Posts for tag: orthodontics
Teeth crowding is a difficult bite problem (malocclusion) that often involves the entire jaw structure to be evaluated. Normally occurring when the jaw doesn’t have adequate space for normal tooth eruption, teeth coming in later put pressure on other teeth, causing them to develop improperly.
Crowding also makes it difficult to realign teeth with braces because there’s simply not enough room for sufficient movement to take place. The solution may then be to consider the removal of some of the teeth to create enough space for orthodontic treatment.
Not just any tooth can be removed, however — we must first conduct a careful analysis to determine which can be removed to facilitate optimum movement of the remaining teeth without disrupting normal mouth function or affecting appearance. The teeth most frequently removed for this purpose are the bicuspids, located between the cuspids or eyeteeth (which are positioned directly under the eyes) and the molars, the largest teeth in the back of the mouth. Sometimes one premolar tooth on each side of the jaw can be removed without sacrificing future form or function.
There are a few important considerations we must keep in mind when extracting teeth for orthodontic reasons; perhaps the most important is preserving bone at the extraction site. Because continuing bone growth depends on the forces generated by teeth when we bite or chew, bone near a missing tooth socket will tend to diminish over time. If there’s insufficient bone during orthodontic treatment, it may result in gum recession and root exposure — not only damaging to the teeth themselves but also to a person’s smile appearance. To avoid this, we sometimes will consider inserting a bone graft, which will stimulate bone growth, into the empty socket immediately after extraction. While this isn’t commonly done, it’s being considered if the patient’s bone is thin and a concern during healing.
We must also consider how to accommodate other, unrelated tooth loss to assure the final result is visually appealing. It may be necessary in these cases to maintain the space at the missing tooth site for a future restoration once the orthodontics is completed. This takes planning as well as the use of restorations like dental implants, bridges or partial dentures.
Regardless of your bite issues, the field of orthodontics has the appliances and techniques to overcome even the most complicated condition. When necessary, using procedures like tooth extraction can help turn an unappealing, dysfunctional bite problem into a beautiful smile.
If you would like more information on orthodontic teeth extractions, 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 “Tooth Removal for Orthodontic Reasons.”
The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.
At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.
Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.
Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.
At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.
If you would like more information on the effects and treatment of impacted 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 “Exposing Impacted Canines.”
Metal braces for correcting teeth alignment have long been a fixture of adolescence. But although they're effective, they tend to put a crimp on a teenager's life with changes in diet and irritation and discomfort from the devices and regular adjustments. For many teens, though, these are minor compared to the change in their appearance that comes with traditional braces, and the embarrassment they may feel.
In recent years, there's been a growing use of another orthodontic device that reduces many of these inconveniences, especially regarding appearance. Known as the clear aligner, this transparent, “almost invisible” device can be taken out for eating, cleaning or important social events.
Clear aligners are a sequential set of clear trays made of polyurethane plastic that are generated for an individual patient using information derived from x-rays, photographs or models. Each tray in the sequence is slightly different from the previous one to account for the tooth movement achieved wearing the previous tray. The patient will wear a tray for about two weeks and then, if all looks well, move to the next tray. This process continues until the teeth arrive at the proper alignment, a period of about six to twenty-four months depending on the patient's initial condition and their progress.
Up until recently, aligners were a viable option for a limited category of patients, mainly adults. Recent advances have changed that. Aligners now include tiny “power ridges” that enable them to move teeth in more than one plane, something previous versions were unable to do. “Eruption tabs” can also be incorporated into aligner sets to hold the space for permanent teeth that haven't erupted yet — a must for many younger patients. We can also temporarily bond attachments to the teeth known as buttons (made with a composite that blends in with the natural tooth color) that give more leverage and stability to the aligner.
With these changes, clear aligners are now an effective choice for a wider group of patients, including many teens. Aligners are comfortable to wear, easy to care for, and for teens acutely conscious of their appearance, less obtrusive than traditional metal braces.
If you would like more information on clear aligners, 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 “Clear Aligners for Teens.”
If you are insecure about your misaligned crooked teeth, then you may be a perfect candidate for clear orthodontic aligners. This system is an alternative to traditional braces that uses a sequence of individual, clear, removable “trays” that fit over your teeth to gradually straighten them. Each tray is completely clear and covers all the teeth thus making it virtually invisible. Each tray is designed to slightly move the teeth until the teeth are in proper alignment. Typically, each tray must be worn for 20 hours a day for 2 weeks before progressing to the next tray in the sequence with each tray moving you closer towards your goal — perfectly aligned teeth.
However, clear orthodontic aligners are not for everyone. If you are interested and wonder if they can benefit you, contact us so that we can schedule an appointment for a thorough evaluation to assess your specific situation. Below, we have briefly outlined some situations when they will and will not work.
Clear orthodontic aligners work if...
- You have mild to moderate crowding or spacing issues between teeth
- Back teeth fit together properly
They may not be the right choice if...
- You have moderate to severe crowding or spacing issues between teeth
- When your bite does not align properly (for example, if you have a large over-, under-, or cross-bite)
- When your teeth are “rotated” way out of position; such misaligned teeth will require special or complex techniques to rotate them back into position, or to pull them down into place or to fill the space left after pulling a tooth to resolve excessive crowding of teeth
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We in dentistry, advise parents to have an orthodontic evaluation some time before your child is 7 years of age. At this time, some of your child's adult teeth have come in and some primary (baby) teeth remain. This is a good time to check for developing problems. Treatment that begins while your child's teeth are coming in is called “interceptive orthodontics.” It provides an opportunity to achieve the best results in orthodontic treatment.
Once this evaluation takes place, it may mean that orthodontic treatment may need to take place in two-stages. A first phase of orthodontic treatment may prevent, intercept or minimize future orthodontic treatment. The first stage may be a process of guiding the growth of the jawbones that support the teeth. This is called “growth modification.” Then when the adult teeth have erupted through the gums, it may be time to do the second and final stage.
If a second phase of treatment is necessary it will probably require braces. These are small metal brackets that are bonded to the teeth. Thin flexible wires are threaded through them, and the wires are designed to push or pull on the teeth to provide a small amount of pressure that makes the teeth slowly reposition themselves within the jawbone. A light and controlled force pulling on a tooth causes new bone and ligament (the fibers that hold teeth in place) to be formed. These are living tissues that are constantly changing and remodeling themselves.
If you wait until your child's permanent (adult) teeth have all come in to start this process, it will be too late to correct some types of orthodontic problems, such as some types of malocclusions (“mal” – bad, “occlusion” – bite). It's better to work together with your child's stages of growth and development in order to have an optimum correction, both in looks and function.
You may be wondering whether a two-stage treatment costs twice as much. In fact, it is likely to be less expensive than a late one-stage treatment would be. Sometimes, the first stage may correct an underlying problem and make further treatment unnecessary. If a second phase is needed, it is likely to be easier and less costly.
Contact us today to schedule an appointment to discuss your questions about orthodontia for your child. You can also learn more by reading the Dear Doctor magazine article “Preventative & Cost Saving Orthodontics.”