Profile change - too protrusive?

[msbee]

Hi everyone!

I'm 5 months into my treatment, and it's been good so far, my teeth are straight, I'm onto my finishing wire...

A bit of background - my main issue was overcrowding, with a mild overjet and overbite. I didn't have any extractions, my wisdom teeth are still in place, and I've got metal Damons.

Ok, so here's what I'm concerned about and hoping for some advice. I feel that my lower row of teeth are too protrusive now, as the orthodontist has "raised my bite" so that I don't have so much of an overbite - apparently 1-2mm is ideal? She told me that without the support of my lower row, the upper row may become more retrusive, and my upper lips will not have the support and may flatten. -- Which all makes sense to me.


Well, below I've posted some sihouette photos I created. The 2nd photo has a fuzzy outline, but you can see that the lower lip is clearly protruding beyond the red line. I don't think the brackets contribute much to the protrusion of the lips coz they're really small...

I suppose without extractions, there's no way for the teeth to go but outwards, and this is something I have to compromise on? I suppose it's not worthwhile to sacrifice my premolars for an improved profile, and with the possible risk of flattening of the nasolabial angle?

I'd appreciate any thoughts you guys have on this! Thanks for reading!

[classII]

Interesting question. Similar ailment, slight overjet, slight overbite, no extractions. 3 years this month bottoms only needed 12 months out.

I think your 5 month picture is off. The jaw looks more recessed than in the pre-braces. But having a look at all your pics. With your laterals flared forward like that you would think that they would cause your upper lip to protrude like in the 5 month picture, which they do not. On the bottom, in your early pics, the front 4 are almost flat, and now that its rounded out very nicely even after only 5 months, you're thinking its filled in and pushing your bottom lip out. I'm not sure it works like that. Just feeling my lowers right now there seems to be tons of room and moving the bottom lip around doesn't even feel like it comes close to "stretching" around my now corrected bottom arch which is even tilted very very slightly forward. Meaning I don't think, or at least for me, feel, the bottom lip is supported as drastically or tightly around the teeth as with the top arch -- which totally defines your top lip as it stretches even when you smile.

Similarly with the top arch, and the original flared laterals,which are forward beyond the normal line and thinking they would be pushing the top lip out, now they are correctly position along with the centrals to create a round arch, you'd think based on that, the top lip would be less supported than before, yet it is not, based on your 5 month pic, it only appears to be in that sillouhtte. Which I don't think it can be and is the reason I think your photo is off.

What I can say is that throughout the process, my tops went through massive changes. Same story tipped back centrals (in my case laterals as well), first straightened out, the agressive flared forward which revealed the gaps between the canines and laterals ( tht was the amount of the overjet), then re-angled and everything repositioned and closed up (entire time the centrals 'locked' and combo backs moved forward to fit the bottoms etc.).

Point being there is it is still to early be overly concerned how it looks right now. Still a long way to go. The other thing that comes to mind is you should be measuring straight down from under your nows to the end of your chin amd against the teeth and not the lips.

[classII]

p.s. which if you do that, just having closed this post and seeing your pic and the lines, you'll see why I suspect that 5 month silhouette is not correct. Looks to me like your head is slightly angled or looking to your left in it.

[msbee]

Hey class 2, thanks for the reply.

Like you, I don't have problems with lip incompetence, I can close them easily my lower lip isn't stretched out. Which is comforting.

But yeah, I don't like the flaring of my teeth currently, can that be corrected even though I have absolutely no space btwn my teeth?

I couldn't find a thread with your story, could you post the link if you have one so I can see some pictures?

I know 5 months is early days yet, but the reason why I'm bringing this up now is because my orthodontist told me at the start of my treatment that I could choose extraction 5-6months on if I don't like the protrusion/toothiness.
I really hope that like you, everything can be re-angled and repositioned ...Sigh.

Similarly with the top arch, and the original flared laterals,which are forward beyond the normal line and thinking they would be pushing the top lip out, now they are correctly position along with the centrals to create a round arch, you'd think based on that, the top lip would be less supported than before, yet it is not, based on your 5 month pic, it only appears to be in that sillouhtte. Which I don't think it can be and is the reason I think your photo is off

You're right that my top lip is well supported - the nasolabial angle is the same pre and post braces, about 110 degrees, and I'm happy with that...
I'm concerned about the lower lip protrusion, which I think may be because of the lower row of teeth flaring out?

