The comments
Dr Sylvain Chamberland, Orthodontiste says:
No. I don't use PFM on upper fixed appliance (braces). It is via a tooth-borne expansion device or a hybrid bone-borne tooth-borne device.Dr Sylvain Chamberland, Orthodontiste says:
Yes. There is no functional appliance that can make lower jaw grow more than inherited.A functional appliance move teeth on the bone but not grow bone.
Dr Sylvain Chamberland, Orthodontiste says:
It is sad that the appliance come off her teeth. The teeth need to be ecthc, wash and dry before placing the device. If it get remove, it is either bad cimentation or bad appliance design. It is very rare that one of my appliace get removed although it could occur sometime.It is the best decision to make a new one and not recement the old one.
Dr Sylvain Chamberland, Orthodontiste says:
Yes, it is possible to have a class II div 1 malocclusion and a brachycephalic face.Yes it is possible that 4 premolar extraction may be indicated.
However, I would be very cautious to cause more disched in appearance with extraction. Moreover, if you mandibular plane is very hopodivergent, I would be reluctant to extract in the mandible.
Dr Sylvain Chamberland, Orthodontiste says:
Il suffit de posturer la mandibule en classe I et mesurer du distal de la canine au distal de la 1re molaire.Dr Sylvain Chamberland, Orthodontiste says:
Bonsoir,If the lateral incisors are smaller than normal and in a peg shape, it could be a good choice to revome the lateral incisors and do the substition with the canine when a patient has a class II relationship.It is feasible to make the substition without leaving gap. Particularly if the patient is class II.
However, your orthodontist should discuss with you the possibility of regain a class I molar relationship and not proceed to extraction.
It is very unlikely that I would plan extraction of the permanent canine in a 11 years old patient.
My final recommendation is to remove the deciduous canine and reassess after 6 months. Often time, maxillary expansion AND extraction of deciduous canine is effective in interception of impacted canine. I would delay as much as possible the extraction of any permanent teeth.
Barbara Gar says:
My 11-year old daughter has just been diagnosed with "class II division malocclusion on a mild skeletal II base complicated by (1) diminutive UL2 and UR2; (2) Impacted UL3 and UR3 with possible cystic change and associated root resorption; (3) retained EDC/CDE (both upper/lower); and (4) upper arch crowding.We are awaiting further test (on cystic change/root resorption) but initial recommended treatment is to either remove the two diminutive incisors (and shape the canine to look like incisors) or to remove the two canines.
Reading your article has reassured me that removing the canines can be the right choice (I had previously only come across removal of premolars in orthodontic treatment) but I'd really welcome your thoughts on these options. In particular the two concerns I have are: with the first option wouldn't the 'shaping as incisors' risk compromising the robustness of the teeth? And wouldn't either of these approach risk leaving gaps between the incisor/canine group and the molar/premolar group (I understand it can be difficult to move molars/premolars forward).
Do says:
Bonsoir Dr j'aimerais avoir une idée sur comment déterminer la longueur du forsus. MerciCassandra says:
Hi is it possible to have a class 2 division 1 with a Brachycephalic face? Around 5 mm overjet. Moderate crowding. Basically class 2 division 1 relationship but a class 2 division 2 profile.Treatment with 4 premolar extraction.
Jackie says:
Good day doctor I have a question.I have extracted 4 teeth to the back and is now wearing braces however I was told that I have a bimaxillary protrusion and have to extract 4 more teeth. I was also told that I had extra teeth. My question is since I have already extracted 4 molars do I have to extract the 4 premolars??
Jimmy jamm says:
My 12 year old son has a class 2 malocclusion. I do not know the measurement of his overbite. The orthodontist gave us 2 options. A Mara appliance 10-12 months followed by upper and lower braces for 18 months. Or invisalign for 30 months. Any thoughts on the 2 treatment options we were given? It is very hard to find solid reviews on the Web that weren't paid for by the company. Thank you in advanceSandalee Karunaratne says:
Dr. Chamberland,My daughter who is 11 years old just started this therapy. Our Dr. has fixed the appliance which we have to expand and reverse as accordingly for several weeks before fixing the face mask. Within the 1 month the process started, the appliance got removed 3 times off the cement fixed to it. Our Dr. is now not sure to carry on the process as if it comes out when the face mask is on; it would hurt my daughter's face. Now for the 4th time he has taken the impression to make a new one.
What could the reason be. Even our Dr. said he had encountered such a case for the first time. Even if it is strongly cemented the appliance got removed. Value your advice on this.
Thank you,
Sandalee
David says:
From the article I understand that an early treatment has little or no effect on subsequent skeletal changes, alignment of teeth, occlusion, duration or complexity of treatment, in comparison with starting during adolescence (phase 2). In one of your comments you write: research have shown that there no appliance that can make the lower jaw grow more than what is inherited. Do you mean that even if you would wear an activator appliance during adolescence, that it would not stimulate growth but only accelerate it achieving the same skeletal end result (adult mandible size)?Emily says:
Dear Dr.Chamberland,Thanks for the great write up about the PFM therapy! May i asked if you have cases with upper fixed appliance used in combination with PFM therapy? I ll be grateful if you could share your case here.Thanks
Kristie says:
I was wondering, Can I get treatment even though I’m from America and speak English?If so, I have a problem. I’ve had my braces taken off almost a year ago but my orthodontist did not do a good job. I have an uneven jaw now. My lips protrude passed my chin and underneath my nose like in your examples. I haven’t had my teeth extracted or had surgery for my jaw but I am willing to.
How long do you think treatment will be and how many options do I have? Thank you, have a nice day.