Kent Lauson, DDS, MS

Underdevelopment of the upper jaw is the cause of almost all malocclusions (crooked teeth, overbites, underbites)  With an underdeveloped upper jaw teeth can tilt forward causing the protrusion.  Functional facial orthopedics can solve these types of problems by widening the upper jaw and pushing forward the pre-maxilla (front part of the upper jaw)  This can create new bone structure and allow teeth to be moved with braces or Invisalign into more ideal positions, including the correction of the protruding teeth.

Almost all malocclusions are the result of an underdeveloped upper jaw.  This is certainly the case here.  This deficiency should be corrected first, then aligners or braces can fix the alignment of the teeth.  Without doing this first will result in an undesirable long term result.  This includes instability of the alignment, upper airway issues with possible later obstructive sleep apnea, possible TMJ dysfunction and even spinal alignment issues.  Extractions as a compromise to expansion should not be considered. For further information please see my book Straight Talk about Crooked Teeth available through Amazon.com

First of all, you do have a beauty that with proper treatment will be unleashed. Your photos do not show all that is necessary to fully evaluate your situation, but I can shed some light on the type of treatment that we would recommend.  You mentioned crossbite (I assume left side) and TMJ Dysfunction that I would suspect would also be on the left.  You have an underdeveloped upper jaw with teeth that are ‘trapping’ the lower jaw into a retrusive position. To properly treat your situation, functional facial orthopedics would be needed prior to braces or Invisalign.  Our treatment would be expansion of the upper jaw to make it wider (correcting the crossbite) and come more forward.  This would allow your lower jaw to come more forward to correct your TMJ dysfunction and facial asymmetry.  Then braces or Invisalign would correct your bite completing a beautiful result that would give you a much improved facial profile with stronger lower jaw.  I hope this is helpful.  Good luck in finding the right doctor.  Many do not have experience in this area (of orthopedic restructuring of the face). You might reference my book Straight Talk about Crooked Teeth for further information.

Almost all malocclusions (improper bite) are due to an underdeveloped upper jaw.  To correct these dental problems, like overbites, crossbites, underbites and dental crowding, the upper jaw should be expanded to a normal arch form.  This should be done with a removable expander that slowly pushes the roof (palate) of the mouth outward over several months.  This slow palatal expansion (SPE) is more physiologic and much more stable long term.  For more complete explanation please, reference one of my books, Straight Talk about Crooked Teeth or The NEO Way.

Because I am well know for treating difficult TMJ and Obstructive Sleep Apnea patients, I do many retreats of previous orthodontic patients.  Many  have had extractions when having orthodontics as a child and now come to me with TMJ and OSA.  Frequently we have had to expand dental arches while treating these conditions, only to have to replace the previously extracted bicuspid teeth with dental implants.  Have the orthodontics done right in the first place which likely will require orthopedic expansion of the dental arches before braces or Invisalign. Stay with non-extraction treatment.  Good luck.

The key to widening a smile is to expand the upper jaw and that can be done at any age with the right technique.  It can be done with a removable Swartz type acrylic appliance.  We enhance the result by using a craniosacral technique called Palatal Suture Release to help with the expansion.  But the most important part is using Slow Palatal Expansion (SPE), with activations no sooner than every 3 days.   Most university trained orthodontists have been taught that this can't be done without surgery.  Just move on if this is what you are told.  Good luck!

The most common cause of a 'weak' chin is a 'trapping' of the lower jaw when facial development occurs.  This occurs as a result of the upper jaw not developing fully which leads to almost all malocclusions including overbites, underbites and crowded teeth.  This underdevelopment can be caused by several factors. 

Chronic mouth breathing or having a tongue tie are two of the most common reasons for having a low tongue posture which typically is the cause of upper jaw underdevelopment.  The lack of ability to have the tongue at the roof of the mouth when at rest is the culprit.  Low tongue posture causes a lack of stimulation needed for the normal development of the upper jaw.  Then the trapping can hold back the lower jaw and results in the recessed lower jaw, do mostly a displacement posterior of the lower jaw.  It is a bit complicated as you can see.

The correction involves freeing up of the lower jaw to come more forward.  the jaw joints have to be evaluated to understand how far the lower jaw can come forward, but usually this can be achieved non-surgically, but the dentist/orthodontist needs to fully understand this principle.  My book Straight Talk about Crooked Teeth explains this in more detail.  Good luck with your treatment.

Thanks for your inquiry.  The answers may save lives as many people have the same problem that you have.  Dr. Brad Lockhart has already given an extensive and outstanding answer to your question so I won't reiterate his statements, but will add a few of my own.  I completely agree with his assessment, which shows his significant breadth of knowledge and experience with these issues.This information is not routinely taught in dental/orthodontic schools.  

I also agree with him that your problem needs to be handled by a dentist/orthodontist who has great experience in this area.  Only a handful of us in the whole USA have this type of experience.  Adult expansion of the maxilla will be needed which may also necessitate replacement of the extracted teeth with implanted teeth.  This treatment would be to, not only widen your upper jaw, but to bring your pre-maxilla more forward helping your airway, giving you normal tongue space and correcting any TMJ (jaw joint) issues.  I presented NINE KEYS TO FACIAL HAMONY in my book Straight Talk about Crooked Teeth, available through AMAZON.com.  Treatment goals are laid out in the book.  It is possible to restore your Mid/Lower face to much more ideal, even at your 41 year old age.  This Functional Facial Orthopedic Treatment will change your life for the better and take away the specter of an early demise due to obstructive sleep apnea.  All of this is done non-surgically.  Good luck to you and all others with this problem.