Tooth975 open bite/tmj question, please help!?

Question

Tooth975,

I have been reading through your answers to people's questions regarding TMJ and other bite problems, and you are more helpful than any orthodontist I have met.  I originally had braces from ages 12-15 to straighten my teeth and close my open bite/fix my cross bite.  I developed TMJ during treatment and my orthodontist basically straightened out my teeth, but didn't move my bite any more because he was scared of making it worse.  I am now seeking treatment for TMJ, open bite, crossbite, and a double bite (which I developed during ortho treatment).  During my first otho treatment, I had an expander, braces, and elastics...no functional appliances.  I've gone on four consultations for treatment the past month (I'm 21 now, so it's been a few years since braces the first time in case you were wondering).  The diagnoses from the last doc is as follows:

There is enough space for all front and lower teeth
The center of the upper two front teeth corresponds with the center of the face.  
The center of the lower two front teeth is 1mm to the left of the center of the face.
The front teeth do not overlap, even with the back teeth closed together.
The upper front teeth are moderately too far ahead of the lower. 
The upper back teeth are inside the lower back teeth on the left.

Skeletal Evaluation:
The upper jaw is in a good position
The lower jaw appears underdeveloped and set back from ideal
The lips are together at rest
The muscles over the chin appear normal.  

*Also I mentioned the double bite...basically my lower jaw sits too far back, but I push it forward because it's more comfortable.

This ortho recommended jaw surgery to move the lower jaw forward and close the open bite, which I'm not sure if I need or not.  Before surgery and braces, she wanted me to get my TMJ stuff treated...however, I'm hesitant because I'm afraid that I will have my TMJ treated and she will mess it up again with the braces because she wants to open my bite even more for surgery.  She said that surgery is the only way to achieve a permanent result, and my bite would most likely re-open if I didn't do surgery.

The other orthodontist wanted me to extract teeth, do braces, elastics/possibly TADS, which I declined and moved on from him because I know extracting teeth is no good.

The other ortho didn't seem to look at my jaw...He didn't mention functional appliances, he just said that he would do braces and TADS.

The last ortho I liked, but he ended up dying in March...He wanted me to do a splint for TMJ, braces, and myofunctional therapy.  I have spoken with a couple of the other orthodontists (including my old one) and they said that it's "Hokus Pokus" and not science based.  This doc made me see an ENT because he said that mouth breathing and nasal obstruction can be a main cause of a tongue thrust...the ENT found nothing.  The first ortho said that my open bite is causing the tongue thrust, and that it's kind of a "chicken or the egg" scenario and that uneven jaws can also cause nasal problems.  Every dentist has commented on how small my mouth is, so I'm not sure if she's right.

I have looked on iaortho.org, and there are no orthos in my town, so I will be traveling out of town...I just wanted to know if you could possibly give me some ideal treatment options to discuss when I go to my other consultations?  I don't really want surgery, but if it's the only option I am willing to do it.  I am going to see an oral surgeon soon anyways (the wisdom teeth are ready to come out), so I figured it wouldn't hurt to ask too.  Ideally, I would like to have a functional appliance to move my lower jaw forward and fix the tmj, and braces and tads to intrude my molars (one ortho said they were over erupted) to close the bite.  I'm not sure if it's possible to do a functional appliance for tmj/moving the lower jaw forward while wearing braces on the top.

I will see if I can post the pictures of my teeth that the ortho took. 

Thank you so so much for reading this and helping me, I greatly appreciate it.  Also, if you know of a good ortho in Arizona, I'd love for a recommendation!

tooth975 · Accepted Answer

Sounds like the orthodontist who died was the best one you found. He was the only one on the right track. You need to find someone who will correct your TMJ and stabilized it with functional orthodontic treatment, not have your TMJ fixed by someone and then go to someone else to have braces or the fear you expressed about having your TMJ treatment being messed up will come true. Open bites are always difficult cases and from the info you provided it sounds like you have a dental open bite instead of a skeletal open bite. The latter is a much more difficult problem to fix. Do you have a tongue thrust (aka abnormal swallowing pattern)? This can cause a dental open bite and must be addressed first before anything else is done or any treatment will be doomed to fail. Since the last ortho recommended myofunctional therapy, I suspect he felt you have a tongue thrust problem.

The orthos that mentioned "Hokus Pokus" are the ones who are married to old and outdated treatment. The paradox there is the advocacy for science based treatment when extracting premolars or perfectly good teeth to solve crowding is insane and non scientific at all.

A good functionally based cephalometric analysis will be needed so make sure one is taken and done before treatment. Keep looking for another orthodontist like the one who died. Cases involving open bites are just too difficult to make recommendations for because lots of info that cannot be provided must be taken into consideration. The "double bite" you mentioned is called a dual bite and is a very common outcome of trying to move the mandible with elastics. I'm sorry but I do not know of a recommendation in Arizona.

JedaSoul&lt;3 · Answer

From my experience I say Do NOT have the surgery! I had several things done because i had extreme tmJ and still do, but when I tell other doctors of my surgery they say that might have made it worse. I was supposed to eventually have 2 surgeries. The one I did have they put 2 screws in one side of my jaw and sanded the jagged bone down on the other side, then I was given a plastic retainer type thing for the top teeth and had to have braces on the bottom to correct the bite. After all that I get the braces off only to have rotting teeth in the back but it didnt correct a darn thing that I can tell. I was supposed to have the surgery to bring my lower jaw out but my insurance wouldnt cover it and its wildly expensive. So after years of doing exactly as they said I am still in pain and can feel my jaw is not set properly at all. 
I wish I had some information that would help you, but I still havent found the fix. I just wanted to let you know that I have had 3 doctors tell me the 2nd surgery would have been a waste. It is Possibly a life long thing unless you can find a Dr that comes up with something new. I suffer from it everyday so I wish you all the luck in the world. If i were you I would keep asking around!

? · Answer

Dual Bite Orthodontics

Anonymous · Answer

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Tooth975 open bite/tmj question, please help!?

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