Realistic Expectations from Orthodontic Treatment


One of the most exciting aspects of orthodontics is that every patient is unique. Orthodontic patients may have mismatched jaw sizes, uniquely shaped teeth, challenging musculature, variable biological responses, and unpredictable levels of cooperation. Because of these uncontrollable variables, it is unrealistic to think we can get the same results in every patient. Just as no two fingerprints are exactly the same, it is not possible make every smile look just like the demonstration models on my shelf. The only realistic approach to orthodontic treatment is to strive for the best outcome for each individual patient.

Perfection is rarely acheivable
In 1976, a poster of Farrah Fawcett in a red bathing suit sold over 12 million copies. Fawcett was 29 at the time and her beautiful figure, smile, and hair created a look that was sought by women of ALL ages. My hairstylist confided in me that it was one of the most frustrating times in her career because women with hair of all types would come into her salon with a picture of Farrah expecting to walk out looking just as good as she did an hour later. She told me that when a woman with thin, straight hair or thick, kinky curly hair would ask for that hairstyle, she would point to a mug sitting at her station which read, “I’m a beautician, NOT a magician!” Unrealistic expectations will never lead to a happy customer; not in hair styling nor in orthodontics.

Orthodontics results are affected by jaw sizes
The most difficult variable to overcome with conventional orthodontics is mismatched jaw sizes. If a patient has upper and lower jaws that are similar in size, the angulation of the upper and lower teeth will be similar. If both jaws are small relative to the size of the teeth, both upper and lower teeth will be flared. If both jaws are bigger, the teeth may appear tipped back. If the upper jaw is smaller than the lower, the top teeth will need to be flared and the lower teeth tipped back if the incisal edges are to come together. If the lower jaw is smaller than the upper, the upper teeth will be tipped back and the lower ones flared. If the jaws are vertically divergent (angled away from each other), the front teeth will not overlap as much as normal. If they are convergent (a deep bite), the teeth will overlap too far.

Dental camouflage is more common than jaw surgery
The only way of changing the size of the jaws is with jaw surgery. Since there is risk and extra cost associated with the surgical re-alignment of the jaws, most orthodontists and their patients opt to accept a "comouflage" approach and position the teeth the best they can with the jaws in their original positions.

Tooth shape affects the final appearance of the teeth
The next variable that cannot be changed by orthodontics alone is the shape of the teeth. Just like Farrah Fawcett’s beautiful hair, some patients have prettier teeth than others. Teeth that are short or worn will never look or fit as nicely as those that are long and naturally shaped. Teeth that are round or shovel-shaped will not lay side-by-side as nicely as those with parallel sides. Your orthodontist is also limited by the color and number of teeth. If you are missing teeth, your best result may look different from a patient with a full complement of teeth.

Individual variation also affects orthodontic outcome
Tongue posture and finger habits also affect the final treatment result. A patient with a very active tongue or forward resting tongue posture may end up with teeth that do not overlap ideally. Little wires and brackets are no match for fingers and thumbs placed in the mouth during treatment. Additionally, every patient’s teeth respond to treatment differently and move at a different rates. The rubber band or spring that moves the teeth quickly in one patient may not have much effect at all in another patient. Age, stage of growth, and bone metabolism also affect the results obtained during treatment.

Patient cooperation is also key
Finally, cooperation is a major variable that affects the quality of the results obtained with orthodontic treatment. All other things being equal, patients who brush their teeth, wear their rubber bands, eat the right foods, and come to all their appointments will end up with better results than patients who do not do their part.

Orthodontists strive to create smiles that are attractive, healthy, and will stay that way as long as possible (stable). Because of the combination of variables that each patient brings with them to their treatment, the results obtained are going to be different. It has been said that perfect is the enemy of good. If you will only be happy with perfect teeth, you may not ever be happy with your orthodontic result. With realistic expectations, however, you and your orthodontist can achieve a wonderful smile that will be an asset the rest of your life.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.