Author Topic: Am I still in crossbite?  (Read 10946 times)

ODog

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Re: Am I still in crossbite?
« Reply #60 on: May 22, 2019, 02:24:57 PM »
Okay, I forgot about that pic.  The link doesn't work anymore.  That seems to be a BS explanation considering many surgeons DO decompensate, even in the case of a segmented LF1.  But yes, the bite is virtually unchanged from that view except MAYBE slightly better occlusion on the left side of the pic.  Your case is beyond my understanding to comment further though.  I don't understand what what your surgeon thinks was corrected.

His explanation is absolutely bulls**t because my original surgeon was also doing a segmental lefort 1. I’m assuming he wanted to do more posterior impaction to close the decompensated AOB and my actual surgeon wasn’t comfortable with posterior impaction (he didn’t do posterior impaction other than the 1 mm from the saw cut) and wanted to just bring down the front.

So does that mean I’m still posteriorly long compared to the front (Skeletal AOB) and my surgeon camouflaged this skeletal discrepancy but reversing the original decompensation? I don’t know that’s why I need to see a US surgeon. I have a consult with Wolford in July.

Dogmatix

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Re: Am I still in crossbite?
« Reply #61 on: May 22, 2019, 03:46:38 PM »
I believe I signed a contract with my orthodontist so I believe I’m financially obligated to finish paying for the treatment. Are you saying I should ask him to support my assertions and if not to drop out of treatment? I can’t afford another orthodontist so I’m not sure that’s an option.

Having your orthodontist speaking for you would be the best. During the treatment you shouldn't actually have to be involved in discussions like these. They should send you back and forth until they can deliver a good end result, and if the surgeon have delivered something to the orthodontist that he can't work with, he should be the one sending it back. That is the ethical approach from them.
BUT, in the case your orthodontist and surgeon are not handling it properly, that's when it gets tricky.

I believe your side view of the bite us same in your first before and after comparison?

The side view that you posted with the blue stuff, I'm not sure how bad it really is. If you bite, your lower incisors are behind the upper, and not edge to edge as I think it has looked like before? Basically, when you bite, your upper incisors and canines should overlap your lower, and not edge to edge or beyond. If there is only a slight problem, it can probably be adjusted orthodontically. E.g on your left side you have some space to pull the lower incisors and canines back.

Looking at your width, I agree. Do they say they have widened your upper arch? Can you see on the x-rays that the maxilla have been splitted, or inside your mouth?

Post bimax

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Re: Am I still in crossbite?
« Reply #62 on: May 22, 2019, 04:24:08 PM »
His explanation is absolutely bulls**t because my original surgeon was also doing a segmental lefort 1. I’m assuming he wanted to do more posterior impaction to close the decompensated AOB and my actual surgeon wasn’t comfortable with posterior impaction (he didn’t do posterior impaction other than the 1 mm from the saw cut) and wanted to just bring down the front.

So does that mean I’m still posteriorly long compared to the front (Skeletal AOB) and my surgeon camouflaged this skeletal discrepancy but reversing the original decompensation? I don’t know that’s why I need to see a US surgeon. I have a consult with Wolford in July.

I really think you should save money and get a second orthodontist option first. Your aesthetic result is so good that something potentially fixed in orthodonture should be handled there.

ODog

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Re: Am I still in crossbite?
« Reply #63 on: May 22, 2019, 04:41:50 PM »
Having your orthodontist speaking for you would be the best. During the treatment you shouldn't actually have to be involved in discussions like these. They should send you back and forth until they can deliver a good end result, and if the surgeon have delivered something to the orthodontist that he can't work with, he should be the one sending it back. That is the ethical approach from them.
BUT, in the case your orthodontist and surgeon are not handling it properly, that's when it gets tricky.

I believe your side view of the bite us same in your first before and after comparison?

The side view that you posted with the blue stuff, I'm not sure how bad it really is. If you bite, your lower incisors are behind the upper, and not edge to edge as I think it has looked like before? Basically, when you bite, your upper incisors and canines should overlap your lower, and not edge to edge or beyond. If there is only a slight problem, it can probably be adjusted orthodontically. E.g on your left side you have some space to pull the lower incisors and canines back.

