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.
When you put braces on a patient like this, the bite gets worse, which means it is more work to correct it. 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:
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!
Robert L. Nisson, DDS MSDDiplomate of the American Board of Orthodontics
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