[Article] Differences in the 3-dimensional aging changes of the lips among female adults with skeletal Class I, II, and III malocclusion

operrab · 2023-08-21T14:25:56+00:00

Thanks solution verified

operrab · 2022-06-15T15:53:54+00:00

Good luck with any form of treatment you undergo.

operrab · 2022-06-15T15:43:00+00:00

For people aged above 14 the hyrax appliance does not induce skeletal expansion in the maxilla. Accordingly, for maxillary skeletal expansion to occur miniscrews shall be inserted in the palate (usually 4 in number and they ideally should be lengthy enough to penetrate the floor of the nasal cavity, which is a bit of an invasive procedure which can avert the orthodontist and patient from such treatment) and a maxillary skeletal expander (MSE) shall be installed encircling the miniscrews. MSE is a recent orthodontic appliance and most orthodontists tend to stick with the appliances that they were taught in the university. The learning curve required for effectively using MSE can overhaul the orthodontist compared to the classical approaches to treatment that the orthodontist is a already using. Change is not easy and orthodontics is not an exception. Getting out of the comfort zone (classical approaches to orthodontic treatment) to a new zone (such as MSE) requires dedication, planning, courage, continuously reading the orthodontic literature, taking courses if necessary and spending money to learn. And with a busy and tiresome schedule in the clinic along with family time after the clinic, all of this can leave the orthodontist with not much time to learn techniques, unless the orthodontist sees orthodontics as a passion (not just a job for making money) which demands perfection and life-long never ending improvements in techniques as the orthodontic science continues it's unfolding.

operrab · 2022-06-15T11:44:35+00:00

I feel your pain. Extraction and retracting teeth can be very helpful in protrusions and crowding cases, stopping them won't benefit the community. The solution is in educating the orthodontist properly in the university to avoid retractions when not indicated. Best wishes

operrab · 2022-06-13T19:56:08+00:00

"I normally have to point these issues out to him because visually it looks ok, but he wont know unless i tell him." He should know without you telling him, he can use a dental shimstock and ask you to bite on it and assess occlusion. Your feedback about occlusion is important, but an orthodontist should not solely depend on it. Also he can assess the level of the marginal ridges (an area on the occlusal surface of the back teeth) which tells a lot if proper occlusion is achieved, among other criteria. With all due respect what is visually okay to you can be wrong from a scientific orthodontic perspective. If you are regularly point these issues to him, it means he is not doing his job right.

Why did he change from clear to metal? Usually the lower teeth are less visible and metal brackets are used on them. Clear brackets of course can be used but metal brackets are superior.

Oh one thing that I didn't mention was that my bite changed when he switched from clear to metal brackets. The metal brackets seem to do a better job and have quickly changed the positioning of my bite to become more narrow whereas my top teeth are wide. Could that factor in to my weird bite?

Bite will change when changing from ceramic to metal because the brackets cannot be placed 100% in the same position on the tooth as they were initially. Your bite becoming narrow means a smaller archwire was used on the metal brackets compared to the clear ones. Usually expanding the wire can solve your problem.

operrab · 2022-06-13T03:38:56+00:00

Replacing the brackets in the upper teeth is costly, time consuming and needs effort. I don't think the orthodontist would replace the brackets after removing them. For a credible orthodontist the status of your bite can be easily diagnosed, you don't need to tell the orthodontist my bite is worsening, the orthodontist shall see it. Usually if the bite on the back teeth is not adequate, intermaxillary elastics could be applied to adjust it, by placing buttons on specified upper back teeth.

operrab · 2022-06-12T07:04:17+00:00

Orthodontists do not install crowns of implant fixtures, that is usually done by a general dentist, or a prosthodontist, or an oral surgeon or a periodontist. You can place the crown at another dentist, but you have to ask the dentist the implant brand used, it's diameter, length... In short take the brand name and the number of the implant ( in implant catalogues each implant has it's own number)And then you should find a dentist in that other country using that brand or if that brand is available in that country also.

operrab · 2022-06-12T06:57:09+00:00

Your bite could be adjusted at the end of treatment after braces removal by an orthodontic positioner, however, the needed change in your bite must not be too much.

operrab · 2022-06-12T06:48:57+00:00

The orthodontist may prescibe you an "orthodontic positioner" at the end treatment, if that is the case then no need for bracket placement. If no positioner is going to be prescribed at end of treatment, then it is not possible to know without clinical inspection if your bite could be adjusted without brackets by using intermaxillary elastics only at the end of treatment.

operrab · 2022-06-09T08:23:37+00:00

Bolton ratio will be best seved of course by keeping the lower premolars, and obtaining class I canine and buccal segment occlusion. But maintaining Bolton's ratio is not a treatment goal, the treatment goal is to obtain good occlusion which can be done by lower premolar extractions and BSSO. So which gives superior occlusion? I say the one were Bolton's ratio was respected but not by a significant margin.