Looking at your width, I agree. Do they say they have widened your upper arch? Can you see on the x-rays that the maxilla have been splitted, or inside your mouth?

My palate certainly looks wider: https://imgur.com/a/lHKJmU8

I don’t know maybe he widened by 5 mm and this is the furthest you can go with a segmental and that’s why I was left in cross bite. Maybe I need SARPE to get more expansion. Or perhaps he only widened like 2 mm but the actual palate change does look like it was more than that. Hmm.

ODog

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Re: Am I still in crossbite?
« Reply #64 on: May 22, 2019, 04:46:17 PM »
I really think you should save money and get a second orthodontist option first. Your aesthetic result is so good that something potentially fixed in orthodonture should be handled there.

That is true. Honestly my ortho is very very good, he’s going to fix the bite to the best that can be reasonably fixed. My open bite will be closed he said, and my smile will be wider than it is currently. I don’t really think another ortho would change anything.

I think his response to my situation is simply to avoid conflict and to make the best out of the situation but his technical skills cannot be doubted. HE knows that it’s a crossbite, his reaction told me so, it’s just he’s reluctant to say it to me directly. So I’m confident he is doing what needs to be fixed. Some people just don’t really feel comfortable commenting poorly on another professional’s work, especially a highly esteemed one. That’s why I’m seeing another ortho and surgeon... however my ortho is 5 star in my area and is not cheap, and has undergone jaw surgery himself. He knows his stuff. Actually he even went to a conference held by William Arnett a couple years ago.

ODog

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Re: Am I still in crossbite?
« Reply #65 on: May 22, 2019, 05:02:58 PM »
https://imgur.com/a/Q34sJJp

Looking at my smile, is my open bite on the left side caused by a upper jaw cant that went uncorrected? I don’t know if my smile is just crooked from the healing, but I did get diagnosed with a maxillary cant at my previous surgeon, however the one that did the surgery did not write this on my file and only commented on midline deviation.

I think if my upper jaw was in 3 segments, the slight cant could also have been corrected and I wouldn’t have that posterior open bite. But do you have to change the position of the lower jaw when fixing a an upper jaw cant, not sure if I’m oversimplifying it.

Also can anyone answer if a maxillary cant to one side can give asymmetry to the mouth where one side drops lower the other. Could that be a tell that the upper jaw isn’t levelled, or could it be purely soft-tissue? Because I do have that.

kavan

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Re: Am I still in crossbite?
« Reply #66 on: May 22, 2019, 05:33:58 PM »
Late to the party here but TBH, I gave up on the FIRST post on this thread because I thought the presentation was poorly organized, confusing and just lacked all the salient info.
Wording like: 'My 6 months pre-op worse than my pre-op.' along with absence of info as to how far along POST OP you actually were and no mention of what the PO brace period was planned to be. Since, then I see you removed your photos from the entry post. But I recall looking at the photo presentation and it looked like the photos were out of order where people may have been looking at a pre-op cross bite and not the post op. Also recall a post where you had to ask if people were sure they were looking at the right photo. But I don't see that entry anymore in this string either. So, it very well could be that some of the early responses you got here could have been reactions to mixed up photos.

Some other points of confused presentation:

1: Not mentioning just how post-op you were. Had to search for that independent of any mention of such in your entry.) You're about 2 months post op right. How post op were the early photos you showed in your entry post were you called it your 'result'? How sure are you that people were not mixing up a post op with a pre-op when they gave initial responses?

2: Casting your ortho and surgeon in a bad light so soon because you're told you need to stay in braces longer as if that's a cop out for their not expanding your maxilla enough. What's so unusual of a in braces post op period taking some time to even things out?  It took 6 months for the member 'post bimax' with AOB before he got his braces off.

3: Presenting the cross bite as your '#1 concern' and main indication for the surgery. Oh no...could not possibly be that such things like recessed maxilla, the anterior open bite with posterior excess gum show and the speech problems you said you had some time back were the main concerns for the surgery. Now after what would have been the the main issues for having this surgery (which you did mention in prior posts), now suddenly the cross bite was your primary concern. Really?

