Treatment plan opinions?

[baroco01]

Hello all,

I am a new member, 29 years old and just had an ortho consultation. I would just like some opinions here from the many seasoned members of this board.

I have fairly crowded upper teeth and mildly crowded lower teeth. I was offered free braces when I was younger but refused due to needing two teeth extracted - young and foolish etc.

As my ortho consult appointment took a couple of months, I decided to run a small experiment first and see if SmileDirectClub would take me as a patient. Bear in mind that I know I am 100% not suitable for any such treatment and this was purely to see what happened - the SDC consult was free.

The 3D result of that is here: https://smiledirectclub.ie/en-ie/treatm ... 683e57560/

As you can see, the result is ridiculous in the sense that my top teeth would be miles ahead of my lower teeth, angled forward. Yes, they are technically straight - but at what cost? I think we can all agree that SDC here should have refused me as a patient.

Anyway, the real ortho consult went very well.

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Ortho pictures: https://ibb.co/7YT2MXQ
My own pictures:
Front: https://ibb.co/Ry1vB2C
Upper: https://ibb.co/0jG4zp4
Lower: https://ibb.co/6mdCs1r


My report 'stats' first:

• Extra Oral: Severe Classs II Skeletal base,
Normal TMJ function,

Intra Oral:
• Class II Division 1 incisor relationship,
• The overjet is 8 mm
• The overbite is 9 mm non-traumatic
• No open bite is evident,
• Right molar full unit Class II,
• Left molar full unit Class II,
• The upper and lower midlines are coincident,
• Good oral hygiene,
• No crossbite evident,
• No displacement evident,
• Upper incisors are rotated,
• Lower arch mildly crowded

The "in an ideal world" treatment would be lower jaw surgery and braces to fix my 'slightly retrognathic mandible'. Obviously that is not an option here considering its simply not worth it.

UR5 and (potentially - in time) UL5 have to be extracted. Initially the ortho indicated the two teeth needed to come out but after thinking about it, he wrote in the report that he was concerned there would be too much space and best to just take out the right one first and see how things go over a few sessions.

Standard full metal on top, ortho didn't believe invisalign could do my rotations (They have had bad experiences in this regard in the past) and even if it could, the two years of exact patient compliance is tough apparently.

Plastic on the bottom for the slight crowding (They 3d print their own version of invisalign).

Elastic bands to help the bite. Slight prominence of upper teeth will need to be accepted without jaw surgery - but far better than current.

Miniscrews/implants to aid movement.

Retention post treatment.

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The reason I am posting here is that I am sure many people have a set of teeth more or less like mine and just would like some opinion on the treatment plan. Realistically I cannot see any way to do it with a tooth or teeth out. There just isn't the space on top and as the SDC 3D model shows, straightening them as is would cause more issues in other ways. I am not too happy about the miniscrew thing, but I am sure I could get used to it. I think its more the thought of it, much like the thought of getting a tooth out - it horrifies me!

Thanks,
Barry.

[djspeece]

Hi Barry, Congratulations on starting your orthodontic adventure. I don't think anyone here is qualified to comment on the quality of your plan, but from the available data the plan seems reasonable. Your teeth and bite appear to be in relatively good shape. I'm not certain if you think you need an extraction that is not included in the ortho's plan, but keep in mind this sort of decision can be made down the line as your teeth move. I had the mini-screws to encourage a couple of stubborn teeth near the end of my treatment. My initial two-year plan stretched to three because of slow tooth movement. At the time I was in my early 60's, and I know that I have very dense bones (when I asked about the slow progress, my ortho replied "Well Dan, some people are just more dense" and then laughed at his little joke. I enjoyed his humor and managed a few pay-backs along the way.) This therapy was called ""Propel," and my ortho offered it for free to give it a try. I was aware of the underlying physiology and at that point was willing to try anything. The marketing materials present the miniscrew insertions and removal as just slightly uncomfortable, but for me it was outright painful. I did the first go-round without anesthesia, but when it came time for round two I insisted on getting numbed up, and he brought in my general dentist (they share office space). I'm not sure if the Propel treatment really helped or not, to tell you the truth. As a funny aside, once the session is over they had me walk over to the sink to rinse with some antibiotic mouthwash. Well, I can tell you that when both sides of your lower jaw and face are numbed up, rinse and spit is a disaster, with the solution spilling out of my mouth and all over my shirt, sink, and so forth. I walked back to the chair drooling with my head held high as though nothing was wrong, but the entire room was ready to burst out laughing.
I am not a SDC fan in any way, shape or form.
Best of luck to you.

[baroco01]

Hi Dan,

Thanks for the quick reply. No, I believe the extraction (Or two) is basically necessary as there isn't any space. If you look at that SmileDirect 3D model of their results without extractions you will see that my top arch is far out from my bottom!

I'm not too worried about those miniscrews, its more the tooth extraction. Everyone I speak to though tells me they really are quick and painless. To be fair, the UR5 that is being taken out has had a root canal a year ago. That was another treatment I was dreading and it turned out to be less painful than some fillings I have had!

The only other thing that slightly concerns me is the chance of my face changing shape, lips changing etc. I will mention that to the ortho next time but I am pretty sure its a minor risk considering the amount of upper crowding. I also read some studies on facial changes after ortho extractions and the general consensus was that there was none/minimal.

[baroco01]

I forgot to say that the way I am looking as the cost/benefit of a tooth/teeth removed is that the probability that I will need a tooth out in the rest of my lifetime is quite high and the benefit here is a straighter upper arch which, in theory, is easier to clean so less caries. So why not get it out now to my benefit as opposed to later under duress!

[djspeece]

That all makes sense. Best of luck!

[baroco01]

Small update on this. I have had my first extraction yesterday, my previously root canalled premolar on the right. I really shouldn't have dreaded the extraction process, its totally painless and perhaps three minutes of discomfort! The worse part is trying to eat/drink after it. It's not even sore, even though its an open wound.

Onto my ortho appointment in a few weeks! I will update this thread if that is okay.

[djspeece]

Congrats and keep up the good work. The board is quiet these days, but eventually some of us old-timers check in. Best of luck to you.

[baroco01]

Update again on my journey. I have my ceramic uppers on about one month, one week. The experience has been fine so far. I have come to terms with just not being able to use my front top teeth for eating anymore! Some discomfort now and again but perfectly manageable. The only two downsides are the slow flossing and clear ligature staining from my black coffee addiction. I am getting my ligatures changed later on this week and I think I will choose a solid colour simply to reduce staining.

In terms of progress, I can definitely already see some. I am surprised as I thought adult movement was supposed to be significantly slower! You cannot really see it in the head on picture below but my front two incisors have definitely rotated a bit towards where they should be.

https://ibb.co/RpkP1jR

Here's to many more moths of effective movement!

[djspeece]

Congratulations on your great progress! Flexibility is key with braces, as you are discovering. The path to the goal is seldom a straight line, as many of us have discovered. I used silver power bands etc. which did not show stains very easily -- no way I am going without coffee! Also, I discovered that interdental brushes AKA Christmas tree brushes were a very effective substitute for traditional flossing. I dipped them in mouthwash and quickly was able to get the job done. You can check out many similar stories on a very funny thread with the subject "Confess your orthodontic sins" which you can find via the search function. Some days you just need a smile, and that thread will probably do the trick. Best of luck to you.