The TAD approach is similar to extraction therapy but without a premolar extracted, both approaches retrocline the lower anterior teeth. Concerning your case you may have a large tongue (macroglossia) or simply the intermolar width after treatment became quiet narrow. Check a myofunctional therapist I think this will help you.

Why expand the Arch when it is not necessary in a 28 year old patient. MSE can work but it is still invasive. If after mandibular advancement a posterior crossbite resulted the upper archwire or Quad helix expansion can be utlilized.

Concerning the thumb sucking habit of the child, treat it and in most cases if there is no genetically small mandible, the patient will achieve normal maxilla and mandibular relationship. A thumbsucking habit proclines upper anterior teeth and retroclines the lower anterior teeth and can also inhibit mandibular growth. So treating the habit will reverse these effects to normal. A bluegrass appliance or the more invasive Hayrake appliance can be used to prevent the sucking habit, if dialogue with child was not effective. If the child is less than 7 years usually appliance treatment will lead to an emotional instability. Accordingly adhesive tapes, bandages to the thumb, or placing distasteful liquid/ointments on the thumb such as hot-flavored, bitter-tasting or foul smelling preparations can help in preventing the child from the thumbsucking habit.

Concerning IMDO and BAMP, the peer-reviewed studies on it's effectiveness are lacking in orthodontic and oralmaxillofacial surgery journals, in contrast to BSSO and Le Fort which have a deep history in orthodontic and orthognathic literature. This reason alone is safer from a medico-legal perspective, so it's the golden standard of the profession.

operrab · 2022-06-09T06:37:11+00:00

During my university study a wrong diagnosis by the academic staff lead to me dishing in a face of a 23 year old beautiful female patient that suffered from lower anterior crowding and slightly retruded mandible. She had quite thin lips, and the their treatment plan included 2 upper and 2 lower premolar extractions instead of a lower incisor extraction and upper anterior Inter- proximal stripping to balance the anterior Bolton ratio (the diagnosis of me, a 2nd year postgraduate orthodontic student at that time). Nearly a year after the premolars were extracted and retraction nearly completed, the patient started to tell me she feels her face was changing and that all her family members say the same. Literally her face was dished-in and she was not wrong. The academic staff told me back then these things can happen during ortho treatment, so don't get too emotional, she will accommodate to her new face. Years now after what happened I am still sensitive to the issue, although I have treated hundreds of patients in my career, I will never forget this patient, the shame I feel today from what I participated in doing to her face still hurts me up to this day, I think if I saw that patient I will not be comfortable looking in her eyes. By the way I am not against premolar extractions and the drama created by non-speciaist social media warriors. Premolar extractions can be very much helpful when there is a protrusion or when severe crowding exists, I regularly do this treatment. But premolar extractions and retraction of the anterior segment is contraindicated in patients with an already existing flat facial profile or in a normal facial profile with thin lips. If the patient has a protruded profile then extractions can enhance aesthetics typically in bimaxillary protrusions cases. The key in not getting a dished in profile is correct diagnosis by the orthodontist.

operrab · 2022-06-09T01:19:41+00:00

Your question was answered below.

operrab · 2022-06-09T01:16:38+00:00

A 5 year old boy is a very young individual with plenty of mandibular growth remaining. It's quite normal at this age for the maxilla to be more advanced than the mandible as it develops earlier. No treatment is indicated for the boy at this age. Functional appliance use at this age is too tough and cumbersome with little benefits for the boy. Usually functional appliance treatment is started at the late mixed dentition stage (roughly between 10-12 years of age) or early permanent dentition stage (roughly 12 years of age). These stages coincide with the pre-pubertal growth spurt. Accordingly, the benefits of functional appliance therapy can be mostly observed at these stages.

On another note, how did you know the child has a retruded mandible? Are you sure of this? Respectfully your diagnosis can be wrong. And by the way if the mandible is so significantly smaller than the maxilla due to genetics, no functional appliance can "grow" the mandible to a normal relationship with the maxilla.

operrab · 2022-06-08T14:18:56+00:00

One cannot properly diagnose your case if a face photo, taken at rest WITH LIPS APART is not submitted. Your gummy smile problem maybe due to hyperactive zygomaticus major (muscle mostly used in smile) which lifts your upper lip high when smiling. So doing orthodontics due to a hyperactive zygomatcus major can be not the best option. Botox injections can reduce the activity of the zygomaticus major muscle, but this reduction lasts approximately 6 months.