4: Thinking you didn't have posterior impaction. You posted a photo elsewhere where you had a LOT of excess posterior gum show in the before and little to none in the after. Removal of all that excess posterior gum show is highly unlikely without posterior impaction. Although there are some situations where intrusion of the back teeth can help close the open bite, those cases are when someone does NOT have a lot of posterior gum show. Who knows. Maybe the surgeon didn't want to tell you that you had posterior impaction if he thought that would  or that too much information could result in your getting it mixed up and alarm you in some way. Surgeons are LESS apt to leave out out information when they feel the patient has a good understandings of how things work from the get go. But if they feel a patient could get easily confused by tech details and would need excess time for explanations of them, they are MORE apt to leave them out. If you really want to know what kind of surgery you got, get your op. report.



Some pointers for you:

Next time you have a surgery, establish what the estimated POST OP period is meant to be before you start jumping the gun, alarming yourself it was done wrong and you need a revision or need to sue and drawing others into the alarm system. Consider making clear how post op you are. Consider using time lines for your pre-ops. If you have 2 pre-ops, put a time line on both of them instead of saying, 'Heres my 6 month pre-op' and just calling the other one just your 'pre-op sans timeline of it. Put as many photos as you can on one imger link and use the text function to note the timeline of each photo for easy comparison with minimal confusion.

As to the question of whether or not you 'need a revision' or are 'still in cross bite', I didn't engage early on due to the confusing presentation and also because given that post op braces can take 6 months or so for some bites to fit into place, I felt it was too early to be even asking it.

I think you should just chill out because based on your most recent pics, it looks like your bite is coming along fine and just MAYBE the doctor was correct when he told you at your last visit you had no cross bite.
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ODog

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Re: Am I still in crossbite?
« Reply #67 on: May 22, 2019, 06:30:59 PM »
But I recall looking at the photo presentation and it looked like the photos were out of order where people may have been looking at a pre-op cross bite and not the post op. Also recall a post where you had to ask if people were sure they were looking at the right photo. But I don't see that entry anymore in this string either. So, it very well could be that some of the early responses you got here could have been reactions to mixed up photos.

I thought this could be the case as well but I had descriptions under each picture and had commented in the post clarifying which of the pictures was the post-op. I also emailed Gj making sure he was looking at the correct picture. I don't think there was a mix-up.

Some other points of confused presentation:

1: Not mentioning just how post-op you were. Had to search for that independent of any mention of such in your entry.) You're about 2 months post op right. How post op were the early photos you showed in your entry post were you called it your 'result'? How sure are you that people were not mixing up a post op with a pre-op when they gave initial responses?

The posters who commented knew how far along post-op I was.

2: Casting your ortho and surgeon in a bad light so soon because you're told you need to stay in braces longer as if that's a cop out for their not expanding your maxilla enough. What's so unusual of a in braces post op period taking some time to even things out?  It took 6 months for the member 'post bimax' with AOB before he got his braces off.

Fair enough in regards to the first part, but I definitely didn't say staying in braces LONGER was a cop-out for not expanding my maxilla enough. How long I'm in braces is irrelevant, I don't care. What I meant was, I didn't want an outcome where 70% of the bite problem was fixed skeletally with surgery, and 30% was compensated for with orthodontics, because I wanted my bones in the best possible position. That's what I meant when I said I don't know why my surgeon is "over-relying on orthodontics to fix the discrepancies." I'm sure all my bite issues could have been fixed somewhat without surgery at all. But you go for surgery to not have to rely on camouflage ortho, and that's what I felt was happening at the time WRT my cross-bite.

3: Presenting the cross bite as your '#1 concern' and main indication for the surgery. Oh no...could not possibly be that such things like recessed maxilla, the anterior open bite with posterior excess gum show and the speech problems you said you had some time back were the main concerns for the surgery. Now after what would have been the the main issues for having this surgery (which you did mention in prior posts), now suddenly the cross bite was your primary concern. Really?

I said it was my number 1 technical indication. Did I say it was my number one concern? I don't think I did. If I DID, I meant it was the number 1 thing a surgeon would point out in my consults. The most obvious thing. Yes, I had many other concerns as well.

