Special Techniques and Case Studies

WHEN NOT TO TREAT

 This patient was referred to me for a Class II malocclusion on the right side.  There was mild crowding and her chin was deviated to her left.  The patient was happy with her smile.  The dentist sent her to me because her front teeth didn’t touch when she bit down.

Diagnostic records were obtained.  The records included articulator mounted models which shows the bite when the jaw joints are in the correct alignment.  The top photo below photo shows how the bite looks when the patient bites normally.  In this top photo the jaw joint is not in alignment. The bottom photo shows what the bite looks like when the jaw joint is aligned correctly.  So essentially this young woman has two bites.

When you put braces on a patient like this, the bite gets worse.  You can’t determine this will happen by just looking in the patient’s mouth before putting on  braces.  In other words, with mounted models, I was able to determine that we were dealing with a larger problem than was initially apparent.  The options (with braces) then became:

• Hang a rubber band or a spring on the left side and pull the lower jaw forward and further out of alignment.
• Remove an upper bicuspid and compensate for the bite problem with braces.
• Jaw Surgery
• NOTHING…  DING DING DING DING!

 This patient had perfectly healthy joints and muscles and almost zero tooth wear.  She was happy with her smile.  She had a good bite of her back teeth and the eye teeth worked fine when she chewed.  Why treat a perfectly healthy and esthetic situation.  Orthodontics could make her bite and joint health worse.  I have spent a great part of my career learning to detect these types of problems BEFORE starting orthodontic treatment.  Relatively few orthodontists have this type of training. 

Some of the happiest patients I have ever had are those for whom I say they don’t NEED orthodontics!