Finishing with a new gap

[TMJJill]

Hi all,

I went into braces as treatment for some serious TMJD issues. I had an orthodontic appointment today and my Orthodontist surprised me by saying my braces could come off at my next appointment. My bite is now in good shape and my tmjd symptoms are significantly improved. I had a couple things that he discussed with me today though. I have a couple teeth that I'd ground down from bruxing over the years. I've been wearing elastics for most of my two year treatment and they just aren't budging. He has offered to build up the teeth to a proper height. (Yeah for him, he offered to include the cost in my treatment so this won't cost me more.) I can be happy with that. I developed a new gap between my lower canine and pre-molar last month though. My orthodontist said we could pull my back teeth up a bit one tooth at a time in order to close the gap. It would keep me in braces longer, but that doesn't bother me. I asked him about how it would change my bite though and he indicated it could cause me more tmjd issues in the future if they move those teeth and I don't have quite the same support in the back. It was an unexpected discussion on my part. I chose to keep the gap because the most important thing for me health-wise is to have a proper bite. I feel a bit like I'm settling after all this time in braces to end up with the gap.

I'm excited that my bite and health are better and the treatment has accomplished that. Is it wrong of me to be a bit bummed about the gap? It was my choice, but I really didn't feel like I had much choice when balanced against the healthy bite issue.

[Tobilei]

No it's not wrong to be bummed at all! I think you probably made the right choice, if you did this to help the TMJ and it's not going to be helped if you close that gap then you really don't want to be closing it, but you're still entitled to feel upset that it will be there. As much as I'd like to think I'll have an amazing smile at the end, my teeth are so many different shapes, sizes and heights that I know I'll feel a bit down about certain things when they come off too.

Is there any other option to help hide the gap? Maybe a veneer over one tooth or something? I know nothing about cosmetic orthodontics so I'm just pulling that one out of thin air but if you tell him that it upsets you but you don't want to close the gap and cause the TMJ to be worse maybe he'll have a suggestion?

[Snowglobe32]

TMJJILL~

Hello! I am in the same boat as you...my braces will be coming off (hopefully in less than two weeks, if not a month) and I will have a tiny gap. It is from an old extraction, long before braces. We have been trying to close it all year. Everything else is good to go. My ortho wanted to get the gap smaller so I can put an enlarged cap/crown on the tooth, which would close it right up but he now thinks insurance may not cover it because it isn't necessary. Someone on this board suggested bonding...not sure what I will do. It is a bit annoying because a little food gets stuck but after almost 4 years in braces, I am done!

It isn't disappointing to me because I look at my before photos and I see the huge improvement so I am perfectly fine with a small gap. The gap isn't visible at all and it doesn't bother me. What bothers me is the additional time I would spend trying to close it. Who knows how much longer it will take? In February, he thought it would take a few months...well, here we are almost 6 months later...

My advice to you would be to find out what your options are (cap, bonding, leave it alone etc) but if it will effect TMJ, I wouldn't chance it. And you are not settling at all.

Good luck to you!

[TMJJill]

Thanks for your replies.

It is a good suggestion, but I don't think the cosmetic work is really an option. The gap is pretty good size. My orthodontist would love to do some additional work on my teeth even outside of that. He really wants to get all the metal out of my mouth. I have a few odd sized teeth too that don't make for a finished look.

My priority for dental work needs to be coming up with $1000 to replace a crown on one of my molars. My orthodontist is out of network. I didn't have issues with that before because none of the orthodontic costs were covered anyway. I really don't want another dentist to do the crown though because if it isn't done well, it could mess with my bite. I need the new crown because the teeth around it have erupted taller and I need to have it replaced at a taller height to match up so I can chew well. Unless some money magically appears, I think I'll be fitted with a retainer without the tooth being fixed. I also need to figure in getting a sleep study done. Last one I had several years ago was wearing a sleep appliance. I wore class II elastics pretty much my entire treatment just to hold my lower jaw forward at night. At this point, I have know idea how I'll do sleep wise without anything. If I get the sleep study done, without wearing elastics, I'll know if he needs to create me a sleep appliance or adjust the retainer to be a sleep appliance. That is more $$ too.

I took a look at some of the before pictures he took. My smile is more symmetrical which I'm happy about. Otherwise, aside from a small gap between my front teeth, my teeth were pretty straight and my smile looked good to me even before treatment. Of course, I was in pain and had lots tons of hearing which wasn't good. My jaw has now come forward 3mm and is no longer pushing on my ears. My arches have increased significantly (from twin to king according to my dentist) which looks nice. I can see more teeth now when I smile. Several of the teeth that I'd ground down through bruxing have been erupted taller to stabilize my bite. I can't say that the change is obvious at all on the surface though. I'd hazard to guess that when the braces come off if I ran into someone I haven't seen a while they would have no idea I've been in braces.

Snowglobe, 4 years is a crazy long time. I'm only 2 years into my braces. I was in splint therapy first though so my overall treatment has been over 3 years. At least with the splints, I could take them off and floss though. Congrats on your debrace date.

My next appointment is 2 months away. I'm on a cancellation list, but that is the soonest they had to get me in to get the braces off and do the build up on a couple teeth. I think this wait will be the longest part of my treatment. On the plus side though, it is 2 days before my birthday. I'll start 43 brace free!

