I have misaligned teeth due to not wearing a retainer after I had worn braces 16 years ago. I am now 31 years old. I was firmly rejected for braces recently by the orthodontist because of some root canals treatments and extractions (last upper molar missing would be a huge risk) that are done already. I believe that because of the extraction of the last upper molar four years ago, my overbite has gotten a lot worse. I was never bothered because it was not visible in my physical appearance. Now it is a lot visible, and I believe it is because of the extraction. I had the root canal treatments three to four years ago. On top of that, I think my nerve is failing on another tooth - the penultimate right molar. I strongly want to fix the overbite and the gap on the right, and I want to move the teeth to fill the gap and make space for a lateral incisor implant. Besides, I wanted to put an implant on the last upper left missing molar, but I have been told it is risky as I need a sinus lift and two sets of bone grafts. The only good thing I see is that I have healthy gums and roots - which I heard may shorten during the orthodontic treatment. But my teeth are terrible. Do you believe I can still fix my overbite with orthodontic treatment? My orthodontist suggested jaw surgery instead, but I am too scared to think of it. Kindly help.
I understand your concern. Indeed the condition of your dentition is not good (attachment removed to protect the patient's identity). There are missing molars, and the overbite has increased because of missing molars allowing front teeth to erupt more and causing deep bite. As profound bite increases, its effects are visible on the face after a certain threshold point, which is detrimental compared to pre-treatment photos. Towards the left lower first molar, the filling is done, but your nerve involvement might be there, which might also need root canal treatment (RCT). Do you feel any sensitivity or pain on the right side lower posterior teeth (back teeth)? (I suggest you need re-treatment). For the case of implants for upper left molars, the area is closest to the maxillary sinus, and after extraction of teeth, the sinus drops down. Due to no teeth present there, we do see sinus down, which causes less bone to be present, making the implant unstable even if tried. I would also suggest getting a sinus lift procedure done if you wish for implants. But as known to you already, it might be risky. You can opt for "flexible, removable partial denture" or "precision attachment" in place of implants. The benefits include no sinus lift procedure is required, no implants related complications and Deep bite correction. For shifting teeth, we will need appliances. As per your dentition, it might not be a thriving option with less support available from the posterior. The alternative could be reshaping teeth esthetically into a smooth, gentle curve based on your face looks. It will require a single sitting and customized as per your smile needs. It has better results without complications and quicker results. Regarding shortening the tooth root, yes, it will occur, and the phenomenon is called root resorption. As the age increase, the chances of resorption also increase. However, it is a reversible condition (only upto a certain extent and when treatment is over). If it goes beyond a correctable situation, the damage will be permanent. It is a complication seen in patients with a higher age group. As you are not willing for surgery, you can opt for a prosthesis, which will help to some extent. Secondly, you can opt for alignment of only anterior teeth upto premolars. It will make the appearance much better added to the prosthesis effect. Thirdly, reshaping of canine and customized smile design. These should help in the best possible way with minor complications and enhance your smile, and results should be good and stable without undergoing surgery. Kindly revert in case of further queries.
Thank you for the reply. I am not concerned with the overall look, but with an overbite and missing spaces. I want to find a promising implantologist and try the sinus lift, graft bone, and dental implant. If this is successful, could I consider braces or Invisalign afterward to help with the overbite? On the right side, I thought of moving the canine and the near teeth to the bottom, so I could fill the interspace and make room for a lateral incisor implant. My doctor did not suggest that, as it might compromise the other teeth and also the bite. Could partial braces be a bad idea in this case? Or at least for the front teeth? Did you mean denture for the upper left missing molar and partial braces for the front teeth? From your reply, you can opt for alignment of only anterior teeth upto premolars. It will make the appearance much better added to the prosthesis effect. I have three RCTs made next to each other by different dentists. I got the middle molar tooth treated four months back. Since then, I have been feeling some pinches daily, but it is on and off. I cannot realize if the pain comes from this or the last one. The last molar from the bottom was treated two years ago. Could you please tell me which one is badly treated? And where exactly? I made too many X-rays, and my dentist says everything is fine with all of them. Kindly help.
I understand your concern. I would like to explain to you the following. Regarding sinus lift, bone graft, and dental implant, I suggest it requires a multi-disciplinary approach, meaning you need specialists from various branches of dentistry to help you out. An oral & maxillofacial surgeon will be doing the sinus lift procedure. A periodontist with implant certification will be doing the bone graft and implant placement procedure. This whole process may take upto six months to complete. Following that, re-assessment and success of the procedure need to be evaluated. If it goes well, I suggest you can consult an orthodontist for the treatment, using Invisalign or braces. If the implant procedure does not go successfully, I suggest you have an alternative of "flexible RPD" (removable partial denture) or "precision attachment," which will be provided by a prosthodontist. Even if you cannot get orthodontic treatment, I also suggest getting your implant procedure. You have multiple missing posterior teeth, which form the base for chewing, and you will end up having more complications if you do not get the treatment done. I suggest you can opt for partial braces for front teeth up to canines or first premolars (next to canines) and get those aligned into a smooth curve for aesthetic looks, and a denture will manage posteriors (behind teeth) or implant if it goes successful. I would not suggest you for a lateral incisor implant, as your dentition is already compromised. As discussed previously, you can opt for re-shaping of canine into lateral incisor, which will be more beneficial and less risky, rather than going for lateral incisor implant. I suggest the best option would be partial braces for anteriors and dentures or implants for posteriors. The middle tooth has not been treated properly. I suggest it needs re-treatment to stop the pinching sensitivity you are facing. Unless re-treated, it would not be helping you in any case. X-rays (attachment removed to protect the patient's identity) confirm the partial treatment, causing you the issue. Kindly revert in case of further queries. Thank you.
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