The comments

Isabelle says:

Hello doctor I don’t know if this conversation is still active but I would like to know your opinion about my smile and bite
I think my jaw is canting to the left but I would like your opinion about it please

Jeelan S says:

Hello doc,
I have bimaxillary dentoalveolar protrusion and I also had my upper left second premolar removed quite a while back. Is there any chance the latter going to effect my treatment for protrusion.

Jana Jacques says:

Dr Chamberland my granddaughter has used this device for a few weeks now. She is developing a rash on her chin. Possibly from drooling while asleep. Any suggestions on how to prevent and treat this rash. Thank you Jana Jacques

Andrea says:

Dear Dr Sylvain

I am in Australia but would really appreciate if you have any thoughts on this situation.

I have a type 2 malocclusion. I do not know the measurements however my upper front teeth sit down over my crowded lower front teeth as far as the gum line of the lower teeth. I seem to have one of those more pointy chin for it - not broad at least. It is quite a tight bite and I have ended up with stress breaks of one of the lower front teeth from it by the time I was 25. I also have quite fangy upper incisors that just keep pushing forward with age. Add to that a nasty case of TMJ. It's not nice.

The issue I have is that my 3.5yr old daughter is shaping up to have the exact same jaw and teeth alignment. It appears exacerbated a little by constantly putting comforters in her mouth (apparently I was the same) - she wont sleep without it in there. I worry that she will have the same issues of TMJ pain, pressure on her front teeth, clenching, a gummy smile etc.

Is it worthwhile to have early intervention to help the jaw grow before braces in adolescence? I understand from what you wrote that it may be helpful for the upper incisors though beyond that, the intervention is not helpful?? Would it help to expand the jaw and keep it expanded even if further teeth alignment was required in adolescence?

Just trying not to leave things too late. I live in a rural area so many things just get ignored if they are not life threatening. I don't want that for my daughter. I don't want her facing a life of jaw pain and self esteem issues around the way her smile looks.

Very much appreciated if you might be able to provide some insight into the best process/timing to make sure my little one doesn't end up like me.

Kindest Regards

Andrea

Kevin says:

Bonjour Docteur Chamberland,

Je présente une malocclusion classe 3. De plus, ma mandibule inférieure droite est plus longue que celle de gauche. Ce qui a pour effet une asymétrie de la mâchoire.

Je souffre de douleurs chroniques souvent quotidiennes, au niveau de la nuque côté gauche, de mon oreille gauche ainsi que de l’articulation temporo-mandibulaire gauche.

Cependant, c’est le côté droit de la mâchoire qui claque lorsque j’ouvre la bouche avec une grande amplitude, sans aucune douleur, ni aucune restriction de mouvement.

J’ai effectué une série de tests au niveau du cerveau notamment (IRM...) qui se sont révélés négatifs.

Mes questions sont :

Pensez-vous que ma malocclusion classe 3 ainsi que l’asymétrie de la mâchoire pourraient être la cause de ces symptômes ?

Un orthodontiste que j’ai consulté par le passé m’a expliqué que je devrai probablement faire une chirurgie orthognatique si je désire realigner mes dents. J’y suis plutôt reticent.

Cependant, je suis prêt à accepter si cette procédure peut me délivrer de ces douleurs qui me gênent depuis 2015.

Pensez-vous qu’une chirurgie orthognatique en vue de corriger ma classe 3 ainsi que l’asymétrie des mâchoires pourrait entraîner une disparition des symptomes douleureux ?

Je vous remercie d’avance pour votre réponse et votre disponibilité.

Bien cordialement,

Kevin

Dr Sylvain Chamberland, Orthodontiste says:

OB of 7 mm is deep overbite. Overjet of 6 mm is large. Chances are that an orthodontics treatment is truly necessary and will be beneficial for eshtetics at the same time.

Dr Sylvain Chamberland, Orthodontiste says:

I don't treat numbers. I need to look at the patient, the ceph, and the intraoral examination.
It is imposible to make any recommendation with so few information.

Amr says:

Dear, I have a convex profile.Age 34, My SNA is 82, SNB 76, ANB 6.4,Nm-Li-PGA 160, lower incisors NBA PNP 10.9. Over jet is 0, proper occlusion. Could you please tell me What would be the treatment of choice to correct the convex profile?

