Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

I Want a Perfect Smile When My Braces Come Off!

Posted by Dr. Jorgensen on September 19th, 2013

Perfect SmileI recently finished treatment on a patient who started with crowded, crooked teeth, a bad bite, and multiple crowns and restorations throughout her mouth. After two and a half years of treatment, I had accomplished all that I could with braces given the condition of her teeth. The crowding was resolved, the teeth aligned, and the bite corrected. I was pleased with the result. To my surprise however, the patient was still unhappy. She grabbed the plastic models of teeth that I have for patient consultations and said, “My teeth don’t look like this. I want a perfect smile when my braces come off.” Why can’t all finished orthodontic cases look perfect?

The appearance of a smile at the end of orthodontic treatment is determined by many things. Some of them are in the hands of the orthodontist, some are determined by the patient, and some are dictated by good old Mother Nature. Here is how each of these variables affects your orthodontic result.

Your orthodontist influences how your smile will look by the treatment plan he selects, the techniques he uses to move your teeth, and his artistic “eye.” Some key decisions include removing teeth or not, replacing missing teeth or closing the spaces, and working with the jaws where they are or having them surgically repositioned. Your doctor’s experience and skill will determine how the teeth are moved into their final positions. Last but not least, part of how your smile will look is preference. Is your orthodontist an artist? Does he pay attention to detail? Your orthodontist does play a major role in how good your smile will look at the end of treatment.

What you do as a patient also has direct influence on how your smile will look when the braces come off. Did you follow your doctor’s recommendation to have teeth pulled or your jaws surgically moved? Do you wear your rubber bands as instructed? Do you come to all of your appointments? Do you brush your teeth to prevent white marks on the enamel and swollen gums? Your orthodontist may have the best treatment plan in the world and be an amazing clinician, but he can’t do it alone. For the best result, you’ll need to take responsibility and give 100% too or you’ll be disappointed.

Even if you and your orthodontist do everything “by the book,” there are still some things that neither of you can control. One of these is your body’s response to the treatment (the biology). Your treatment plan may be perfect and you may wear your elastics like a champ, but there are times when the teeth don’t cooperate. Sometimes your muscles and habits work against the forces provided by the braces (i.e. clenching and grinding). Other times teeth are fused to the bone and can’t be moved (anykylosis). Less than ideal jaw growth can also prevent an ideal outcome (I recently had a patient who grew 8 inches during treatment and he was a junior in high school). These are just a few examples of how nature can thwart the best laid plans of both doctor and patient.

One last area that doesn’t fit perfectly into either the patient or Mother Nature columns is the shape and size of your teeth and jaws. You might have been born with short teeth but like the look of long ones. You might prefer a strong chin but got your mother’s instead. You may have had perfect teeth at one time but now have crowns, bridges, or even be missing some teeth. All of these variables will affect your final result. While it is possible to perform full mouth reconstruction (crowning every tooth) or jaw surgery, many patients do not want to take the medical risks or incur the costs that accompany such procedures. In these cases patients must allow the orthodontist to work with the anatomy that they have in spite of their less than ideal sizes and shapes.

I wish I had a body like the guys in Men’s Health magazine. Unfortunately I can’t spend enough time in the gym to look like them and I love chips and salsa with my dinner. I also wish I had more hair! I’ve looked into hair plugs, but they are expensive and look kind of painful. Likewise, you must realize that most orthodontists generally do the best they can with the teeth you bring them. If you do your part and Mother Nature cooperates a little, you can end up with a beautiful smile that will serve you a lifetime!

14 comments so far in response to “I Want a Perfect Smile When My Braces Come Off!”

  1. Mei-Lin says:

    All I know is that I hope to have a glowing smile also and plan on doing everything my orthodontist tells me to do….. Even wearing my tortuous bands!!!

  2. Samah says:

    This is exactly what I thought would happen, I wanted a perfect smile. But apparently i have a visible gap between my canine and the tooth behind it. I was told it isn’t a gap because the teeth are touching at the top it’s just my tooth anatomy. What do you think of bonding for the gap? It’s on both sides? Thank you.

    • The gap you are describing is called an embrasure. It is normal and does not cause any problems. If you really don’t like the appearance of your particular embrasures, you could have some bonding done, but it isn’t necessary. Many patients are concerned like you until they discover everyone else has the same thing.