I wasn't rotated in the photo but nevertheless, I'll try to take another profile photo and post again

[classII]

No pics or story. Just looked at your 5 month pics, that second small pic of the profile, does indeed show or look like the lowers are flared forward quite a bit. What does the ortho say about that? My over bite is being fixed by intruding the front 4 on the top, and that was also done on the bottom when it was braced. Is the ortho going to do that your bottoms as well. The whole thing is about the Curve of Spee



What is the diagnosis of the bottom front 4, over erupted and do they plan on intruding them? that would reduce the angles. Extractions would be +/-2mm closures, say 1.5mm if controlled (pulling the backs forward and the fronts back fractiononally so as to not create incompetence. I think the key is to find out what the plan is with the bottom, doesn't look like it should be flared like that at the end. If it is (or will be) and if extractions would be too drastic, perhaps IPR would be the solution. Seems a bit unfair when the ortho asks you if you like it like that or not when there should be a set or technically correct position that they should be in a the end of treatment.

I'd recheck what the master plan is and if after only 5 months the bottom is expected to be like that at the end of treatment. Have you discussed it now at this 5 month phase or are you running your own analysis before doing so?

[classII]

I should read your story more carefully its known to be over crowding from the outset, but I'd still ask the ortho to determine if the profile has indeed changed for good a this very early stage, what the options are (extractions, IPR, intruding, other), and what difference in actual measurement will there be. To determine if its actually worth it. My view is that you should have always looked like that had your teeth never had never been a problem unless its technically over some or the Golden Rule or Measurement number (whatever it is). In other words if your teeth were always straight would an ortho have said while you have prefectly straight teeth and a perfect bite you have too many teeth and would look better if you had extractions and reduced the size of your arch. Does it look abnormal now or just different because it is fixed and only looks slightly different to than before.

Have a look at gracey82's story similar in no extracts full set and some IPR work to balance everything out to her liking.

viewtopic.php?t=31880&start=0&postdays= ... highlight=

[msbee]

Hi class2.

during my 5th appointment a few days ago, I asked my ortho about the lower row being protrusive and she said that it's to support the upper row - to avoid flattening of the nasolabial angle.
So I guess it sounds as if this is the result that she wants!
I'll have to ask her directly if this is the final appearance I can expect coz the more I look at myself, the more I feel it's not what I want.

I feel almost like a grouper!!


Thanks for gracey's link, it does look much better with the IPR, I wonder if that'll work for me, without making the nasolabial angle too obtuse.

Perhaps if I can have the lower incisors intruded just like you did, and consequently create more of an overbite, that'll make it better?

[fosterp]

You aren't making a correct comparison of profiles because in the pictures the orientation of your head is not the same. In the pre brace photo your head is facing straight while in the 5 month photo it is slightly tilted downward

any change in the relation to your chin and nose is probably due to the increase in anterior facial height due to eruption of your posterior teeth to correct your overbite

[poppy123]

....omg this thread has totally lost me!

[classII]

Very confusing.

Just re-read your story. You don't still have the molar build ups do you?

That 5 month profile pic, if you could close your moth your bottom teeth would be behind the tops and I can't see how it would touch or push out the bottom lip as in the 5 month silhouette. If that pic is biting down onto the molar buildups, then as in the picture the teeth look like the
first ange below which may be what you are seeing.

Once set and once you can close it should be like the second angle below.

Has the ortho flaired the bottoms to compensate or camouflage the overjet?

It can be from 0 to 4mm.They could reduce the angle as 3 below coupled with intruding if it you think it is protruding too much.

However, first I think its obviously best to determine if there is actually a problem right now and its not the photo is off or is created by the mouth being open due to the molar buildups. Ask the ortho to show you on that "schematic" hand drawn pic of your teeth with the lines and angles they have, if for sure a the end it will be "x" protrusion which for sure will push the lips out etc. If that is true, then what can be done without having extractions to reduce it. IPR, reduce the angle and increase the overjet (within tolerance) if so, what would the consequence be there, other.

Off the bat it would have to be massively over-flaired all round to create such a huge difference in the lip structure as it appears in the 5 month sillouhete, so massive that it simply cannot be correct. Other than just a phase in the process (as mentioned mine were intentionally agressively flaired while magic was being performed elsewhere -- then reduced once that was done), or not. Just eyeballing the actual pic, if you do have molar buildups and they were removed, how would you close your moth (aside from the lower brackets being there). The angles look all wrong, you'd bite down the lowers would hit the uppers immediately and slide back forcing your jaw backwards.

note of course: I'm no expert other than fully monitoring my own from the outset and others similar to it. But overall the big picture to me just doesn't look correct or maybe ready, to make any determinations as to the final outcome. Yet.

