Additional Opinions: Top Dental Midline Alignment

[christianlee]

Hi Orthodontists!

I am 10 months into my orthodontics treatment, and I am currently at a crossroad to decide whether to correct the top midline alignment. My orthodontist has given me some factors to consider, but the final decision is up to me, so I would like to get some more opinions given the facts, risks, and other disadvantages of pursuing the correction.

Facts:

• My top central incisors’ midline is slightly towards the left, approximately 1 mm off-centered
• My bottom central incisors’ midline is further to the left by another 1 mm, approximately

Solution:

• Currently, I’m only aware of temporary anchorage devices (TADs) as the most appropriate and least invasive method of aligning the top dental midline to my face’s midline.

Risks of TADs and Disadvantages of Aligning the Midline (based on what I read/heard):

• I was told that the aligned teeth midline may rebound towards its original position after the orthodontic treatment even with the use of retainers (fixed or unfixed), because retainers hold the attached teeth’s relative position to each other, but do not prevent the movement of the entire row of teeth. Therefore, the whole row of teeth can shift, causing the midline to relapse towards its original (current) position.
• TADs can damage the root of the adjacent teeth, which can lead to complications ranging from simply needing to monitor it closely, to the complete extraction of the damaged tooth.
• The use of TADs to pull teeth will result in not just the desired lateral movement, but also undesired movement towards the inside of the mouth (adversely affecting the arch).

Questions I have:

1. Are all the listed risks and disadvantages significant to the degree that they should prevent me from pursuing midline alignment?
2. Are there other solutions other than TADs that I should consider?
3. Is there any good solution to prevent the midline from relapsing by way of the entire row of teeth shifting by itself after the end of the orthodontics treatment?
4. If I was your patient and wanted to pursue the top row’s midline alignment, would you recommend against it based on the above risks/disadvantages or other information I’ve missed?

Below are photos of my teeth with my head as centered as possible. Throughout the pictures taken, I’ve progressively increased the degree of my smile while trying to maintain my philtrum/lips as centered as possible to provide the least-biased perspective.

https://imgur.com/a/SPVOIBY

I appreciate your advice very much!

Thank You!