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Orthodontic camouflage versus orthognathic surgery

Question

Hello,

I underwent an orthodontic treatment, including braces, 4 years ago. I underwent a palatal expansion in my upper jaw and 4 teeth were extracted since I did not have enough space to accommodate them.

I was treated for a severe anterior open bite + mandibular retrogenia. A surgery was strongly recommended to me, but my orthodontist told me that he could treat me without having to undergo such a surgery.

Orthodontic camouflage

Today, I am under the impression that everything is moving and that the problem is “camouflaged” rather than being fixed. I developed speech problems (lisping), difficulty chewing, repetitive jaw cracking sounds…

Can I undergo an orthognathic surgery without going through orthodontics again?

Thank you

Answer

I think that you case illustrates the limitation of what can be done orthodontically in the case of a severe anterior open bite.

Having an anterior open bite indicated that you suffered from a vertical maxillary excess problem or a vertical deficiency of the ramus of the mandible.

Anterior open bite

Indeed, an anterior open bite can develop if the upper maxilla excessively grows vertically or if the vertical growth of the condyle is deficient in a way that the ramus of the mandible is too short, resulting in an anterior opening. I could continue elaborating on other fine details, but I would lose you in the explanations.

Camouflage and vertical dimension

You are right when you say that your problem was camouflaged. Indeed, the issue regarding the excessive vertical dimension was never addressed. Your teeth were retracted and extruded. Your lisping (sigmatism) problem was present before your treatment. I do not believe that your treatment caused the problem. The cracking problem could indicate an internal derangement problem and a problem in the alteration of the shape of the condyles.

An orthodontic camouflage treatment means that the teeth were placed to compensate the skeletal problem. Therefore, dental compensations are made to match the skeletal relationship.

If you envision a surgical treatment, you will benefit from undergoing an orthodontic treatment to undo these dental compensations and make it possible to correct the skeletal discrepancies optimally.

If decompensation of the dentition is not done, a surgical treatment can be performed, but the skeletal correction may not be optimal. I say that carefully since I have not seen your case.



Questions and comments

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  1. It is fairly commun to extract 4 premolars to accomodate the canine. If the orientation of the canine is vertical, chances are good. But why extract now? Is she ready, at 10, for a comprehensive orthodotnic treatment? Or is it a case of serial extraction that need early tratment?

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