bone loss I've had, btw, I've been told is marginal from a crestal point. But, the interdental bone, periodontal ligament has been destroyed and the gums have shrunk to the crestal floor. There is no "predictable" way to reconstruct this. Gum surgery is usually for the front of the teeth. My perio said that gum surgery is contingent upon the structure of the interdental papilla and interdental bone (which is gone), so surgery they say is not an option. My only hope is through careful orthodontic movement to move the teeth and create new structure - so this is why the orthodontist is key. I need someone with experience in this issue.
BTW, also, my ortho consultant said "I had a patient who had this problem in 1985". So much for my ortho saying "Oh, this is a common occurance in adult orthodontics". Birte Melsen writes "anytime you have a negative result in an orthodontic patient is because your force system was wrong".
I thinking of taking a dental allergy test (Clifford and Melisa). Anyone have that done. Is allergic reaction a possibility? My sister and neice have a nickel allergy. I went into the hospital with acute pericarditis. Cause unknown. Heart doctor didn't mention my braces as a potential, but, since an ortho consult brought up the potential, I'm wondering if I should get this test done (he wants to just remove the braces and control/retain).
Sorry for the long post. I'll keep it shorter next time.
I know it is reallt hard to disecern truth in this business oriented medical industry. and I know me, a random cyber-voice may not have much creed- but I know Dr. nordland's grafts do stay!
Atleast give his office a call.
As for pictures from me- I cansee what I can do. I have to put them together. I kindof want to anyway- a progression series ( I am still way in progress) that is easily accessible and postable.
But I am not very computer savy so it may take a while.
I will need to get assistance from my husband when he gets home later!
All I can respond to is the doc telling you the other docs gratf won't stick and don't look as good as pic- NOT TRUE!
A year later I still have significantly more root coverage than I did before the grafting.
Atleast give his office a call.
As for pictures from me- I cansee what I can do. I have to put them together. I kindof want to anyway- a progression series ( I am still way in progress) that is easily accessible and postable.
But I am not very computer savy so it may take a while.
I will need to get assistance from my husband when he gets home later!
All I can respond to is the doc telling you the other docs gratf won't stick and don't look as good as pic- NOT TRUE!
A year later I still have significantly more root coverage than I did before the grafting.
It makes me so angry to hear that your ortho was so irresponsible!
I know what you mean about "playing the deck of cards you have been handed". I had ortho treatment as a kid, and my parents and I trusted this ortho and let him extract two perfectly healthy teeth. After about three years of treatment, it was clear that there was little or no progress, and we just decided to stop going. Years later I decided to get treatment as an adult, and I found out those teeth should have never been extracted. I was angry at the tme, but I realized there was no way to get those teeth back - just have to move forwards and work with what I have.
I was lucky enough that I did not have any damage or trauma to my mouth, other than those missing teeth, and I was able to find a very, very good ortho who has done amazing things for me. I hope you are able to find the same thing.
Are you planning to report this ortho - so that he doesn't make this mistake on anyone else?
I know what you mean about "playing the deck of cards you have been handed". I had ortho treatment as a kid, and my parents and I trusted this ortho and let him extract two perfectly healthy teeth. After about three years of treatment, it was clear that there was little or no progress, and we just decided to stop going. Years later I decided to get treatment as an adult, and I found out those teeth should have never been extracted. I was angry at the tme, but I realized there was no way to get those teeth back - just have to move forwards and work with what I have.
I was lucky enough that I did not have any damage or trauma to my mouth, other than those missing teeth, and I was able to find a very, very good ortho who has done amazing things for me. I hope you are able to find the same thing.
Are you planning to report this ortho - so that he doesn't make this mistake on anyone else?