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Long ago, after years of wearing braces and expanders to correct some pretty severe problems, when they came off I received what I now know is called a fiberotomy on my top teeth only. I was also instructed to wear top and bottom retainers.

I was... less than loyal to my retainers.

After a period of time, my bottom teeth reverted partway back to their original positions -- today, they aren't even close to straight. My top teeth, however, remain perfectly straight to this day, almost 20 years later.

However, I've noticed that every single person I have ever spoken to who had dental work done has never heard of this procedure. It strikes me as odd because the procedure was quick, simple, and apparently with excellent outcome.

My questions are:

  • The lack of awareness of this procedure leads me to believe that it is not that common. If this is true, why is it so? Are there risks? Is the success rate not high?
  • The procedure seemed to entirely negate the need for a retainer, for me at least. Is this typical? If so, why would retainers ever be recommended over a fiberotomy? Are there only certain cases where the procedure is effective?
  • Is there any reason, related to the questions above, why the procedure wasn't done on my bottom teeth?

Or is there perhaps some more modern alternative to both fiberotomies and retainers that has appeared in the last 20 years?

  • I pinged you in chat. I can give a chat answer but not a definitive answer. :) – JohnP Feb 29 '16 at 2:06
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  • Retainers prevent the teeth from reverting to their original position, and therefore progressively force the periodontal ligament (PDL) to adapt itself to the new position. Doing a Fiberotomy accelerated the process by detaching the fibers of the PDL that are still trying to hold and/or bring back the tooth in the previous position.

  • This does not negate the need for a retainer, since there is no guarentee that all the fibers that could cause unwanted movement have been cut, or that other causes have been eliminated. In other words, your mileage might vary, depending on how much was cut and how many other factors are at play...

  • ...Which bring me to the last point: Even if the fiberotomy was performed on the bottom teeth (of the jaw), the crowding would have happened anyways, and would have required a fixed appliance (lingual wire) to prevent the crowding. The reason for that is the "Late Mandibular Incisor Crowding" caused by the remodelling of the jaws, shown on the image bellow.

Schematic representation of the remodeling of the jaw Notice how near the front teeth, who are in a kind of half-circle, the reformation is inward. The diameter of the arch (half-circle) is reduced throughout life, and therefore the teeth are forced to get crowded to fit in the reduced space. This can even happen to older people who did not get an orthodontic treatment!

Sources:

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    Makes sense. Is there any reason not to do a fiberotomy on the top and bottom of every person every time, even with retainers? Why isn't the procedure more common? It seems like the worst that can happen is it has no effect, but what's the deciding factor on whether to perform the procedure or not? – Jason C Feb 29 '16 at 17:50
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    I actually don't have an excellent answer to that, but I'm not sure if anyone would want to pay for an additional treatment that doesn't actually prevent the crowding from happening again. To paraphrase my previous answer, cutting the ligament fibers will do nothing against the squeletal changes of the jaw. They are two completely separate processes, which have a similar effect of crowding the teeth. – enap_mwf Feb 29 '16 at 17:57

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