Posts for tag: orthodontic treatment
Overbites, underbites, crossbites—these are just a few of the possible malocclusions (poor bites) you or a family member might be experiencing. But no matter which one, any malocclusion can cause problems.
Besides an unattractive smile, a malocclusion makes it more difficult to chew and to keep the teeth and gums clean of disease-causing bacterial plaque. Thus correcting a malocclusion improves dental health; a more attractive smile is an added bonus.
This art of correction—moving teeth back to the positions where they belong—is the focus of a dental specialty called orthodontics. And, as it has been for several decades, the workhorse for achieving this correction is traditional braces.
Braces are an assembly of metal brackets affixed to the teeth through which the orthodontist laces a metal wire. The wire is anchored in some way (commonly to the back teeth) and then tightened to apply pressure against the teeth. Over time this constant and targeted pressure gradually moves the teeth to their new desired positions.
The reason why this procedure works is because teeth can and do move naturally. Although it may seem like they’re rigidly set within the jawbone, teeth are actually held in place by an elastic tissue network known as the periodontal ligament. The ligament lies between the tooth and bone and keeps the tooth secure through tiny fibers attached to both it and the bone. But the ligament also allows teeth to continually make micro-movements in response to changes in chewing or other environmental factors.
In a sense, braces harness this tooth-moving capability like a sail captures the wind propelling a sailboat. With the constant gentle pressure from the wires regularly adjusted by the orthodontist, the periodontal ligament does the rest. If all goes according to plan, in time the teeth will move to new positions and correct the malocclusion.
In a way, braces are the original “smile makeover”—once crooked teeth can become straight and more visually appealing. More importantly, though, correcting a poor bite improves how the mouth works, especially while eating, and keeping things clean. A straighter smile isn’t just more attractive—it’s healthier.
If you would like more information on correcting misaligned teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Moving Teeth with Orthodontics.”
Every year many parents learn their “tweenager” or teenager needs their bite corrected, often with specialized orthodontics. Imagine, though, if these families could go back in time to when their child’s poor bite was just developing to stop or slow it from forming.
Time travel may still be science fiction, but the approach suggested isn’t. It’s called interceptive orthodontics, a group of techniques and procedures performed during the early stages of jaw development. The focus is usually on getting abnormal jaw growth back on track, enough so that a poor bite won’t form.
The upper jaw, for example, may be growing too narrow, reducing the amount of available space for tooth eruption. If it isn’t corrected, teeth can erupt out of position. To correct it, an orthodontist places a palatal expander in the roof of the child’s mouth (palate). The appliance applies gentle pressure against the inside of the teeth, which stimulates the jaws to develop wider.
The expander works because of a separation in the bones at the center of the palate, which later fuse around puberty. The pressure applied from the expander keeps this gap slightly open; the body then continues to fill the widening expansion with bone, enough over time to widen the jaw. If you wait until puberty, the gap has already fused, and it would have to be reopened surgically to use this technique. Ideally, then, a palatal expander should be employed at a young age.
Not all interceptive techniques are this extensive—some, like a space maintainer, are quite simple. If a primary (baby) tooth is lost prematurely, teeth next to the empty space tend to drift into it and cause the intended permanent tooth to erupt out of place due to a lack of space. To prevent this an orthodontist places a small wire loop within the space to prevent other teeth from moving into it.
These are but two examples of the many methods for stopping or slowing a developing bite problem. To achieve the best outcome, they need to be well-timed. Be sure, then, to have your child undergo an orthodontic evaluation around age 6. If an interceptive orthodontic approach is needed, it could eliminate the need for more extensive—and expensive—treatment later.
Applying braces or clear aligners to move misaligned teeth is only part of an orthodontist's overall mission to eliminate poor bites (malocclusions). Sometimes a malocclusion isn't caused by the teeth at all—the size of the jaw is the problem!
One type in particular, a cross-bite, often happens because the upper jaw has developed too narrowly. As a result, many of the upper teeth fit inside the lower, the opposite of normal. But a tool called a palatal expander can alleviate the problem if it's applied at an early enough age.
The device works because the upper jawbone initially forms as two halves that fit together along a center line in the roof of the mouth (the palate) running from the back of the mouth to the front. These two bone halves remain separate during childhood to facilitate jaw growth, but eventually fuse around puberty.
