Challenges in Orthodontic Treatment Before Jaw Surgery: Seeking Solutions

Q: Challenges in Orthodontic Treatment Before Jaw Surgery: Seeking Solutions

Hello： According to what you mentioned, the canine teeth have already been aligned, and now we just need to straighten the incisors before proceeding with the surgery. <br>Throughout the treatment process, there are inherent uncertainties and risks. <br>If the physician can succe

Orthodontic treatment is not progressing smoothly?

First of all, to simplify the situation, I am currently undergoing orthodontic treatment prior to orthognathic surgery.
I have been wearing clear aligners for 10 months.
However, the method used by my orthodontist to meet the requirements of the oral surgeon (to align my canine tooth) has severely impacted my daily life and has resulted in my inability to proceed with the surgery.
Here is a more detailed description.
I apologize for the length as I hope to clarify the situation as much as possible:
1.
My teeth were not originally misaligned, but my upper right canine was significantly rotated inward.
The oral surgeon's requirement before surgery is that this canine needs to be aligned properly to ensure the dental midline is correct during the operation.
2.
Since the surgeon collaborates with several orthodontists, I consulted two of them and began wearing clear aligners in August 2022.
This orthodontist designed a total of 30 sets of aligners.
However, starting in early December (around the 16th or 17th set), I experienced issues with the aligners not fitting my teeth properly, and I immediately reported this to the orthodontist.
After examining my teeth, the orthodontist decided that I should continue wearing the remaining aligners.
Each subsequent aligner fit less and less, and there was no visible improvement in the alignment of my canine.
Over several months and multiple follow-up appointments, I inquired whether I needed to have my teeth rescanned or new aligners made, but the orthodontist insisted that I continue with the current aligners.
3.
In April 2023, after reaching the 29th aligner, the orthodontist decided to cut part of the aligner and attach a lingual button to my second molar and canine, using rubber bands to pull (which I was instructed to do during my non-meal times).
In June 2023, the orthodontist added another lingual button to my upper right incisor, pulling the rubber band from the back side of the canine (with a strong rubber band fixed on top).
Although the alignment of the canine improved, my incisors began to tilt and rotate, resulting in increasingly larger gaps between my front teeth.
This was accompanied by severe pain and abnormal sensitivity in that area, significantly affecting my daily life; I felt hesitant to speak or smile freely.
4.
A few days ago, the orthodontist asked me to confirm with the surgeon whether the canine was aligned enough for surgery.
However, the surgeon's assistant informed me that although the canine was more aligned, the incisors were misaligned, making surgery "impossible." Essentially, they suggested that all six anterior teeth needed to be properly aligned before proceeding.
5.
After communication between the surgeon and the orthodontist, the orthodontist informed me that the force from the clear aligners was insufficient.
He stated that if it weren't for his efforts to use this device to rotate my canine, it would not have aligned as quickly (although initially, he only mentioned that clear aligners would be slower than traditional braces, without indicating that they would be ineffective).
Regarding the misalignment of my incisors affecting my daily life and surgical plans, he simply said, "Please let it go."
6.
I have never been in a rush for surgery; what I want is a predictable approach that considers dental health and achieves the pre-surgical goals.
I believe I have been very compliant with medical advice and have communicated any dental issues promptly, yet the process has not gone smoothly.
Therefore, I am eager to hear opinions from other professionals.
The questions I most want to ask are: (1) Do you think using the incisors to align the canine is a reasonable decision? Are there better alternatives? (2) Should I continue to trust this orthodontist with my future treatment, given that he is unaware that the incisors need to be aligned for surgery?

Nancy, 20~29 year old female. Ask Date: 2023/07/09

Dr. Lin Jiayong reply Dentistry

Hello: According to what you mentioned, the canine teeth have already been aligned, and now we just need to straighten the incisors before proceeding with the surgery.
Throughout the treatment process, there are inherent uncertainties and risks.
If the physician can successfully address these issues and fulfill the commitments made to you initially, they should be considered a good doctor! It is advisable to continue having the physician align the incisors, so that the surgery can proceed smoothly.
There will inevitably be a transitional period during the process, so it is best to complete the entire treatment as soon as possible.

Reply Date: 2023/07/09

More Info

Your situation is indeed complex and reflects the challenges many patients face during orthodontic treatment leading up to jaw surgery. Let's break down your concerns and address your questions systematically.

Understanding Your Treatment Journey
1. Orthodontic Goals: The primary goal of orthodontic treatment before jaw surgery is to align the teeth properly to ensure that the surgical outcome is optimal. In your case, the requirement to correct the position of your canine tooth (犬齒) is crucial for achieving a balanced bite and proper alignment of the dental midline.

2. Use of Clear Aligners: Clear aligners, while effective for many patients, can sometimes be less predictable than traditional braces, especially in complex cases like yours. The fact that your canine tooth was not aligning as expected and that the aligners were not fitting properly indicates that there may have been a need for more frequent adjustments or a different approach altogether.

3. Complications with Other Teeth: The introduction of lingual buttons and rubber bands to assist in moving your canine tooth is a common practice. However, if this method is causing your front teeth to rotate and create gaps, it suggests that the forces applied may not be balanced or appropriate for your specific dental structure. This can lead to discomfort and further complications, as you've experienced.

Addressing Your Questions
1. Is it reasonable to use the front teeth to correct the canine?
Using the front teeth to help reposition the canine can be a valid strategy, but it should be done with caution. Ideally, the orthodontist should monitor the overall alignment of all teeth during this process. If the method is causing significant issues with your front teeth, it may indicate that a different approach is necessary. Traditional braces may provide more control over tooth movement in complex cases, allowing for adjustments that align all teeth simultaneously without compromising others.

2. Should you continue with the same orthodontist?
Trust in your orthodontist is essential, but it is also important to feel confident in their treatment plan. Given that your orthodontist did not initially recognize the need to align your front teeth before surgery, it raises valid concerns about their understanding of your specific case. It may be beneficial to seek a second opinion from another orthodontist who has experience with jaw surgery cases. This could provide you with alternative treatment options and help you feel more secure in your care.

Recommendations Moving Forward
- Seek a Second Opinion: Consult with another orthodontist who specializes in pre-surgical orthodontics. They can evaluate your current treatment plan and suggest alternatives that may be more effective in achieving your goals without compromising your dental health.

- Communicate Openly: If you choose to continue with your current orthodontist, ensure that you communicate your concerns clearly. Discuss the pain and discomfort you are experiencing and express your desire for a treatment plan that prioritizes both your health and your quality of life.

- Consider Traditional Braces: If your case is particularly complex, traditional braces may offer more precise control over tooth movement compared to clear aligners. This could help in achieving the desired alignment of your canine and front teeth more effectively.

- Monitor Progress Closely: Regular check-ins with your orthodontist are crucial. If you notice any worsening of your symptoms or alignment issues, don’t hesitate to voice these concerns.

In conclusion, navigating orthodontic treatment before jaw surgery can be challenging, especially when unexpected complications arise. It’s essential to advocate for your health and seek the best possible care. By exploring your options and ensuring clear communication with your healthcare providers, you can work towards a solution that meets your needs and prepares you for successful jaw surgery.

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