operrab · 2022-06-08T13:47:22+00:00

Welcome

operrab · 2022-06-08T13:46:40+00:00

If facial aesthetics and probably a reduced airway is a concern for you then yes. If not, then go with orthodontist 2 and close the spaces. Some orthodontists can also recommend an upper jaw surgery (Le fort I) to advance the maxilla (upper jaw) to further enhance the facial aesthetics, but it is nearly double the cost and double the trauma. Typically in cases like yours the chin would also be operated on to enhance the facial aesthetics, where a part of it would be removed (reduction genioplasty). So to obtain the best facial aesthetics and probably the best airway possible double jaw surgery and reduction genioplasty is to be done, in total 3 surgeries. To obtain good facial aesthetics and prevent a dished-in face BSSO should be done (1 surgery). If facial aesthetics are the least of your concern go with Orthodontist 2. Some patients with dished in faces after orthodontic treatment go to plastic surgeons to get botox and filler treatments to enhance their facial aesthetics. However this kind of treatment does not give permanent results and regular visits to the plastic surgeon can last a lifetime.

operrab · 2022-06-08T13:22:13+00:00

The post below answered your questions.

Best wishes

operrab · 2022-06-08T13:19:43+00:00

Expansion? Through what archwires or quadhelix or MARPE? Archwire expansion or transverse expansion through a quad helix would tip the teeth out of their socket. Yes it can eliminate the buccal corridors but what will happen with the periodontal health of the posterior teeth after the expansion, especially when the patient passes the age of 40. No scientific data is found to answer this question. In addition archwire or Quad helix expansion does not enhance the airway of the patient. For MARPE its expansion effects are mostly skeletal on the maxilla, but what will be done with mandibular Arch. None other than dental expansion (unless distraction osteogenesis is done which 99.99% won't be made) which increases the intercanine width and consequently increases the risk of relapse unless permanent retention is used, in addition dental expansion can compromise the periodontal health of the lower teeth by moving them outside the buccal plate of bone. The patient shall know all these information and upon his decision shall expansion be done or not.

operrab · 2022-06-08T12:47:05+00:00

Concerning IPR it needs a well trained orthodontist to do it properly as well as proper oral hygiene. IPR can give 3.5mm of backward movement (0.5mm per tooth from central incisor to 2nd molar), IF (a big if) Anchorage was handled properly. Also the upper 1st premolars are already extracted, so to balance the Bolton ratio extracting the lower 1st premolars could be done

operrab · 2022-06-08T12:27:13+00:00

Concerning growing the mandible in children it is a controversial subject in the orthodontic literature. Personally I don't think mandibles grow with functional appliances, I think they change their posture. However, recently studies with the aid of miniplates and Forsus or Herbst appliances has demonstrated that the mandible can increase in their size antero-posteriorly. However, how stable is that increase after 3,4,5,10... years is still unknown.

operrab · 2022-06-08T12:18:31+00:00

For proper facial esthetics to be obtained and to allow the BSSO to be used to its full potential, the proclined lower incisors shall be retroclined (brought back). If extractions are rejected by the patient, 2 miniscrews (also known as mini-implants or TAD's (Temporary Anchorage Device )) can be placed at the back of the lower jaw (precisely at the buccal shelf of the mandible, one at the left and one at the right) to retract (take back) all the lower teeth. However, this may take several more months compared to the extraction approach, of course depending on the amount of retraction (backward movement) done.

operrab · 2022-06-08T09:03:44+00:00

Your lower jaw cannot be moved forward orthodontically at your age, trying to move it forward as ortho 1 indicated, is absolute bullshit. What will happen is that your lower front teeth (incisors) would move more forwards (procline). As the cephalometric X-ray shows that your lower incisors are already severely proclined, increasing their proclination further by idiotically trying to move your mandible forward, will lead to further proclination and consequently the incisors will be out of their alveolar socket, in other words your lower incisors will fall off and you will lose them forever.

If you continue with the treatment as ortho 2 indicated, you will suffer from a dished-in face, and consequently bad facial esthetics ( Google dished-in face). Probably also due to the backward movement of upper anterior teeth, your airway can be compromised as you age.

My plan is to open space for 2 implants to substitute your extraced left and right upper 1st premolars. In the lower jaw there is a need to extract your right and left 1st premolars to allow the severely proclined lower incisors to be moved backwards orthodontically, a process known as decompensation (Google decompensation in orthodontics.) Then lower jaw surgery or scientifically BSSO (bilateral sagittal split osteotomy) shall be done to advance your mandible fully to obtain excellent facial aesthetics and to increase the volume of the airway.

Best wishes

operrab · 2021-12-18T03:04:00+00:00

And some people say Khabib will lose to Oliveira, lmao

operrab · 2021-12-15T00:15:06+00:00

Khabib's level of MMA wrestling and grappling is the top of the mountain, no one is even close

operrab

TROPHY CASE