Success Story

1

The lady in the picture was far braver than her orthodontist, viz. me. She came at around age 50 years and that too with rheumatoid arthritis. She came because she wanted to set her teeth right, to be able to smile without embarrassment.

It wasn’t just about closing the spaces. Her lower front teeth were shaking considerably and without braces, she would surely have lost them in a few days.
What braces did for her, was to reduce the mobility of those lower teeth from grade III to grade I with subsequent splinting. Unfortunately, her implants could not integrate due to her arthritis. Her replacements are underway.
But the point is, give things a fair try!

To begin with, this girl had a complete upper midline shift to the right with the canine buccally blocked out, over-retained upper left E with the underlying premolar positioned perpendicular to it’s ideal position. There was of course, the asymmetric Molar relationship.

This was my approach –
Asymmetric extraction – 14, 25 and 34 (as unconventional as it gets)
Asymmetric open-coil spring and intraoral elastics to shift the upper midline towards the left.
It took me a real exhaustive 3 years and a very co-operative patient to achieve this result. As for room for improvement, there certainly is and I’d like to hear it from you all!!

This boy had too many teeth in his upper jaw and too few in the lower jaw. To be precise, four permanent teeth were naturally missing in his lower jaw. The correction in the upper jaw then required removal of four teeth.
To summarise, he has eight less teeth than the average person!! But a far charming smile than what he came with.

This 40 something man walked in for braces as the spaces between his teeth were bothering him. Not only has his set of teeth improved for a more presentable smile, his gum levels have also become better through sheer tooth movement.
A lot of middle aged and older patients are now willing to undergo orthodontic treatment as these possibilities were probably not available to them back in their youth.

It takes only a moment to share the results of orthodontic treatment on social media, but it takes 24, sometimes 36 months of discipline and careful planning and treatment execution, sometimes bordering Zen practice!!!
But all of it is always worth our while, when we see the final smile..

But always room for us orthodontists to grow!
However, the patient is smiling away to glory..

Different problems, different solutions.
Same family. 😊

When you see a single front tooth going backwards behind your child’s lower teeth, it’s an alarm bell of things to come.
One obvious future problem is that teeth won’t have space in the jaws.
A second problem, which to the layperson is not known, is that the lower jaw gets positioned in an abnormal way and continues to jut out.
In the above case, a ridiculously simple approach in orthodontics, is to use a Z spring.
Once the incisor got corrected, there was deprogramming of the mandible, which exposed the underlying constricted maxilla.
The child could close only on the two corner teeth (canines).
Here’s where the jackscrew was cleverly used to broaden the upper jaw, and consequently settle her occlusion.

I do believe that body positivity is a great sentiment for people to be compassionate towards each other.
But when you choose to improve your health or groom yourself to feel more comfortable in your skin, you are being compassionate to yourself!

All my life I’ve believed if there’s a problem, there is to be found it’s solution.
But with experience and maturity, I’ve realised that the problem never goes away. You have to keep staying ahead of it, trying not to let it beat you.
Today, with the pandemic exploding all around, we haven’t run ahead of it in time or with enough resources. It’s heart breaking.
Till a couple of weeks ago, I was attending to the regular orthodontic patients with due precautions. But I’ve stepped down for a few days, because the smallest risk of transmission isn’t worth it.
I’m staying home.

The success of interceptive treatment depends on the patient following up regularly and agreeing to undergo every step of the treatment.
In this case, this 10 year old came with a class III malocclusion with an impending crowding of teeth.
She was asked to –
1) extract the upper and lower first premolars to prevent bilateral canine impaction
2) undergo some surgery advised by the ENT doctor for her airway obstruction
The cause of class III seemed to be nasal obstruction as well as a tongue tie.
She only extracted upper premolars and did not return till 3 years later. The upper canines had smoothly come into the arch in place of the extracted premolars. But the lower teeth and the crossbite had become worse.
We did achieve a good result with a quad helix and braces but lost out on an important growth phase.

Some of our patients are really enthusiastic about their braces, and carry them off like their most favourite accessory!
Like this one, whose braces came off yesterday, was sad to see them go 😅
You can see why!
Picture courtesy – Patient V.P.