  3. Annie says:

    I have expanders on both my bottom and top. Ive had them for about 7 months now and am supposed to have them for 2 more. My gums on the inside of my mouth, behind the teeth, sort of in the dip on the bottom of my mouth are starting to overlap the metal on the expanders. My orthodontist said when I very first got then to massage it with my electric toothbrush but it really hurts and starts to bleed and I feel like its not worth it if it doesn’t work. What are your suggestions.

    • You need to see your orthodontist as mere brushing may not fix this problem. If your gums are growing over parts of your expanders, they may need to be removed before scheduled.

  4. Concerned Parent says:

    After looking on the internet at various websites, I think my son has an open bite on the right side of his mouth, and the points of his molars don’t fit the grooves of his opposite molars on that same side after braces. He’s been in braces 3 years, and the doctor removed his braces recently . We have had several issues during treatment of wires coming off, and having to go back right after an adjustment, at no fault on our part. It has been very frustrating over the past 3 years. My son is the one who told me that he thought his teeth shouldn’t have that open space after braces, or I wouldn’t have really noticed. It’s made him sad, because in his own words he shouldn’t have to settle for this result after 3 years of treatment . I am just frustrated and feeling down myself, because I think he’s right. I need to make things right for him, and I don’t know what to do. Whenever I’ve had a problem and bring it up to the doctor she sweeps it under the rug, or is actually rude. We went in this past Thursday to let the doctor know that the retainer isn’t fitting properly, after only being out of braces a week, and she said there was nothing wrong with it, and it should be loose on one side? Anyway, that’s her response whenever we come in for a problem, she says there’s nothing wrong. I get the feeling that because we have Medicaid for the insurance that they have given my son substandard care. We had to wait 2 months for the Essex( plastic clear ) retainer because the first time they said the lab couldn’t read the impressions? Then I had to constantly call to fit my son in to have impressions remade. No effort was made on their part to fit him in, but I finally got him in a month after the first impression. During this time he had brackets and wires on the front and bottom teeth, but they had taken off the metal bands from the back of his teeth. I want to take him for a second opinion to see what another orthodontist thinks.

  5. Laura N. says:

    My son has had an aligner for 2 months now. I know this post isnt on aligners specifically but Im not sure where I can get a better answer. After about a week i guess because he is a typical boy :) the clear part is yellow and nasty. He insists he doesn’t care… but I do! I called my Orthodontist and asked how to clean it and he told me tablets can ruin the aligner so I should use vinegar with mouthwash. That didnt really work well. Do you have any advice to help! Thanks.

    • I don’t know exactly what type of plastic your son’s aligners are, but I recommend Efferdent, Polydent, or similar for their aligners. I’ve seen no yellowing. My patients get new aligners every two weeks, so by the time one set gets gross, the next one is ready to replace it.

  6. nyatio says:

    Im near to get my braces off, within a month. For my top teeth, i am really statisfied. But for my lower teeth, i dont think they are straight enough. I have bridges on my lower teeth, at left side, from the teeth after canine all the way till the very back teeth all ate bridges so no brackets of braces are put in. This mean that only canine to canine of my lower teeth are having brackets of braces. They have been improvement of my lower teeth since i get braces but not as straight as i hope. Could it be because of the bridges on my lower teeth, it cannot be more straighter?? Because when i see people with braces, they have brackets for all teeth till the very back teeth.

    • Braces cannot change the position of teeth associated with bridges. When I have a patient with a bridge, I have to use them as a starting point because I know I can’t move them. Your orthodontist’s hands are tied when it comes to the position of teeth that are part of a bridge.

  7. Meghan says:

    so I just got my braces off (today actually) and I feel like I look like a chipmunk :/ I really liked my smile when I had my braces on and I thought they would look even better when I got them off. but now I don’t even want to smile!!! will I eventually get used to it and my smile will look regular again? what are good ways to make your smile look good/ have a healthy smile?

    • Every patient feels like their teeth are too big when the braces come off. It is an optical illusion because the braces have been covering a lot of the tooth structure for two years. The horizontal wire also gave the illusion that the teeth are only half as tall as they look now. You should be used to your smile within a few days. Having said that, if your teeth stick out too far because you didn’t have teeth removed and should have, that will not get better with time.

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