Solving this mess - what would you opt for?

[Beks]

Just out of curiosity, if you had your (extracted)tooth there, would you like your smile? You mentioned not liking how your smile currently looks. If you would like it if your tooth were there, I suggest going with the implant, ending the orthodontic treatment, and getting a retainer placed. That my opinion, of course.
The orthodontist/patient trust sounds awful, and I just cant see you being happy with anything she does, unless there is some some of compromise from this point forward. You don't like the position she put you in, it was wrong. But can she fix it so that you no longer have TMJ issues? She doesn't seem trustworthy based on your post, but perhaps another orthodontist can assist you. Only, you have to be prepared for them to work with the issue that she caused. If the only possible way to fix any of this is extraction, would you go with that treatment to fix your bite completely? I know you said you wouldnt, but you have to be prepared mentally for them to ask you that, if you think they would. If that is the only way to fix all of the issues, aside from getting an implant, then an implant seems to be the best course of action, and putting it off longer will just be more frustrating. I sincerely hope you can find a solution that works for you. I had a 7 mm midline shift when I was in my teens because a dentist told my parents it was the only way to fix my crowding. They extracted 1 tooth, and I absolutely hated how my smile looked after everything shifted. Promises of a spacer never happened. To fix that as an adult, with the overcrowding, I opted for the best thing for me.... which was to extract another tooth on top, along with 2 on the bottom, and pull my midline back to the center. Its helped my bite tremendously. I don't feel like my mouth is smaller at all, because the arch has "filled out" from all of my teeth being a jumbled mess. While I had a V shaped arch on top and bottom, now I don't.
With that said, if I didnt feel comfortable pulling a perfectly healthy tooth, there's no orthodontist in the world that could make that better. The implant sounds like a great way to achieve what you want. No shift in midline, and your teeth/smile almost back to normal.

[pcspinheiro]

Hi Becks and thanks for your thorough reply!
Even if I had that tooth I would still dislike my smile because she messed with the vertical positions of my front 6, making them all aligned by their tips, hiding half of my teeth when I smile and leaving a horrible gum line. To me, accepting ( hopefully without depressing...) a small midline shift is the least of all evils when my horrible smile is reset, so to speak. My mouth is narrower and my speech is altered (she won't admit to either) and an implant would void fixing these things later, which I probably will need to do... horizontally my teeth are fine and I could happily live with the current slight overjet, or a little more, if that tooth was present. But I was lied and scared into thinking my teeth would look horrible without extractions due to lack of space for all of them, so I took her professional opinion seriously and did it. Luckily, I chose to extract first on the side that was clearly a little crowded. I don't trust this ortho at all, and I have good reasons for it. You can't just lie to an adult to get them to do what you want, ignoring their only and real complaint and putting them on a long, harmful and unnecessary treatment. If this was the US she would have been sued a long time ago, but here it's just not worth the hassle... The problem is that no other Ortho that I saw until now accepted to take me in. They all agree on the wrong that was done to me, by ignoring my objective and chief complaint to lead me down this path with wrong information. But basically, her wrongdoing her problem to solve, that's how I read it. But even after the extraction, the problems with TMD, the awful smile, the most frustrating is that she won't change her ways... She could have changed the brackets when I complained about the smile over 1 year ago, as I was still on very thin NiTi wires. But she didn't, as "this is how it should be". She could use a reverse wire on the bottom to open my bite mainly by intrusion of anterior teeth to avoid messing more with my bite and worsen my TMD, and I've asked this repeatedly for many months now. But she won't. I feel trapped, I need to get free, but I can't let my teeth stay like this as I hate them so much. Same deal with closing my extraction gap; she must have used several Kg of force to insert the rectangular wire into the molar tubes ( I even had to complain that it was too much force and I feared she might break a tooth) and then she's trying to close the gap using friction mechanics with a little elastic ligature - the same that hold the wire to brackets - as the sole source of force. I though I would get a strong spring, so I called her attention to the fact that I did not believe this would do it. It's pure physics, god damn it! If you need to exert "x" Kg of force to insert the wire and win over the friction, then you need "x" + "z" force to make things move! Quite obviously and as expected, NOTHING is moving after 2 1/2 months in! On my recent appointment 2 weeks ago I even suggested that we cut the wire shorter so that only the 1st molar an 2nd premolar were being pulled (leaving the second molar out for now, to reduce the friction and force needed. But no, again my suggestion was readily dismissed as "my first molar would rotate". Then again, won't my second rotate if her plan could ever to work??? And even if that would happen, isn't it better to have my first rotate as it can be corrected using the other teeth for anchor on both sides? It's just so frustrating to see her doing things wrong (now that I know better) and not being able to do anything about it! I was sincerely hopping to end this by December, but closing my gap at a rate of zero mm/month won't do it. Plus, she's not doing anything in parallel, she won't work on my smile, she won't work on my lower teeth (I've have the same arch on the lower teeth for over 10 months), I've had the extraction gap for over 1 1/2 years!

My mind is dead set for my next appointment: either she starts doing something different (friction-less mechanics, for example) or I'm asking to get the braces off. Period. I'm sure it will do me good to spend my summer vacation not wondering about my next appointment.

[pcspinheiro]

So, to those that may have followed my ranting about how bad things were going with my ortho, I debraced yesterday. I had posted elsewhere but I guess this is the right site for it. Things were going nowhere, with her insisting on impossible mechanics to close my extraction gap, so I just told her i wanted my braces
off, period... In fact, the combination of wrong torque being applied to the canine on that side (I so told her about it months ago!) and the opposite force on the front teeth, that could not dissipate through tooth movement, were causing my front teeth to get crooked again but in different ways. I had to remove the laceback and wires myself before this last appointment. One day brace free and they are straight again (no retainer). I'm getting an MRI in 3 weeks (150€, since if done for free through the health system it would take well over 1 year. Glad I'm insured!) to check up on my TMJ, but I have to say that 1 day brace free and I feel less stress on it. Can be placebo, but I think the braces were forcing my mandible to bite too far back and probably a bit crossway due to bracket conflicts on the canines.

I'm glad I took this decision, but it only came too late...

I'm seeing a new ortho in September to see what can be done about my current issues, and how. And another one after that if I don't like what I hear, then another and another, until someone proposes a plan I'm comfortable with and goes along the lines of what I believe is needed.

Cheers!

[djspeece]

Best of luck with the next round! Enjoy the summer until then.

[pcspinheiro]

Thanks!
What really annoys me the most is that I could be done for good! Had she accepted that I did not like this stupid smile 1 1/2 years ago; had she not pushed for unnecessary extraction. I'm not even talking about leveling the lower teeth and setting my bite right,as it would be ok if left alone... It still annoys me, but a little less now.

[assertives]

Thanks!
What really annoys me the most is that I could be done for good! Had she accepted that I did not like this stupid smile 1 1/2 years ago; had she not pushed for unnecessary extraction. I'm not even talking about leveling the lower teeth and setting my bite right,as it would be ok if left alone... It still annoys me, but a little less now.

Let it go. It's over, just focus on fixing the issue at hand and then go about your merry ways! While it could have been good, it could also have been way worse.

All the best for your next round!