4: Thinking you didn't have posterior impaction. You posted a photo elsewhere where you had a LOT of excess posterior gum show in the before and little to none in the after. Removal of all that excess posterior gum show is highly unlikely without posterior impaction. Although there are some situations where intrusion of the back teeth can help close the open bite, those cases are when someone does NOT have a lot of posterior gum show. Who knows. Maybe the surgeon didn't want to tell you that you had posterior impaction if he thought that would  or that too much information could result in your getting it mixed up and alarm you in some way. Surgeons are LESS apt to leave out out information when they feel the patient has a good understandings of how things work from the get go. But if they feel a patient could get easily confused by tech details and would need excess time for explanations of them, they are MORE apt to leave them out. If you really want to know what kind of surgery you got, get your op. report.

Yes! Which is confusing. My posterior gum show is gone. I had a lot before. Also my mandible plane seems less steep. But I asked him a couple times before surgery about posterior impaction. I think at that point he thought I meant anterior impaction. Whatever maybe he was distracted.

But AFTER surgery he showed me his hand-written surgical report (Yes, very old school), which shows 1 mm vertical reduction at the back. He said the back was shortened but only by a mm and that was from the saw cut and so he disregarded that as counting as a "posterior impaction." Looking at my gum show pre-op wouldn't you agree that I'd have needed more than 1 mm?

I doubt that he didn't want to tell me for fear of "worrying me" because by that point I understood what it was for, what it does, and how it would it benefit my face. I relayed that my orthodontist and I feel that my face is shorter which was a GOOD thing and I thanked him for that, and then inquired whether this achieved with posterior impaction. He replied with the above ^ "well yeah but only by 1 mm" and said if anything my face was LONGER because of the anterior drop-down of 3 mm. Lol so if anything his denial of impaction would have alarmed me more than conceding to it.

Some pointers for you:

Next time you have a surgery, establish what the estimated POST OP period is meant to be before you start jumping the gun, alarming yourself it was done wrong and you need a revision or need to sue and drawing others into the alarm system. Consider making clear how post op you are. Consider using time lines for your pre-ops. If you have 2 pre-ops, put a time line on both of them instead of saying, 'Heres my 6 month pre-op' and just calling the other one just your 'pre-op sans timeline of it. Put as many photos as you can on one imger link and use the text function to note the timeline of each photo for easy comparison with minimal confusion.

As I said I did write descriptors under each picture, by simply "Pre-op" I meant immediately before surgery as in 1-2 weeks before as in I was already ready orthodontically for 2 months before my surgery date and so it was irrelevant to add an exact timeline. My point was that this was my final bite that had me ready for surgery.

As to the question of whether or not you 'need a revision' or are 'still in cross bite', I didn't engage early on due to the confusing presentation and also because given that post op braces can take 6 months or so for some bites to fit into place, I felt it was too early to be even asking it.

I think you should just chill out because based on your most recent pics, it looks like your bite is coming along fine and just MAYBE the doctor was correct when he told you at your last visit you had no cross bite.

Fair enough. This is great news if I don't need a revision. I know it seems like I was overreacting but I did have many well-respected members here telling me to sue. I didn't open the thread claiming lawsuit.

kavan

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Re: Am I still in crossbite?
« Reply #68 on: May 22, 2019, 07:48:22 PM »
I thought this could be the case as well but I had descriptions under each picture and had commented in the post clarifying which of the pictures was the post-op. I also emailed Gj making sure he was looking at the correct picture. I don't think there was a mix-up.

What I found confusing was the 'this is my 6 month post op' vs 'this is my post op' where the latter had no time frame to it. If you still have the imgur link of the photo presentation (it's not there anymore), I can better clarify what I thought could have been better organized.



The posters who commented knew how far along post-op I was.

Perhaps so. But it was not mentioned in your opening entry.

Fair enough in regards to the first part, but I definitely didn't say staying in braces LONGER was a cop-out for not expanding my maxilla enough. How long I'm in braces is irrelevant, I don't care. What I meant was, I didn't want an outcome where 70% of the bite problem was fixed skeletally with surgery, and 30% was compensated for with orthodontics, because I wanted my bones in the best possible position. That's what I meant when I said I don't know why my surgeon is "over-relying on orthodontics to fix the discrepancies." I'm sure all my bite issues could have been fixed somewhat without surgery at all. But you go for surgery to not have to rely on camouflage ortho, and that's what I felt was happening at the time WRT my cross-bite.

