V shaped protruding upper front teeth and crooked lower front teeth

Concern:

This adult female presented concerned about her protruding upper front teeth and crooked lower front teeth.

Examination showed a “V” shaped upper arch with her upper front teeth leaning too far forward. The lower arch was a more natural “U” shape. Her lower front teeth were crooked and leaning too far forward. Her cheek [side] teeth were biting together whereas her front teeth were apart [open bite].

Radiographic analysis confirmed normal growth of the jaws. The ‘open bite’ was classified as a ‘dental’ open bite in which the position of the teeth was responsible for the ‘gap’ between her front teeth.

Treatment Performed:

Three options for treatment were proposed:

1. Braces without tooth removal. This option would straighten her front teeth but they would still be leaning too far forward, perhaps even more so and the gap between them [open bite] would remain as is or become slightly larger. Estimated treatment time was 21-24 months.
2. Braces with tooth removal. This option would straighten the front teeth and allow for them to be tipped back so they no longer leant too far forward. As the front teeth tipped back it was also expected they would come together closing the open bite.  A choice of removal of either the 5^th tooth [second premolar] or the 6^th tooth [first molar] on either side in the upper and lower jaws was provided. This option therefore really consisted of two different options. Estimated treatment time was 21-24 months.
3. Braces without tooth removal combined with jaw surgery. This option was a variation on option 1 where jaw surgery during orthodontic treatment would be used to close the open bite. An Oral and Maxillofacial Surgeon [OMFS] would undertake jaw surgery to one or both her jaws during her braces treatment to bring her front teeth together.  Estimated treatment time was 21-24 months

It was decided to proceed with treatment as outlined in option 2. As her wisdom teeth [3^rdmolars] had previously been removed it was decided to maintain two molar teeth on each side. The patient was referred back to her dentist for removal of her four second premolar teeth.

Treatment was undertaken with braces to her upper and lower teeth.  Elastic bands were worn for a period of 18 months. This varied from nights only to full time wear.  Total treatment time was 25 months.

Result:

Adults have for most purposes stopped growing. This can translate in to longer treatment times than in teenagers or children. Offsetting and balancing this lack of growth is a typically highly motivated and co-operative patient, which is not always the case in younger patients.

The lack of growth in adults can influence the options available. Some things which are possible in teenagers or children might not be possible in adults. Where teeth have been removed for adult orthodontic treatment closure of the resultant ‘extraction’ spaces in some cases can prove extremely difficult. Sometimes some space can remain.

This treatment is an example of adult orthodontic treatment in which teeth were removed to achieve the desired correction. A wonderful result has been achieved. The front teeth are no longer protruding. The open bite has been closed. The teeth are now well aligned with a good bite. Space has been completely closed where teeth were removed to facilitate the correction.