[pellepee]

TMJJill I have been following your treatment since 2011 when I had started my splint therapy. I am so happy to hear you are near the end! Despite the extra things you still need to get sorted I am so happy for you, and the gap? Personally I like teeth that have a "flaw", it adds character to a person. Not to say people with straight teeth don't have character... but those little things you notice in people you are close to like a crooked smile, a funny tick, faint freckles... it's nice. I have even heard of people purposefully asking for slightly crooked teeth in their dentures so that they look "real". You don't want to look like Miley Cyrus. (Nothing against her just... those teeth are pretty... creepy...)

While not everyone would like that, it could be a way to think about it? I'm a person that needs to have other ways to think about things just to get over them. sayings, quotes etc... it helps me a lot.

I'm sure I could ask my orthodontist but usually question time for me is after he has pulled, pushed and changed everything so I'm all flustered but, do you know how they would make the sleep appliance/splint in the retainer? My prosthodontist did mention that I might have a night-time splint to stop my jaw from falling backwards and while I sleep on my side (because hey presto! My jaw falls back!) Pushing my jaw left or right is not ideal, and I would like to be able to train myself to sleep on my back for the sake of my jaw health. I also find some days if my posture is bad (sitting at my desk or driving) I get jaw pain so it would be nice to be able to go home and know my splint will think for my jaw and I don't have to take codeine.

It is nice your ortho will build up your teeth free of charge essentially. It sounds like he is committed to getting your bite nice and functional for you.

I hope this is still good news for you though. You've been through a tough time. xoxo

[JumpTheDitch]

Don't be bummed TMJJill, you've put it the hard yards & achieved what you probably once thought was impossible - you will have a stable, healthy bite which 1) functions well, 2) looks great, most importantly 3) DOESN'T CAUSE YOU PAIN - WOO HOO!!

How great is it that your only treatment concern now is aesthetic only; you can trust your bite to allow you to live your life without headaches/hearing loss/balance issues/etc/etc/etc! Think back to the first day you got your splint, did you dare dream your treatment journey would be so successful? That at the end of it your only quibble would be aesthetic? You now have a bite you can live with, no more bulky splint or braces, be proud you weathered the storm & achieved your goal

My lower braces go on next week, I'm so not looking forward to going into adult braces again, I'm encouraged & delighted for you that you're almost out of jail!

I also had a sleep study courtesy of my dentist, I did try a night-time appliance for sleep apnea but it didn't make a difference. I finally tried cpap & was amazed by the results, it might be something to try if you're still having A/H events after your treatment.

Congratulations on your debracing, revel in your success, you've earnt it!

[TMJJill]

Thank you both for your encouraging words. I was really feeling conflicted when I posted the other day.

You are correct about my journey. I have come a long way since 2008 when my symptoms started. It took me so long to figure out it was a jaw problem that I was in bad shape before I started my treatments. I had an ear that wouldn't pop (for over a year), intense never-ending ear pain (like a bad ear infection), moderate hearing loss, constant muscle spasms in the face and neck, bruxism. Now, my ear has equalized, it isn't in pain, my hearing loss isn't getting any worse (can't fix what was lost ), and the muscles are happier. I also have the better symmetry that I hadn't even realized was so far off. I know I'll always have TMJD and need to constantly work on keeping the muscles happy, but at this point my symptoms are under control which was what my ultimate goal way. After I finished Phase I, my Orthodontist actually told me that in the industry a 30% improvement in TMJD symptoms is actually considered a successful treatment. I think that is one of the best kept secrets from TMJD patients. It is a tough problem to have and patients have such a wide range of problems.

I had a front gap my entire life and it never bothered me. I like the idea of thinking of my new gap as having character. Just wish food didn't slip into it. I guess I'll get used to it though.

I've never actually been diagnosed with a sleep disorder other than the bruxism. I have other health problems that are very commonly connected with sleep disorders though. That is why I've been monitored for one. My sleep tests a couple years ago were mixed. I've had the splints and/or elastic configurations for over 3 years at night to hold my jaw into place. Even with my better bite, I'm still worried about how much my jaw may be falling back when I sleep without the braces or splints. (You know it is a bit rough knowing I spent $1500 on a wonderfully helpful custom splint before and can't wear it anymore.) My Orthodontist has talked over the course of my treatment about being able to build up my retainer to help at night or actually using a sleep appliance as a nighttime retainer. He didn't actually talk about it at my appointment this week and I forgot to ask until after he had left the room. The assistant said it wouldn't hurt to get the sleep study done so he can look at the results prior to making the retainer. He is trained in sleep dentistry so I know he can help if I need it.

pellepee, the upper sleep splint I wore before my braces had a 'wedge' that came down behind my lower teeth and kept my lower jaw from falling back into my ear when I slept. It also had a small 'beak' in the front that kept my bite at a correct height in conjunction with my daytime tmjd treatment at the time. It worked incredibly well for me. I couldn't touch my teeth together while I had it in and my bruxism 'habit' decreased. I almost cried when I got my braces on and had to give up that splint because it worked so well. I had some adjustment when I got my braces on and went through a bit of a rough period, but the class II elastics at night actually helped keep the jaw forward.

Jumptheditch, I hope your braces treatment this time helps your tmjd symptoms as much they did mine.