To me, it came off that someone was covering up for not doing it right and instead depending on braces to do all the work that 'should have' been done during the surgery and that was in a circumstance where you were just too early post op. Surgery alone does not always get the bite right directly after surgery and post op brace adjustments are common.



I said it was my number 1 technical indication. Did I say it was my number one concern? I don't think I did. If I DID, I meant it was the number 1 thing a surgeon would point out in my consults. The most obvious thing. Yes, I had many other concerns as well.

To me, it came off as your stressing the crossbite correction was the number 1 indication for having the surgery or a primary concern whereas in your prior posts, the other corrections were prioritized such as AOB, speech, recessed maxilla, mandible, chin ect.



Yes! Which is confusing. My posterior gum show is gone. I had a lot before. Also my mandible plane seems less steep. But I asked him a couple times before surgery about posterior impaction. I think at that point he thought I meant anterior impaction. Whatever maybe he was distracted.

I can pretty much guess what he did: Posterior impaction to the 2 side maxilla segments beyond the lateral incisors (or maybe canines), a little downgraft of upper front teeth (segment being from lateral incisor to lateral incisor-or maybe canines-) so all would be kind of 'leveled out' and ready for advancement. As for the front central incisors, they could be pulling them down with the braces (extrusion) as they probably had to be pulled down more than the 'level out' of the posterior impaction with blended with the whole anterior downgraft.



But AFTER surgery he showed me his hand-written surgical report (Yes, very old school), which shows 1 mm vertical reduction at the back. He said the back was shortened but only by a mm and that was from the saw cut and so he disregarded that as counting as a "posterior impaction." Looking at my gum show pre-op wouldn't you agree that I'd have needed more than 1 mm?

Again, the only way to have leveled out the smile so there was not all that posterior gum show would be posterior impactions of the of the 2 segments lateral to the lateral incisors (or canines) and to bring front segment down a bit and quite possibly pull down the front central incisors with the braces. So the impaction would have been more than 1mm. If one segment was longer than the other, maybe the 1mm refers to 1mm more than the other side.




I doubt that he didn't want to tell me for fear of "worrying me" because by that point I understood what it was for, what it does, and how it would it benefit my face. I relayed that my orthodontist and I feel that my face is shorter which was a GOOD thing and I thanked him for that, and then inquired whether this achieved with posterior impaction. He replied with the above ^ "well yeah but only by 1 mm" and said if anything my face was LONGER because of the anterior drop-down of 3 mm. Lol so if anything his denial of impaction would have alarmed me more than conceding to it.

Well, the anterior part of the face can look longer with an anterior drop down and can also look longer when the posterior part is impacted. But if the whole face (whole gestalt) looks shorter, that would be from the mandible being able to swing up in CCW direction subsequent to removal of posterior excess pushing it down. Can also be from a CCW effect of type of genio aimed at that.




As I said I did write descriptors under each picture, by simply "Pre-op" I meant immediately before surgery as in 1-2 weeks before as in I was already ready orthodontically for 2 months before my surgery date and so it was irrelevant to add an exact timeline. My point was that this was my final bite that had me ready for surgery.
Well, hard for me to tell what was meant and easier when the time frame is given.



Fair enough. This is great news if I don't need a revision. I know it seems like I was overreacting but I did have many well-respected members here telling me to sue. I didn't open the thread claiming lawsuit.

I think they were just tapping into your very EARLY alarm and quite frankly, I was surprised that advice was given SO EARLY post op during the 'brace stay on' period. There is little to be alarmed about at this stage of the game. Your recent post op palate looks normal and not narrow and you should allow maybe 6 months or so for all the teeth to 'mesh'. Recent photos show improvement from the early post op. Best of luck. You will do alright.
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ODog

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Re: Am I still in crossbite?
« Reply #69 on: May 23, 2019, 09:53:16 AM »
Kavan,

Regarding the posterior impaction, I consulted with a new ortho today who assessed my bite. He said if my upper jaw was brought down at the front, there would be no shaving at the back (impaction) because the leveling would be created by the “tilting” down of the upper jaw, with the back being pushed up. This would eliminate the excess gum posteriorly. I think this is more in line with what my surgeon actually did. Does this seem right to you?