Consisting of two sets of wire arms joined together by a hinge mechanism in the middle, the expander device is positioned up against the palate. The orthodontist extends each arm to press against the inside of the back teeth, then adds more outward pressure by turning the mechanism in the middle with a small key. During wear, the patient or caregiver will turn the mechanism in the same way to keep up the pressure on the two sides of the jaw.
This continual pressure keeps the two bones moving away from each other and maintaining a center gap between them. In response, more bone forms on the two halves to fill the gap. In time, the newly formed bone should widen the jaw enough to correct any developing malocclusion.
Timing is everything with a palatal expander—if not used before the jaw bones fuse, the patient will need a surgical procedure to separate the bones to pursue treatment. To catch the problem early enough, children should have an orthodontic evaluation on or before they turn six. An orthodontist may be able to identify this or other emerging bite problems and intervene before it becomes worse. Taking this approach can help save you and your child more expensive orthodontic treatment down the road.
If you would like more information on correcting poor bites, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Palatal Expanders: Orthodontics is more than just Moving Teeth.”
After living with braces for a couple of years, the “big reveal” finally happens and you see your new smile for the first time. But then you’re told you have to wear another mouth appliance—around the clock to start and then just at night. After all the new smile excitement, wearing a retainer can be a little anticlimactic.
But this part of your orthodontic treatment is as important as the earlier tooth movement phase. That’s because your new “forever smile” doesn’t necessarily come with a “forever” guaranty. In fact, your teeth could quickly begin moving back to where they were before braces if you don’t wear a retainer.
The reason why is because of a tough but elastic gum tissue called the periodontal ligament. This ligament lies between the teeth and the jawbone, attaching to both through tiny extending fibers. The periodontal ligament actually does most of the anchoring work to hold your teeth in place.
The ligament is also why we’re able to move your teeth to different positions: As braces apply pressure to the teeth and jaw in the direction of desired movement, the ligament remodels itself to allow the teeth to take up these new positions.
The tissues involved, though, still retain a kind of “memory” of where the teeth used to be. This creates an immediate tendency for the teeth to revert to these old positions. To prevent this, we use a retainer that when worn keeps or “retains” the teeth in their new positions until they’ve stabilized and the old tissue “memory” fades.
There are different types of retainers, some removable and some fixed in place. Choosing the best one for a particular patient will depend on the complexity of the bite treatment, the patient’s age and level of self-responsibility and the preferences of the orthodontist. Whichever type of retainer you eventually use, it’s important you wear it to preserve all of the time and effort that went into transforming your smile.
Wearing a retainer might not be high on your “exciting things to do” list. But it’s the best way to guarantee you’ll enjoy your new smile for years to come.
If you would like more information on keeping your new smile after braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Importance of Orthodontic Retainers.”
We often associate orthodontics with moving several teeth on the upper or lower arches (or both) with braces or clear aligners. But not all patients require a major endeavor — sometimes only one or a few teeth need to be moved, and not very far.
A slight gap between the two upper front teeth is one type of situation that only requires minor tooth movement: just a few teeth need to be moved and usually just a millimeter or two. The appliances needed to achieve this are also relatively simple in design: removable retainers or small scale fixed braces with small springs or elastics that place pressure against the teeth. The process may also only take a few months rather than two years as with major tooth movement.
Preparing for the procedure, though, must be undertaken with great care. We need to first determine if moving the teeth even slightly could affect the bite with the opposite teeth. We must also ensure the roots of the teeth intended for movement are in good position for allowing the space to be closed.
We must then consider the other supporting structures for the teeth. It’s important for gums and bone to be healthy — if not, treating any found disease may be necessary first before beginning orthodontics. And, if the gap between the two upper teeth was created by an abnormally large frenum, the small strip of tissue connecting the lip to the upper gum, it may be necessary to remove it before tooth movement can begin to ensure the closed gap stays closed.
Like any other orthodontic treatment, minor tooth movement first requires a thorough examination with x-ray imaging to determine the exact tooth position, bite issues and the surrounding gum and bone health. We can then be reasonably certain if this straightforward procedure is right for you, and could help you obtain a more attractive smile.
If you would like more information on different orthodontic treatment choices, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Minor Tooth Movement.”