How do orthodontists fix crowding, without doing extractions?

[Tiny]

So, I was having a little look at my lower teeth the other day.  Which I really noticed that despite having 2 molars removed, I still had significant crowding in my lower jaw.  Some of my teeth were turned sideways to fit into my mouth

Before jaw surgery I would obviously need these straightened out, plus the lower teeth pulled back in to their correct position.  However, there just doesn't seem like there is space in my jaw for any of this.  There is no space behind my last molars (wisdom teeth) - literally none at all.

Kindof makes me wonder if I will have to have the jaw expansion before my teeth can be straightened/uncrowded, cos I'm sure as hell not having any more extractions.  Is this ever done?

Did anyone else have lower or upper crowding and no space for the teeth to straighten them much?

[needadvancement]

Wilckodontics. Currently fixing the same issues you have(though I never had extractions and never will). This treatment's whole idea is to produce more bone mass so that the teeth have room to move around safely.

There are probably other ways, but I would be very careful with that. Moving the teeth around jaws that have no room for them can produce all kinds of problems with the gums receeding, bone resorption etc.

[Tiny]

Wilckodontics. Currently fixing the same issues you have(though I never had extractions and never will). This treatment's whole idea is to produce more bone mass so that the teeth have room to move around safely.

Except I need more physical space!  How does more bone mass give me more space?

[needadvancement]

^Not sure what you mean with that. It's a simple concept, with the thickening of the alveolar bone the teeth can move around without the roots being pushed out of the bone, and since the gums were cut and pulled open and then stitched back together, they will heal and adapt along with the new bone mass.

You said you're getting jaw surgery though, what type? If there's gonna be advancement of the jaws they will surely need to extract anyway.

[molestrip]

Use an anchor to pull the molars back, if you have space behind them. Alternatively, your ortho needs to tip the teeth. Out for more space, in for less.

[Lazlo]

I don't really get what Wickodontics is. I mean isn't it just a form of braces? Someone care to explain I'm in retard mode.

[Tiny]

Use an anchor to pull the molars back, if you have space behind them.

I don't.  Zero. None

Alternatively, your ortho needs to tip the teeth. Out for more space, in for less.

They are already tipped out and need to be brought back to their proper positions so I can do the bimax

[Tiny]

I don't really get what Wickodontics is. I mean isn't it just a form of braces? Someone care to explain I'm in retard mode.

They cut into the gum and expose the jaw bone, which then they scrape to weaken it somewhat.  That means that the teeth can move more quickly.  The bone then heals stronger and thicker than before


SARPE is not an option cos it's my lower jaw.  I'm starting to think I might have to get the surgery before my teeth are in the "ideal" position

[terry947]

The new way of fixing crowding is by expansion.

[molestrip]

If your jaw is that small that you still don't have enough space, then chances are you need jaw surgery anyway for airway issues. My opinion here would be very controversial among surgeons but I say if a kid doesn't have space for bicuspids, leave them in until they're old enough and advance the jaws to make space for them. And check that the airway falls within norms.

[Lazlo]

wait wickidontics is sarpe?

okay well then it's simple, sarpe does actually GROW more space by growing your jaw!! at least your upper palate, which is really what is most often needed. Wish I had had that done!!! Will regret for the rest of my life.

[needadvancement]

If your jaw is that small that you still don't have enough space, then chances are you need jaw surgery anyway for airway issues. My opinion here would be very controversial among surgeons but I say if a kid doesn't have space for bicuspids, leave them in until they're old enough and advance the jaws to make space for them. And check that the airway falls within norms.

That's the thing, the worst orthodontists look at fixing the teeth alone instead of fixing the jaws along with it. At an early enough age a child can fix even a severe class 3 without extractions or surgery, there are appliances that will pull the jaws into the correct positions and if there isn't space then expansion is also perfectly manageable.

It would have degraded my childhood and cost my parents a ton of money but I wish I had expanders on both jaws and also something like a herbst appliance to pull my mandible forward. I don't know the order of these treatments but it would have developed my face and teeth to its full potential and I wouldn't have needed surgery ever. I'm sure many adults here feel the same way.

[molestrip]

@Lazlo Can you elaborate on that statement? You had a 3-piece LeFort, correct? What morbidities did you encounter? This book says there's a 20% chance of long term periodontal defects. Osteonecrosis is obviously a risk but a small one. There's also endodontic risks but some surgeons claim it's minimal if adequate space is left. Someone I spoke to with a big name surgeon ended up losing 3 teeth, one had to be replaced with an implant and the other two needed root canals I think. This person mentioned having prior trauma, which I've also had on my two upper incisors. Supposedly, there's long term risk even if things seem to heal fine. Bone blood flow drops 20% permanently with every LeFort, even more for segments and teeth adjacent to osteotomies but I don't know how much. They say it doesn't impact tooth vitality until a threshold is crossed, which could be years down the line due to aging. That is, people who had them have less margin for bone blood flow loss with aging.

I should post my coronal views of my teeth but from my measurements, my maxilla actually seems to have surprisingly perfect transverse dimensions with only a mild high arch which won't be fixed of course. I can't get a good view of the anterior bite but I think it looks normal too but doesn't matter since that's dentoalveolar anyway. In other words, I can't see any skeletal reason for my malocclusion except for the retrognathic ramus and resulting large gonial angle. I suppose there's slight asymmetry as well. Still, the 3-piece recommendation, from 4/5 surgeons I consulted, blows my mind. My running theory is that like many men I got late stage growth however I got it while in active orthodontic retention from my hawley and night guard. The result is that my retainers orthodontically tipped my molars inwards as the palate expanded and intruded the incisors. The current position of the teeth, then, can't be used as a guide for approximating a skeletal deformity. This should all be obvious from the CBCTs they all insist I keep on getting. I'm still trying to figure out how my orthodontist is decompensating with my CBCT as well.

Anyway, would be curious to hear about your experience anyway even if I won't have it. Every time you mention that I feel more and more comfortable with my surgeon choice

[terry947]

i feel the same way lazlo. Thank God my ortho didnt pull any teeth, but still, i have a narrow mandibular and maxillary arch.

@ molestrip - post a ceph, i might have seen it before but forgot what you're dealing with.