K says:

It has been “recommended” my daughter age 13 get braces. She has class 2 mallocclusion, overbite closed OB=7mm, overjet moderate =6mm, no crossbite
I am trying to determine if this recommendation is a more cosmetic or truly medically necessary. The dental receptionist believes braces are medically necessary for the overbite. Thoughts?

Dr Sylvain Chamberland, Orthodontiste says:

I am departing for vacation today. I doubt that I will be able to reply, but you can send it via facebook.com/drsylvainchamberland.
PS: it is a cephalogram that I need. The pan may be of some help too.

Tommy says:

Thanks you for your reply Dr Chamberland! I forgot to say it is for a 13 year old boy. Can I email you a copy of his X-ray?
Many thanks!

Dr Sylvain Chamberland, Orthodontiste says:

Extraction of 1^st premolars will permit more retraction than extracting 2^nd premolars. Therefore, if maximum retraction is needed, extraction of 1^st premolars would be my 1^st choice. If moderate retraction is needed, extraction of 2^nd premolars will work fine. The caucasian female above had 1^st premolars extraction. The afro-american female had maxillary 1^st and mandibular 2^nd premolar extracted. She was class II div 1 at baseline and need some camouflage of the class II relationship.
I hope that help. There may be other subtle reason that may influence the choice, but without seeing a patient I can't tell.

Tommy says:

Hi Dr,
How do you decide whether first or second premolar should be extracted for Bimaxillary protrusion?
Extraction of which premolar in theory will achieve more retraction? as we were told to extract first pre molar by one orthodontist, 2nd premolar by another.
Thank you!

Dr Sylvain Chamberland, Orthodontiste says:

Veneers are definitely not a good option. It will camouflage the misalignment and will not correct the class II skeletal discrepancy.
The best tx option is likely orthodontic decompensation and orthognathic surgery to advance the mandible.
Depending on your profile, an alternative approach could be extraction of 2 maxillary premolars to align and retract upper anterior teeth and camouflage the cl II discrepancy.
You should visit an orthodontist to analyze the best treatment option.

Laura says:

This has been so helpful after looking extensively on the internet as I’ve been classified as having a type 2 division 2 overjet.
What do you suggest is the best course of treatment (as a guide) to correct it?
I’ve been fobbed off with veneers but these obviously wouldn’t correct the inward lean of my upper teeth.
Best wishes

Dr Sylvain Chamberland, Orthodontiste says:

I would not use Invisalign in an extraction case. Moreover, at t38, it may be even more difficult. I recommend conventional braces.

Dr Sylvain Chamberland, Orthodontiste says:

Oupps!
This is a major mistake. I would not fix a mistake by doing a 2nd mistake. Personnaly, I would manage mechanics, keep the other canine and extract the 1st premolar. Did you take action against the dentist who extract the wrong tooth?
Having said that, it could be a good solution to extract the other canine, but chances that I would not do that.

Dr Sylvain Chamberland, Orthodontiste says:

If your upper lip are protruding and the treatment plan is to extract 2 maxillary premolars and retract the anterior teeth, chances are that it will reduce upper lip protrusion. I assumed that it is what you need.
it may change facial esthetics in some manner.
I don't know if this is the right thing to do for you because I never met you and don't have any photo or cephalogram. I will assume that your orthodontist know what he is doing.
As for Invisalign, it is OK, but may not be the best appliance to retract with efficiency the anterior teeth.

Dr Sylvain Chamberland, Orthodontiste says:

Thank you for sending the panogramm to facebook.com/drsylvainchamberland.

I would not worry at this age for the canine. They appear to have a favorable path of eruption.

They definitively not in zone 2. I would say it is in zone 1, which is a safe zone.

I would reassess in 1 year. If there is no posterior crossbite, I would delay palatal expansion.

Does-it answer to your question?

 

Dr Sylvain Chamberland, Orthodontiste says:

If I read you well, the overjet has reduce from 5 to 3,8 mm. The CPAP is effective for you. We change conclude that some dental change occur, but since you were class II with large overjet and dental spacing, the side effect of tooth change improve your bite by doing some camouflage.

This seems to be good. I recommend that you continue verification with you dentist regularly.