You did see my before-after profile however and it does seem like I got some CCW-r effect. Would this have been possible with the method stated above, I.e. without impaction?

In regards to my bite, the new Ortho said it’s too early to say anything and to wait 6 months. He doesn’t think there will be any crossbite issues after ortho treatment.

kavan

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Re: Am I still in crossbite?
« Reply #70 on: May 23, 2019, 12:33:33 PM »
Kavan,

Regarding the posterior impaction, I consulted with a new ortho today who assessed my bite. He said if my upper jaw was brought down at the front, there would be no shaving at the back (impaction) because the leveling would be created by the “tilting” down of the upper jaw, with the back being pushed up. This would eliminate the excess gum posteriorly. I think this is more in line with what my surgeon actually did. Does this seem right to you?

You did see my before-after profile however and it does seem like I got some CCW-r effect. Would this have been possible with the method stated above, I.e. without impaction?

In regards to my bite, the new Ortho said it’s too early to say anything and to wait 6 months. He doesn’t think there will be any crossbite issues after ortho treatment.

I don't think so because the posterior excess which resulted in excess posterior gum show was gone. Also, a lot of posterior excess where a person can't close their bite can give kind of creates a 'gullet' look to back of jaw  where there is no demarcation from it to connecting neck area. That's gone too. However, I could be wrong. In my PM to you, I explained 'upward swings' and downward swings in terms of the right and left side of a clock. So CW on right side of clock is downward swing but on left side of clock CW is upward swing. It's the very noticible 'upward swing' I see to back of jaw that makes me think you got posterior impaction. Again, I could be wrong but gave my explanation of why I thought that was so. But on some level, I 'knew' you would get an upward swing effect from the surgery which I see in the photos sent. Anyway, all pans out to no reason for ALARM and plenty reason to be very happy with the great aesthetic outcome.
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ODog

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Re: Am I still in crossbite?
« Reply #71 on: May 23, 2019, 04:14:32 PM »
I don't think so because the posterior excess which resulted in excess posterior gum show was gone. Also, a lot of posterior excess where a person can't close their bite can give kind of creates a 'gullet' look to back of jaw  where there is no demarcation from it to connecting neck area. That's gone too. However, I could be wrong. In my PM to you, I explained 'upward swings' and downward swings in terms of the right and left side of a clock. So CW on right side of clock is downward swing but on left side of clock CW is upward swing. It's the very noticible 'upward swing' I see to back of jaw that makes me think you got posterior impaction. Again, I could be wrong but gave my explanation of why I thought that was so. But on some level, I 'knew' you would get an upward swing effect from the surgery which I see in the photos sent. Anyway, all pans out to no reason for ALARM and plenty reason to be very happy with the great aesthetic outcome.

Yeah I certainly agree with all you’ve said ^. There’s no way I didn’t get impacted considering all these changes. But I guess it’s possible something else was done.

kavan

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Re: Am I still in crossbite?
« Reply #72 on: May 23, 2019, 04:29:53 PM »
Yeah I certainly agree with all you’ve said ^. There’s no way I didn’t get impacted considering all these changes. But I guess it’s possible something else was done.

i know they can 'intrude' the back teeth--shove them back into the bone--and that can help relieve some posterior excess associated with AOB. Who knows, maybe there is some mechanical device to shove the  gums and bone up higher that could give the effect of posterior impaction.
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Post bimax

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Re: Am I still in crossbite?
« Reply #73 on: May 23, 2019, 04:49:07 PM »
i know they can 'intrude' the back teeth--shove them back into the bone--and that can help relieve some posterior excess associated with AOB. Who knows, maybe there is some mechanical device to shove the  gums and bone up higher that could give the effect of posterior impaction.

My ortho actually suggested this to close my AOB  but said the chance of relapse is somewhat high and that JS would be a more comprehensive solution.

PloskoPlus

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Re: Am I still in crossbite?
« Reply #74 on: May 23, 2019, 05:43:16 PM »
My ortho actually suggested this to close my AOB  but said the chance of relapse is somewhat high and that JS would be a more comprehensive solution.
Molestrip managed to fix his (pretty bad) AOB orthodontically.