In this clinical lecture, Dr. William M. Hang recounts a landmark case involving a patient, Peg, who suffered daily TMJ-related headaches and facial flattening after having her lateral incisors extracted as part of orthodontic treatment. Confronted with a lack of precedent in the literature, Dr. Hang decided to reopen the extraction spaces despite significant risks, including potential open bite, loss of tooth support, and periodontal complications. He secured agreement from Peg’s general dentist to provide post‑treatment care, then aggressively moved both upper and lower teeth to recreate the missing incisors, fracturing a porcelain‑fused‑to‑metal crown in the process. The treatment eliminated Peg’s headaches, restored lip fullness, and dramatically improved facial aesthetics. A 23‑year follow‑up shows Peg, now a dance instructor, remains headache‑free, has received implants, and exhibits only modest gum recession, which Dr. Hang notes is not a mortality risk. He contrasts his clinical observations with the prevailing scholarly claim that orthodontics does not affect facial appearance, arguing that patient outcomes tell a different story. The talk concludes with brief remarks on broader health concerns, noting that while gum recession is rarely fatal, sleep‑apnea‑related deaths are common, underscoring the importance of holistic dental care.
Chapters
And maybe you're even going to have some kids that come in who've already had the 4 teeth taken out. And what are you going to do if it's too late? We're going to talk about that. In 1985, these teeth walked through the door of my office. This woman had had lateral incisors extracted as part of her orthodontics. She had a headache every day. And I was a rookie at trying to treat TMJ problems, but it looked to me like she needed to have these spaces opened up, and I didn't know that it could be done. And I felt sorry for her because the headaches were awful. And so I said, well, Peg, if we— I might try to do this. It's never— I don't think it's ever been done in the history of the profession. I don't know that anyone has ever opened spaces. I've not seen anything in the literature. I might produce an open bite requiring surgery. I don't care. I might push your teeth off the bone support, you might lose teeth. I don't care. You might have to see a periodontist. I don't care. I don't care. I don't care. The sky may fall. I don't care. So, in essence, she wrote herself out a ticket to become a guinea pig for me. We reopened the spaces. I went over to the dentist's office one night, who was her dentist, and I said, Bob, I wanna treat Peg. I'm gonna try to reopen her spaces. What do you think? I think you're crazy. I said, so if I'm successful, will you treat her? Yeah, no problem. Be happy to. We treated her. We opened the spaces here. Down here, she had a bridge right in here. She had a crown that she was grinding through right there. So I opened space here, clear, opened this space up like crazy. By the time I'm done, She'd fractured off most of the porcelain off the porcelain fused to metal crown. She was a vice. I created a massively bigger space over here than we started out with. I advanced these lower teeth like crazy as I advanced the upper anterior teeth. I created an arch like this. Her headaches went away completely. Her face From pencil-thin lips with dished-in face. Here she is after she'd returned from visiting her mother in Florida, and her mother said, Peg, you've got lips! Yeah, I guess so. Don't look like an old grandmother with pencil-thin lips anymore because we put your teeth back in your face. But of course, the refereed literature says that orthodontics doesn't affect the face. I understand what the refereed literature says. Apparently, my patients don't seem to understand that. Here she is. I was out running a year ago in the springtime, and I decided I got to talk to her, so I called her up. Peg, how you doing? Hey, great, Dr. Hang. Still free of headaches? Yep, no problem. So I show it here. I sent her in to see Mark Price, who bought my practice in Rutland, Vermont. Mark took these pictures. 23 years later, that's what Peg looks like. She's a dance instructor. No headaches. Life is good. She's got— had some more work done, whatever. She's got implants in down here now. But that's the amount of recession she has. I'm guessing she's not gonna die of recession. You know, I do read the obituaries, and I'm looking for those patients that die of gum recession. Have any of you ever seen that happen? No. I didn't think so. That's a second. Okay, but you know, people die every day of sleep apnea-related issues.