To invent your own life’s meaning is not easy, but it’s still allowed, and I think you’ll be happier for the trouble.
Bill Watterson

You know what’s weird? Day by day, nothing seems to change, but pretty soon…everything’s different.
~ Bill Watterson,
Calvin and Hobbes

Mid-week cheer!
We were due to remove this young man’s braces in December 2019! Which got pushed a little because of his board exams. Three months later, exams were over but the pandemic came to town.
A whole year later, he’s finally got the smile we were working towards and boy, is everything right with the world! At least, there’s that feeling 😬
Restorative work courtesy
– @sanketsheth

Growth is a beautiful thing to even watch. But it’s a blessing when you get to mould it in a certain direction.
End of phase 1 treatment with an appliance called twin block that helps the lower jaw assume a more forward position. It is a kind of interceptive treatment for children whose lower jaws are backwardly placed due to some habit, most commonly thumbsucking.
How does phase 1 help phase 2?
1) Removal of teeth is avoided
2) Treatment time is shorter
3) Better balanced facial features, the chin is stronger.

Work in progress –
Three impacted canines and an over-retained deciduous canine, with inadequate space in the arch was the initial presentation.
The milk tooth was extracted alongwith both upper first premolars and a lower lateral incisor.
Left upper canine and right lower canine were allowed to erupt naturally into the extraction spaces. However, surgical exposure was carried out for upper right canine as it was at an unfavourable angle and quite high up in the bone.

Case of the year(s) –
Sometimes, when you complete a case and stand back and look how far you brought the person, you stagger a bit yourself!
It took me two phases over four years to reverse the damage that prolonged thumbsucking had caused in this girl. It is also unnerving that if left unchecked, she would definitely have had asymmetric jaws and would have needed surgery in adulthood.
Automation is changing even healthcare and DIY aligner companies are sprouting around us, making people believe they can correct their own teeth with ease. Try as they might, they can never eliminate the personal care of a doctor. Now more than ever, it is important to talk about the work that we do, so that people can make the right choices and not fall for quick fixes in the form of OTC aligners.

This year, every smile that we’ve put on someone’s face (literally and figuratively), has been manifold precious than before.
Because it’s been against so many odds, it has been more gratifying to bring their treatment to completion.

She had a Sunday bite. Like an example out of our orthodontic textbook. It’s a classic posed smile to make your teeth look better than they really are, keeping the lower jaw ahead.
Most new patients when asked to smile for photographs find it hard to do so because up until then they’ve mostly been trying to hide their teeth. It doesn’t come naturally to them, and believe me you (I’ve been on the other side), that’s a real handicap! Glad to have helped one more young lady get that easy and natural smile! @ Mumbai, Maharashtra

Timelines ~
At the start of the decade, in 2010, I entered the 3 year post-graduate course in Orthodontics, taking baby steps to start my first few braces patients by the end of 2010.
So technically, we had about 2 years to complete our cases. And if we couldn’t, then we had to pass them on to juniors.
Back then, extraction cases within two years seemed like an insurmountable task! Still, I discovered 3 premolar extraction cases turned out brilliantly and predictably quickly.
Presented here is my last debonding of 2019, a 3 premolar extraction case that I coolly dusted my hands off in one year. @ Mumbai, Maharashtra

A hapless young girl, anxious about her facial features came to me for braces. She had already lost a lot of weight at the local gym, in the hope of looking better, but it had backfired.
We had many counseling sessions in which I persuaded her to see an endocrinologist and a plastic surgeon. My reasons were –
1) Short stature and limbs
2) Deficient eyebrows and lashes and sparse hair
3) Deficient malar area
4) Abnormally shaped and short nose
5) Thin lips
6) Deficient chin in profile

The endocrinologist diagnosed her with skeletal dysplasia associated with parathyroid disorder.
OPG revealed four over-retained milk teeth and three impacted permanent teeth in the upper jaw.
There wasn’t much that I could do about her features but the impacted teeth were surgically exposed and brought down by forced eruption, and we did get an improvement in the mandibular deviation. @ Mumbai, Maharashtra

Monday makeovers!! @ Mumbai, Maharashtra

A concave profile in a child needs to ring alarm bells, the reason being in case it can be corrected with braces, it’s possible only during the growth period.
If neglected, in a later period of life only a surgery can correct the lower jaw position.
No wonder it was long ago said that “The best time to correct a cross bite is the first time it is seen!”
P.s. When corrected, it is one of the most satisfying outcomes for not only the patient, but also the orthodontist!!

The last post was all about the type of profiles seen in people.
Here’s one of our patients whose profile improved from convex to a straight one during the course of her braces treatment.