[VA5]

Well I think it's obvious to anybody looking at your before and after that your bottom is definitely protruding more than before. And it makes sense b/c if you don't get ipr or extractions and all you want is to straighten your teeth, then your teeth have nowhere to go but outwards. So that's what happened with your teeth. If you think extractions is too much to get, to improve your profile, then I'd definitely at least look into ipr.

[fosterp]

Well I think it's obvious to anybody looking at your before and after that your bottom is definitely protruding more than before. And it makes sense b/c if you don't get ipr or extractions and all you want is to straighten your teeth, then your teeth have nowhere to go but outwards. So that's what happened with your teeth. If you think extractions is too much to get, to improve your profile, then I'd definitely at least look into ipr.

That is not true at all. The relation of the upper and lower lips have not changed. It looks like it has changed because of the way she drew the line from her nose to her chin, but the change is not that her lip is protruding its that her chin has moved downward and back which is due to the correction of the overbite.

And teeth do have a place to move besides outward. They can move laterally, which, if you have done any reading on the "damon approach," is precisely what they do to correct crowding.

[VA5]

Well I think it's obvious to anybody looking at your before and after that your bottom is definitely protruding more than before. And it makes sense b/c if you don't get ipr or extractions and all you want is to straighten your teeth, then your teeth have nowhere to go but outwards. So that's what happened with your teeth. If you think extractions is too much to get, to improve your profile, then I'd definitely at least look into ipr.

That is not true at all. The relation of the upper and lower lips have not changed. It looks like it has changed because of the way she drew the line from her nose to her chin, but the change is not that her lip is protruding its that her chin has moved downward and back which is due to the correction of the overbite.

And teeth do have a place to move besides outward. They can move laterally, which, if you have done any reading on the "damon approach," is precisely what they do to correct crowding.

Well appearance wise (forget her line), it does appear her bottom lip is protruding.. even w/o looking at the chin. I personally would not want that to happen to me. Is there a way to correct the protrusive appearance? Maybe that's what she'd like to know? She doesn't seem to like it either, she likens her appearance to a fish, after all.

Well I have never read anything about the damon approach. So they push your teeth laterally, meaning they widen the arch? How come my ortho and all the other ones I consulted with, didn't give me that option and instead told me I needed to extract to get rid of my protrusion?

[Flaka]

I feel almost like a grouper!!

I know what you mean. I feel like a barracuda.

[msbee]

Flaka: I really hope things get better for you too, it's quite annoying to feel your lip sticking out isn't it? For a moment yesterday, I felt as if I needed some extra effort to pronounce the consonant "b" too! Eeps!


fosterp: I sure hope you’re right, that the arch can widen further to accommodate the teeth – I am on the Damon system currently. =)
While I agree that the degree of tilt of my head is different in the photos, the reason I drew the line is because the relation of the lips to the nasomental line does not change despite the orientation of the head.



I’m not sure if my chin has receded – that was a thought I was entertaining, but I haven’t gotten round to measuring the mentocervical angle yet.

Class2: My molar buildups were removed last month. My molars meet, but the bite isn’t perfect.
When I asked my ortho if the bottoms were too protrusive - she said it’s ok, and it’s to support my upper row.
Perhaps this isn’t the final outcome I can expect, I sure hope it isn’t!

classII: Just eyeballing the actual pic, if you do have molar buildups and they were removed, how would you close your moth (aside from the lower brackets being there). The angles look all wrong, you'd bite down the lowers would hit the uppers immediately and slide back forcing your jaw backwards.

I don’t understand your question? Right now, both my upper and lower incisors meet, they don’t hit the brackets at all.

VA5: Is there a way to correct the protrusive appearance? Maybe that's what she'd like to know? She doesn't seem to like it either

Yes! VA5, that’s exactly my question. I know that the person I should really be speaking to is my ortho, but everyone on this board has a wealth of experience to share, and it’s always so educational to read have you guys have to say.



So to rephrase the question –how do I get my teeth to be less proclined/flared without excessive flattening of the nasolabial angle? Perhaps IPR the answer…I hope so at least.