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Questions and Answers: The case of Rosa — Planning is crucial in orthodontics

Questions and Answers: The case of Rosa — Planning is crucial in orthodontics

In this installment I will answer Rosa, who follows our blog.

The case of Rosa

“Good morning
I am writing to tell you my experience — a bad experience with orthodontics. After almost three years with Damon braces I am quite disappointed. The problem I had was the following: my eye teeth were very high and my teeth in general were not aligned, besides that I have problems with my jaw, I suppose that is because my bite has never been good. They removed two wisdom teeth because they were not coming out, and since my palate is very narrow, the toothbrush could not reach that far back and it was better to remove them. As I mentioned, my palate is very narrow, the dentist recommended that I use Damon braces, so I would not have to use the appliance that is fitted into the palate with other braces, in order to widen it, since apparently Damon braces “do it all”. Well, this is not so, after three years, the lower teeth are in their place, the upper teeth on the right as well, but starting at the right front incisor across to the left eye tooth, my teeth are sticking out — in fact the eye tooth and the left lateral incisor have not come down — they look like they are going to come out of my mouth, let me explain, for many months they have been practically horizontal … just awful … Since I have to get an implant for a lower molar that was removed when I was small — and this has to be before they remove the braces — they did a scan and my upper incisors didn’t show on it, no wonder, they are practically horizontal. Three years later and looking at the scan, the orthodontist tells me that my teeth are either going to stay like they are now, or maybe a little better … sticking out, or else they will have to remove the second premolars, but if they take them out my lip is going to recede … They have been doing stripping on me for a long time and each time the files are bigger, I don’t think this can be good in the long run … Did they wait three years just to tell me that I end up with a botched job? And this is not just any dentist … it cost me a lot of money and a lot of time for me to end up with these teeth and this mouth … If by spending so much money and time I were to have optimal results, I wouldn’t mind so much … By the way I am 44 years old, but they didn’t hesitate three years ago to give me braces, and I even asked about it … They say that my kind of mouth has too many problems, it must be one of a kind …”

Our answer

Before saying more, I must recognize that, not knowing the case first hand, we cannot give a solid opinion about it. However, the case that Rosa describes is quite similar to many cases that we see every day in our office; Rosa’s case sounds like a surgical case with a narrow palate that requires surgical expansion. Damon braces CANNOT solve skeletal problems. Many patients ask our opinion in order to understand the state of their orthodontic treatment. We have discussed iatrogenesis and the harm that certain people inflict on patients in a prior entry on the difference between straightening teeth and doing an orthodontic treatment.

The Damon Brackets System

The Damon bracket is a very good bracket, personally I like it very much and I use it for certain cases. A case with high canines and with severe lower crowding is a case that requires planning, like any other orthodontic case. If the orthodontist goes ahead with leveling without first opening some space, he or she is likely to cause an open bite and very protruded incisors with all their implications — esthetically, for gum health and for lengthened treatment time … the success of the treatment does not depend on the bracket, but on the professional.

Many people “sell” the Damon system as a cure all, or  the system that does not require extractions or an easy system that “works on its own”. THIS IS FALSE!

The following photos show a patient treated with Damon who came to ask our opinion about his treatment. Iatrogenesis can be clearly seen. The patient presents a clear skeletal problem that cannot be solved by brackets alone, but in combination with orthognathic surgery.

iatrogenia ortodoncia friedlander barcelona segunda opinion invisalign lingual damon.jpg

Photos of a patient who came to ask our opinion about his treatment. Iatrogenesis can be clearly seen.

The Damon system requires good treatment planning just like any other system of braces, whether invisible lingual braces or Invisalign.

Another matter is the stripping or interproximal reduction that she mentions they have been doing from visit to visit. Stripping, like any other procedure, is planned and calculated before beginning the treatment, at times it is decided on during the treatment, but in these cases a very small amount is done, only to match up the sizes of the teeth and their shape … in no case is stripping done to try to cover for a lack of planning of the case.

People put their health into our hands, our commitment is to solve their problems in the best way possible, and to continue treating them until the problem is solved … in no case do we answer a patient “this is all there is” (because normally it is not true)

If money is all the professional has in mind as a motive for the treatment, the case no doubt will turn out badly.

In closing, dear Rosa, the best thing you can do now is to get other opinions from several orthodontists and have them solve these problems for you.

For further information please contact us by telephone (+34) 93 832 72 81.

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